[Progression of the pension-application process in psychosomatic patients]

Psychosomatic disorders have become increasingly important as a reason for premature retirement. To identify specific characteristics of pension applicants, we broke a random sample consisting of 1,109 patients admitted to Burg Hospital within the framework of psychosomatic rehabilitation programmes into three main groups: a) patients who had not applied for any kind of pension benefits and 'high-risk groups' of pension aspirants who b) had either already submitted an application or c) intended to do so. The comparison of the sociomedical data from the two groups showed that the high-risk group contained a markedly larger percentage of unemployed patients and patients who had been on sick leave for longer periods. The average age of the pension aspirants was higher. Moreover, this group contained a larger percentage of male patients than did the non-applicant group. An assessment of rehabilitation potential uncovered a distinctly depressed potential in the high-risk group. Moreover, the assessment of individual patient performance conducted at the end of each rehabilitation programme yielded significantly lower scores for the high-risk groups in comparison with the non-applicant group. On the basis of the decrease in symptoms, it is evident that only small therapeutic success can be achieved with these patients, who as a group display a significantly lower therapeutic motivation than their non-applicant counterparts. Furthermore, there was a higher incidence of recurrent depressive disorders and somatic pain disorders in the high-risk groups. The development of pension aspirations can be described as a process starting with a disorientation phase, proceeding to an ambivalence phase and culminating in a rigid terminal phase. Patients who have reached this stage are generally resistant to rehabilitation efforts. For this reason, early recognition of pension aspirations is of critical importance.