Original research| Volume 99, ISSUE 1, P57-64, January 2018

Prevalence and Characteristics of Work Anxiety in Medical Rehabilitation Patients: A Cross-Sectional Observation Study



      To investigate frequency, type, and characteristics of work anxieties in patients with somatic illness.


      Cross-sectional observation study.


      Neurology, orthopedic, and cardiology rehabilitation clinics.


      Patients (N=1610; age, 18–65y) with work anxieties.


      Not applicable.

      Main Outcome Measures

      Patients who scored high on at least 2 of 9 items in the work-anxiety screening questionnaire and who reported impairment were investigated with a differential diagnostic interview on work anxieties and with the Mini-International Neuropsychiatric Interview on non–work-related common mental disorders. Patients also filled out a self-rating questionnaire on their subjective symptom load and sociodemographic data.


      Approximately 20% to 27% of the investigated inpatients in somatic rehabilitation (altogether n=393) received a work-anxiety diagnosis. Patients with orthopedic illness report highest work anxiety and have previous longest sick leave (20.6wk in the past 12mo). Patients with orthopedic illness suffer from work-related adjustment disorder with anxiety, social anxieties, and workplace phobias, whereas patients with cardiac illness are more often affected by hypochondriac anxieties. Anxieties of insufficiency and worrying occur equally in all indications.


      About a quarter of patients in somatic rehabilitation are in need of additional diagnostic attention owing to work anxieties. Differential diagnostic of work anxiety is needed for initiating adequate therapeutic action. Somatic rehabilitation physicians should be aware of work anxieties in their patients, especially in patients with orthopedic illness with previous long-term sick leave.


      List of abbreviations:

      IMET (Index for the Measurement of Restrictions in Participation), MINI (Mini-International Neuropsychiatric Interview), WAI (Work-Anxiety-Interview), WHO-5 (WHO-Five Well-Being Index), WPS (Workplace Phobia Scale)
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        • Muschalla B.
        • Linden M.
        Workplace phobia—a first explorative study on its relation to established anxiety disorders, sick leave, and work-directed treatment.
        Psychol Health Med. 2009; 14: 591-605
        • Linden M.
        • Muschalla B.
        Anxiety disorders and workplace-related anxieties.
        J Anxiety Disord. 2007; 21: 467-474
        • Muschalla B.
        • Heldmann M.
        • Fay D.
        The significance of job-anxiety in a working population.
        Occup Med. 2013; 63: 415-421
        • Muschalla B.
        • Linden M.
        [Work-anxieties and workplace phobia. Phenomenology, diagnostic, therapy, social medicine] [German].
        Kohlhammer-Verlag, Stuttgart2013
        • Linden M.
        • Dirks S.
        • Glatz J.
        [“Pathological Realangst” in cardiovascular illness] [German]..
        Z Psychosom Konsiliarpsychiatrie. 2008; 2: 248-254
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders (DSM-IV).
        American Psychiatric Association, Washington (DC)1994
        • World Health Organization
        International statistical classification of diseases and related health problems, Tenth revision.
        World Health Organization, Geneva1992
        • Haines J.
        • Williams C.L.
        • Carson J.M.
        Workplace phobia: psychological and psychophysiological mechanisms.
        Int J Stress Manage. 2002; 9: 129-145
        • Smith M.E.
        Work phobia and sickness leave certificates.
        Afr J Psychiatry. 2009; 12: 249-252
        • Payne R.L.
        • Fineman S.
        • Jackson P.R.
        An interactionist approach to measuring anxiety at work.
        J Occup Psychol. 1982; 55: 13-25
        • Muschalla B.
        • Linden M.
        • Jöbges M.
        Work-anxiety and sickness absence after a short inpatient cognitive behavioral group intervention in comparison to a recreational group meeting.
        J Occup Environ Med. 2016; 58: 398-406
        • World Health Organization
        WHO-Five Well-Being Index.
        WHO Collaborating Center for Mental Health, Psychiatric research Unit, Frederiksborg General Hospital, Denmark1998
        • Deck R.
        • Walther A.L.
        • Staupendahl A.
        • Katalinic A.
        [Limitations of social participation in general population—normative data of the IMET based on a population-based survey in northern Germany].
        Rehabilitation (Stuttg). 2015; 54 ([German]): 402-408
        • Muschalla B.
        • Vilain M.
        • Lawall C.
        • Lewerenz M.
        • Linden M.
        Participation restrictions at work indicate participation restrictions in other domains of live.
        Psychol Health Med. 2012; 17: 95-104
        • Sheehan D.
        • Lecrubier Y.
        • Sheehan H.
        • et al.
        The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.
        J Clin Psychiatry. 1998; 59: 22-33
        • Baumeister H.
        • Höfler M.
        • Jacobi F.
        • Wittchen H.U.
        • Bengel J.
        • Härter M.
        [Mental disorders in patients with musculoskeletal illness in comparison to the general population] [German].
        Z Klin Psychol Psychother. 2004; 33: 33-41
        • Cornelius B.
        • van der Klink J.J.
        • Brouwer S.
        • Groothoff J.W.
        Under-recognition and under-treatment of DSM-IV classified mood and anxiety disorders among disability claimants.
        Disabil Rehabil. 2014; 36: 1161-1168
        • Servant D.
        • Pelissolo A.
        • Chancharme L.
        • LeGuern M.E.
        • Boulenger J.P.
        [Adjustment disorders with anxiety: clinical and psychometric characteristics in patients consulting a general practitioner].
        Encephale. 2013; 39 ([French]): 347-351
        • Melloh M.
        • Elfering A.
        • Käser A.
        • et al.
        What is the best tie point to identify patients at risk of developing persistent low back pain?.
        J Back Musculoskelet Rehabil. 2015; 28: 267-276
        • Brünger M.
        • Spyra K.
        Prevalence of comorbid depressive symptoms in rehabilitation: across-indication, nationwide observational study.
        J Rehabil Med. 2016; 48: 903-908
        • Deutsche Rentenversicherung Bund
        [German pension fund position paper on mental disorders in rehabilitation and disability pension] [German].
        Deutsche Rentenversicherung Bund, Berlin2014
      1. Hillert A. Müller-Fahrnow W. Radoschewski F.M. [Medical and vocational rehabilitation] [German]. Deutscher Ärzte-Verlag, Cologne2009
        • Jöbges M.
        • Michels K.U.
        • Michels K.J.
        • Hoffmann F.
        [Quality report of the Brandenburg Clinic 2010] [German]. KG.
        MMK Mediatas Media Kontor, Bernau2011
        • Nash-Wright J.
        Dealing with anxiety disorders in the workplace: importance of early intervention when anxiety leads to absence from work.
        Prof Case Manag. 2011; 16: 55-59
        • Streibelt M.
        • Bethge M.
        • Gross T.
        • Herrmann K.
        • Ustaoglu F.
        • Reichel C.
        Predictive value of a screening instrument for the risk of non–return to work in patients with internal diseases.
        Arch Phys Med Rehabil. 2017; 98: 989-996