Psychosomatische Rehabilitation bei deutschen und ausländischen Versicherten der Rentenversicherung im Vergleich

Abstract

This study aims to comprehensively analyse the course of psychosomatic rehabilitation - from access to quantifiable rehabilitation outcomes. A comparison is made between 3 groups of patients: German citizens, patients of Turkish nationality or patients of foreign or unknown nationality. The data set used comprises routine data of the German Pension Insurance regarding psychosomatic rehabilitation from the so called Reha-Statistik-Database (RSD, database for rehabilitation statistics) over a period from 2007 to 2014. We included 128,165 compulsorily insured persons who underwent psychosomatic rehabilitation in 2012. Among the patients in psychosomatic rehabilitation in 2012 5.8 % were of foreign nationality. Turkish patients were with 2.0 % the largest group, patients with another or unknown nationality or stateless patients constitute the additional group. The most common diagnoses for all groups were affective disorders and neurotic, somatoform and stress disorders. Differences between the groups can be demonstrated with regard to sociodemographics and employment status prior to rehabilitation: Patients of foreign nationality, and here especially Turkish patients, are on average younger, more often married and have less advanced vocational training than German patients. Accordingly, they work more often in less qualified jobs with lower wages. The health status prior rehabilitation, measured as days of sick leave, is also worse compared to German patients. In contrast to other indications there is no disadvantage regarding access to psychosomatic rehabilitation. On the contrary: the age-standardised uptake ratios of Turkish patients, especially of women, are markedly higher than in Germans. Treatment during psychosomatic rehabilitation is more or less identical. With regards to outcome of rehabilitation, reintegration into working life or transition into disability pension Turkish patients are less successful. As important influential variables for return to work (RTW) the following factors were identified: Employment duration in the last 12 months before the start of rehabilitation, the medically tested ability to work for the last employment, age and wage in the last year before the start of rehabilitation. Even after the inclusion of these variables in the logistic regression model, a direct influence of the Turkish citizenship has remained. In this study Turkish patients are a special group. This is especially true for Turkish women. They start from a lower baseline in comparison with their male compatriots, they have higher access to psychosomatic rehabilitation and the results of rehabilitation are less favourable. These findings may be attributable to the markedly worse health and employment status of the female Turkish patient group. Nevertheless, nationality itself remains to be a significant influencing factor.

Symptom manifestation and treatment effectiveness, -obstacles and -facilitators in Turkish and Moroccan groups with depression in European countries: A systematic review

“…This study excluded unemployed patients (students, housewives, retired patients), which might have affected the external validity of the findings. Turkish-Germans showed similar symptom reduction to native Germans and other immigrant groups in the two studies with control groups, including one with a large national sample(Mösko et al, 2011, Zollmann et al, 2016. However, Turkish-German patients showed the smallest treatment effect sizes regarding depression, other symptoms and general psychopathology in a small sample(Mösko et al, 2011).…”

“…Another MQ study found that Turkish-and Moroccan-Dutch patients receiving secondary care had lower treatment intensity compared to natives, also after adjusting for demographics and illness severity (Fassaert et al, 2010b). In Germany, two WQ studies found that Turkish-German had the shortest treatment duration in inpatient psychosomatic rehabilitation and general outpatient care (Mösko et al, 2011, Schouler-Ocak et al, 2010), however, this finding was not confirmed by a recent, also WQ study with a much larger sample (Zollmann et al, 2016). The latter study also showed that receiving the same type of treatment or treatment duration as the native group did was not necessarily a facilitating factor of therapeutic success.…”

“…The latter study also showed that receiving the same type of treatment or treatment duration as the native group did was not necessarily a facilitating factor of therapeutic success. Turkish-German still showed worse mental health and work outcomes (Zollmann et al, 2016). Factors facilitating therapeutic success included a participatory acculturation strategy in the Netherlands (Nap et al, 2015) and younger age and longer duration of stay in Austria (Renner and Berry, 2011), which were factors predictive of greater symptom reduction during or after treatment for depression.…”

“…Mösko et al, 2011; Nickel et al., 2006a;Zollmann et al, 2016). Intention-to-treat analyses revealed significant improvement of Turkish-German patients at discharge on depressive, somatic, anxiety, and phobic symptoms, as well as paranoid ideation, psychoticism, hostility and the global severity index(Nickel et al, 2006a;Zollmann et al, 2016).…”

“…Mösko et al, 2011; Nickel et al., 2006a;Zollmann et al, 2016). Intention-to-treat analyses revealed significant improvement of Turkish-German patients at discharge on depressive, somatic, anxiety, and phobic symptoms, as well as paranoid ideation, psychoticism, hostility and the global severity index(Nickel et al, 2006a;Zollmann et al, 2016). There was no reduction of obsessive-compulsive symptoms or interpersonal difficulties, and poor to moderate improvement on socio-medical indicators (e.g., the percentage of patients employed, number of working hours/ weeks;Nickel et al, 2006a).…”