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- Depression (1)
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Due to increased life expectancy, a growing number of retirees are spending more and more time in retirement. Life satisfaction in later life therefore becomes an increasingly important societal issue. Good work ability and health are prerequisites for a self-determined transition to retirement, for example allowing for a continuation of gainful employment beyond retirement age. Such continued employment is one way of dealing with the consequences of a historically unique long retirement phase: a self-determined continued employment can have a positive effect on individual well-being, on societal level relieve the burden on the pension insurance system, and on meso-level provide companies with urgently needed human capital. The self-determination of life circumstances is postulated by Self-Determination Theory (SDT) as a basic psychological need with effects on individual well-being. This dissertation investigates work ability as a concept that supports workers, employers, and societies in the extension of working lives, and how work ability is related to the level of self-determination in the transition to retirement, and ultimately life satisfaction.
In the first study of this dissertation, the Work Ability Survey-R (WAS-R) was translated from English into German and then evaluated regarding its psychometric properties and construct validity. The WAS-R operationalizes work ability as the interplay of personal and organizational resources and thus allows companies to derive targeted interventions to maintain work ability.
In the second study, the WAS-R was examined together with the questionnaire Work-Related Behavior and Experience Pattern (Arbeitsbezogenes Verhaltens- und Erlebensmuster, AVEM) regarding its construct validity. A striking feature of this study was the high number of participants with the answering pattern indicating low work-related ambitions and protection. Persons with this pattern are in danger of entering the risk pattern for burnout in the future. The findings support the validity of the WAS-R.
In the third contribution, two studies examined the experience of control (i.e., autonomy) in the transition to retirement as a mediator between previous work ability, health, and financial well-being, and later life satisfaction in retirement. Control was found to partially mediate the relationship between work ability and later life satisfaction. Different mechanisms on later life satisfaction of work ability and health, and the subjective and objective financial situation were found.
This dissertation contributes to research on and practice with aging workers in two ways: (1) The German translation of the WAS-R is presented as a useful instrument for measuring work ability, assessing individual and organizational aspects and therefore enabling employers to make targeted interventions to maintain and improve work ability, and eventually enable control during later work life, the retirement transition and even old age. (2) This dissertation corroborates the importance of good work ability and health, even in old age, as well as control in these phases of life. Work ability is indirectly related to life satisfaction in the long period of retirement, mediated by a sense of control in the transition to retirement. This emphasizes the importance of the need for control as postulated by the SDT also in the transition to retirement.
Depressive disorders are highly prevalent mental disorders associated with an enormous individual and societal burden. The efficacy of both; treatment and prevention of depression have been meta-analytically demonstrated. Over the past two decades, an increasing number of internet-based interventions for depression has been developed and their efficacy was also metaanalytically shown. However, the uptake of such interventions – despite all the suggested advantages of internet-based interventions – is still rather low. The stigma still associated with “depression” may be one major barrier also to internet-based interventions. To overcome this barrier and potentially increase uptake, the paradigm of indirect interventions has been proposed recently. Indirect interventions primarily address common mental health problems, which are presumed to be less stigmatizing, and are suggested to reduce depressive symptoms indirectly. Targeting common mental health problems that are transdiagnostic risk factors for depression and other mental disorders – such as stress or repetitive negative thinking – seems especially promising.
This dissertation evaluated the efficacy of three different internet-based interventions that can be regarded as indirect interventions to reduce depression since they primarily targeted risk factors for depression. For this purpose three registered randomized controlled trials were conducted. In addition to assessing the efficacy of the interventions regarding the primary outcomes, the efficacy to reduce depression and further secondary outcomes was studied. In Study I (N = 200) the efficacy of an internet-based stress management intervention (iSMI), which was adapted and tailored to career starting teachers, was compared to a waitlist control group (WLG). The participants of the intervention group (IG) reported significant reductions on the primary outcome perceived stress at post-intervention (T2), ΔWLG-IG = 3.5, d = 0.52, 95% CI [0.24, 0.80], and threemonth follow-up (3-MFU), d = 0.49, 95% CI [0.21, 0.77]. Furthermore, it was shown that the intervention indirectly also reduced depression at T2, d = 0.66, 95% CI [0.38, 0.94], and 3-MFU, d = 0.47, 95% CI [0.19, 0.75], nad produced significant clinically meaningful reductions of depression with a number needed to treat (NNT) of 3.9 at T2. The effects were sustained at an extended 6-MFU. Besides efficacy, the feasibility to complement the iSMI with a newly developnedte rinet-based classroom management training was shown. Moreover, mediation analyses corroborated the role of problem- and emotion-focused coping skills in the intervention’s effect on stress and the indirect effect of the intervention on depression through stress.
Study II (N = 262) demonstrated the efficacy of an internet- and app-based gratitude intervention on the reduction of primary assessed repetitive negative thoughts at T2, ΔWLG-IG = 6.6, d = 0.61, 95% CI [0.36, 0.86], and 3-MFU, d = 0.75, 95% CI [0.50, 1.00], as compared to a WLG. The participants of the IG also reported significantly reduced depressive symptoms at T2, d = 0.38, 95% CI [0.13, 0.62], and 3-MFU, d = 0.40, 95% CI [0.15, 0.64], with significant clinically meaningful effects with an NNT of 4.3 at T2. The effects were sustained at an extended 6-MFU. Besides efficacy, mediation analyses showed that repetitive negative thinking mediated the gratitude intervention’s effect on depression.
Finally, Study III N( = 351) showed that an interneta-sbed intervention, tackling worries at the beginning of the COVID-19 pandemic, was effective as compared to an active mental health advice group. At T2, two weeks after randomization, the IG reported significantly reduecveedl sl on the primary outcome worry as compared to controΔlsW, LG-IG = 5.0, d = 0.38, 95% CI [0.17, 0.59]. Participants of the IG also reported significantly reduced levels of depression at T2, d = 0.47, 95% CI [0.26, 0.68], with significant clinically meaningful reductions with an NNT of 3.6. The extended follow-ups in the IG indicated that the improvements from baseline were sustained until the 2-MFU and the 6-MFU. In a mediation analysis, worry was shown to mediate the intervention’s effect on depression.
Across all three studies a reliable deterioration of depression was occasionally observed ranging from 3% to 5% in the IGs and from 5% to 12% in the control groups at T2. In summary, the studies in this dissertation demonstrated the efficacy of various indirect interventions focusing on rather common psychological problems to indirectly reduce depressive symptoms. The extent to which depression severity could be reduced is comparable to reductions found within participants with comparable baseline depression severity, in internetbased interventions directly addressing depressive symptoms. Indirect interventions are suggested to increase the uptake of interventions that reduce depressive symptoms, since they might be perceived as less stigmatizing and might broaden the range of interventions to choose from. Future research needs to compare indirect interventions for depression with direct interventions in head-to-head studies regarding uptake, efficacy and potential harmful effects. The indirect interventions examined in this dissertation could then complement the existing range of care for depression and thereby contribute to a reduction of the treatment gap and the burden of disease associated with depression.
Internet- and mobile technologies are increasingly used to deliver mental health care. E-Mental Health is promising for the prevention and treatment of mental disorders. However, while E-Mental Health was shown to be an effective treatment tool, fewer studies investigated the prevention of mental health problems with E-Mental Health approaches. In a series of three studies, this dissertation examines internet- and mobile-based approaches for the early monitoring and supporting of mental health. First, a pilot study investigates the use of smartphone data as collected by daily self-reports and sensor information for the self-monitoring of bipolar disorder symptoms. It was found that some, but not all smartphone measurements predicted clinical symptoms of mania and depression, indicating that smartphones could be used as an earlywarning system for patients with bipolar disorder. Second, a randomized controlled trial evaluates the effectiveness of an internet-based intervention among persons with depression and sickness absence. The intervention was found to be effective in reducing depressive symptoms compared to a control group, suggesting that the internet can provide effective support for people with sickness absence due to depression. Third, a study protocol proposes to combine self-monitoring with a mobile intervention to support mental health in daily life. Supportive self-monitoring will be evaluated in a fully mobile randomized controlled trial among a sample of smartphone users with psychological distress. If supportive self-monitoring on the basis of a smartphone application is effective, it could be widely distributed to monitor and support mental health on a population level. Finally, the contribution of the presented studies to current research topics in E-Mental Health is discussed.