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Objective: The objective of this survey was to investigate undergraduate German medical students' attitudes toward child and adolescent psychiatry (CAP) and to describe the characteristics of students considering CAP as a possible career choice. Methods: The authors conducted a cross-sectional, multicenter survey of medical students (at the time of their first CAP lecture) at seven German medical schools. The students completed an anonymous self-report questionnaire, asking about their attitude toward CAP and their view of CAP as a possible career choice. Results: Of the 574 students, 42.9% had "high" or "very high" interest in CAP, and 59.4% rated CAP basic knowledge as "highly" or "very highly" relevant for their prospective work as physicians. CAP was a possible career choice for 25.4%. The most frequently mentioned reasons for choosing CAP were interesting clinical cases (65.8%), helping ill children (52.1%), and close patient-physician contact (50.7%). The most frequently mentioned reasons against this decision were a definite decision for another subspecialty (54.8%), expected difficulties in working with parents and family members (35.3%), and an expected high emotional burden (29.6%). In addition to the highly significant correlation with general interest in CAP, students with previous experience in general psychiatry and CAP clinical courses, as well as female students and students with relatives or acquaintances with CAP-related disorders, showed the highest interest in CAP as a possible career choice. Conclusion: The majority of the students surveyed showed a positive attitude toward CAP and considered CAP basic knowledge to be relevant for their future work. When designing recruitment strategies, it may be helpful to consider that CAP exposure early in the curriculum might be decisive and that students with previous clinical courses in this field, as well as female students, showed the highest interest in CAP as a possible career choice. (Contains 3 tables and 2 figures.)

Aims: To perform an economic evaluation of guided and unguided internet-based interventions to reduce problematic alcohol consumption in employees compared with a waiting-list control condition (WLC) with unrestricted access to treatment-as-usual. Design: A cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a societal and a cost-benefit analysis from the employer's perspective with a 6-month time horizon. Setting: Open recruitment in the German working population. Participants: Employees (178 males, 256 females, mean age 47 years) consuming at least 14 (women) or 21 (men) standard units of alcohol (SUAs) per week and scoring = 8 (men) or 6 (women) on the Alcohol Use Disorders Identification Test. Measurements: On-line questionnaires administered to assess SUAs and assess quality of life (AQoL-8D) and resource use. Outcome measure was responder (= 14/= 21 SUAs) for the CEA and quality-adjusted life years (QALYs) for the CUA. Net benefit regression was used to estimate cost-effectiveness for each study arm. Bootstrapping and sensitivity analyses were performed to account for uncertainty. Interventions: Five weekly modules including personalized normative feedback, motivational interviewing, goal setting, problem-solving and emotion regulation, provided with adherence-focused guidance [n = 142; responders: n = 73 (51.4%); QALYs = 0.364, standard error (SE) = 0.006] or without guidance [n = 146; n = 66 (45.2%); 0.359, 0.007]. Controls were on a waiting-list [n = 144; n = 38 (26.4%); 0.342, 0.007]. Findings: From a societal perspective, the guided intervention had a probability of 55% (54%) of being the most efficient strategy at a willingness-to-pay (WTP) of €0 per responder (QALY) gained, compared with the unguided intervention and the control condition. At a WTP of €20 000 per QALY gained, the probability was 78%. From an employer's perspective, the guided intervention had a higher probability of a positive return on investment (81%) compared with the unguided intervention (58%). Conclusion: A guided internet-based intervention to reduce problematic alcohol consumption in employees appears to be both cost-beneficial and cost-effective. [ABSTRACT FROM AUTHOR]

Introduction: There is neither strong evidence on effective treatments for patients with chronic back pain (CBP) and depressive disorder nor sufficiently available mental health care offers.Objective: The aim is to assess the effectiveness of internet- and mobile-based interventions (IMI) as a scalable approach for treating depression in a routine care setting.Methods: This is an observer-masked, multicenter, pragmatic randomized controlled trial with a randomization ratio of 1:1.Patients with CBP and diagnosed depressive disorder (mild to moderate severity) were recruited from 82 orthopedic rehabilitation clinics across Germany. The intervention group (IG) received a guided depression IMI tailored to CBP next to treatment-as-usual (TAU; including medication), while the control group (CG) received TAU. The primary outcome was observer-masked clinician-rated Hamilton depression severity (9-week follow-up). The secondary outcomes were: further depression outcomes, pain-related outcomes, health-related quality of life, and work capacity. Biostatistician blinded analyses using regression models were conducted by intention-to-treat and per protocol analysis.Results: Between October 2015 and July 2017, we randomly assigned 210 participants (IG, n = 105; CG, n = 105), mostly with only a mild pain intensity but substantial pain disability. No statistically significant difference in depression severity between IG and CG was observed at the 9-week follow-up (β = -0.19, 95% CI -0.43 to 0.05). Explorative secondary depression (4/9) and pain-related (4/6) outcomes were in part significant (p < 0.05). Health-related quality of life was significantly higher in the IG. No differences were found in work capacity.Conclusion: The results indicate that an IMI for patients with CBP and depression in a routine care setting has limited impact on depression. Benefits in pain and health-related outcomes suggest that an IMI might still be a useful measure to improve routine care. [ABSTRACT FROM AUTHOR]

The Perceived Stress Scale (PSS) is a popular instrument for measuring the degree to which individuals appraise situations in their lives as excessively uncontrollable and overloaded. Despite its widespread use (e.g., for evaluating intervention effects in stress management studies), there is still no agreement on its factor structure. Hence, the aim of the present study was to examine the dimensionality, measurement invariance (i.e., across gender, samples, and time), reliability, and validity of the PSS. Data from 11,939 German adults (73% women) were used to establish an exploratory bifactor model for the PSS with one general and two specific factors and to cross-validate this model in a confirmatory bifactor model. The model displayed strong measurement invariance across gender and was replicated in Study 2 in data derived from six randomized controlled trials investigating a web-based stress management training. In Study 2 (overall N = 1,862), we found strong temporal invariance. Also, our analyses of concurrent and predictive validity showed associations with depressive symptoms, anxiety, and insomnia severity for the three latent PSS factors. These results show the implications of the bifactor structure of the PSS that might be of consequence in empirical research. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To test the efficacy of a web‐based alcohol intervention with and without guidance. Design: Three parallel groups with primary end‐point after 6 weeks. Setting: Open recruitment in the German working population. Participants: Adults (178 males/256 females, mean age 47 years) consuming at least 21/14 weekly standard units of alcohol (SUA) and scoring ≥ 8/6 on the Alcohol Use Disorders Identification Test. Intervention: Five web‐based modules including personalized normative feedback, motivational interviewing, goal setting, problem‐solving and emotion regulation during 5 weeks. One intervention group received an unguided self‐help version (n=146) and the second received additional adherence‐focused guidance by eCoaches (n=144). Controls were on a waiting list with full access to usual care (n=144). Measurements: Primary outcome was weekly consumed SUA after 6 weeks. SUA after 6 months was examined as secondary outcome, next to numbers of participants drinking within the low‐risk range, and general and work‐specific mental health measures. Findings: All groups showed reductions of mean weekly SUA after 6 weeks (unguided: −8.0; guided: −8.5; control: −3.2). There was no significant difference between the unguided and guided intervention (P=0.324). Participants in the combined intervention group reported significantly fewer SUA than controls [B=−4.85, 95% confidence interval (CI)=−7.02 to −2.68, P < 0.001]. The intervention groups also showed significant reductions in SUA consumption after 6 months (B=−5.72, 95% CI=−7.71 to −3.73, P < 0.001) and improvements regarding general and work‐related mental health outcomes after 6 weeks and 6 months. Conclusions: A web‐based alcohol intervention, administered with or without personal guidance, significantly reduced mean weekly alcohol consumption and improved mental health and work‐related outcomes in the German working population. [ABSTRACT FROM AUTHOR]

Background: Problematic alcohol consumption is associated with a high disease burden for affected individuals and has a detrimental impact on companies and society due to direct and indirect health costs. This protocol describes a study design to evaluate the (cost)-effectiveness of a guided and unguided Internet-based self-help intervention for employees called "GET.ON Clever weniger trinken" (be smart - drink less) compared to a waiting list control group.Methods: In a three-arm randomized controlled trial, 528 German adults who are currently members of the workforce will be recruited by occupational health departments of major health insurance companies. Employees aged 18 and older displaying problematic drinking patterns (>21/14 drinks per week and an AUDIT score > 8/6 for men/women) will be randomly assigned to one of three following study conditions: 1. unguided web-based self-help for problematic drinking, 2. adherence-focused guided self-help, and 3. waiting list control. Self-report data will be collected at baseline (T1), 6 weeks (T2), and 6 months (T3) after randomization. The primary outcome will be the reduction of alcohol standard units during the 7 days prior to T2, using the Timeline Followback method. Cost-effectiveness analyses to determine direct and indirect costs will be conducted from the perspectives of employers and the society. Data will be analyzed on an intention-to-treat basis and per protocol.Discussion: There is a need to identify effective low-threshold solutions to improve ill-health and reduce the negative economic consequences due to problematic alcohol drinking in workforces. If the proposed web-based intervention proves both to be efficacious and cost-effective, it may be a useful tool to increase utilization rates of interventions for problematic drinking in occupational settings.Trial Registration: German Register of Clinical Studies (DRKS): DRKS00006105 , date of registration: 2014-07-07. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated health related quality of life of pediatric patients with nonneurogenic urinary incontinence and determined potential influencing factors. Also, health related quality of life results in our sample were compared to those of other chronic childhood health conditions. Materials and Methods: This cross-sectional study was done at 3 tertiary referral centers for childhood urinary incontinence. From July 2007 to April 2008 we consecutively evaluated 65 boys and 38 girls with a mean ± SD age of 9.3 ± 2.2 years (range 6 to 18) and their parents. Of the patients 12 had monosymptomatic enuresis, 79 had nonmonosymptomatic enuresis and 12 had isolated daytime incontinence. To evaluate participants we used the self-reported and proxy versions of the 10-item DISABKIDS chronic generic measure, short version, a health related quality of life questionnaire with cross-cultural validity. Results: Mean questionnaire total scores were 43.2 and 42.8 for the self-reported and proxy versions, respectively, which showed significant correlation (r = 0.628). Age, sex, urinary incontinence type and severity, fecal incontinence and constipation had no significant association with questionnaire total scores (each p >0.05). Compared to questionnaire results in a reference sample of children with chronic health conditions average scores in our sample did not differ significantly from those in pediatric patients with asthma, arthritis, atopic dermatitis, cystic fibrosis, diabetes or epilepsy on the self-reported version, and asthma, atopic dermatitis, cystic fibrosis or epilepsy in the proxy version. Conclusions: Health related quality of life of children and adolescents with urinary incontinence appears to be comparable to that in pediatric patients with other chronic conditions, eg asthma or epilepsy. [Copyright &y& Elsevier]

Purpose: We translated and cross-culturally adapted the English version of the Pediatric Incontinence Questionnaire, and tested the reliability and validity of the German version. Materials and Methods: This cross-sectional study was done at 3 tertiary referral centers for childhood urinary incontinence. The self-reported and proxy English version was translated and cross-culturally adapted. From July 2007 to April 2008 we evaluated the German version in 91 boys and 54 girls with a mean ± SD age of 9.3 ± 2.2 years (range 6 to 18) with nonneurogenic urinary incontinence and in their parents. For concurrent criterion related validity, the German questionnaire scales were compared with those of the DCGM-10/-12. Results: On reliability testing of the self-reported and proxy German versions Cronbach''s α was 0.84 and 0.86, respectively. Interrater convergence between the self-reported and proxy versions showed an ICC of 0.81. Reproducibility was satisfactory for the self-reported and proxy versions (ICC 0.77, 95% CI 0.77–0.90 and 0.85, 95% CI 0.67–0.84, respectively). German version scores correlated with DCGM-10/-12 scores (self-report and proxy r = −0.71 and −0.69, respectively). Mean German version total scores were 23.0 in boys and 23.9 in girls. Except for a slight significant association between age and German version total score in the proxy version (p = 0.01), age, sex and incontinence type or severity (number of wet days/nights per 14 days) were not significantly associated with German version total scores. Conclusions: The German version of the Pediatric Incontinence Questionnaire is a valid and reliable outcome measure to assess health related quality of life in children and adolescents with urinary incontinence. [Copyright &y& Elsevier]

Background: Structural and behavioral interventions to manage work-related stress are effective in employees. Nonetheless, they have been implemented insufficiently, particularly in micro- and small-sized enterprises (MSE). Main barriers include a lack of knowledge and limited resources, which could potentially be overcome with simplified web-based alternatives for occupational stress prevention. However, there is a lack of implementation research about web-based prevention in realistic settings of MSE., Objective: The aim of this study is to evaluate the implementation process and success of an integrated web-based platform for occupational stress prevention ("System P") and to identify potential barriers for its uptake and use in MSE in Germany., Methods: This study with a mixed-methods approach investigates eight process-related outcomes in a quantitative part I (adoption, reach, penetration, fidelity/dose, costs, acceptability) and a qualitative part II (acceptability, appropriateness and feasibility). Part I has a pre-post design with two measurements (6 months apart) with 98 individual participants and part II consists of 12 semi-structured interviews with managers and intercorporate stakeholders., Results: Part I revealed shortcomings in the implementation process. Adoption/Reach: Despite extensive marketing efforts, less than 1% of the contacted MSE responded to the offer of System P. A total of 40 MSE registered, 24 of which, characterized by good psychosocial safety climate, adopted System P. Penetration: Within these 24 MSE, 15% of the employees used the system. Fidelity/Dose: 11 MSE started a psychosocial risk-assessment (PRA), and no MSE finished it. The stress-management training (SMT) was started by 25 users and completed by 8., Costs: The use of System P was free of charge, but the time required to engage with was an indirect cost. Part II added insights on the perception of the web-based intervention: Acceptance of System P by users and stakeholders was good and it was assessed as appropriate for MSE. Results for feasibility were mixed., Conclusions: Although System P was generally perceived as useful and appropriate, only a small number of contacted MSE implemented it as intended. Prior experience and sensitivity for occupational (stress) prevention were mentioned as key facilitators, while (perceived) indirect costs were a key barrier. Enabling MSE to independently manage stress prevention online did not result in successful implementation. Increasing external support could be a solution. ⁺ FULL PROJECT NAME: "PragmatiKK - Pragmatische Lösungen für die Implementation von Maßnahmen zur Stressprävention in Kleinst- und Kleinbetrieben" (= Pragmatic solutions for the implementation of stress prevention interventions in micro and small-sized enterprises)., Trial Registration: German Register of Clinical Studies (DRKS) DRKS00026154, date of registration 2021-09-16., (© 2024. The Author(s).)

Background: Various smartphone applications (apps) for people with tinnitus are available and promise tinnitus relief. Yet, it is difficult for people suffering from tinnitus and healthcare professionals to estimate their quality, potential, or risks. The current study aims to generate an overview of available tinnitus apps in the German language and to offer orientation for research and healthcare providers., Method: The most prominent stores were searched systematically (November 2020-April 2021; Google Play Store and Apple App Store). Apps specifically developed for tinnitus were evaluated by two independent raters using multiple approaches: a) a quality screening was performed using the German version of the Mobile App Rating Scale (MARS-G), b) intervention components were assessed using a newly developed list of categories, and c) implemented strategies for active tinnitus management were analyzed using behavior change techniques (BCTs)., Results: The search yielded 1073 apps, of which 21 apps were analyzed. The apps' overall quality as assessed by MARS‑G was average (M = 3.37, SD = 039). A lot of apps offered sounds (n = 18) and information (n = 9) or assessed tinnitus characteristics (n = 13). Out of 93 BCTs, 24 were identified at least once. Only one app was evaluated in non-randomized trials., Conclusion: Although a variety of apps are available, most of them focus on a few intervention components (e.g., sounds or information). Therefore, apps do not exploit their potential to impart important evidence-based content for tinnitus management. The app evaluation using multiple approaches points out potential for improvement., (© 2023. The Author(s).)

Purpose: In order to maintain the effect achieved in the psychosomatic rehabilitation measure, psychosomatic rehabilitation aftercare is indicated for most rehabilitation patients. Due to the low availability of aftercare therapists close to home, the use of digital offers is a possibility to enable access independent of location. The aim of the study was to evaluate the therapeutic effects of web-based aftercare in comparison to face-to-face (F2F) therapy (both on the conceptual basis of the Curriculum Hannover) in the equivalence study and to no standardized aftercare (care as usual, CAU) in the superiority study., Methods: 300 rehabilitation patients with an indication for psychosomatic aftercare were assigned to the equivalence study if an aftercare service close to home was available and then randomized to F2F or online aftercare. Without a service close to home, the participants were assigned to the superiority study and randomized to online or CAU group. The outcomes (primary: psychological and somatoform complaints, secondary: subscales of the HEALTH-49, employment prognosis, ability to work) were assessed by online questionnaires at the end of rehabilitation, 9 or 12 and 15 or 18 months after rehabilitation and evaluated with multiple imputation and intention-to-treat-analyses. For the primary outcome, a sensitivity analysis was also carried out on the basis of the completed dataset., Results: After excluding non-adherent participants, n=142 participants were evaluated in the equivalence study and n=111 in the superiority study. In the equivalence study, no significant differences (d=0,28 and 0,10 with ITT-analyses; d=0,09 and 0,03 with completed dataset) were found between online and F2F follow-up with regard to short-term and long-term psychological and somatoform complaints. In the superiority study, long-term psychological and somatoform complaints decrease in the online group, while in the CAU group they first decreased at T2 (d=0,56) and increased again at T3 (d=0,72). The latter finding is confirmed with the analysis of the completed dataset (d=0,12), while an increase was seen in the online group at T3 (d=0,10)., Conclusion: According to the results of the present study, web-based psychosomatic aftercare seems to have a longer-term advantage for rehabilitants without access to previous aftercare. Compared to F2F implementation, it can be considered equivalent., Competing Interests: Dahmen A, Gao L, Keller FM, Lehr D, Lippke S geben keinen Interessenskonflikt an. Becker P ist Gesellschafterin der Dr. Becker Unternehmensgruppe, die sich zum Ziel gesetzt hat, wissenschaftliche Erkenntnisse in den Versorgungsalltag zu übertragen, indem sie Fachkräften im Gesundheitswesen digitale Angebote und Schulungen für Online-Gruppeninterventionen in der Nachsorge nach Rehabilitationsmaßnahmen zur Verfügung stellt sowie Online-Gruppeninterventionen zur Nachsorge von Patienten der Dr. Becker Klinikgruppe durchführt., (Thieme. All rights reserved.)

Background: While work-related rumination increases the risk of acute stressors developing into chronic load reactions and adverse health, mental detachment has been suggested as a way to interrupt this chain. Despite the importance of mentally detaching from work during leisure time, workers seem to struggle to disengage and, instead, experience the constant mental representation of work-related stressors, regardless of their absence. Those who struggle with work-related rumination could benefit from an easy-access intervention that fosters mental detachment by promoting recreational activities. Especially during vacations, workers appear to naturally engage in sufficient recovery activities; however, this beneficial behaviour is not sustained. The smartphone app-based intervention "Holidaily" promotes recovery behaviour and, thus, mental detachment from work with the intension of extending the beneficial effects of workers' vacations into their daily working life., Methods: This randomised-controlled trial (RCT) evaluates the efficacy of "Holidaily". The Holidaily app is a German stand-alone program for mobile devices with either Android/iOS operating systems. The sample includes workers, who are awaiting to go on vacation and are randomly assigned to either the intervention (IG) or a waitlist-control group (CG). The IG receives two weeks pre-vacation access to Holidaily, while the CG receives access two weeks post-vacation. On a daily basis participants in the IG are provided with three options promoting recreational activities and beneficial recovery experiences. Online questionnaires are distributed to all participants at several timepoints. The primary outcome measure assesses participants' work-related rumination (Irritation Scale). A significant difference two weeks post-vacation is expected, favouring the IG. Secondary outcomes include symptoms of depression, insomnia severity, emotional exhaustion, thinking about work, recovery experiences, vacation specifics, work and personal characteristics. To help explain the intervention's effect, explorative analyses will investigate the mediation properties of the frequency of engaging in recreational activities and the moderation properties of Holidaily users' experiences., Discussion: If successful, workers will maintain their recovery behaviour beyond their vacation into daily working life. Findings could, therefore, provide evidence for low-intensity interventions that could be very valuable from a public-health perspective. App-based interventions have greater reach; hence, more workers might access preventative tools to protect themselves from developing adverse health effects linked to work-related rumination. Further studies will still be needed to investigate whether the vacation phenomenon of "lots of fun quickly gone" can be defied and long-term benefits attained., Trial Registration: German Clinical Trials Registration DRKS00013650 . Registered retrospectively 15.01.2018.

Background: Major depressive disorder (MDD) imposes a considerable disease burden on individuals and societies. A large number of randomised controlled trials (RCTs) have shown the efficacy of Internet-based guided self-help interventions in reducing symptoms of depression. However, study quality varies considerably. The aim of this study is to evaluate the efficacy of a new Internet-based guided self-help intervention (GET.ON Mood Enhancer) compared to online-based psychoeducation in an investigator-blinded RCT., Methods/design: A RCT will be conducted to compare the efficacy of GET.ON Mood Enhancer with an active control condition receiving online psychoeducation on depression (OPD). Both treatment groups will have full access to treatment as usual. Adults with MDD (n=128) will be recruited and randomised to one of the two conditions. Primary outcome will be observer-rated depressive symptoms (HRSD-24) by independent assessors blind to treatment conditions. Secondary outcomes include changes in self-reported depressive symptom severity, anxiety and quality of life. Additionally, potential negative effects of the treatments will systematically be evaluated on several dimensions (for example, symptom deteriorations, attitudes toward seeking psychological help, relationships and stigmatisation). Assessments will take place at baseline, 6 and 12 weeks after randomisation., Discussion: This study evaluates a new Internet-based guided self-help intervention for depression using an active control condition (psychoeducation-control) and an independent, blinded outcome evaluation. This study will further enhance the evidence for Internet-based guided self-help interventions for MDD., Trial Registration: German Clinical Trial Registration (DRKS): DRKS00005025.

Background: Insomnia and work-related stress often co-occur. Both are associated with personal distress and diminished general functioning, as well as substantial socio-economic costs due to, for example, reduced productivity at the work place and absenteeism. Insomnia complaints by people experiencing work-related stress are correlated with a deficient cognitive detachment from work. Diffuse boundaries between work and private life can additionally complicate the use of recreational activities that facilitate cognitive detachment.Cognitive behavioral therapy for insomnia is effective but rarely implemented. Internet-based cognitive behavioral therapy for insomnia could potentially reduce this deficit given its demonstrated effectiveness. Less is known, however, about the efficacy of internet-based cognitive behavioral therapy for insomnia in populations affected by high work stress. Thus, the aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed, guided online training which is based on Cognitive Behavioral Therapy for insomnia and tailored to teachers affected by occupational stress., Methods/design: In a two-arm randomized controlled trial (N = 128), the effects of a guided online sleep training will be compared to a waitlist-control condition. German teachers with significant clinical insomnia complaints (Insomnia Severity Index ≥ 15) and work-related rumination (Irritation Scale, subscale Cognitive Irritation ≥ 15) will be included in the study. The primary outcome measure will be insomnia severity. Additionally, an economic evaluation from a societal perspective will be conducted. Data from the intention-to-treat sample will be analyzed two and six months after randomization., Discussion: To the best of our knowledge, this is the first study to evaluate an online sleep training tailored to a specific population with work stress, that is, teachers. If this type of intervention is effective, it could reduce the paucity of cognitive behavioral therapy for insomnia and augment the support for teachers in coping with their insomnia problems., Trial Registration: German Clinical Trial Register (DRKS): DRKS00004700.

Aims: The aim of this study was to determine the psychometric properties of the German version of the Pediatric Enuresis Module to assess Quality of Life, Short Form (PEMQOL-SF) in a sample of parents of children with urinary incontinence., Methods: The parents of 88 children (63 male, 25 female, mean age: 9.3 [SD ± 2.5, range 6-18] years) with urinary incontinence were asked to complete the PEMQOL-SF. For evaluation of convergence validity, parents and children completed the respective versions of the DCGM-10 and the PinQ questionnaire., Results: Mean PEMQOL-SF scores were 72.2 [SD ± 14.1] (child impact scale) and 73.7 [SD ± 16.5] (family impact scale). The PEMQOL-SF had a Cronbach's alpha of 0.68 (child impact scale) and 0.80 (family impact scale), respectively. PEMQOL-SF child [family] impact scale scores correlated with the DCGM-10 with scores of r = 0.34 (r = 0.13; self-report version) and r = 0.63 (r = 0.48; proxy version) and with the PinQ with scores of r = -0.31 (r = -0.16; self-report version) and r = -0.63 (r = -0.54; proxy version), respectively., Conclusions: The psychometric properties of the PEMQOL-SF were good for the family impact scale, but poor for the child impact scale. In its present form, the PEMQOL-SF cannot be recommended for routine clinical use. Nevertheless, a reduction of questionnaire items could lead to better psychometric properties., (© 2010 Wiley-Liss, Inc.)

Affective disorders in schoolteachers are a frequent reason for absenteeism and early retirement. The objective of this study was to clarify the relationship between effort-reward imbalance at work, overcommitment, and affective disorders. In addition, we examined the differential impact of different types of reward (salary, job security/promotion, and esteem). In a matched case-control study of 244 teachers, 122 teachers in inpatient treatment for affective disorders were compared to 122 healthy controls. Logistic regression analyses revealed strong associations between effort-reward imbalance and affective disorders. Overcommitment was not an independent risk factor for depression. The lack of esteem by supervisors or colleagues was a more important risk factor for depression than low salary or job security. Results suggest that perceived esteem is essential in understanding the nature of stress. Interventions for preventing depression in the workplace should address supervisors' and colleagues' skills in adequately appreciating their supervisees and co-workers.