Milieu-specific differences in symptom severity and treatment outcome in psychosomatic rehabilitation in Germany

Frontiers in Psychiatry · 4 authors, 4 centres

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TL;DR

This cohort study of 2,000 patients in two German psychosomatic rehabilitation clinics found that patients from different social milieus, as classified by the Sinus model, had significant differences in depressive symptoms and psychosocial impairment at admission and discharge after 5 weeks of treatment. Patients from the 'Precarious Milieu' consistently had the highest burden of symptoms and impairment.

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The study included 2,000 patients from two German psychosomatic rehabilitation clinics, classifying them by social milieu using the Sinus milieu indicator. Depressive symptoms (BDI-II, N=1,832) and psychosocial impairment (HEALTH-49, N=1,829) were measured at admission (T0) and discharge after 5 weeks of treatment (T1). Mixed-model ANOVAs revealed significant milieu differences in severity at T0 and T1, with patients from the Precarious Milieu showing the highest burden. All patients from all milieus improved significantly over treatment (p < 0.001). Significant interaction effects indicated milieu-dependent differences in improvement for depressiveness and three HEALTH-49 scales, though the effect sizes were generally weak. At discharge, patients from the Precarious Milieu still had higher symptom and impairment levels than patients from better-off milieus had at admission. Limitations include a non-representative milieu distribution and the observational design, which prevents causal conclusions about the factors driving these associations.

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cohort

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psychiatry

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ORIGINAL PAPER

PMC10465793

Milieu-specific differences in symptom severity and treatment outcome in psychosomatic rehabilitation in Germany

Frontiers in Psychiatry

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ABSTRACT

Abstract Introduction Previous 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. Methods As 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. Results Milieu 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, p adj = 0.005], Interactional difficulties [ F (9, 1819) = 2.74, p adj = 0.036] and Activity and Participation [ F (9, 1819) = 4.94, p adj < 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. Discussion Social 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. Keywords: psychosomatic medicine, rehabilitation, treatment outcome, social milieu, mental health disparities, social determinants of health, social inequality, health equity

CITATION EXPORT

Henrika Kleineberg-Massuthe, Lilia Papst, Markus Bassler et al.. Milieu-specific differences in symptom severity and treatment outcome in psychosomatic rehabilitation in Germany. Frontiers in Psychiatry. (2023). https://doi.org/10.3389/fpsyt.2023.1198146

AUTHORS

4 · 4 CENTRES

Henrika Kleineberg-Massuthe, Lilia Papst, Markus Bassler, Volker Köllner

1Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Centrum für Innere Medizin und Dermatologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
2Institute for Social Medicine, Rehabilitation Sciences and Health Services Research (ISRV), Hochschule Nordhausen, Nordhausen, Germany
3Center for Oncology and Psychosomatics, Rehazentrum Oberharz, Clausthal-Zellerfeld, Germany
4Department of Psychosomatics and Behavioral Psychotherapy, Reha-Zentrum Seehof, Teltow, Germany