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DOI: 10.1055/a-2663-0619
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Similar work demands, similar problem solving, but more self-regulation problems in employees with mental disorders as compared to others

Beschäftigte mit psychischen Erkrankungen im Vergleich zu anderen: stärkere Selbstregulationsprobleme, ähnliche Arbeitsanforderungen und Problemlösen
Beate Muschalla
1   Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany
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Abstract

Purpose

Sick leave due to mental disorders is a world-wide problem. The key issue for work ability is a good person-job-fit, i. e., work demands and coping capacities must fit together. Employees with mental disorders perceive similar work demands like mentally healthy employees, but have problems with work-coping. Until now it is not well described which concrete work-coping and problem-solving capacities are similar or different in employees with and without mental disorders.

Methods

A convenience sample of 372 employed people from heterogenous professions (average age 39 years, range 18–66, 55% female, 30.9% mental disorders) filled in an online questionnaire. Participants were asked about work-related characteristics and socio-demographics, mental disorders, and filled in self-rating questionnaires on psychological capacities (Mini-ICF-APP-S), work demands (Mini-ICF-APP-W), work anxiety (WPS), work coping (JoCoRi) and problem solving (12-WD scale).

Results

Employees with and without mental disorders described similar work demand levels. Employees with mental disorders perceived themselves weaker in nine out of thirteen psychological capacity dimensions, reported higher work-anxiety, lower person-job-fit, and longer sick leave duration. Employees with mental disorders were weaker in self-regulation, i. e., stress and symptom management. In contrast, there were no differences in general problem solving: both groups were similarly convinced about their ability to handle tasks, colleagues and supervisors.

Conclusion

Support for employees with mental health problems (in prevention and reintegration) should be directed to their individual specific needs. Education in self-regulation of problems might be more in need than general problem solving education.


 

Zusammenfassung

Ziel der Studie

Arbeits- und Erwerbsunfähigkeit aufgrund psychischer Erkrankungen sind ein weltweites Problem. Entscheidend für die Arbeitsfähigkeit ist ein guter Person-Job-Fit. Bislang ist nicht differenziert untersucht, welche konkreten Arbeitsbewältigungs- und Problemlöse-Fähigkeiten Beschäftigte mit und ohne psychische Erkrankungen erleben.

Methodik

Eine repräsentativ-nahe Stichprobe von 372 Erwerbstätigen aus heterogenen Berufsfeldern (Durchschnittsalter 39 Jahre, Spanne 18–66, 55% weiblich, 30,9% psychische Erkrankung) füllte einen Online-Fragebogen aus, mit Selbsteinschätzung der psychischen Fähigkeiten (Mini-ICF-APP-S), der Arbeitsanforderungen (Mini-ICF-APP-W), der Arbeitsangst (WPS), der Arbeitsbewältigung (JoCoRi) und des Problemlöseverhaltens (12-WD-Skala).

Ergebnisse

Beschäftigte mit und ohne psychische Erkrankung beschreiben ihre Arbeitsanforderungen auf ähnlichem Niveau. Beschäftigte mit psychischen Erkrankungen nehmen sich in der psychischen Leistungsfähigkeit schwächer wahr, berichten höhere Arbeitsangst, geringeren Person-Job-Fit und längere Arbeitsunfähigkeitsdauer. Beschäftigte mit psychischen Erkrankungen sind schwächer im Stress- und Symptommanagement. Dagegen gab es keine Unterschiede bei den Problemlösekompetenzen (Arbeitstermine, Umgang mit Kollegen und Vorgesetzten).

Schlussfolgerung

Die Unterstützung von Beschäftigten mit psychischen Erkrankungen sollte auf ihre individuellen spezifischen Bedürfnisse ausgerichtet sein. Im klinischen Einzelfall in Prävention (BGM, BEM) oder Rehabilitation ist jeweils zu prüfen, ob Kompensationsmaßnahmen für Selbstregulationsprobleme ggf. dringender erforderlich sind als ein Training allgemeiner Problemlösungskompetenzen.


 

Keywords

work demands - problem solving - capacities - self-regulation - mental disorders - work-anxiety

Schlüsselwörter

Arbeitsanforderungen - Problemlösen - Fähigkeiten - Selbstregulation - Psychische Erkrankung - Arbeitsangst

Mental disorders regularly come along with coping problems in general and working life. Sick leave due to mental health problems has become an increasing problem over the past fifteen years. Often discussed questions are whether a) workplace demands make sick or b) people with mental disorders have more problems at work, partly due to increased social and cognitive work demands. On the one hand, there is evidence that work conditions may impact on health outcomes [1]. But on the other hand, there is evidence for hypothesis (b), since epidemiology of mental disorders shows constant rates of about 30% of the general population [2]. It is not the disorders as such which have become more frequent, but the illness-related participation impairments. Illness-related participation impairments become observable under specific psychosocial demands, in specific settings, especially the workplace. These may result in sick leave or work disability. The assumption b) also makes sense when remembering that mental disorders are chronic illnesses: Symptoms and problems occur recurrently over the life span [3]. About three fourths of mental disorders are chronic [4], and they are usually not caused by environmental factors and live events [5] or work conditions.

Given that rates of mental disorders are on a constant level, increased rates of sick leave due to mental disorders [6] may be associated with either capacity problems of the employees, or with work demands. It could be that employees with mental disorders have other work demands. Or, it could be that they have more capacity problems than employees without mental disorders.

Work demands (e. g. I have to speak with many people at work) must be distinguished from capacities of the person (e. g. I am pretty good in contacting others). Previous research shows the importance of capacities and coping: Persons with mental disorders report lower psychological capacities than healthy persons [7]. Work ability and return to work succeed better in case employees perceive higher work-coping [8]. Concerning work demands, persons with and without mental disorders report similar working conditions in previous investigations [9].

Until now, it has not been investigated differentiated, which concrete work-coping activities employees with mental disorders perceive as more impaired. Adding to the previous empirical findings, the question arises how employees with and without mental disorders report their work demands, and their capacity profiles. For understanding work-coping more differentiated, more elaborated analysis of employees’ work-coping behavior and problem-solving attitudes is needed. Understanding the differences between employees with and without mental disorders in work-coping and problem-solving will be a key prerequisite for designing person-job-fit and workplace adjustment.

Research question

  1. Basic descriptive research question: In which way are work demands and capacity problems associated with perceived person-job-fit and sick leave in employees from heterogenous professions?

  2. Replication research question: Do employees with mental disorders perceive similar work demands, and more capacity problems than employees without mental disorders?

  3. Differentiated analysis of work coping: Which dimensions of work coping and problem-solving attitudes are weaker in employees with mental disorders in comparison to mentally healthy employees?


 

Methods

Study design, setting and participants

A cross-sectional observation study was conducted with the aim to investigate employed people from heterogenous professional fields. The investigation was conducted by means of an online questionnaire. Eligible participants had to be in working age (18–67 years old) and carrying out any professional activity for at least 15 hours per week or more. The link for the questionnaire was placed in 40 public online city or organizational websites or mailing lists in Germany in spring of the year 2022. Beside work-related facts (sick leave duration in past 12 months) and socio-demographics (gender, age), participants were asked for mental disorders, and filled in self-rating questionnaires on capacity problems [7] according to the Mini-ICF-APP capacity concept [10] [11] [12] [13], work demands [14], work anxiety [15] [16], and diverse facets of work coping and problem solving [17] [18] [19].


 

Instruments

Mental disorder was assessed with a content valid overall question which had been validated by structured interview in previous research [16] [20]: “Mental disorders are common diseases. A quarter of the general population suffers from some mental illness. Do you suffer from health problems that are not purely physical (e. g., pronounced anxiety, prolonged mood problems, difficulty regulating emotions, multiple interpersonal problems)?” This question covers all relevant overall criteria for any mental disorder: symptoms and participation problems. The question can be answered with yes or no.

Capacity Problems (Mini-ICF-APP-S [7])

Self-rating for psychological capacities (Mini-ICF-APP-S [6] ). The Mini-ICF-APP-S is a self-rating of psychosocial capacities [7] which covers the same 13 capacity dimensions ([Table 1]) as the original, internationally validated and established, [10] [11] [12] [13] observer rated Mini-ICF-APP. Like the observer-rating, the Mini-ICF-APP-S self-rating includes 13 items which each represent one capacity dimension: (1) adherence to regulations, (2) planning and structuring tasks, (3) flexibility, (4) applying expertise, (5) capacity to judge and decide, (6) endurance, (7) assertiveness, (8) contacts with others, (9) teamwork and group interaction capacity (10) dyadic relationships, (11) proactivity, (12) self-care, and (13) mobility. Descriptions of each capacity dimension are provided. The rating points are described at a behavioral level, i. e., the extent to which the person can (or finds it difficult to) perform capacity-related activities. The self-rating therefore enables a bipolar rating from 0=this is definitely one of my strengths to 3=this is somehow possible, 4=this does not always work, to 7=I am completely unable to do this. This bipolar rating with eight scale points makes it possible to describe capacities as relative strengths or impairments. Cronbach’s alpha over all 13 items was 0.823 in this present study. This means that the items reflect different capacity dimensions, but have a certain overlap, indicating a general capacity level. Ratings 4 and 5 mean observable impairments which cause trouble for others, ratings 6 and 7 mean need for support by others.

Table 1 Active work-coping behavior and complex problem-solving attitudes (wisdom) in employees with and without mental disorders. Mean (standard deviation) are reported, or percentages.

Employees with mental disorder (n=115)

Employees without mental disorder (n=257)

Group differences between employees with and without mental disorders (T-test, X 2), p-values and effect sizes Cohen’s d

All employees (N=372)

Age

37.76 (11.86)

39.10 (12.32)

p=0.32, d=0.07

38.46 (12.07)

Gender female%

68.4%

49.3%

p<0.001

55.5%

Sick leave duration in the past 12 months in weeks (mean over all)

2.88 (4.9)

1.02 (2.28)

p<0.001, d=0.57

1.58 (3.38)

Sick leave duration in the past 12 months in weeks (mean over those who have been on sick leave)

5.08 (5.6) n=72

2.60 (3.04) n=108

p<0.001, d=0.58

Professional education

p=0.05

Without professional education

1.7%

0.4%

0.8%

In professional training / studies

8.5%

4.4%

5.6%

Completed apprenticeship

19.7%

14.5%

16.1%

Bachelor

8.5%

7.3%

7.7%

Master of crafts

0.0%

3.6%

2.6%

Master of Arts or Science

61.5%

69.8%

67.3%

Work Anxiety [percentage of employees with high work-phobic anxiety]

1.08 (0.86) [8.4%]

0.41 (0.47) [0.8%]

p<0.001, d=1.11

0.60 (0.68) [2.9%]

My workplace fits to my capacities. [percentage of employees with good person-job-fit, i. e. rating 3–4 on scale 0–4]

2.85 (0.85) [69.5%]

3.15 (0.75) [85.0%]

p<0.001, d=0.39

3.07 (0.79) [80.7%]

Work-Coping (JoCoRi, scale 0–4)

 Work-Coping Mean

2.62 (0.61)

2.90 (0.52)

p<0.001, d=0.50

2.81 (0.56)

 When I get nervous or stressed at work, I can calm myself down.

2.13 (0.98)

2.80 (0.88)

p<0.001, d=0.73

2.61 (0.96)

 I can tolerate that I do not feel my best at work all the time.

2.47 (0.93)

2.72 (0.95)

p=0.03, d=0.26

2.65 (0.94)

 When I have too much work, I say to myself that I will manage this, and I begin with a first step.

2.71 (1.09)

3.20 (0.80)

p<0.001, d=0.55

3.05 (0.93)

 When I am impaired at work due to health problems, I tell this my supervisor in a way that helps him understand the problem so that we can search for a solution together.

2.22 (1.37)

2.54 (1.11)

p=0.02, d=0.27

2.45 (1.19)

 When a conflict arises at work, I address it, or I help actively to solve the problem.

2.51 (1.01)

2.63 (0.84)

p=0.25, d=0.14

2.60 (0.89)

 When I have problems with job assignments or work–procedures, I start searching for information or turn to the person in charge.

3.15 (0.89)

3.25 (0.80)

p=0.30, d=0.12

3.22 (0.83)

 I can work together with colleagues and supervisors, as well as with those whom I do not like personally.

3.15 (0.78)

3.14 (0.82)

p=0.88, d=0.02

3.14 (0.80)

Problem Solving Attitudes (Wisdom 12 WD Scale, scale 1–6)

 Wisdom attitudes mean [unwise, score<3.5 on scale 1–6]

4.57 (0.56) [4%]

4.69 (0.49) [2.1%]

p=0.07, d=0.22

4.65 (0.52) [2.9%]

 Before reacting to a problem, it is important for me to understand what the problem is.

5.07 (0.95)

5.19 (0.81)

p=0.25, d=0.81

5.15 (0.85)

 What is good or bad depends essentially on the circumstances.

4.70 (0.94)

4.73 (0.89)

p=0.79, d=0.03

4.72 (0.91)

 In my opinion everyone should be happy in their own way.

5.24 (0.85)

5.23 (0.92)

p=0.94, d=0.01

5.22 (0.92)

 It is interesting for me to look at what others may think about a topic.

4.62 (1.14)

4.54 (1.00)

p=0.54, d=0.07

4.57 (1.04)

 If you are satisfied with what you have, you are better off than if you cry over what you do not have.

5.09 (1.07)

5.26 (0.92)

p=0.15, d=0.17

4.68 (1.09)

 As far as possible I try not to take myself so important.

4.47 (1.19)

4.50 (1.12)

p=0.84, d=0.03

5.20 (0.98)

 I cannot expect others to like me if I do not behave accordingly.

4.78 (1.14)

4.75 (1.11)

p=0.86, d=0.02

4.75 (1.13)

 I cannot demand to be always in a good mood.

4.99 (1.02)

4.97 (1.06)

p=0.85, d=0.02

4.97 (1.05)

 If possible, I try not to get upset, because there is nothing to gain by getting upset myself.

3.82 (1.35)

4.26 (1.18)

p=0.003, d=0.36

4.13 (1.25)

 I always try to empathize with how my counterpart feels.

4.92 (1.12)

4.59 (1.05)

p=0.009, d=0.31

4.68 (1.09)

 I am one of those people who say that things happen as they happen.

3.61 (1.48)

4.03 (1.33)

p=0.010, d=0.31

3.90 (1.39)

 I always see crises also as an opportunity for the future.

3.56 (1.41)

4.21 (1.20)

p<0.001, d=0.51

4.01 (1.30)

 

Work-Anxiety (WPS [15])

The Workplace Phobia Scale [15] is a self-rating scale consisting of 13 items for measuring work-phobic anxiety, i. e., anxiety with work-related panic and work-related avoidance behavior. The WPS’s psychometric properties have been tested using a psychosomatic inpatient sample. The split-half reliability was 0.97, Cronbach’s alpha of the whole WPS scale was 0.915 in this present study, indicating that the items measure the same concept, i. e. work-anxiety. The items are rated on a 5-point-scale from 0=no agreement to 4=full agreement. The mean score indicates overall work-phobic anxiety level. The WPS has been validated using structured diagnostic interviews as criteria [15] [16]. The WPS is given to the participants under the title Questionnaire on Workplace Problems and examines “behavior, thoughts, and feelings which can occur in relation to the workplace”.


 

Work-Coping (JoCoRi [17])

Participants were asked to give a short rating on their perceived work-coping-perception on seven coping items. Cronbach’s alpha over the 7 JoCoRi items was 0.688 in this present study, indicating that the scale includes different coping contents. The instruction above the short work-coping questionnaire was: “Please imagine being at your workplace right now. How could you do the following things if you were at your workplace in this moment?” Thus, participants are asked to imagine to be at their workplace. This technic is called cognitive rehearsal and is used in cognitive behavioural interventions (e. g. [18]). It means an exposition in sensu, because the person is required to imagine being at the workplace. Each item is rated from 0=not able to do this to 4=best coping ability for doing this. The mean score indicates overall level of active work coping.


 

Problem Solving Attitudes (12-WD wisdom scale [19])

Workplaces pose complex problems on employees. The capacity to choose the right coping strategy necessary for coping is known as wisdom. Wisdom-related attitudes were then measured with the 12-WD Scale [19]. Participants are asked to indicate on 12 self-rating items to which extent they agreed with the wisdom ideas. Answers were given on a 7-point-scale from 0=do not agree at all to 6=agree exactly. The mean score indicates the degree of wisdom attitudes, a score below 3.5 indicates unwise attitudes. Cronbach’s alpha over all 12-WD scales items was 0.683 in this present study, which indicates moderate correlations between the items. The items thus reflect different contents, which is in line with the multidimensional wisdom concept covering 12 different wisdom dimensions.


 

Work demands (Mini-ICF-APP-W [14])

The work capacity demand self-rating covers the same capacity dimensions as the Mini-ICF-APP-S. The Mini-ICF-APP-W asks to which degree the workplace requires the respective capacities from the employee. The last item of the scale addresses the perceived person-job-fit, by asking to which degree the workplace “fits to the capacities” of the employee. The scale has been validated by an interview [14]. The scale does not correlate with capacities or symptom load, which is an important validity aspect, as it shows that work demands can be distinguished from wellbeing. Each item is rated from 0=do not agree at all to 4=completely agree. Higher value indicated higher demands. Ratings 3 and 4 represent strong demands of the respective capacity. Participants were instructed to refer to their present or (if presently unemployed) to their last workplace. Cronbach’s alpha over all items of the Mini-ICF-APP-W was 0.831 in this present study, indicating that the items measure different work demands, which have however a certain overlap.


 

 

Statistical analysis

Data have been analyzed using SPSS. Only persons with complete sociodemographic (age, gender) and sufficient data from the rating scales (at least 80% of items filled in) were included in the analysis. Data replacement has not been applied. Mean scores of multi-items scales were calculated if at least 80% of the items were available.

Group differences have been explored concerning degree (T-test) and frequencies (Chi2-Test, [Table 1]), with effect sizes according to Cohen [21]. Spearman correlations have been calculated in order to explore relationships between work demands and capacity problems (Supplementary Table 1). Percentages are displayed ([Fig. 1]) in order to present the frequencies of occurrence for work demands and employees’ capacity problems.

Zoom
Fig. 1 Percentages of relevant (observable or in need for support) capacity problems (left figure, rating 4–7 in the Mini-ICF-APP-S) and work demands (right figure, high demands indicated by ratings 3 or 4 in the Mini-ICF-APP-W) in employees from heterogenous professional settings with or without mental disorders.

 

 

Results

Participants

There were 526 persons who began filling in the questionnaire. There were 372 persons who completed the questionnaire and were presently employed or in a professional training. The latter could be analyzed. Our sample comes near to a younger German working population with academic background ([Table 1]): Average age was 39 years, with range from 18–66, which is near the population average age (43 years [22]). 30.9% of the 372 employees reported a mental disorder, which is similar to general epidemiology of mental disorders [2]. 95% were presently employed, 6% in professional training or studies. Unlike the general working population in which most people have intermediate educational qualification, the majority (67.3%) of the here investigated sample had an academic education. 80.7% of the investigated said their workplace was fitting to their capacities. The average sick leave duration in the past 12 months was 1.58 weeks with some variation (SD=3.38 range 0–52 weeks). This is a bit shorter than in general population, where on average 14.6 days on sick leave per employed person were registered [23]. In the group of mental disorders nearly 70% of participants were female, which is similar to psychotherapy samples [15]. The rate of persons with high work-phobic anxiety in this sample was 2.9%, and therefore similar to 2.26% in a representative sample from 2019 [24]. Sex was equally distributed in the group without mental disorders.


 

Associations between perceived person-job-fit, work demands and capacity problems

The perceived person-job-fit is stronger when lower capacity problems are reported (Supplementary Table 1). Higher competence and decision-making demands, as well as higher interactional demands come along with good respective capacities. According to this complementary fit of demands and capacities, these capacity dimensions seem to be especially prone for person-job-fit in the here investigated sample: in case stronger demands in decision making and competence are required, person-job-fit is a bit higher (r=0.11*, 12** ). Higher demands for interactional capacities (contact r=0.14*, group r=0.18** , dyadic r=0.17** ) are also associated with slightly stronger person-job-fit. In general, even though significant, the correlations are however rather small.

Sick leave is independent from specific work demands. Longer sick leave comes along with lower person-job-fit (r=−0.12*). Employees with problems in endurance and flexibility are rather prone for sick leave (r=0.23** , 13*).


 

Work demands and capacity profiles of employees with and without mental disorders

[Fig. 1] displays on the left side the relative frequencies of relevant work demands (3–4 on the Mini-ICF-APP-W scale from 0–4), and on the right side the frequencies of employees’ self-reported capacity problems (in the sense of observable problems or even need for support, i. e. rating 4–7 on Mini-ICF-APP-S scale 0–7).

No matter whether they had a mental health problem or not, the majority of the here investigated employees (>60%) reported high work demands in terms of group interaction, endurance and proactivity, competence and planning and structuring ([Fig. 1], left side). Specific demands for mobility (14%) and self-care (26%) were rather seldomly reported.

Whereas employees with and without mental disorders describe the profile of their work demands similarly ([Fig. 1], left side), there are relevant differences in their perceived capacity status: more employees with mental disorders perceive themselves weak in several capacity dimensions ([Fig. 1], right side), i. e. being in need of help concerning planning and structuring (mental health problem: 22.4% vs healthy: 6.7%), flexibility (26.2% vs. 4.4%), competency (9.7% vs 2.4%), proactivity (34% vs. 15.1%), endurance (40.8% vs. 9.8%), self-care (38.9% vs. 16.4%), and the interactional capacities contacts with others (29.4% vs. 14.4%), group interaction (10.8% vs. 4.5%) and dyadic relationship (16.5% vs. 6.6%).


 

Work coping and problem-solving (wisdom) attitudes in employees with and without mental disorders

Employees with mental disorders report higher work-anxiety, lower person-job-fit, and longer sick leave duration ([Table 1]) as compared to employees without mental disorders.

Employees with mental disorders have weaker work coping (JoCoRi) especially in stress and symptom management, i. e. self-calming in stressful moments at work, or when work amount is high, tolerating feeling unwell, and addressing one’s own health problems. In contrast, in general problem solving there were no differences between employees with and without mental disorders: both groups are similarly convinced that they can handle job appointments, conflicts, colleagues and supervisors.

Similarly, employees with and without mental disorders do similarly agree to practical problem-solving ideas (understanding the problem, self- and problem relativization). But, employees with mental disorders report lower agreement to those ideas which target self-management (trying not to upset oneself), tolerance of uncertainty and crisis.


 

 

Discussion

First, sick leave was independent from specific work demands, but associated with reduced person-job-fit and with capacity problems of the employees: Especially those with problems in endurance and flexibility were prone for sick leave. This supports the idea, that not work demands alone are important, but the relational person-job-fit or misfit [25]. When an employee has a specific capacity impairment, but this is required at his workplace, and there is no compensation for the impairment, work ability may become worse and end up in sick leave [13]. Flexibility and endurance are capacities which are regularly impaired in persons with mental disorder, this was also found in clinical samples [26]. Thus, capacity problems in these domains may get into trouble with related work demands quite often.

Second, employees with and without mental disorders perceive similar profiles and levels of work demands. Especially planning and structuring, proactivity and endurance are required in most workplaces, 80% of the investigated employees agreed that they had these work demands. This shows that employees with mental disorders describe their work demands similar like others. Work demands can be assessed on a descriptive level, and can thus be distinguished from work-related affects or valuation (e. g. such as “I have too much work”). This replicates findings from a previous study in a clinical sample [14].

Employees with mental disorders report however more capacity problems. More than 20% are observably impaired in more than half of the capacity dimensions. This fits to findings from an earlier study comparing patients in psychotherapy treatment and people from the general population [7]. Capacity problems can be self-reported, distinguish mentally healthy and mental ill persons, and can be addressed in work settings (e. g. training or work adjustment). The capacity concept is valuable for occupational health practice, since it does not require to speak about illness and symptoms (which is the duty of the occupational physician, but not of the supervisor), but points out capacity strengths and problems on a concrete behavior and activity level. This gives way for immediate action at work.

Third, work coping of employees with and without mental illness is partly similar, but partly different: Employees with mental disorders are similarly fit in coping with conflicts or problem solving, and report similar problem solving (wisdom) attitudes. However, they describe themselves weaker in emotional self-regulation capacities (uncertainty tolerance, symptom tolerance, calming oneself down, speaking about one’s health problems). This shows that coping at work is a multidimensional issue and must be assessed and described differentiated in concrete behavioral aspects. Calming oneself down when being anxious in a work situation is a quite different behavior than solving a practical problem at work. According to the nature of mental disorders, employees with mental disorders can be expected to have more symptoms, such as depressed mood, anxiety, uncertainty fear, as compared to employees without mental disorders. From the strong difference of work anxiety level in people with and without mental disorders (effect size>1) it can be seen that people with mental disorders are especially prone to suffer from specific additional problems in the domain of work. Thus, the employees with mental disorders do not only have to cope with the regular work problem solving, but additionally with (specifical work-related) self- and symptom management. This is not easy, especially for those who have not yet found functional strategies for their self-regulation. In consequence, there may be observable problems for them with fulfilling work duties in time, or being proactive or flexible [26].

Limitations and further research

Capacities and capacity demands, as well as psychopathology and coping were assessed by self-ratings, thus there may be an impact due to common method bias [27].

The assessment of capacities and capacity limitations in social medicine practice is based on expert ratings [13], supported by self-ratings. However, given that self-perceived work ability is a strong predictor of future real work ability [28], important information can also be obtained from capacity self-ratings. A self-rated capacity profile reflects the patient’s self-image and may provide information that could be useful for planning further therapy, capacity training or work adjustment.

The study is cross-sectional and no causal interpretation may be derived from the data. Majority of employees were white-collar and academics, thus results may not be generalizable for e. g. blue-collar and craftsmen professions.

Correlations between person-job-fit and capacities were significant, but small to moderate. The degree of correlation can be due to the fact that work aspects – beside person capacities - impact on person-job-fit, such as work surrounding, work satisfaction, type of work, qualification education.

Only employed persons were investigated here. Unemployed persons, especially those with mental disorders, need attention in further research for differentiation of their capacity profiles, because integration in the general labor market is most challenging for this group [29].

In this present explorative study, the established Mini-ICF-APP psychosocial capacity concept, work-anxiety, and the past sick leave duration were chosen as markers for work ability (problems). There are other well-known instruments which could also be used in future research, e. g. the Work Ability Index [30], or different scales on work performance problems developed in the German rehabilitation context [31] [32] [33].


 

Implications for rehabilitation

The focus of rehabilitation is not (only) on reducing illness symptoms, but on capacities and participation and their restauration. The here conducted study for the first time explores the distribution and correlation pattern of work demands on the one hand and person-capacities on the other hand, along with work participation and mental health markers. It is of value to know about the distribution of these rehabilitation-relevant characteristics in people with mental disorders as compared to others: The results give advice what people with mental disorders may need in prevention and treatment, including work-related rehabilitation (MBOR, [34] [35] [36] [37]), e. g. treatment and counselling concerning work-anxiety, and work-related self-regulation.

The here investigated general population working sample of working people may seem to be not directly representative for “psychosomatic inpatient rehabilitation patients in Germany” [35] [36] [37], However, rehabilitation is not limited to rehabilitation clinics, but means treatment of chronic illness. There are many people with mental illness who did not (yet) undergo treatment in an inpatient rehabilitation clinic, but have rehabilitation-relevant work problems (work anxiety, sick leave). Clinical rehabilitation practice requires a broader perspective on work and (mental) health characteristics from general working people. People with mental disorders are highly prone to have or develop work problems (which became visible in this investigation as well) and be in need of preventive or rehabilitative treatment to guard against chronic participation impairments.


 

 

Conclusion

Work demands in terms of capacity demands are similarly reported by employees with and without mental disorders. Employees with mental disorders regularly report observable and relevant capacity impairments which are associated with lower person-job-fit and with sick leave. Their work-coping behavior is lower than that of mentally healthy employees in terms of emotional self-regulation (tolerance of symptoms, calming oneself down, uncertainty tolerance), but not in work-related practical aspects like relational thinking and problem solving (wisdom) attitudes. Support for employees with mental health problems should be directed to their individual needs, e. g. support or compensation for self-regulation problems. This could be done by flexible work adjustments [38], or behavior-oriented support at work.


 

Data availability

Data can be requested from the author.


 

Ethics approval

This research was approved by the faculty of Life Sciences Ethic Board of the Technische Universität Braunschweig, approval number FV 2022-01.


 

Author contribution

The author conceptualized and designed the study, initiated and supervised data collection, conducted data analysis and interpretation of the data, and wrote the manuscript.


 

 

Conflict of Interest

Disclosure statement: The author reports there are no competing interests to declare.

Acknowledgements

The author wants to thank B.Sc. Anke Sondhof who managed data collection.

Supplementary Material


Correspondence

Prof. Beate Muschalla
Technische Universität Braunschweig
Psychotherapy and Diagnostics
Humboldtstraße 33
38106 Braunschweig
Germany   

Publication History

Article published online:
08 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Fig. 1 Percentages of relevant (observable or in need for support) capacity problems (left figure, rating 4–7 in the Mini-ICF-APP-S) and work demands (right figure, high demands indicated by ratings 3 or 4 in the Mini-ICF-APP-W) in employees from heterogenous professional settings with or without mental disorders.