Dataset Information

Gender effects on outcomes of psychosomatic rehabilitation are reduced.

ABSTRACT:

Objective

The study examined whether psychiatric/psychosomatic rehabilitation continues to have a better course of treatment for women than men.

Methods

We compared the course of global symptom severity, health-related quality of life and functioning between admission and discharge in patients (848 men, 1412 women) at an Austrian psychiatric/psychosomatic rehabilitation clinic.

Results

Gender-specific differences in the course of treatment were all too small to be clinically relevant. The differences were smallest in the middle-aged cohort. However, at the time of admission, women reported a slightly higher symptom burden.

Conclusion

Overall, the results show a gender-fair effectiveness of the rehabilitation. The new findings could be explained by changes in living conditions, gender roles, or better treatment methods.

SUBMITTER: Burghardt J

PROVIDER: S-EPMC8396777 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Gender effects on outcomes of psychosomatic rehabilitation are reduced.

Burghardt Juliane J Riffer Friedrich F Sprung Manuel M

PloS one 20210827 8

<h4>Objective</h4>The study examined whether psychiatric/psychosomatic rehabilitation continues to have a better course of treatment for women than men.<h4>Methods</h4>We compared the course of global symptom severity, health-related quality of life and functioning between admission and discharge in patients (848 men, 1412 women) at an Austrian psychiatric/psychosomatic rehabilitation clinic.<h4>Results</h4>Gender-specific differences in the course of treatment were all too small to be clinicall ...[more]

PMID: 34449826

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Project description:BackgroundResearchers have highlighted a large-scale global unmet need for rehabilitation. While sex and gender have been shown to interact with each other and with other social and structural factors to influence health and wellbeing, less is known about how sex and gender shape rehabilitation participation and outcomes within health systems.MethodsUsing an intersectional approach, we examine literature that explores the relationship between sex and/or gender and rehabilitation access, use, adherence, outcomes, and caregiving. Following a comprehensive search, 65 documents met the inclusion criteria for this scoping review of published literature. Articles were coded for rehabilitation-related themes and categorized by type of rehabilitation, setting, and age of participants, to explore how existing literature aligned with documented global rehabilitation needs. Responding to a common conflation of sex and gender in the existing literature and a frequent misrepresentation of sex and gender as binary, the researchers also developed a schema to determine whether existing literature accurately represented sex and gender.ResultsThe literature generally described worse rehabilitation access, use, adherence, and outcomes and a higher caregiving burden for conditions with rehabilitation needs among women than men. It also highlighted the interacting effects of social and structural factors like socioeconomic status, racial or ethnic identity, lack of referral, and inadequate insurance on rehabilitation participation and outcomes. However, existing literature on gender and rehabilitation has focused disproportionately on a few types of rehabilitation among adults in high-income country contexts and does not correspond with global geographic or condition-based rehabilitation needs. Furthermore, no articles were determined to have provided an apt depiction of sex and gender.ConclusionThis review highlights a gap in global knowledge about the relationship between sex and/or gender and rehabilitation participation and outcomes within health systems. Future research should rely on social science and intersectional approaches to elucidate how gender and other social norms, roles, and structures influence a gender disparity in rehabilitation participation and outcomes. Health systems should prioritize person-centered, gender-responsive care, which involves delivering services that are responsive to the complex social norms, roles, and structures that intersect to shape gender inequitable rehabilitation participation and outcomes in diverse contexts.

Project description:IntroductionPrevious studies that focused on socioeconomic differences did not comprehensively explain existing inequalities in psychosomatic rehabilitation in Germany. We applied a social milieu approach, which additionally includes sociocultural factors such as lifestyles, attitudes and values, to investigate differences among patients in symptom severity, psychosocial impairment and improvement over the course of the intervention.MethodsAs a model for social milieus, the empirical Sinus milieus were used. 2,000 patients of two psychosomatic rehabilitation clinics in Germany were included and their milieu was assessed with the Sinus milieu indicator for Germany 10/2018 questionnaire. BDI-II (N = 1,832) and HEALTH-49 (N = 1,829) questionnaires were used to measure depressiveness and psychosocial impairment at admission (T0) and discharge after 5 weeks of treatment (T1). Milieu differences in severity and improvement were analyzed by mixed-model ANOVAs.ResultsMilieu distribution was not representative of the overall population of Germany. We found significant differences between patients from different milieus in both BDI-II and HEALTH-49 (p < 0.001). Patients from the Precarious Milieu had the highest burden of depressive symptoms in BDI-II and the highest impairment on all HEALTH-49 scales at T0 and T1. Over the course of rehabilitation, patients from all milieus improved significantly in all domains (p < 0.001). Significant interaction effects showed milieu-dependent differences in improvement for depressiveness on the BDI-II [F(9, 1822) = 2.50, p = 0.008] and for three HEALTH-49 scales, namely Psychological well-being [F(9, 1819) = 3.30, padj = 0.005], Interactional difficulties [F(9, 1819) = 2.74, padj = 0.036] and Activity and Participation [F(9, 1819) = 4.94, padj < 0.001], while post-hoc tests only revealed two significant group differences for the last scale. In all domains, patients from the Precarious Milieu retained higher symptoms and impairment at T1 than patients from better-off milieus had at T0.DiscussionSocial milieu was associated with symptom severity, treatment access and outcome of psychosomatic rehabilitation patients. Milieu-specific sociocultural habits, psychosocial needs and therapeutic demands may help describe differences and should be considered in therapy planning and implementation, to improve equal access, quality and effectiveness of rehabilitation. Therefore, further research on milieu-specific differences and needs is necessary.

Project description:Psychiatric disorders increasingly contribute to disability and early retirement. This study was conducted to investigate whether machine learning can contribute to a better understanding and assessment of such a reduced earning capacity. It analyzed whether impaired earning capacity is reflected in missing treatment effects, and which interventions drive treatment effects during psychosomatic rehabilitation. Analyses were based on routine clinical data encompassing demographics, diagnoses, psychological questionnaires before, and after treatment, interventions, and an interdisciplinary assessment of earning capacity for N = 1,054 patients undergoing psychosomatic rehabilitation in 2019. Classification of patients by changes in self-reported mental health and interventions predictive of changes were analyzed by gradient boosted model. Clustering results revealed three major groups, one of which was comprised almost exclusively of patients with full earning capacity, one of patients with reduced or lost earning capacity and a third group with mixed assessments. Classification results (Kappa = 0.22) indicated that patients experienced modestly divergent changes over the course of rehabilitation. Relative variable influence in the best model was highest for changes in psychological wellbeing (HEALTH-49). Regression analysis identified intervention A620 (physical exercise therapy with psychological goal setting) as most influential variable predicting changes in psychological wellbeing with a model fit of R 2 = 0.05 (SD = 0.007). Results suggest that disability due to psychiatric disorders does associate with distinct demographic and clinical characteristics but may be less clear-cut in a subgroup of patients. Trajectories of treatment response show moderately divergent paths between patient groups. Moreover, results support both physical exercise therapy as efficient intervention in reducing disability-associated impairments and the complementarity of a multimodal treatment plan.

Project description:BackgroundHigh dropout rates are a common problem reported in web-based studies. Understanding which risk factors interrelate with dropping out from the studies provides the option to prevent dropout by tailoring effective strategies.ObjectiveThis study aims to contribute an understanding of the predictors of web-based study dropout among psychosomatic rehabilitation patients. We investigated whether sociodemographics, voluntary interventions, physical and mental health, digital use for health and rehabilitation, and COVID-19 pandemic-related variables determine study dropout.MethodsPatients (N=2155) recruited from 4 psychosomatic rehabilitation clinics in Germany filled in a web-based questionnaire at T1, which was before their rehabilitation stay. Approximately half of the patients (1082/2155, 50.21%) dropped out at T2, which was after the rehabilitation stay, before and during which 3 voluntary digital trainings were provided to them. According to the number of trainings that the patients participated in, they were categorized into a comparison group or 1 of 3 intervention groups. Chi-square tests were performed to examine the differences between dropout patients and retained patients in terms of sociodemographic variables and to compare the dropout rate differences between the comparison and intervention groups. Logistic regression analyses were used to assess what factors were related to study dropout.ResultsThe comparison group had the highest dropout rate of 68.4% (173/253) compared with the intervention groups' dropout rates of 47.98% (749/1561), 50% (96/192), and 42.9% (64/149). Patients with a diagnosis of combined anxiety and depressive disorder had the highest dropout rate of 64% (47/74). Younger patients (those aged <50 y) and patients who were less educated were more likely to drop out of the study. Patients who used health-related apps and the internet less were more likely to drop out of the study. Patients who remained in their jobs and patients who were infected by COVID-19 were more likely to drop out of the study.ConclusionsThis study investigated the predictors of dropout in web-based studies. Different factors such as patient sociodemographics, physical and mental health, digital use, COVID-19 pandemic correlates, and study design can correlate with the dropout rate. For web-based studies with a focus on mental health, it is suggested to consider these possible dropout predictors and take appropriate steps to help patients with a high risk of dropping out overcome difficulties in completing the study.

Dataset Information

Gender effects on outcomes of psychosomatic rehabilitation are reduced.

Objective

Methods

Results

Conclusion

Publications

Gender effects on outcomes of psychosomatic rehabilitation are reduced.

Similar Datasets

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