The causes of mental illness is classified in a framework concept of a biopsychosocial disease genesis.
At the biological level:
- genetic factors,
- structural and functional changes in the brain as well
- investigated general somatic disease factors affecting the brain as causes of mental disorders.
Come in the realm of psychological causation factors
- cognitive processes such as incorrect processing of traumatic events,
- neurotic malpositions,
- Excessive attention to irrelevant stimuli or misinterpretations of reality, which in turn are the basis of some psychological symptom formation.
Finally, in the area of social causation factors such as migration to a new living environment, influences from the world of work or the family are considered. Such examinations are often made more difficult by the fact that for the same psychological symptom formation there can be manifold, interindividual and also intraindividual different constellations of causal factors.
Quantitative heterogeneity of the causes of mental disorders
In addition to this qualitative heterogeneity of the causal factors, quantitative heterogeneity must also be taken into account: The different causes can therefore vary in different relative strengths of expression, but ultimately have the same effect. So if you want to investigate the influence of psychological stress on the cause of mental disorders, the whole variety of potential bio-psychosocial disease factors must be taken into account. It is often difficult to infer the causal link between this factor and the mental disorder from an observed association between a factor and a mental disorder.
It should also be noted that most interactions in these areas are bidirectional.
Using the example of work stress and mental illness: mental stress can be an important factor in the causal chain of unfavorable influencing factors for the development of a mental disorder such as depression. Conversely, depression also means that stress in the workplace can be compensated for worse psychologically, the actual “normal” stress then take on a new meaning for the person concerned – mostly in the sense of stress that is no longer bearable, for example with depression to stay.
The first conclusion that emerges from the conception of the mental disorder as a biopsychosocial illness is that there are no simple cause-and-effect relationships between the world of work and mental disorders, but that complex models, taking into account all the factors and conditions mentioned, will be required to clarify connections.
Frequency of mental disorders
Among the mental disorders, anxiety disorders, depression, schizophrenia and alcohol-related illnesses are among the most common illnesses. The development of the last few years shows a constancy of this high frequency of mental disorders in the population. The recently reported first analyzes of the new Federal Health Survey 2012 showed a practically unchanged annual prevalence of 33% mental disorders. The “treatment rate” is still relatively low and is 30-60% of those affected.
Prevalence of use
Now every third insured person had contact with care providers at least once during the observation period due to a mental disorder. Most of the care was provided in the outpatient area by general practitioners and other somatic specialists; in the inpatient area, care by psychiatric hospitals or specialist psychiatric departments dominated alongside care in specialist somatic hospitals or departments.
These usage figures underline the need for a sufficient number of psychiatrists and psychiatric inpatient facilities as well as the great importance that general practitioners and all somatic disciplines attach to competence in the detection and treatment of mental disorders, which is already evident in medical studies, but also through the development of special training modules for physicians in somatic disciplines should be considered.
Inability to work and early retirement due to mental disorders
Around ten percent of the days of absence among the actively employed can be traced back to mental disorders. According to the data analyzed by the health insurance companies, the proportion of incapacity for work has shown an increasing trend over the past ten years or so. Analyzes of the Insurance Association show that the group of mental disorders is meanwhile the most common cause for “early retirement” due to an illness-related reduction in earning capacity. Approx. 40% of all cases are caused by mental disorders.
The age of early retirement for mental disorders is below the age for early retirement for somatic diseases. These figures underline the high burden on those affected, but also on the care system, by the temporary or permanent consequences caused by mental disorders in the field of employment. Restoring the ability to work as quickly as possible is therefore important from the point of view of those affected because work is not only a source of income but also a place where people can shape their lives and realize themselves, which is evident, for example, from the fact that unemployment is a significant psychological stress factor. On the other hand, a quick restoration of the ability to work is important from an economic point of view,
Models to explain the relationships between mental stress at work and incapacity for work
The current models show multifactorial influencing factors that explain the relationships between psychological stress in the workplace and mental disorders on the one hand and incapacity for work on the other. First of all, it must be stated that none of the models offers a really comprehensive theory and that usually only partial aspects of the models have been empirically checked. It should also be noted that, from stress research, “inverted U-curves” usually represent the relationship between the extent of stress and performance – under-demanding is just as unfavorable as excessive. Finally, it is known from social science research that work not only plays a role for the purpose of remuneration but also through social contacts.”
In essence, the following factors play together to varying degrees in order to illustrate the relationship between psychological stress at the workplace and workability:
- Illness-related factors such as the severity of symptoms of the mental disorder;
- Type and extent of psychological stress in the workplace, e.g. B. Time pressure or overtime;
- Possibility of adapting the workload to a temporary reduction in the workload due to illness or increased family support;
- individual-psychological factors such as material or ideal recognition by superiors as well as the ability to cope with psychological stress, which varies from person to person.
In principle, there are several starting points for minimizing incapacity for work and early retirement due to mental disorders. In the long term, clarifying the causes of mental disorders and the development of new prevention and therapy methods that can be hoped for is probably the most promising way to reduce the number of those affected by preventing the development of mental disorders or shortening the duration of the illness.
For this purpose, the development of new, as effective as possible therapeutic methods would also be promising. While these approaches tend to hold out the prospect of long-term improvement, a short-term effective approach could be an increase in the treatment rate – assuming that only about every second person affected is in contact with the care system at all, there were “awareness” programs, that is, one Greater education of the population about the symptoms of mental disorders and their treatability is required.
Another starting point would be to intervene with employers and the physicians caring for the mentally ill to make it easier for the mentally ill to return to work. Here, more effective reintegration measures could be developed, which on the one hand enable an earlier return to working life, but on the other hand, also build up the stress at the workplace in a dosed manner and adapted to the individual course of the illness.
Here, for example, the health insurances, through job coaches, were able to play an integrating function between outpatient and inpatient care on the one hand and curative and rehabilitative care on the other.
Particularly important in this area would be individualized reintegration adapted to the respective workplace, which, due to the abundance of factors that play a role in “return to work”, only appears promising with an individualized approach. In any case, the effectiveness of possible interventions would have to be evaluated through accompanying research in order to examine both the effects of such measures on the development of the disease, the utilization of the care system and the costs.
