zhwi000025 10.3205/zhwi000025 urn:nbn:de:0183-zhwi0000255 Übersichtsarbeit Review Article Reconciling work and family life with the focus on the health of mothers – a scoping review Bode Bode Annika A M.A.

Universität Witten/Herdecke, Fakultät für Gesundheit, Department für Pflegewissenschaft, Alfred-Herrhausen-Straße 50, 58455 Witten, DeutschlandHochschule Osnabrück, Fakultät Wirtschafts- und Sozialwissenschaften, Osnabrück, DeutschlandUniversität Witten/Herdecke, Fakultät für Gesundheit, Department für Pflegewissenschaft, Witten, DeutschandKooperatives Forschungskolleg „FamiLe – Familiengesundheit im Lebenslauf“, Osnabrück und Witten, Deutschland

Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Alfred-Herrhausen-Straße 50, 58455 Witten, GermanyOsnabrück University of Applied Sciences, Faculty of Business Management and Social Sciences, Osnabrück, GermanyWitten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, GermanyCooperative Research Centre “FamiLe – Family Health in the Life Course”, Osnabrück and Witten, Germany

annika.bode@uni-wh.de author Dorin Dorin Lena L Dr

Bundesinstitut für Berufsbildung, Robert-Schuman-Platz 3, 53175 Bonn, DeutschlandKooperatives Forschungskolleg "FamiLe - Familiengesundheit im Lebenslauf", Osnabrück und Witten, DeutschlandBundesinstitut für Berufsbildung, Bonn, DeutschlandKooperatives Forschungskolleg „FamiLe – Familiengesundheit im Lebenslauf“, Osnabrück und Witten, Deutschland

Federal Institute for Vocational Education and Training, Robert-Schuman-Platz 3, 53175 Bonn, GermanyCooperative Research Centre "FamiLe - Family Health in the Life Course", Osnabrück and Witten, GermanyFederal Institute for Vocational Education and Training, Bonn, GermanyCooperative Research Centre “FamiLe – Family Health in the Life Course”, Osnabrück and Witten, Germany

author Metzing Metzing Sabine S Prof. Dr.

Universität Witten/Herdecke, Fakultät für Gesundheit, Department für Pflegewissenschaft, Alfred-Herrhausen-Straße 50, 58455 Witten, DeutschlandKooperatives Forschungskolleg "FamiLe - Familiengesundheit im Lebenslauf", Osnabrück und Witten, DeutschlandUniversität Witten/Herdecke, Fakultät für Gesundheit, Department für Pflegewissenschaft, Witten, DeutschandKooperatives Forschungskolleg „FamiLe – Familiengesundheit im Lebenslauf“, Osnabrück und Witten, Deutschland

Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Alfred-Herrhausen-Straße 50, 58455 Witten, GermanyCooperative Research Centre "FamiLe - Family Health in the Life Course", Osnabrück and Witten, GermanyWitten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, GermanyCooperative Research Centre “FamiLe – Family Health in the Life Course”, Osnabrück and Witten, Germany

author Hellmers Hellmers Claudia C Prof. Dr.

Universität Witten/Herdecke, Fakultät für Gesundheit, Department für Pflegewissenschaft, Alfred-Herrhausen-Straße 50, 58455 Witten, DeutschlandKooperatives Forschungskolleg "FamiLe - Familiengesundheit im Lebenslauf", Osnabrück und Witten, DeutschlandHochschule Osnabrück, Fakultät Wirtschafts- und Sozialwissenschaften, Osnabrück, DeutschlandUniversität Witten/Herdecke, Fakultät für Gesundheit, Department für Pflegewissenschaft, Witten, DeutschandKooperatives Forschungskolleg „FamiLe – Familiengesundheit im Lebenslauf“, Osnabrück und Witten, Deutschland

Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Alfred-Herrhausen-Straße 50, 58455 Witten, GermanyCooperative Research Centre "FamiLe - Family Health in the Life Course", Osnabrück and Witten, GermanyOsnabrück University of Applied Sciences, Faculty of Business Management and Social Sciences, Osnabrück, GermanyWitten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, GermanyCooperative Research Centre “FamiLe – Family Health in the Life Course”, Osnabrück and Witten, Germany

author German Medical Science GMS Publishing House

Düsseldorf

610 women's health maternal health return to work managing work and family review literature Gesundheit Mütter Vereinbarkeit von Beruf und Familie Lebenslagen Literaturreview 20210831 20211110 20230330 germ engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). 2366-5076 10 GMS Zeitschrift für Hebammenwissenschaft GMS Z Hebammenwiss 01 Hintergrund: Die physische und psychische Gesundheit sowie die Gesundheit im Allgemeinen von Müttern nach Mutterschutz bzw. Elternzeit ist, im Zuge der Vereinbarkeit von Beruf und Familie, multidimensionalen Einflüssen ausgesetzt, die bisher in Deutschland nicht systematisch untersucht wurden. Ziel: Das Ziel dieses Literaturreviews ist die Darstellung der Gesundheit von Müttern unter Einbezug der Einflussfaktoren aus Beruf und Familie. Methodik: Die systematische internationale Literaturanalyse für das Scoping-Review erfolgte zwischen September 2016 und Dezember 2018 in den Datenbanken Medline via Pubmed, PsycINFO, PsycARTICLES und GESIS (Sowiport) für den Veröffentlichungszeitraum 2007-2018. Ergebnisse: Es wurden 86 Studien eingeschlossen. Positive Auswirkungen auf die Gesundheit von Müttern entstehen, wenn eine berufliche Tätigkeit persönlich gewünscht ist und die berufliche Rolle bereichernd und mit dem Familienleben als gut vereinbar eingeschätzt wird. Sehr individuell scheint zu sein, zu welchem Zeitpunkt der berufliche Wiedereinstieg erfolgt, in welchem Umfang gearbeitet wird und wie hoch das Einkommen ist. Entscheidend ist die insgesamt positive Einschätzung der Berufsausübung bezüglich der eigenen Lebenssituation. Wenn die Anforderungen mit den zur Verfügung stehenden Ressourcen bewältigt werden, steigt das Wohlbefinden. Diskussion: Die Relevanz des Umfangs der Beschäftigung, des Zeitpunkts der Rückkehr in den Beruf sowie der erlebten Kontrolle im Alltag für die mütterliche Gesundheit sind abhängig vom Gesamtkontext und von systemspezifischen Rahmenbedingungen. Es ist bisher nicht ausreichend untersucht, welche Konsequenzen sich aus den individuellen Lebenslagen für die Gesundheit von Müttern in Deutschland ergeben. Daher haben weitere Studien zum Zusammenspiel von Erwerbsarbeit und Familie für die Gesundheit von Müttern in Deutschland und daran angelehnte politische Maßnahmen das Potential, die Frauen- und Familiengesundheit nachhaltig zu stärken. Background: The subjective physical and mental health of mothers who have finished their parental leave and are reconciling work and family life is exposed to multidimensional influences. These factors have not yet been systematically investigated in the national context of Germany. Objectives: The overall aim of this literature review is to depict the health of mothers while they are combining work and family, taking the influencing factors into account. Methods: Between September 2016 and December 2018, we conducted a systematic international literature analysis in the databases Medline via Pubmed, PsycINFO, PsycARTICLES and GESIS (Sowiport) for the years 2007 to 2018 based on a scoping review. Results: A total of 86 studies were included. Positive effects on the health of mothers arise when a work situation is personally desired and the professional role is considered positive, fulfilling and compatible with family life. The point in time at which a mother returns to work, the hours worked and the level of income seem to be very individual. A key factor is the individual’s overall positive appraisal of their present life situation. Well-being increases if the demands are met with the resources available. Conclusions: The relevance for maternal health of the hours worked, the time point of the return to work and the control experienced in everyday work and family life depend on the overall context and national system-specific circumstances. So far, there has been insufficient research on the consequences of individual living situations for the health of mothers in Germany. For this reason, further research on how the specific interaction between gainful employment and the family impacts the health of mothers in Germany and on the political measures related to this research have the potential to sustainably strengthen the health of women and families. HintergrundDer Übergang vom Frausein zum Muttersein hat entscheidenden Einfluss auf die persönliche Entwicklung und die Gesundheit einer Frau , , . Außerdem prägt die Gründung einer Familie die berufliche Identität neu, denn viele Frauen möchten bzw. können sich nach der Geburt nicht zwischen Familie und Beruf entscheiden, sondern versuchen beide Aspekte mit den jeweiligen Herausforderungen in Einklang zu bringen , . Wenn der Wiedereintritt in den Beruf bewältigt werden muss, so kann das Wohlbefinden von Müttern beeinträchtigt werden durch die erneute Übergangsphase aufgrund der anderen Tages- und Organisationsstruktur , . Individuelle gesundheitsförderliche und präventive Beratungsangebote für Mütter im Vorfeld des beruflichen Wiedereinstiegs nach der Elternzeit scheinen – auch international – nicht flächendeckend als integraler Bestandteil des Gesundheits- und Sozialsystems etabliert zu sein. Die international unterschiedlichen politischen Regelungen beeinflussen den Wiedereinstieg im Anschluss an die Elternzeit . In Deutschland nehmen 50% der Mütter einen beruflichen Wiedereinstieg vor, wenn das jüngste Kind 0-2 Jahre alt ist , , . Insbesondere der Anteil der Mütter steigt, die um den ersten Geburtstag des Kindes den beruflichen Wiedereinstieg realisieren , . Mit der Einführung des Elterngeldes im Jahr 2007 durch das Bundeselterngeld- und Elternzeitgesetz (BEEG) wird über eine grundsätzliche finanzielle Unterstützung von Familien in der frühen Elternzeit versucht, die Vereinbarkeit von Beruf und Familie zu unterstützen . Während in Deutschland maximal 14 Monate Elterngeld (inklusive Partnermonate) bezahlt werden und es einen Anspruch auf drei Jahre Elternzeit gibt , existieren z.B. in Großbritannien kürzere, aber wie in Deutschland auf nationaler Ebene einheitlich geltende Elternzeitregelungen. Ähnliches gilt für die nordeuropäischen Länder wie Dänemark, Island, Schweden und Norwegen sowie die Benelux-Länder . In den USA hingegen existiert kein gesetzlich geregelter bezahlter Mutterschutz, abgesehen von einer unter Berücksichtigung des „Family and Medical Leave Act“ zu prüfenden bis zu zwölfwöchigen Auszeit , . Teilweise wird diese Möglichkeit durch sehr heterogene arbeitgeberabhängige Elternzeit-Bedingungen erweitert , die jedoch nur 50% der arbeitenden Frauen einschließen . In den nordeuropäischen Ländern (außer Finnland) sowie in den Benelux-Ländern und Frankreich kehren viele Mütter innerhalb der ersten zwei Lebensjahre des jüngsten Kindes in ihren Beruf zurück , . Gründe hierfür sind u.a. ein gut ausgebautes, flächendeckendes staatliches Betreuungssystem und eine gesellschaftlich hohe Akzeptanz der Fremdbetreuung insbesondere von unter dreijährigen Kindern , . Während in Deutschland und den europäischen Ländern mit vergleichbaren Regelungen ein frühzeitiger Wiedereinstieg häufiger von Müttern realisiert wird, die eine bessere berufliche Bildung (mit Ausnahme von Dänemark und Schweden) und ein höheres Einkommen haben (weniger relevant für Dänemark und Deutschland), sind die frühzeitigen Wiedereinsteigerinnen in den USA tendenziell weniger gebildet und befinden sich in schlechter bezahlten beruflichen Positionen . Insgesamt zeigt sich, dass bei der Entscheidung für oder gegen einen beruflichen Wiedereinstieg sowohl politische und wirtschaftliche Voraussetzungen, als auch die in der Familie gelebten Werte und Normen sowie die gesellschaftliche Akzeptanz eine Rolle spielen. Somit sind geographische, soziale und kulturelle Hintergründe für die (frühzeitige) Vereinbarkeit von Beruf und Familie relevant , . Unter Berücksichtigung der genannten Aspekte zeigt sich mit Blick auf die Gesundheit von Frauen in der Familienphase, dass das subjektive Gesundheitsempfinden und -verhalten von Müttern multidimensionalen Einflüssen ausgesetzt sind, die unter Einbezug der individuellen Lebenslagen bisher in Deutschland nicht systematisch untersucht wurden. Diese Einflüsse sind aus familienpolitischer und gesundheitsökonomischer Sicht relevant insbesondere vor dem Hintergrund der zunehmenden Geburtenrate in Deutschland , , und der steigenden Erwerbsbeteiligung von Frauen . Das Ziel der Arbeit ist daher die systematische Darstellung der physischen und psychischen Gesundheit von Müttern sowie ihrer Gesundheit im Allgemeinen unter Berücksichtigung der Einflussfaktoren aus Beruf und Familie. BackgroundThe transition to motherhood has a decisive influence on women’s personal development and health , , . Moreover, starting a family reshapes professional identity, as many women do not want to, or cannot choose between family and career after the birth of their children but instead try to reconcile the two aspects, with all the challenges this brings , . When mothers have to manage the return to work, the new transition phase resulting from the different structure of daily life and organisation can negatively impact their well-being , . One-to-one tailored preventative advice services provided to mothers in preparation for the return to work after the end of maternity leave can promote good health. However, such services do not appear – also in other countries – to be a widely established integral component of the health and social care system. The various political regulations in the different countries influence women’s return to work following their maternity leave . In Germany, 50% of mothers intend to return to work when their youngest child is 0–2 years of age , , . The share of mothers who go back to work around the first birthday of their child, in particular, is on an upward trend , . The introduction of parental benefits in 2007 with the German Parental Allowance and Parental Leave Act (Bundeselterngeld- und Elternzeitgesetz, BEEG) aims to provide universal financial support for families during the early stage of parental leave with a view to helping them reconcile work and family life . While in Germany, a maximum of 14 months of parental allowance is paid (including partner months) and parents are entitled to three years of parental</PlainText></TextGroup> leave <TextLink reference="20"></TextLink>, in other countries, such as the UK, parental leave is shorter, but like in Germany, parental leave policies there are universally applied at national level. The situation is similar in the Northern European countries (Denmark, Iceland, Sweden and Norway), as well as the Benelux countries <TextLink reference="85"></TextLink>. In the USA, in contrast, there is no paid maternity leave regulated by law, aside from 12 weeks of unpaid leave under the Family and Medical Leave Act <TextLink reference="85"></TextLink>, <TextLink reference="115"></TextLink>. This possibility is being partially extended through very heterogenous employer-dependent parental leave conditions <TextLink reference="52"></TextLink>, which only cover 50&#37; of working women, however <TextLink reference="12"></TextLink>. </Pgraph><Pgraph>In the Northern European countries (except Finland), as well as the Benelux countries and France, many mothers return to work within the first two years of life of their youngest child <TextLink reference="81"></TextLink>, <TextLink reference="83"></TextLink>. The reasons for this are, among other factors, a well-established, comprehensive public childcare system and a high level of social acceptance of childcare, especially for children under the age of three <TextLink reference="87"></TextLink>, <TextLink reference="120"></TextLink>. While in Germany and other European countries with similar regulations, mothers with better vocational education (with the exception of Denmark and Sweden) and a higher income (a less relevant factor for Denmark and Germany) are more likely to return to work early <TextLink reference="87"></TextLink>, mothers in the USA who return early tend to be less well educated and work in lower-paid jobs <TextLink reference="29"></TextLink>. </Pgraph><Pgraph>Overall, we find that when it comes to the decision for or against a return to work, political and economic conditions, the values and norms observed in the family, as well as social acceptance all have a role to play. Consequently, geographical, social and cultural factors are all of relevance when it comes to the (early) reconciliation of work and family life <TextLink reference="5"></TextLink>, <TextLink reference="104"></TextLink>. </Pgraph><Pgraph>Taking the aforementioned aspects into consideration, in terms of the health of women with young children, it is shown that mothers&#8217; subjective health perception and behaviour is exposed to multidimensional influences which, taking into account individual life situations, have not yet been systematically researched for Germany. These factors are highly relevant for family policy and health economics, particularly against the backdrop of Germany&#8217;s rising birth rate <TextLink reference="39"></TextLink>, <TextLink reference="92"></TextLink>, <TextLink reference="110"></TextLink> and women&#8217;s increasing labour force participation <TextLink reference="109"></TextLink>. The overall aim of this study is thus to provide a systematic repre<TextGroup><PlainText>sen</PlainText></TextGroup>tation of the physical, mental and general health of mothers, while balancing work and family life, taking the aforementioned factors of influence into account.</Pgraph></TextBlock> <TextBlock language="de" linked="yes" name="Methodik"> <MainHeadline>Methodik</MainHeadline><Pgraph>Ein wichtiger Unterschied zu klassischen systematischen Reviews besteht darin, dass Scoping-Reviews einen &#220;berblick &#252;ber die vorhandene Evidenz geben, unabh&#228;ngig von der Qualit&#228;t der einzelnen eingeschlossenen Studie <TextLink reference="119"></TextLink>. Die Erstellung eines Scoping-Reviews ist sinnvoll, wenn die Literatur noch nicht umfassend bewertet wurde oder wenn diese eine komplexe bzw. heterogene Problematik aufweist, so dass ein pr&#228;ziserer systematischer Review der Evidenz nicht angezeigt ist <TextLink reference="119"></TextLink>. Da es sowohl national als auch international keine systematische Aufbereitung des Themas &#8222;Frauengesundheit im Kontext der Vereinbarkeit von Beruf und Familie&#8220; unter Ber&#252;cksichtigung der Komplexit&#228;t der Einflussfaktoren gibt, ist die Durchf&#252;hrung eines Scoping-Reviews ein geeignetes Mittel zur Beantwortung der Fragestellung.</Pgraph><SubHeadline>Systematische Literaturrecherche </SubHeadline><Pgraph>F&#252;r das vorliegende Scoping-Review wurde von September 2016 bis Dezember 2018 in den Datenbanken Medline via Pubmed, PsycINFO, PsycARTICLES und GESIS (Sowiport) eine systematische Literaturrecherche <TextLink reference="119"></TextLink> begrenzt auf den Zeitraum 2007 bis 2018 zu der Fragestellung durchgef&#252;hrt, welche beruflichen und familialen Faktoren die physische und psychische Gesundheit von Frauen im Kontext der Vereinbarkeit von Beruf und Familie beeinflussen. Der Zeitraum wurde begrenzt, da sich die Lebenssituation von M&#252;ttern in den letzten rund 15 Jahren aufgrund der Zunahme der Erwerbsbeteiligung von Frauen international in Abh&#228;ngigkeit von den politischen und gesellschaftlichen Rahmenbedingungen (z.B. Einf&#252;hrung von Elterngeld&#47;Elternzeit) zu unterschiedlichen Zeitpunkten ver&#228;ndert hat. </Pgraph><Pgraph>Die Recherche erfolgte in den Datenbanken Medline via Pubmed, PsycINFO, PsycARTICLES und GESIS (Sowiport) mit folgenden Begriffen unter Einbezug von MeSH-Terms (Medical Subject Headings) sowohl einzeln als auch in Kombination wie auch mit Hilfe von Varianten: </Pgraph><Pgraph>((((((((((&#34;women&#39;s health&#34;&#91;MeSH Terms&#93; OR (&#34;women&#39;s&#34;&#91;All Fields&#93; AND &#34;health&#34;&#91;All Fields&#93;) OR (&#34;woman&#39;s&#34;&#91;All Fields&#93; AND &#34;health&#34;&#91;All Fields&#93;) OR &#34;woman&#39;s health&#34;&#91;All Fields&#93;) OR (mother&#39;s&#91;All Fields&#93; AND (&#34;health&#34;&#91;MeSH Terms&#93; OR &#34;health&#34;&#91;All Fields&#93;))) OR (&#34;maternal health&#34;&#91;MeSH Terms&#93; OR (&#34;maternal&#34;&#91;All Fields&#93; AND &#34;health&#34;&#91;All Fields&#93;))) OR (&#34;women&#39;s health&#34;&#91;MeSH Terms&#93;)) OR (mother&#39;s&#91;All Fields&#93; AND wellbeing&#91;All Fields&#93;)) OR (woman&#39;s&#91;All Fields&#93; AND wellbeing&#91;All Fields&#93;)) OR (women&#39;s&#91;All Fields&#93; AND wellbeing&#91;All Fields&#93;)) OR ((&#34;mothers&#34;&#91;MeSH Terms&#93; OR &#34;mothers&#34;&#91;All Fields&#93; OR &#34;maternal&#34;&#91;All Fields&#93;) AND wellbeing&#91;All Fields&#93;)) AND (((((demand&#91;All Fields&#93; OR demand&#39;&#91;All Fields&#93;) OR (resource&#91;All Fields&#93; OR resource&#39;&#91;All Fields&#93;)) OR (&#34;Stress&#34;&#91;Journal&#93; OR &#34;stress&#34;&#91;All Fields&#93;)) OR (&#34;conflict (psychology)&#34;&#91;MeSH Terms&#93; OR (&#34;conflict&#34;&#91;All Fields&#93; AND &#34;(psychology)&#34;&#91;All Fields&#93;) OR &#34;conflict&#34;&#91;All Fields&#93;)) OR (&#34;balance&#34;&#91;All Fields&#93;)) AND (&#34;work&#34;&#91;MeSH Terms&#93; OR &#34;work&#34;&#91;All Fields&#93;)) AND (&#34;family&#34;&#91;MeSH Terms&#93; OR &#34;family&#34;&#91;All Fields&#93;)). </Pgraph><Pgraph>F&#252;r die deutschsprachige Recherche wurden die Suchbegriffe entsprechend &#252;bersetzt. Zus&#228;tzliche Studien wurden mit Hilfe einer manuellen Recherche in der als relevant bewerteten Literatur identifiziert. Zusammenfassend werden die Suchhistorie in Abbildung 1 <ImgLink imgNo="1" imgType="figure"/> und die Suchstrategie in Tabelle 1 <ImgLink imgNo="1" imgType="table"/> dargestellt. </Pgraph><SubHeadline>Ein- und Ausschlusskriterien </SubHeadline><Pgraph>Die Festlegung der Ein- und Ausschlusskriterien sowie der Zielkriterien erfolgte prim&#228;r durch die Erstautorin in fortlaufendem Austausch mit den Co-Autorinnen. Abgeleitet aus der Fragestellung wurden die drei folgenden Zielkriterien definiert, deren Erf&#252;llung ein Einschlusskriterium f&#252;r die Aufnahme einer Ver&#246;ffentlichung in die weitere Analyse bildet: </Pgraph><Pgraph><OrderedList><OrderedList><ListItem level="2" levelPosition="1" numString="1.">Gesundheit (physisch&#47;psychisch&#47;allgemein), Wohlbefinden, Stress, depressive Symptome </ListItem><ListItem level="2" levelPosition="2" numString="2.">M&#252;tter </ListItem><ListItem level="2" levelPosition="3" numString="3.">Berufst&#228;tigkeit bzw. Vereinbarkeit von Beruf und Familie</ListItem></OrderedList></OrderedList></Pgraph><Pgraph>Als Einschlusskriterium in Bezug auf die Stichprobe wurde formuliert, dass es sich um berufst&#228;tige und nicht-berufst&#228;tige M&#252;tter mit einem oder mehreren im Haushalt lebenden Kindern insbesondere im Alter von 12-36 Monaten in Anlehnung an den Wiedereinstieg in den Beruf in Deutschland handeln soll. Aufgrund der vielschichtigen kulturellen, gesellschaftlichen, politischen und medizinischen Einfl&#252;sse sowohl auf die Frauengesundheit als auch auf Faktoren der Vereinbarkeit von Beruf und Familie wurden nur Studien aus westlichen Industriel&#228;ndern und vergleichbaren L&#228;ndern bzw. Regionen inkludiert. Es wurden qualitative, quantitative und mixed-method Studien ebenso wie systematische &#220;bersichtsarbeiten einbezogen, die in deutscher oder englischer Sprache verfasst und im Hochschulnetz bzw. per Fernleihe verf&#252;gbar waren, bei denen ein Abstract zur Verf&#252;gung stand und die ein Reviewverfahren durchlaufen haben. Ausgeschlossen wurden Kongressbeitr&#228;ge, Kommentare zu Artikeln, Buchkapitel, Rezensionen zu B&#252;chern und politische Dokumente ebenso wie Studien mit einem besonderen thematischen Fokus (z.B. M&#252;tter mit akuten oder chronischen Erkrankungen) und Untersuchungen aus Entwicklungsl&#228;ndern bzw. vergleichbaren L&#228;ndern oder Regionen sowie Studien, bei denen die drei Zielkriterien nicht erf&#252;llt sind. </Pgraph><Pgraph>Zun&#228;chst wurden 1.479 Titel und Abstracts im Hinblick auf die Relevanz der Fragestellung unter Ber&#252;cksichtigung der genannten Kriterien untersucht. Nach Entfernung von 32 Duplikaten wurden weitere 1.119 Abstracts ausgeschlossen, da maximal ein Zielkriterium erf&#252;llt war. </Pgraph><SubHeadline>Assessment der Qualit&#228;t der eingeschlossenen Studien </SubHeadline><Pgraph>In einem Scoping-Review erfolgt in der Regel keine formale Bewertung der methodischen Qualit&#228;t der eingeschlossenen Studien, da dies dem Ziel widerspricht, einen &#220;berblick &#252;ber die vorhandene Evidenz zu geben <TextLink reference="119"></TextLink>. Es liegt in der Methodik des Scoping-Reviews begr&#252;ndet, dass die Entscheidung f&#252;r bzw. gegen eine Studie auf inhaltlichen Kriterien beruht, da der Einbezug von Qualit&#228;tskriterien f&#252;r ein Scoping-Review nicht vorgesehen ist <TextLink reference="119"></TextLink>. Dennoch wurde eine Bewertung der Qualit&#228;t der Studien mit Hilfe des Critical Appraisal Skills Programme (CASP) <TextLink reference="33"></TextLink> und den zugeh&#246;rigen studiendesignabh&#228;ngigen Checklisten vorgenommen. Die Kriterien beziehen sich zusammengefasst auf die Validit&#228;t der Studie, die Ergebnisse und deren Objektivit&#228;t und Reliabilit&#228;t bzw. Glaubw&#252;rdigkeit sowie die Schlussfolgerungen und deren Wertigkeit. Die Ergebnisse liegen bei der Erstautorin. Aus den oben genannten Gr&#252;nden wurde auf Grundlage dieser Bewertung aber keine Studie ausgeschlossen, jedoch erfolgte bei gr&#246;&#223;eren Einschr&#228;nkungen oder reduzierter G&#252;te in der Qualit&#228;t ein entsprechender Hinweis im Text.</Pgraph><SubHeadline>Methoden zur Analyse&#47;Synthese der Studienergebnisse </SubHeadline><Pgraph>Insgesamt 328 Volltexte durchliefen die n&#228;chste Screeningstufe, bei der inhaltsanalytisch unter Ber&#252;cksichtigung der drei Zielkriterien, der Endpunkte sowie der Einflussfaktoren die Studien unabh&#228;ngig durch die Erst- und Zweitautorin ausgew&#228;hlt wurden. Anschlie&#223;end erfolgte eine thematische Clusterung zur Beschreibung der Ergebnisse. Im Zuge der thematischen Clusterung der Ergebnisse stellte sich das Anforderungs-Ressourcen-Modell mit der Kernaussage, dass der Gesundheitszustand eines Individuums davon abh&#228;ngt, wie die internen und externen Anforderungen mit den vorhandenen internen und externen Ressourcen bew&#228;ltigt werden, als ein relevanter theoretischer Bezugsrahmen f&#252;r diese Arbeit heraus <TextLink reference="11"></TextLink>. Aus der Metaperspektive wurde f&#252;r die Darstellung der Ergebnisse entschieden &#8211; unter Ber&#252;cksichtigung der gesundheitlichen Endpunkte sowie der Clusterung der Einflussfaktoren (Anforderungen versus Ressourcen, intern versus extern, familial versus beruflich versus pers&#246;nlich, Bereicherung versus Belastung) &#8211; eine Gliederung anhand von pers&#246;nlichen, familialen und beruflichen Einflussfaktoren vorzunehmen. </Pgraph></TextBlock> <TextBlock language="en" linked="yes" name="Methods"> <MainHeadline>Methods</MainHeadline><Pgraph>An important difference between a scoping review and a conventional systematic review is that the former provides an overview of the existing evidence, irrespective of the quality of the individual studies included <TextLink reference="119"></TextLink>. A scoping review can be useful if the literature has not yet been comprehensively evaluated or if it comprises a complex or heterogenous problem so that a more precise, syste<TextGroup><PlainText>ma</PlainText></TextGroup>tic review of the evidence is not required <TextLink reference="119"></TextLink>. Given that there has been no systematic treatment of the issue of &#8220;women&#8217;s health in the context of reconciling work and family life&#8221; at national or international level, in light of the complexity of the relevant factors of influence, a scoping review is a suitable method to answer the research question. </Pgraph><SubHeadline>Systematic literature review </SubHeadline><Pgraph>For this scoping review, a systematic literature review <TextLink reference="119"></TextLink> was conducted from September 2016 to Decembe<TextGroup><PlainText>r 2018</PlainText></TextGroup> in the Medline via Pubmed, PsycINFO, <TextGroup><PlainText>Psyc</PlainText></TextGroup>AR<TextGroup><PlainText>TI</PlainText></TextGroup>CLES and GESIS (Sowiport) databases. The review was limited to the period from 2007 to 2018 and focused on the research question of what work-related and family-related factors influenced the physical and mental health of women in the context of reconciling work and family life. We limited the timescale because the life situation of mothers has changed at different points over the last 15 years or so due to the increase in women&#8217;s labour market participation worldwide, depending on the political and social conditions (e.g. introduction of parental allo<TextGroup><PlainText>wance</PlainText></TextGroup>&#47;parental leave). </Pgraph><Pgraph>The literature review was conducted in the Medline via Pubmed, PsycINFO, <TextGroup><PlainText>Psyc</PlainText></TextGroup>ARTICLES and GESIS (Sowiport) databases based on the following terms including MeSH terms (Medical Subject Headings), both separately and in combination, also using variants: </Pgraph><Pgraph>((((((((((&#34;women&#39;s health&#34;&#91;MeSH Terms&#93; OR (&#34;women&#39;s&#34;&#91;All Fields&#93; AND &#34;health&#34;&#91;All Fields&#93;) OR (&#34;woman&#39;s&#34;&#91;All Fields&#93; AND &#34;health&#34;&#91;All Fields&#93;) OR &#34;woman&#39;s health&#34;&#91;All Fields&#93;) OR (mother&#39;s&#91;All Fields&#93; AND (&#34;health&#34;&#91;MeSH Terms&#93; OR &#34;health&#34;&#91;All Fields&#93;))) OR (&#34;maternal health&#34;&#91;MeSH Terms&#93; OR (&#34;maternal&#34;&#91;All Fields&#93; AND &#34;health&#34;&#91;All Fields&#93;))) OR (&#34;women&#39;s health&#34;&#91;MeSH Terms&#93;)) OR (mother&#39;s&#91;All Fields&#93; AND wellbeing&#91;All Fields&#93;)) OR (woman&#39;s&#91;All Fields&#93; AND wellbeing&#91;All Fields&#93;)) OR (women&#39;s&#91;All Fields&#93; AND wellbeing&#91;All Fields&#93;)) OR ((&#34;mothers&#34;&#91;MeSH Terms&#93; OR &#34;mothers&#34;&#91;All Fields&#93; OR &#34;maternal&#34;&#91;All Fields&#93;) AND wellbeing&#91;All Fields&#93;)) AND (((((demand&#91;All Fields&#93; OR demand&#39;&#91;All Fields&#93;) OR (resource&#91;All Fields&#93; OR resource&#39;&#91;All Fields&#93;)) OR (&#34;Stress&#34;&#91;Journal&#93; OR &#34;stress&#34;&#91;All Fields&#93;)) OR (&#34;conflict (psychology)&#34;&#91;MeSH Terms&#93; OR (&#34;conflict&#34;&#91;All Fields&#93; AND &#34;(psychology)&#34;&#91;All Fields&#93;) OR &#34;conflict&#34;&#91;All Fields&#93;)) OR (&#34;balance&#34;&#91;All Fields&#93;)) AND (&#34;work&#34;&#91;MeSH Terms&#93; OR &#34;work&#34;&#91;All Fields&#93;)) AND (&#34;family&#34;&#91;MeSH Terms&#93; OR &#34;family&#34;&#91;All Fields&#93;)). </Pgraph><Pgraph>For the German-language literature review, the above search terms were translated into German. Further studies were identified by means of a manual search of the literature determined as relevant. The search history is shown in Figure 1 <ImgLink imgNo="1" imgType="figure"/> and the search strategy is summa<TextGroup><PlainText>rised</PlainText></TextGroup> in Table 1 <ImgLink imgNo="1" imgType="table"/>. </Pgraph><SubHeadline>Inclusion and exclusion criteria</SubHeadline><Pgraph>The inclusion and exclusion criteria as well as the target criteria were primarily determined by the main author in continuous communication with her co-authors. The following three target criteria were derived from the research question. Their fulfilment is one of the criteria for a publication to be included in the further analysis: </Pgraph><Pgraph><OrderedList><OrderedList><ListItem level="2" levelPosition="1" numString="1.">Health (physical&#47;mental&#47;general), well-being, stress, depressive symptoms</ListItem><ListItem level="2" levelPosition="2" numString="2.">Mothers </ListItem><ListItem level="2" levelPosition="3" numString="3.">Employment or reconciliation of work and family life</ListItem></OrderedList></OrderedList></Pgraph><Pgraph>The inclusion criteria with regards to the sample was formulated as follows: the studies included must involve working and non-working mothers with one or more children living in the household, in particular children aged 12&#8211;36 months, in the context of the return to work in Germany. Due to the multidimensional cultural, social, political and medical influences, both on women&#8217;s health and on the factors related to the reconciliation of work and family life, only studies from Western industrial and similar countries or regions were included. Qualitative, quantitative and mixed methods studies as well as systematic reviews were incorporated, which were written either in German or English, accessible on the university network or through inter-library loan, had an abstract and had been subject to a review process. Conference contributions, commentaries on articles, book chapters, book reviews and political documents were all excluded, as were studies with a particular thematic focus (e.g. mo<TextGroup><PlainText>thers</PlainText></TextGroup> with acute or chronic diseases) and studies from developing or similar countries or regions as well as those that did not fulfil the target criteria. </Pgraph><Pgraph>Initially, 1,479 titles and abstracts were examined for their relevance to the research question based on the aforementioned criteria. After removing 32 duplicates, another 1,119 abstracts were excluded for only fulfilling a maximum of one of the target criteria. </Pgraph><SubHeadline>Quality assessment of the studies included </SubHeadline><Pgraph>As a rule, a scoping review does not involve a formal assessment of the methodological quality of the studies included, as this contradicts the aim of providing an overview of the existing evidence <TextLink reference="119"></TextLink>. In accordance with the scoping review methodology, the decision for or against a particular study is based on content-related criteria, since with this methodology, no quality-related criteria are used. Scoping reviews generally do not involve the application of quality criteria <TextLink reference="119"></TextLink>. Nevertheless, the quality of the studies was evaluated using the Critical Appraisal Skills Programme (CASP) <TextLink reference="33"></TextLink> and the associated checklists by study design. In summary, the criteria relate to the validity of the study, the results and their objectivity and reliability or credibility, as well as the conclusions and their valency. The findings of this assessment are in the possession of the main author. For the reasons described above, however, no study was excluded from the review on the basis of this assessment. That said, in the case of major limitations or reduced quality, this was noted in the text.</Pgraph><SubHeadline>Methods for the analysis&#47;synthesis of the study findings </SubHeadline><Pgraph>A total of 328 full texts underwent the next screening stage, during which, based on content analysis and taking into account the three target criteria, the endpoints and the factors of influence, the studies were selected by the main and second author, independently of each other. This was followed by a thematic clustering to describe the findings. During the course of this thematic clustering, it became evident that the demand-resource model &#8211; with the key message that the health status of an individual depends on how the internal and external demands are managed using the available internal and external resources &#8211; was a relevant theoretical framework for this study <TextLink reference="11"></TextLink>. From the meta perspective, we decided &#8211; taking into account health endpoints as well as the clustering of factors of influence (demands versus resources, internal versus external, family versus professional versus personal, fulfilment versus strain) &#8211; to subdivide the results into personal, family-related and work-related factors. </Pgraph></TextBlock> <TextBlock language="de" linked="yes" name="Ergebnisse der Synthese"> <MainHeadline>Ergebnisse der Synthese</MainHeadline><Pgraph>Die Ergebnisse aus der Datenbankrecherche werden entsprechend des Flie&#223;diagramms des PRISMA Statements <TextLink reference="77"></TextLink> dargestellt (siehe Abbildung 1 <ImgLink imgNo="1" imgType="figure"/>). Keine Studie ber&#252;cksichtigt passgenau das Einschlusskriterium M&#252;tter von Kindern im Alter zwischen 12 und 36 Monaten. Aufgrund der international unterschiedlichen Bedingungen in Bezug auf den beruflichen Wiedereinstieg wurde entschieden, alle 86 Studien aufzunehmen, die einerseits berufst&#228;tige M&#252;tter mit Kindern unter sechs Jahren einbeziehen und andererseits die Gruppe der M&#252;tter aus der Gesamtstichprobe heraus separat ausweisen. </Pgraph><Pgraph>In den 86 eingeschlossenen Studien werden unterschiedliche gesundheitliche Zielgr&#246;&#223;en definiert (siehe <TextGroup><PlainText>Tabelle 2 </PlainText></TextGroup><ImgLink imgNo="2" imgType="table"/>). Werden in den Studien allgemeine Gesundheitsbegriffe verwendet &#8211; ohne explizite Unterscheidungen z.B. zwischen physischer und psychischer Gesundheit &#8211; beziehen sich die Ergebnisse auf die &#8222;Gesundheit im Allgemeinen&#8220; und nachfolgend ist von &#8222;Gesundheit&#8220; ohne weitere Spezifizierung die Rede. Die beruflichen und familialen Bedingungen beeinflussen die Gesundheit von M&#252;ttern zum einen direkt und zum anderen indirekt &#252;ber die individuelle Bewertung der Vereinbarkeit von Beruf und Familie und den damit verbundenen Rollenanforderungen bzw. dem subjektiven Stress. In diesem Kontext werden Bereicherungs- und Belastungshypothesen untersucht und diskutiert, wobei der wissenschaftliche Fokus &#252;berwiegend auf den Belastungsfaktoren liegt <TextLink reference="17"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="43"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="78"></TextLink>, <TextLink reference="106"></TextLink> (siehe Abbildung 2 <ImgLink imgNo="2" imgType="figure"/>). </Pgraph><SubHeadline>Pers&#246;nliche Einflussfaktoren </SubHeadline><Pgraph>Gesunde Frauen werden oft zu gesunden M&#252;ttern <TextLink reference="74"></TextLink>. Das Meistern dieser &#220;bergangsphase agiert als ein Moderator zwischen der Rollenerfahrung und der psychischen Gesundheit <TextLink reference="112"></TextLink>. H&#228;ufig gibt es konstante An- bzw. Abwesenheit von depressiven Symptomen bei M&#252;ttern von Beginn der Schwangerschaft bis zum Ende des ersten Jahres nach der Geburt des Kindes <TextLink reference="91"></TextLink> und auch dar&#252;ber hinaus <TextLink reference="50"></TextLink>. Jede f&#252;nfte Mutter hat relevante depressive Symptome <TextLink reference="100"></TextLink>. Jedoch zeigt sich kein signifikanter Einfluss der Zahl der Kinder und des Alters der Mutter bei der ersten Geburt auf m&#252;tterliche Depressionen <TextLink reference="100"></TextLink>. In einer Studie aus den USA haben junge M&#252;tter (&#60; 20 Jahre zum Zeitpunkt der ersten Geburt) signifikant h&#246;here Depressionswerte als &#228;ltere M&#252;tter <TextLink reference="43"></TextLink>. Dies wird begr&#252;ndet mit h&#246;herer finanzieller Belastung und einem niedrigeren pers&#246;nlichen Kontrollgef&#252;hl <TextLink reference="43"></TextLink>. &#196;ltere M&#252;tter sind in einer schwedischen Studie ges&#252;nder <TextLink reference="44"></TextLink>. Eine brasilianische Studie, die allerdings nur Frauen &#252;ber 34 Jahre einschlie&#223;t, deutet dahingegen an, dass die &#228;lteren M&#252;tter weniger gesund sind <TextLink reference="53"></TextLink>. Gleichzeitig gibt es Hinweise, dass das Stressempfinden der M&#252;tter mit zunehmendem Alter sinkt <TextLink reference="100"></TextLink>. </Pgraph><Pgraph>Eine gesundheitlich gef&#228;hrdete Gruppe unter den M&#252;ttern scheinen Angeh&#246;rige von Minderheiten zu sein, insbesondere wenn sie sich in prek&#228;ren Lebensverh&#228;ltnissen befinden <TextLink reference="96"></TextLink>: Sie haben teilweise besondere Rollenkonflikte zu l&#246;sen <TextLink reference="29"></TextLink> und gesundheitliche Beeintr&#228;chtigungen zu bew&#228;ltigen <TextLink reference="96"></TextLink>, die zu den Anforderungen hinzukommen, die alle M&#252;tter betreffen. </Pgraph><Pgraph>Eine fehlende oder unzureichende Bew&#228;ltigung dieser &#220;bergangsphase, in der das eigene Selbstverst&#228;ndnis und die Sensibilit&#228;t in Bezug auf das Erf&#252;llen von Erwartungen Anderer die Gesundheit der M&#252;tter beeinflussen, kann einen negativen Einfluss auf die Gesundheit, die Ressourcen und die Arbeitsmotivation haben, w&#228;hrend eine gelingende Bew&#228;ltigung die Pers&#246;nlichkeit der M&#252;tter st&#228;rkt <TextLink reference="4"></TextLink>. Eine positive Haltung zur Elternschaft f&#252;hrt zu h&#246;herem Arbeitsengagement und einem verbesserten Wohlbefinden <TextLink reference="40"></TextLink>. Au&#223;erdem wirken sich ein ausgepr&#228;gtes Kontrollgef&#252;hl <TextLink reference="120"></TextLink>, etablierte Coping-Strategien, Resilienz <TextLink reference="4"></TextLink>, <TextLink reference="94"></TextLink> und ein gr&#246;&#223;eres Selbstbewusstsein verbunden mit einer h&#246;heren Sensibilit&#228;t in Bezug auf die eigenen Bed&#252;rfnisse, das Umfeld <TextLink reference="4"></TextLink> sowie die Alltagsorganisation <TextLink reference="94"></TextLink>, positiv auf die Gesundheit von M&#252;ttern aus. </Pgraph><SubHeadline>Familiale Einflussfaktoren </SubHeadline><SubHeadline2>Familiale Kontrolle und Zufriedenheit </SubHeadline2><Pgraph>Kontrolle &#8211; als subjektiv wahrgenommenes Kontrollgef&#252;hl &#8211; spielt auch im Zusammenhang mit den familialen Einflussfaktoren auf die Gesundheit von M&#252;ttern eine wichtige, wenn auch kontrovers diskutierte Rolle: Kontrolle &#252;ber die h&#228;uslichen Aktivit&#228;ten <TextLink reference="74"></TextLink>, <TextLink reference="99"></TextLink>, mit der M&#246;glichkeit eigene Entscheidungen zu treffen, geht ebenso wie soziale, emotionale und praktische Unterst&#252;tzung zu Hause <TextLink reference="29"></TextLink> mit weniger Stress <TextLink reference="99"></TextLink> und einer besseren Gesundheit einher <TextLink reference="74"></TextLink>. Im Gegensatz dazu sind in einer anderen Studie Frauen h&#228;ufiger &#252;berlastet, die in hohem Ma&#223;e Kontrolle &#252;ber die h&#228;uslichen Aktivit&#228;ten haben, weil in diesem Fall Kontrolle &#8211; gleichgesetzt mit ungewollter alleiniger Verantwortung &#8211; zur &#220;berforderung f&#252;hren kann <TextLink reference="15"></TextLink>. </Pgraph><Pgraph>Ob die positiven Einfl&#252;sse auf die Berufst&#228;tigkeit durch Zufriedenheit mit der famili&#228;ren Situation auch Auswirkungen auf die Gesundheit haben, ist nicht eindeutig <TextLink reference="52"></TextLink>, <TextLink reference="112"></TextLink>. Die Depressionswerte von M&#252;ttern hingegen sinken mit guter sozialer Unterst&#252;tzung <TextLink reference="35"></TextLink>. M&#252;tter in einer Partnerschaft haben unabh&#228;ngig vom beruflichen Status das geringste Risiko zu erkranken <TextLink reference="118"></TextLink>. Zudem steht die Zufriedenheit mit der Partnerschaft in signifikantem Zusammenhang zum m&#252;tterlichen Wohlbefinden <TextLink reference="6"></TextLink>. </Pgraph><SubHeadline2>Zahl und Alter der Kinder </SubHeadline2><Pgraph>Grunds&#228;tzlich dauert die Anpassungsphase nach der Geburt des ersten Kindes l&#228;nger als bei allen nachfolgenden Kindern <TextLink reference="10"></TextLink>. Die R&#252;ckkehr in den Beruf innerhalb des ersten Jahres nach der Geburt ist f&#252;r M&#252;tter mit ein oder zwei Kindern wahrscheinlicher <TextLink reference="120"></TextLink> bzw. wird mit drei und mehr Kindern seltener <TextLink reference="28"></TextLink>. Das Risiko f&#252;r eine Work-Life-Imbalance w&#228;chst mit zunehmender Kinderzahl, bleibt jedoch ab dem zweiten Kind relativ konstant und geht einher mit einem Risiko f&#252;r die Gesundheit <TextLink reference="54"></TextLink>. </Pgraph><Pgraph>In einer US-amerikanischen Untersuchung erleben 53&#37; der arbeitenden M&#252;tter einen Family-Work-Konflikt, der z.B. durch Rollenpr&#228;ferenzen und die Zahl der Kinder beeinflusst wird <TextLink reference="51"></TextLink>. Mit zunehmender Zahl der Kinder steigt das Ma&#223; der Rollen&#252;berlastung signifikant &#8211; im Sinne einer &#220;berforderung, die aus der Parallelit&#228;t zu vieler einzunehmender Rollen erw&#228;chst &#8211; bei gleichzeitig r&#252;ckl&#228;ufiger Zufriedenheit mit der arbeitsfreien Zeit und Abnahme der psychischen Gesundheit <TextLink reference="44"></TextLink>, <TextLink reference="89"></TextLink>. In einer Studie treten Stresssymptome bei M&#252;ttern mit zwei Kindern wahrscheinlicher auf als bei M&#252;ttern mit nur einem Kind <TextLink reference="32"></TextLink>. F&#252;r M&#252;tter mit drei und mehr Kindern best&#228;tigt sich diese Tendenz nicht <TextLink reference="32"></TextLink>. Untersuchungen, die das Alter des j&#252;ngsten Kindes in Relation zur Gesundheit der M&#252;tter in den Fokus nehmen, weisen heterogene Ergebnisse auf <TextLink reference="6"></TextLink>, <TextLink reference="45"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="118"></TextLink>.</Pgraph><SubHeadline2>Anforderungen durch Hausarbeit und Familie </SubHeadline2><Pgraph>Frauen, deren famili&#228;re Belastungen die Berufst&#228;tigkeit beeinflussen, haben eine schlechtere psychische <TextLink reference="112"></TextLink> bzw. allgemeine Gesundheit <TextLink reference="53"></TextLink>. Weiter wird deutlich, dass ein h&#246;herer zeitlicher Aufwand f&#252;r die Aktivit&#228;ten des t&#228;glichen Lebens, z.B. Haushaltst&#228;tigkeiten, zu mehr depressiven Symptomen bei M&#252;ttern f&#252;hrt <TextLink reference="35"></TextLink> bzw. sich ein Zusammenhang zu einer schlechteren Gesundheit zeigt <TextLink reference="53"></TextLink>. In anderen Studien ist hingegen nicht die Menge der Hausarbeit entscheidend f&#252;r die empfundene Belastung <TextLink reference="106"></TextLink> bzw. das Wohlbefinden, sondern die gerechte Verteilung innerhalb der Partnerschaft <TextLink reference="6"></TextLink>, <TextLink reference="106"></TextLink>. Eine h&#246;here Belastung durch Hausarbeit steht in Verbindung mit einer schlechteren mentalen und selbsteingesch&#228;tzten Gesundheit <TextLink reference="41"></TextLink>, <TextLink reference="106"></TextLink>, insbesondere bei geringerer Vitalit&#228;t <TextLink reference="106"></TextLink>. Frauen &#252;bernehmen mehr Hausarbeit <TextLink reference="41"></TextLink>, <TextLink reference="53"></TextLink>, auch wenn sie in Vollzeit arbeiten <TextLink reference="41"></TextLink>. Zu einem Ungleichgewicht zwischen Anstrengungen und Belohnungen in Bezug auf Haus- und Familienarbeit <TextLink reference="103"></TextLink> kommt es insbesondere bei vollzeitarbeitenden M&#252;ttern <TextLink reference="103"></TextLink> und bei M&#252;ttern in anspruchsvollen beruflichen Positionen <TextLink reference="53"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="101"></TextLink>, die zus&#228;tzlich die Hauptlast von Haushalt und Familienarbeit tragen <TextLink reference="103"></TextLink>. M&#252;tter, die dieses Ungleichgewicht erleben, haben eine schlechtere psychische und subjektive Gesundheit insgesamt <TextLink reference="103"></TextLink>. Au&#223;erdem empfinden sie ein h&#246;heres Ma&#223; an Stress, M&#252;digkeit, physischen, psychosomatischen und allgemeinen gesundheitlichen Beschwerden sowie mehr arbeitsbezogene Belastungen auf die Familie, unzureichende Regenerationszeiten und eine geringere Zufriedenheit mit der Partnerschaft und dem eigenen Leben <TextLink reference="41"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="102"></TextLink>, <TextLink reference="106"></TextLink>. </Pgraph><SubHeadline2>Alleinerziehende</SubHeadline2><Pgraph>Die Ergebnisse zur physischen und psychischen Gesundheit sowie zu Gesundheitsrisiken (z.B. Stress) und Depressionen von M&#252;ttern in Abh&#228;ngigkeit vom Partnerschaftsstatus sind heterogen: Teilweise gibt es keinen Unterschied zwischen der Gesundheit von M&#252;ttern mit und ohne Partnerschaft <TextLink reference="55"></TextLink>, <TextLink reference="106"></TextLink>, <TextLink reference="114"></TextLink> und teilweise ist die Gesundheit Alleinerziehender im Vergleich schlechter <TextLink reference="44"></TextLink>, <TextLink reference="47"></TextLink>, <TextLink reference="78"></TextLink>, <TextLink reference="90"></TextLink> bzw. das Stresslevel <TextLink reference="64"></TextLink>, <TextLink reference="100"></TextLink> und das Gesundheitsrisiko h&#246;her <TextLink reference="34"></TextLink>, <TextLink reference="122"></TextLink>. Wesentlicher Moderator f&#252;r diese Gruppe scheinen deutlich h&#228;ufiger auftretende finanzielle Schwierigkeiten zu sein <TextLink reference="17"></TextLink>, <TextLink reference="34"></TextLink>, <TextLink reference="47"></TextLink>, <TextLink reference="61"></TextLink>, insbesondere bei M&#252;ttern mit kleinen Kindern <TextLink reference="121"></TextLink>. Die Gesundheit von Alleinerziehenden kann im Vergleich zu M&#252;ttern in einer Partnerschaft verst&#228;rkt von einer beruflichen T&#228;tigkeit profitieren <TextLink reference="55"></TextLink>, <TextLink reference="64"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="100"></TextLink>, vor allem bei langfristigen Besch&#228;ftigungen <TextLink reference="73"></TextLink>, <TextLink reference="124"></TextLink>. Im Hinblick auf einen gesundheitsf&#246;rderlichen Umfang der beruflichen T&#228;tigkeit bei alleinerziehenden M&#252;ttern zeigen sich wiederum heterogene Ergebnisse <TextLink reference="78"></TextLink>, <TextLink reference="124"></TextLink>. Zudem haben Alleinerziehende eine h&#246;here Belastung durch Hausarbeit als M&#252;tter in einer Partnerschaft <TextLink reference="78"></TextLink>. Dies kann ein Grund sein, warum sozialer Unterst&#252;tzung bei alleinerziehenden M&#252;ttern ein h&#246;herer Stellenwert zukommt <TextLink reference="17"></TextLink>, <TextLink reference="34"></TextLink>, <TextLink reference="121"></TextLink>. Positive allt&#228;gliche Erfahrungen pr&#228;gen M&#252;tter in Bezug auf die psychische Gesundheit unabh&#228;ngig von ihrem Partnerschaftsstatus <TextLink reference="17"></TextLink>. </Pgraph><SubHeadline2>Fremdbetreuung und Berufst&#228;tigkeit des Lebenspartners bzw. der Lebenspartnerin </SubHeadline2><Pgraph>Die M&#252;ttergesundheit verbessert sich durch die Inanspruchnahme von Kinderbetreuung <TextLink reference="28"></TextLink>. Allerdings kann durch Zweifel an der Betreuungsqualit&#228;t Unsicherheit entstehen <TextLink reference="5"></TextLink>. Dies h&#228;ngt eng zusammen mit Schuldgef&#252;hlen durch die Doppelrolle und dem Gef&#252;hl, keine gute Mutter zu sein <TextLink reference="5"></TextLink>. Auch das Aus&#252;ben einer beruflichen T&#228;tigkeit des Partners oder der Partnerin steht in einem positiven Zusammenhang zur m&#252;tterlichen Gesundheit <TextLink reference="120"></TextLink>, wobei die Arbeitsbedingungen keine Auswirkungen haben <TextLink reference="91"></TextLink>. </Pgraph><SubHeadline2>Zeitverwendung und Rollenidentifikation </SubHeadline2><Pgraph>Die m&#252;tterliche Gesundheit leidet insbesondere, wenn der Arbeitsaufwand f&#252;r Familie und Beruf sehr hoch ist und nicht ausreichend Ressourcen zur Kompensation eingesetzt werden k&#246;nnen <TextLink reference="42"></TextLink>. In einer Schweizer Studie zeigt sich, dass alle Gruppen mit berufst&#228;tigen Frauen weniger Zeit in die Arbeit investieren m&#246;chten <TextLink reference="90"></TextLink>. Eine m&#246;gliche Rollen&#252;berlastung alleine steht nicht zwingend in Zusammenhang mit einer schlechteren physischen und psychischen Gesundheit <TextLink reference="90"></TextLink>, jedoch scheint die mit der Qualit&#228;t <TextLink reference="38"></TextLink> und Zahl der Rollen <TextLink reference="108"></TextLink> verbundene Dynamik relevant zu sein <TextLink reference="108"></TextLink>: Mit zunehmender Zahl der Rollen sinkt die Wahrscheinlichkeit f&#252;r eine schlechte psychische Gesundheit, wohingegen eine Reduzierung der Zahl der Rollen das Risiko f&#252;r eine schlechte psychische Gesundheit, psychiatrische Erkrankungen und krankheitsbedingte Fehltage erh&#246;ht <TextLink reference="108"></TextLink>. Die subjektive Wahrnehmung der Qualit&#228;t der m&#252;tterlichen Rolle und insbesondere die mit der Rolle verbundenen Sorgen stehen in signifikantem Zusammenhang zu psychologischem Stress <TextLink reference="38"></TextLink>. Dieses Ergebnis betont die Bedeutung des Rollenerlebens &#8211; als subjektives Empfinden in Bezug auf die Wahrnehmung einer Rolle &#8211; f&#252;r das Wohlbefinden von Frauen mit Kindern <TextLink reference="38"></TextLink>. </Pgraph><SubHeadline>Berufliche Einflussfaktoren </SubHeadline><Pgraph>In Bezug auf die Einsch&#228;tzung des allgemeinen Gesundheitszustandes und der Lebensqualit&#228;t gibt es in einer longitudinalen Studie keine signifikanten Unterschiede zwischen berufst&#228;tigen und nicht berufst&#228;tigen M&#252;ttern <TextLink reference="93"></TextLink>. Entscheidend ist nicht der berufliche Status, sondern eine positive Einstellung und Identifikation mit der beruflichen Rolle <TextLink reference="26"></TextLink>. M&#252;tter scheinen die beste Gesundheit zu haben, wenn sie sich stark mit ihrer beruflichen T&#228;tigkeit identifizieren <TextLink reference="73"></TextLink> und sie diese als abwechslungsreich und verantwortungsvoll und somit als Bereicherung f&#252;r das eigene Leben ansehen <TextLink reference="17"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="101"></TextLink>. M&#252;tter, die bevorzugen beruflich t&#228;tig zu sein und dies realisieren, sind psychisch ges&#252;nder und zufriedener mit der erhaltenen emotionalen Unterst&#252;tzung <TextLink reference="31"></TextLink>, scheinen jedoch mehr krankheitsbedingte Fehltage zu haben <TextLink reference="107"></TextLink>. Weicht jedoch der berufsbezogene Status der M&#252;tter von ihren W&#252;nschen ab, haben sie ein schlechteres Wohlbefinden <TextLink reference="26"></TextLink>, h&#246;here Depressionswerte <TextLink reference="59"></TextLink>, <TextLink reference="116"></TextLink> und weniger emotionale Unterst&#252;tzung als M&#252;tter, die aus eigenem Wunsch arbeiten oder zu Hause bleiben <TextLink reference="26"></TextLink>, <TextLink reference="31"></TextLink>. Nicht erwerbst&#228;tigen M&#252;ttern mit einem Besch&#228;ftigungswunsch geht es signifikant schlechter als M&#252;ttern, die aus &#246;konomischen Gr&#252;nden arbeiten <TextLink reference="31"></TextLink>. </Pgraph><Pgraph>Bildung ist ein Schutzfaktor vor schlechten Arbeitsbedingungen und schlechter Gesundheit <TextLink reference="53"></TextLink>, <TextLink reference="71"></TextLink>. Junge M&#252;tter haben h&#228;ufiger eine unterbrochene schulische und berufliche Bildung, welche sich kurz- und langfristig negativ auf die psychische Gesundheit auswirkt <TextLink reference="3"></TextLink>, <TextLink reference="72"></TextLink>, jedoch zeigen sich ambivalente Ergebnisse in Bezug auf Depressionswerte bei niedriger Bildung <TextLink reference="71"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="117"></TextLink>. Gelingt eine berufliche T&#228;tigkeit trotz fr&#252;her Mutterschaft, ist die psychische Gesundheit besser <TextLink reference="56"></TextLink>. Liegen trotz hoher Bildung negative Einfl&#252;sse der Arbeit auf die Familie vor, dann leidet die Gesundheit der Frauen erheblich <TextLink reference="53"></TextLink>. </Pgraph><Pgraph>Die grunds&#228;tzlich positive Auswirkung der Berufst&#228;tigkeit gilt f&#252;r die psychische Gesundheit <TextLink reference="55"></TextLink>, <TextLink reference="112"></TextLink>, das psychische Wohlbefinden <TextLink reference="26"></TextLink> und als Schutzfaktor vor Depressionen <TextLink reference="16"></TextLink>, <TextLink reference="93"></TextLink>. Au&#223;erdem verbessert eine berufliche T&#228;tigkeit die Lebensqualit&#228;t und f&#246;rdert die sozialen Beziehungen der M&#252;tter <TextLink reference="93"></TextLink>. In Bezug auf das subjektive Gesundheitsempfinden gilt der positive Einfluss insbesondere, wenn die berufliche T&#228;tigkeit als R&#252;ckzugsm&#246;glichkeit aus dem h&#228;uslichen Umfeld bewertet wird <TextLink reference="98"></TextLink>. Hat die berufliche T&#228;tigkeit einen insgesamt positiven Einfluss auf das Familienleben, entsteht eine puffernde Wirkung f&#252;r die erlebten Konflikte bei der Vereinbarkeit, weniger beruflicher und familialer Stress <TextLink reference="65"></TextLink> und ein positiver Einfluss auf die physische Gesundheit <TextLink reference="10"></TextLink>, <TextLink reference="52"></TextLink>. Das Aus&#252;ben eines Berufes steht au&#223;erdem in Zusammenhang mit weniger elterlichem Stress <TextLink reference="28"></TextLink>. Zwischen einer fehlenden Besch&#228;ftigung und der M&#252;ttergesundheit zeigen lediglich zwei Studien positive Zusammenh&#228;nge: M&#252;tter, die ausschlie&#223;lich Hausfrauen sind, haben in jeweils einer Studie ein insgesamt geringeres Risiko f&#252;r das Auftreten von depressiven Symptomen <TextLink reference="100"></TextLink> bzw. weniger Gesundheitsprobleme <TextLink reference="88"></TextLink>. Ein Schutzfaktor f&#252;r nicht berufst&#228;tige M&#252;tter bildet die Annahme, dass eine berufliche T&#228;tigkeit nachteilig f&#252;r ihre Kinder sei <TextLink reference="26"></TextLink>. In einer Studie gibt es h&#228;ufiger berufliche Konsequenzen f&#252;r die Familie als familiale Auswirkungen auf den Beruf, dabei existiert kein Zusammenhang zur physischen Gesundheit &#91;54&#93;. Insgesamt scheinen sich aus einem erlebten Konflikt zwischen Arbeit und Familie, der dar&#252;ber hinaus h&#228;ufig eigene Bed&#252;rfnisse in den Hintergrund dr&#228;ngt <TextLink reference="96"></TextLink>, negative Auswirkungen auf die physische und psychische Gesundheit <TextLink reference="10"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="96"></TextLink>, <TextLink reference="98"></TextLink> bzw. das Wohlbefinden <TextLink reference="6"></TextLink> zu ergeben. </Pgraph><SubHeadline2>Zeitpunkt des beruflichen Wiedereinstiegs </SubHeadline2><Pgraph>Die gesundheitsbezogenen Ergebnisse &#8211; unter Ber&#252;cksichtigung von depressiven Symptomen <TextLink reference="28"></TextLink>, <TextLink reference="48"></TextLink>, <TextLink reference="75"></TextLink>, <TextLink reference="120"></TextLink> im Hinblick auf den Zeitpunkt der Wiederaufnahme der beruflichen T&#228;tigkeit von M&#252;ttern &#8211; sind ambivalent <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="104"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="120"></TextLink>, insbesondere unter Einbezug des Bildungsstatus <TextLink reference="70"></TextLink>, <TextLink reference="117"></TextLink>. Erfolgt der berufliche Wiedereinstieg innerhalb von elf Wochen nach der Geburt, zeigen sich in einer Studie keine signifikanten gesundheitsbezogenen Unterschiede im Vergleich zu nicht berufst&#228;tigen M&#252;ttern in der Phase des Wiedereinstiegs <TextLink reference="51"></TextLink>. In zwei anderen Studien zeigen sich negative Auswirkungen auf die Gesundheit <TextLink reference="27"></TextLink>, <TextLink reference="104"></TextLink> f&#252;r M&#252;tter mit weniger als zwei Monaten bezahltem Mutterschutz und einer Wiederaufnahme der beruflichen T&#228;tigkeit vor dem dritten Lebensmonat des Kindes <TextLink reference="27"></TextLink> bzw. im vierten Lebensmonat <TextLink reference="104"></TextLink>. Eine weitere Studie kommt hingegen zu dem Ergebnis, dass M&#252;tter, die innerhalb der ersten sechs Monate zur&#252;ck in den Beruf gehen, seltener eine schlechte Gesundheit haben, als nicht beruflich aktive M&#252;tter <TextLink reference="28"></TextLink>. </Pgraph><Pgraph>Eine durch Geldleistungen abgesicherte Phase im Anschluss an die Geburt spielt zur Verbesserung der psychischen M&#252;ttergesundheit <TextLink reference="105"></TextLink> und anhaltenden Reduzierung des Stressrisikos <TextLink reference="123"></TextLink> eine entscheidende Rolle <TextLink reference="105"></TextLink>. Ein fr&#252;hzeitiger beruflicher Wiedereinstieg innerhalb der ersten drei <TextLink reference="69"></TextLink> bzw. sechs Monate <TextLink reference="120"></TextLink> nach der Geburt bleibt nur dann ohne gesundheitliche Risiken f&#252;r M&#252;tter <TextLink reference="120"></TextLink> bzw. bietet psychologische Vorteile <TextLink reference="69"></TextLink>, wenn er ohne finanziellen Zwang und rein aus eigener Motivation erfolgt <TextLink reference="69"></TextLink>, <TextLink reference="120"></TextLink>. Ist finanzieller Druck Ursache f&#252;r den fr&#252;hen Wiedereinstieg, so ist die M&#252;ttergesundheit gef&#228;hrdet <TextLink reference="114"></TextLink>. Elternzeiten &#252;ber die ersten drei bzw. sechs kindlichen Lebensmonate hinaus und Geldleistungen stehen &#252;berwiegend in Verbindung mit einer besseren psychischen Gesundheit <TextLink reference="69"></TextLink>, <TextLink reference="105"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="123"></TextLink>, insbesondere bei M&#252;ttern, die in Vollzeit zur&#252;ckkehren <TextLink reference="69"></TextLink>. Finanziell und vertraglich erm&#246;glichte berufliche Auszeiten innerhalb des ersten kindlichen Lebensjahres zeigen zwei bis drei Jahre nach der Geburt weniger Stress bei M&#252;ttern und wirken sich bis ins hohe Alter positiv auf die mentale Gesundheit aus <TextLink reference="8"></TextLink>. </Pgraph><SubHeadline2>Umfang der beruflichen T&#228;tigkeit </SubHeadline2><Pgraph>Die psychische Gesundheit von Vollzeit arbeitenden M&#252;ttern scheint vergleichbar mit denen der allgemeinen Frauenbev&#246;lkerung zu sein <TextLink reference="45"></TextLink>, <TextLink reference="114"></TextLink>, wobei M&#252;tter eher ihre Berufst&#228;tigkeit reduzieren als Frauen ohne Kinder <TextLink reference="62"></TextLink>. Insbesondere zeitlicher Stress kann zu einem Wunsch nach Arbeitszeitreduzierung f&#252;hren <TextLink reference="45"></TextLink>. Kann der Beruf nicht mehr bew&#228;ltigt werden, wird das Wohlbefinden beeintr&#228;chtigt und es kommt h&#228;ufig zu einem Arbeitsplatzwechsel, teilweise erfolgt der Wiedereinstieg bereits in ein neues Besch&#228;ftigungsverh&#228;ltnis <TextLink reference="5"></TextLink>. </Pgraph><Pgraph>Bei isolierter Betrachtung der Ergebnisse zum Umfang der beruflichen T&#228;tigkeit von M&#252;ttern im Kontext von Gesundheit zeigen sich heterogene Ergebnisse: So verbessert sich einerseits die M&#252;ttergesundheit mit steigenden Arbeitszeiten <TextLink reference="28"></TextLink> bzw. haben Frauen, die weniger als 39 Wochenstunden arbeiten, scheinbar eine schlechtere Gesundheit insgesamt <TextLink reference="53"></TextLink>. Insbesondere Frauen, die weniger als 24 Stunden pro Woche arbeiten und noch weniger arbeiten m&#246;chten, haben die schlechteste mentale Gesundheit <TextLink reference="15"></TextLink>. Andererseits sind in anderen Studien in Teilzeit besch&#228;ftigte M&#252;tter ges&#252;nder <TextLink reference="73"></TextLink>, <TextLink reference="119"></TextLink> und erleben weniger Konflikte in der Vereinbarkeit von Beruf und Familie <TextLink reference="16"></TextLink> bzw. haben eine weniger beeintr&#228;chtigte Gesundheit <TextLink reference="44"></TextLink> als vollzeitbesch&#228;ftigte M&#252;tter. Dies best&#228;tigen weitere Untersuchungen, in denen M&#252;tter mit Kindern unter sechs Jahren eine umso schlechtere Gesundheit <TextLink reference="97"></TextLink>, <TextLink reference="111"></TextLink> bzw. reduzierteres Wohlbefinden aufweisen <TextLink reference="6"></TextLink>, desto mehr Stunden sie arbeiten <TextLink reference="6"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="111"></TextLink>, wobei dieser Zusammenhang durch den erlebten Work-Family Konflikt moderiert wird <TextLink reference="6"></TextLink>. Eine Zunahme von Konflikten in der Vereinbarkeit von Beruf und Familie steht in Zusammenhang mit mehr psychischen Unsicherheiten und Zeitdruck <TextLink reference="58"></TextLink>. F&#252;r das m&#252;tterliche Wohlbefinden <TextLink reference="50"></TextLink> und die psychische Gesundheit <TextLink reference="52"></TextLink> scheinen hohe Belastungen auf der Arbeit <TextLink reference="52"></TextLink>, insbesondere in Kombination mit langen Arbeitszeiten, besonders gef&#228;hrdend zu sein <TextLink reference="50"></TextLink>. </Pgraph><Pgraph>Verh&#228;ltnism&#228;&#223;ig sicher scheint zu sein, dass Frauen, die mit dem Umfang ihrer beruflichen T&#228;tigkeit zufrieden sind, eine bessere mentale Gesundheit <TextLink reference="15"></TextLink> und weniger Stress haben <TextLink reference="55"></TextLink>. Wenn ein h&#246;herer Stundenumfang gewollt und realisiert ist, verbessert sich die Gesundheit h&#228;ufig sogar <TextLink reference="46"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="62"></TextLink>. &#220;bersteigt das berufliche Engagement hingegen 50 Stunden pro Woche, leidet die Gesundheit <TextLink reference="97"></TextLink>. </Pgraph><SubHeadline2>Arbeitsbedingungen </SubHeadline2><Pgraph>F&#252;r M&#252;tter in einer Partnerschaft hat der Work-Family-Konflikt den st&#228;rksten Einfluss auf das Wohlbefinden <TextLink reference="17"></TextLink>. Wenn M&#252;tter ihre Arbeitszeit flexibel gestalten k&#246;nnen, gibt es weniger Familienkonflikte <TextLink reference="25"></TextLink>, die M&#252;ttergesundheit kann profitieren <TextLink reference="10"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="64"></TextLink>, <TextLink reference="91"></TextLink> &#8211; insbesondere beim fr&#252;hen Wiedereinstieg <TextLink reference="28"></TextLink> &#8211; und es treten weniger Depressionen auf <TextLink reference="99"></TextLink>. Qualitativ hochwertige Arbeitsbedingungen &#8211; ausgezeichnet durch ein hohes Ma&#223; an Autonomie in Form von eigener Kontrolle, Verantwortung und Entscheidungsspielr&#228;umen, Sicherheit und sozialer Unterst&#252;tzung sowie weniger arbeitsbezogenem Stress &#8211; verbessern die Vereinbarkeit, gehen mit weniger Depressionen einher <TextLink reference="35"></TextLink>, <TextLink reference="116"></TextLink> und f&#246;rdern sowohl die psychische Gesundheit <TextLink reference="40"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="120"></TextLink> als auch das Wohlbefinden bzw. die Gesundheit insgesamt <TextLink reference="10"></TextLink>, <TextLink reference="15"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="74"></TextLink>, <TextLink reference="111"></TextLink>. Zudem f&#252;hlen sich M&#252;tter emotional gest&#228;rkt <TextLink reference="60"></TextLink>. Entscheidend ist jedoch nicht nur das Vorhandensein von individuell anpassbaren qualitativ hochwertigen Arbeitsbedingungen <TextLink reference="111"></TextLink>, sondern auch deren Verankerung und Akzeptanz im Unternehmen und in der Gesellschaft <TextLink reference="9"></TextLink> anstelle von Einzelma&#223;ahmen <TextLink reference="76"></TextLink>, <TextLink reference="113"></TextLink>. Weitere berufliche Ressourcen sind das Einkommen, der Bildungsstand und die berufliche Position <TextLink reference="120"></TextLink>, wobei alleinige finanzielle Verg&#252;nstigungen nur in geringem Ma&#223;e einen positiven Effekt auf das Wohlbefinden haben <TextLink reference="40"></TextLink>, <TextLink reference="57"></TextLink>. </Pgraph><Pgraph>Verschlechtern sich die Arbeitsbedingungen, z.B. durch eine vom Arbeitgeber geforderte verst&#228;rkte Flexibilit&#228;t <TextLink reference="28"></TextLink>, <TextLink reference="50"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="99"></TextLink>, <TextLink reference="117"></TextLink>, leidet in der Regel die Arbeitsplatzqualit&#228;t mit negativen Konsequenzen, z.B. in Form von psychischem Stress, erschwerter Vereinbarkeit sowie Einschr&#228;nkungen im Wohlbefinden <TextLink reference="32"></TextLink>, 101&#93;, psychischen Belastungen <TextLink reference="10"></TextLink> und Beeintr&#228;chtigungen der Gesundheit z.B. durch Depressionen <TextLink reference="28"></TextLink>, <TextLink reference="50"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="99"></TextLink>, <TextLink reference="117"></TextLink>. Dies gilt nicht zwingend f&#252;r Frauen mit niedriger Bildung oder Angst vor Fehlern, denn in diesem Fall kann Eigenverantwortung auch zum Gesundheitsrisiko werden <TextLink reference="7"></TextLink>. </Pgraph><SubHeadline2>Finanzielle Faktoren </SubHeadline2><Pgraph>Ein geringes Einkommen ist besonders herausfordernd f&#252;r die Vereinbarkeit von Beruf und Familie <TextLink reference="91"></TextLink>. Finanzieller Stress ist der zuverl&#228;ssigste Vorhersagewert in Bezug auf die physische <TextLink reference="114"></TextLink> und psychische Gesundheit <TextLink reference="17"></TextLink>, <TextLink reference="114"></TextLink> und dar&#252;ber hinaus f&#252;r Stress und Depressionen <TextLink reference="71"></TextLink>, <TextLink reference="100"></TextLink>. Dabei ist finanzieller Stress ein st&#228;rkerer Einflussfaktor als niedriges Einkommen im Hinblick auf eine schlechte Gesundheit. Dies gilt insbesondere f&#252;r alleinerziehende M&#252;tter unabh&#228;ngig von ihrem Besch&#228;ftigungsstatus <TextLink reference="2"></TextLink>. Lediglich in einer schwedischen Studie zeigt sich, dass in der Gruppe der M&#252;tter mit hohem Einkommen h&#228;ufiger eine beeintr&#228;chtigte Gesundheit vorliegt <TextLink reference="44"></TextLink>. </Pgraph></TextBlock> <TextBlock language="en" linked="yes" name="Results of the synthesis"> <MainHeadline>Results of the synthesis</MainHeadline><Pgraph>The results of the database review are presented in accordance with the PRISMA Statement flow diagram <TextLink reference="77"></TextLink> (see Figure 1 <ImgLink imgNo="1" imgType="figure"/>). No single study precisely fulfilled the inclusion criterion &#8220;mothers of children aged between 12 and 36 months&#8221;. In light of the international differences in the conditions with regard to the return to work, we decided to incorporate all 86 studies that firstly, include working mothers with children under the age of six and secondly, show mothers as a separate group from the total sample. </Pgraph><Pgraph>In the 86 studies included in the review, different health-related independent variables were defined (see <TextGroup><PlainText>Table 2 </PlainText></TextGroup><ImgLink imgNo="2" imgType="table"/>). If general health terms were used in the studies &#8211; without explicit distinctions such as between physical and mental health &#8211; the results refer to &#8220;health in general&#8221; and thereafter to &#8220;health&#8221; with no further specification. Work and family conditions influence the health of mothers both directly and indirectly via the mothers&#8217; individual assessment of the compatibility of work and family life and the associated demands of the roles, that is subjective stress. In this context, the fulfilment and strain hypotheses are analysed and discussed with the main scientific focus being on the strain factors <TextLink reference="17"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="43"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="78"></TextLink>, <TextLink reference="106"></TextLink> (see Figure 2 <ImgLink imgNo="2" imgType="figure"/>). </Pgraph><SubHeadline>Personal factors of influence</SubHeadline><Pgraph>Healthy women often become healthy mothers <TextLink reference="74"></TextLink>. Being able to manage this transitional phase serves as a mo<TextGroup><PlainText>dera</PlainText></TextGroup>tor between experience of the role and mental health <TextLink reference="112"></TextLink>. The presence or absence of depressive symptoms among mothers is frequently consistent from the beginning of pregnancy until the end of the first year after the birth of the baby <TextLink reference="91"></TextLink> and even beyond <TextLink reference="50"></TextLink>. One in five mothers suffers from relevant depressive symptoms <TextLink reference="100"></TextLink>. However, the number of children and the age of the mother at the birth of her first child are not shown to have a significant effect on maternal depression <TextLink reference="100"></TextLink>. In a study conducted in the USA, young mothers (&#60;20 years of age at the time of the first birth) have significantly higher depression scores than older mothers <TextLink reference="43"></TextLink>. This can be explained by greater financial strain and a reduced sense of personal control <TextLink reference="43"></TextLink>. A Swedish study showed that older mothers are healthier <TextLink reference="44"></TextLink>. A Brazilian study, in contrast, albeit one that only includes women over the age of 34, suggests that older mothers are in fact less healthy <TextLink reference="53"></TextLink>. At the same time, there are also indications that mothers&#8217; stress perception decreases with age <TextLink reference="100"></TextLink>. </Pgraph><Pgraph>One group of mothers at risk of poor health appear to be members of minorities, in particular those also facing precarious living conditions <TextLink reference="96"></TextLink>. Some of these mothers have to resolve specific role conflicts <TextLink reference="29"></TextLink> and manage health problems <TextLink reference="96"></TextLink>, all of which is added to the usual demands that affect all mothers. </Pgraph><Pgraph>An inability to adequately manage this transition phase, during which a mother&#8217;s own self-image and sensitivity when it comes to fulfilling others&#8217; expectations impacts her health, can have a negative effect on maternal health, resources and work motivation, while successfully ma<TextGroup><PlainText>na</PlainText></TextGroup>ging the phase can strengthen a mother&#8217;s perso<TextGroup><PlainText>na</PlainText></TextGroup>lity <TextLink reference="4"></TextLink>. A positive attitude towards parenthood results in higher work commitment and improved well-being <TextLink reference="40"></TextLink>. Further, a strong feeling of control <TextLink reference="120"></TextLink>, well-established coping strategies, resilience <TextLink reference="4"></TextLink>, <TextLink reference="94"></TextLink> and greater self-confidence combined with a mother&#8217;s better awareness of her own needs, her environment <TextLink reference="4"></TextLink>, as well as the organisation of daily life <TextLink reference="94"></TextLink> has a positive effect on maternal health. </Pgraph><SubHeadline>Family-related factors of influence</SubHeadline><SubHeadline2>Family control and satisfaction </SubHeadline2><Pgraph>Control &#8211; as a subjectively perceived sense of control &#8211; also plays an important, albeit controversially discussed role in the context of family-related factors influencing maternal health. Control over household chores <TextLink reference="74"></TextLink>, <TextLink reference="99"></TextLink>, along with the ability to make independent decisions, as well as social, emotional and practical support at home <TextLink reference="29"></TextLink> are all associated with less stress <TextLink reference="99"></TextLink> and better health <TextLink reference="74"></TextLink>. In contrast, another study shows that those women with a high level of control over household chores &#8211; equated with unwanted sole responsibility &#8211; are more likely to be overstrained, because, in this case, control can lead to the mother being overburdened <TextLink reference="15"></TextLink>. </Pgraph><Pgraph>Whether or not the positive impact of satisfaction with family circumstances on employment can also have an effect on health is not entirely clear <TextLink reference="52"></TextLink>, <TextLink reference="112"></TextLink>. However, maternal depression scores are shown to be reduced by good social support <TextLink reference="35"></TextLink>. Mothers in a relationship are at least risk of falling ill, irrespective of their professional status <TextLink reference="118"></TextLink>. In addition, satisfaction with this relationship is significantly associated with maternal well-being <TextLink reference="6"></TextLink>. </Pgraph><SubHeadline2>Number and age of children </SubHeadline2><Pgraph>Generally, the adjustment phase after the birth of the first child takes longer than with all subsequent children <TextLink reference="10"></TextLink>. Mothers with one or two children <TextLink reference="120"></TextLink> are more likely to work during the first year after the birth, while for those with three children or more the probability is lower again <TextLink reference="28"></TextLink>. The risk of work-life imbalance increases with the number of children, but remains rela<TextGroup><PlainText>tive</PlainText></TextGroup>ly constant after the second child, and is accompanied by a risk to health <TextLink reference="54"></TextLink>. </Pgraph><Pgraph>A US study showed that 53&#37; of working mothers experienced a family&#8211;work conflict, which is influenced, for instance by role preferences and the number of children <TextLink reference="51"></TextLink>. The degree of role strain &#8211; in the sense of being overtaxed by the existence of too many overlapping roles &#8211; increases significantly with the number of children, and this is accompanied by declining satisfaction with non-working time and deteriorating mental health <TextLink reference="44"></TextLink>, <TextLink reference="89"></TextLink>. In one study, mothers with two children are more likely to show stress symptoms than mothers with just one child <TextLink reference="32"></TextLink>. For mothers with three children or more, this trend is not confirmed however <TextLink reference="32"></TextLink>. Studies that focus on the relationship between the age of the youngest child and the health of the mother show heterogeneous results <TextLink reference="6"></TextLink>, <TextLink reference="45"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="118"></TextLink>.</Pgraph><SubHeadline2>Demands of housework and family</SubHeadline2><Pgraph>Women whose family pressures affect their jobs have poorer mental <TextLink reference="112"></TextLink> and general health &#91;55&#93;. Further, it is shown that more time spent on activities of daily life, e.g. household chores, leads to more depressive sym<TextGroup><PlainText>ptoms</PlainText></TextGroup> among mothers <TextLink reference="35"></TextLink> or is associated with poorer health <TextLink reference="53"></TextLink>. Yet, other studies show that it is not just the amount of housework that is important for the perceived strain <TextLink reference="106"></TextLink> or well-being, but the fair division within the relationship <TextLink reference="6"></TextLink>, <TextLink reference="106"></TextLink>. A higher housework load is associated with poorer mental and self-rated health <TextLink reference="41"></TextLink>, <TextLink reference="106"></TextLink>, in particular in the presence of lower energy levels <TextLink reference="106"></TextLink>. Women take on more housework <TextLink reference="41"></TextLink>, <TextLink reference="53"></TextLink>, even if they work full time <TextLink reference="41"></TextLink>. An imbalance between effort and reward when it comes to housework and family-related work <TextLink reference="103"></TextLink> is experienced, in particular, by mothers working full time <TextLink reference="103"></TextLink> and mothers in demanding professional positions <TextLink reference="53"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="101"></TextLink>, who also bear the main burden of household and family work <TextLink reference="103"></TextLink>. Mothers who experience this imbalance have poorer mental and subjective overall health <TextLink reference="103"></TextLink>. Moreover, these mothers experience higher levels of stress, tiredness, physical, psychosomatic and general health complaints, as well as more work-related pressure in the family, insufficient time to regenerate and lower satisfaction with their relationships and their own lives <TextLink reference="41"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="102"></TextLink>, <TextLink reference="106"></TextLink>. </Pgraph><SubHeadline2>Single parents</SubHeadline2><Pgraph>The findings regarding physical and mental health as well as health risks (e.g. stress) and depression among mothers, by relationship status, are heterogenous. In some studies, there is no difference between the health of mothers in a relationship and those who are not <TextLink reference="55"></TextLink>, <TextLink reference="106"></TextLink>, <TextLink reference="114"></TextLink> and in some cases, the health of single parents is comparatively poorer <TextLink reference="44"></TextLink>, <TextLink reference="47"></TextLink>, <TextLink reference="78"></TextLink>, <TextLink reference="90"></TextLink> and&#47;or the stress levels <TextLink reference="64"></TextLink>, <TextLink reference="100"></TextLink> and health risks higher <TextLink reference="34"></TextLink>, <TextLink reference="122"></TextLink>. For this group, an important moderator seems to be the financial difficulties that occur considerably more frequently <TextLink reference="17"></TextLink>, <TextLink reference="34"></TextLink>, <TextLink reference="47"></TextLink>, <TextLink reference="61"></TextLink>, especially among mothers of small children <TextLink reference="121"></TextLink>. The health of single mothers, as compared with mothers in a relationship, benefits more from going out to work <TextLink reference="55"></TextLink>, <TextLink reference="64"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="100"></TextLink>, in particular long-term employment <TextLink reference="73"></TextLink>, <TextLink reference="124"></TextLink>. With regard to the extent of employment that promotes good health among single mothers, the results are once again heterogenous <TextLink reference="78"></TextLink>, <TextLink reference="124"></TextLink>. Moreover, single mothers have a higher housework load than mothers in a relationship <TextLink reference="78"></TextLink>. This is one possible reason that social support is given higher priority among single mothers <TextLink reference="17"></TextLink>, <TextLink reference="34"></TextLink>, <TextLink reference="121"></TextLink>. Positive experiences of everyday life impact the mental health of mothers, irrespective of their relationship status <TextLink reference="17"></TextLink>. </Pgraph><SubHeadline2>Childcare and partner employment status</SubHeadline2><Pgraph>Maternal health is improved through the use of childcare <TextLink reference="28"></TextLink>. However, insecurities can arise due to doubts about the quality of the care provided <TextLink reference="5"></TextLink>. This is closely connected with feelings of guilt due to the double role and a sense of not being a good mother <TextLink reference="5"></TextLink>. A partner being in employment is also positively associated with maternal health <TextLink reference="120"></TextLink>, although employment conditions have no effect <TextLink reference="91"></TextLink>. </Pgraph><SubHeadline2>Use of time and role identification </SubHeadline2><Pgraph>Maternal health particularly suffers when the amount of work involved in managing family and work is very high and there are not enough resources available to compensate for this <TextLink reference="42"></TextLink>. A Swiss study shows that all groups that include working women would like to invest less time in their jobs <TextLink reference="90"></TextLink>. Possible role strain alone is not necessarily associated with poorer physical and mental health <TextLink reference="90"></TextLink>, but the dynamic associated with the quality <TextLink reference="38"></TextLink> and number of different roles <TextLink reference="108"></TextLink> seems to be of rele<TextGroup><PlainText>van</PlainText></TextGroup>ce here <TextLink reference="108"></TextLink>. As the number of roles increases, the probability of poor mental health declines, while a reduction in the number of roles increases the risk of poor mental health, psychiatric illnesses and the amount of absence due to sickness <TextLink reference="108"></TextLink>. The subjective perception of the quality of the maternal role and, in particular, the worries connected with the role are significantly associated with psychological stress <TextLink reference="38"></TextLink>. This finding empha<TextGroup><PlainText>sises</PlainText></TextGroup> the importance of role experience &#8211; subjective role perception &#8211; for the well-being of women with children <TextLink reference="38"></TextLink>. </Pgraph><SubHeadline>Work-related factors of influence </SubHeadline><Pgraph>With regards to the assessment of general health and quality of life, the results of one longitudinal study show no significant differences between working and non-working mothers <TextLink reference="93"></TextLink>. It is not employment status that is the key factor here, but rather a positive attitude and identification with the professional role <TextLink reference="26"></TextLink>. Mothers seem to be in the best health if they can strongly identify with their jobs <TextLink reference="73"></TextLink> and see this role as varied and responsible and thus as a source of fulfilment in their lives <TextLink reference="17"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="101"></TextLink>. Mothers who prefer to be in work and manage to achieve this have better mental health and are more satisfied with the emotional support they receive <TextLink reference="31"></TextLink>, but also seem to take more sick days <TextLink reference="107"></TextLink>. If, however, the professional status of a mother does not fulfil her expectations, her well-being is likely to be poorer <TextLink reference="26"></TextLink>, and she will show higher depression scores <TextLink reference="59"></TextLink>, <TextLink reference="116"></TextLink> and perceive less emotional support than mothers who choose to work or stay at home <TextLink reference="26"></TextLink>, <TextLink reference="31"></TextLink>. Non-working mothers who want to work are significantly worse off than mothers who go out to work for economic reasons <TextLink reference="31"></TextLink>. </Pgraph><Pgraph>Education is a factor that protects people from poor employment conditions and poorer health <TextLink reference="53"></TextLink>, <TextLink reference="71"></TextLink>. Young mothers are more likely not to have completed their school or vocational education, which has both short and long-term negative effects on their mental health <TextLink reference="3"></TextLink>, <TextLink reference="72"></TextLink>, although the findings regarding depression scores among those with lower levels of education are ambiva<TextGroup><PlainText>lent</PlainText></TextGroup> <TextLink reference="71"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="117"></TextLink>. If, despite having children at a younger age, mothers manage to go out to work, their mental health is better <TextLink reference="56"></TextLink>. If, despite higher levels of education, women&#8217;s employment has a negative impact on the family, their health suffers considerably <TextLink reference="53"></TextLink>. </Pgraph><Pgraph>The essentially positive effect of employment applies to mental health <TextLink reference="55"></TextLink>, <TextLink reference="112"></TextLink>, mental well-being <TextLink reference="26"></TextLink> and also serves as to protect against depression <TextLink reference="16"></TextLink>, <TextLink reference="93"></TextLink>. Furthermore, employment improves quality of life and promotes mothers&#8217; social relationships <TextLink reference="93"></TextLink>. When it comes to subjective health perception, the positive effect is particularly strong if going out to work is perceived as an opportunity to retreat from the domestic environment <TextLink reference="98"></TextLink>. If a mother going out to work has an overall positive effect on family life, this acts as a buffer for the conflicts experienced in trying to reconcile work and family life, results in less work-related and family stress <TextLink reference="65"></TextLink> and has a positive impact on mental health <TextLink reference="10"></TextLink>, <TextLink reference="52"></TextLink>. Pur<TextGroup><PlainText>suing</PlainText></TextGroup> a profession is also associated with less parental stress <TextLink reference="28"></TextLink>. Only two studies show positive correlations between a lack of job and maternal health. In one study, mothers who are exclusively housewives had an overall reduced risk of depressive symptoms <TextLink reference="100"></TextLink> and in a second, they had fewer health problems <TextLink reference="88"></TextLink>. One factor protecting non-working mothers is their belief that going out to work would be detrimental to their children <TextLink reference="26"></TextLink>. One study found that women&#8217;s employment was more likely to have consequences for the family than family life having an impact on women&#8217;s employment, but does not show a correlation for physical health <TextLink reference="52"></TextLink>. Overall, the conflict between work and family, in which women&#8217;s own needs frequently take a back seat <TextLink reference="96"></TextLink>, seems to have negative effects on physical and mental health <TextLink reference="10"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="96"></TextLink>, <TextLink reference="98"></TextLink> and well-being <TextLink reference="6"></TextLink>. </Pgraph><SubHeadline2>Timing of return to work </SubHeadline2><Pgraph>The health-related findings &#8211; taking into account depressive symptoms <TextLink reference="28"></TextLink>, <TextLink reference="48"></TextLink>, <TextLink reference="75"></TextLink>, <TextLink reference="120"></TextLink> with regard to the timing of mothers&#8217; return to work &#8211; are ambivalent <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="104"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="120"></TextLink>, particularly when education status is factored in <TextLink reference="70"></TextLink>, <TextLink reference="117"></TextLink>. According to one study, if women return to work within 11 weeks after the birth there are no significant health-related diffe<TextGroup><PlainText>ren</PlainText></TextGroup>ces compared to the non-working mothers during the return-to-work phase <TextLink reference="51"></TextLink>. Two other studies show nega<TextGroup><PlainText>tive</PlainText></TextGroup> effects on health <TextLink reference="27"></TextLink>, <TextLink reference="104"></TextLink> among mothers taking less than two months of paid maternity leave and returning to work before their child is three months old <TextLink reference="27"></TextLink> or in the child&#8217;s fourth month <TextLink reference="104"></TextLink>. Another study, in contrast, comes to the conclusion that mothers who go back to work within the first six months, are less likely to have poor health than mothers who are not employed <TextLink reference="28"></TextLink>. </Pgraph><Pgraph>Having a financially secure phase after the birth thanks to parental leave benefits plays a key role in improving maternal mental health <TextLink reference="105"></TextLink> and in sustainably reducing the risk of stress <TextLink reference="123"></TextLink>. An early return to work within the first three <TextLink reference="69"></TextLink> or six months <TextLink reference="120"></TextLink> after the baby is born thus poses no health risks for mothers <TextLink reference="120"></TextLink> and&#47;or has psychological benefits <TextLink reference="69"></TextLink>, if they are not forced to go back to work for financial reasons and the return is purely self-motivated <TextLink reference="69"></TextLink>, <TextLink reference="120"></TextLink>. If, however, financial pressure is the reason for an early return to work, this is a risk factor for maternal health <TextLink reference="114"></TextLink>. Parental leave beyond the first three or six months of the child&#8217;s life as well as monetary benefits are predominantly associated with better mental health <TextLink reference="69"></TextLink>, <TextLink reference="105"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="123"></TextLink>, in particular for mothers who return to full-time employment <TextLink reference="69"></TextLink>. Financial and contractual circumstances allowing mothers to take leave from work during the first year of the child&#8217;s life is shown to result in less stress among mothers two to three years after birth and continues to have positive effects on mental health into old age <TextLink reference="8"></TextLink>. </Pgraph><SubHeadline2>Working hours</SubHeadline2><Pgraph>The mental health of mothers who work full time appears to be comparable with that of the general female population <TextLink reference="45"></TextLink>, <TextLink reference="114"></TextLink>, although mothers are more likely to reduce their working hours than women without children <TextLink reference="62"></TextLink>. Time stress in particular can result in the desire to reduce working hours <TextLink reference="45"></TextLink>. If women can no longer cope with their jobs, this has a negative impact on their well-being and often leads to them changing jobs with the return to work sometimes resulting in a new employment status <TextLink reference="5"></TextLink>. </Pgraph><Pgraph>Viewed in isolation, the results regarding the mothers&#8217; working hours in the context of health produces heterogenous findings. On the one hand, maternal health improves with increasing working hours <TextLink reference="28"></TextLink> or women who work fewer than 39 hours per week seem to have poorer overall health <TextLink reference="53"></TextLink>. In particular, women who work fewer than 24 hours per week and would like to work even less have the poorest mental health <TextLink reference="15"></TextLink>. Other studies, in contrast, find that women in part-time employment are healthier <TextLink reference="73"></TextLink>, <TextLink reference="118"></TextLink> and experience less conflicts in reconciling work and family life <TextLink reference="16"></TextLink> and&#47;or fewer health problems <TextLink reference="44"></TextLink> than mothers who work full time. This is confirmed by other studies in which mothers with children under the age of six demonstrate poorer health <TextLink reference="97"></TextLink>, <TextLink reference="111"></TextLink> and&#47;or more reduced well-being <TextLink reference="6"></TextLink>, the more hours they work <TextLink reference="6"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="111"></TextLink>, although this correlation is moderated by the work&#8211;family conflict experienced <TextLink reference="6"></TextLink>. An increase in conflicts in reconciling work and family life is associated with more mental uncertainty and time pressure <TextLink reference="58"></TextLink>. Particular risk factors for maternal well-being <TextLink reference="50"></TextLink> and mental health <TextLink reference="52"></TextLink> appear to be high workplace stress <TextLink reference="52"></TextLink>, in particular in combination with long working hours <TextLink reference="50"></TextLink>. </Pgraph><Pgraph>It can be stated with relative certainty that women who are happy with the hours they work have better mental health <TextLink reference="15"></TextLink> and less stress <TextLink reference="55"></TextLink>. If women want to increase their hours and manage to achieve this, this frequently improves their health even further <TextLink reference="46"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="62"></TextLink>. If, however, work commitment exceeds 50 hours per week, health then suffers <TextLink reference="97"></TextLink>. </Pgraph><SubHeadline2>Employment conditions</SubHeadline2><Pgraph>For mothers in a relationship, the work&#8211;family conflict has the strongest impact on well-being <TextLink reference="17"></TextLink>. If mothers are able to organise their working hours flexibly, there are fewer family conflicts <TextLink reference="25"></TextLink>, maternal health benefits <TextLink reference="10"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="64"></TextLink>, <TextLink reference="91"></TextLink> &#8211; particularly in the case of early return to work <TextLink reference="28"></TextLink> &#8211; and depression is less likely to occur <TextLink reference="99"></TextLink>. High-quality employment conditions &#8211; characterised by a high degree of autonomy in the form of control, responsibility and decision-making freedoms, security and social support as well as less work-related stress &#8211; improve the reconcilability of work and family life, are associated with less depression <TextLink reference="35"></TextLink>, <TextLink reference="116"></TextLink> and promote both mental health <TextLink reference="40"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="120"></TextLink> and well-being and&#47;or overall health <TextLink reference="10"></TextLink>, <TextLink reference="15"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="74"></TextLink>, <TextLink reference="111"></TextLink>. Good employment conditions also strengthen mothers emotionally <TextLink reference="60"></TextLink>. However, it is not just the existence of high-quality working conditions, which can be tailored to the em<TextGroup><PlainText>ployee&#8217;s</PlainText></TextGroup> individual needs, that is a key factor <TextLink reference="111"></TextLink>, but rather for these conditions to be firmly embedded in and accepted by the company and society <TextLink reference="9"></TextLink> rather than being one-off measures <TextLink reference="76"></TextLink>, <TextLink reference="113"></TextLink>. Other work-related resources are income, level of education and employment position <TextLink reference="120"></TextLink>, although financial benefits alone only have a limited positive effect on well-being <TextLink reference="40"></TextLink>, <TextLink reference="57"></TextLink>. </Pgraph><Pgraph>Should the working conditions deteriorate, e.g. as a result of the employer demanding more flexibility <TextLink reference="28"></TextLink>, <TextLink reference="50"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="99"></TextLink>, <TextLink reference="117"></TextLink>, job quality tends to suffer, with negative consequences, for example in the form of psychological stress, more difficulties reconciling work and family life as well as reduced well-being <TextLink reference="32"></TextLink>, <TextLink reference="99"></TextLink>, greater mental strain <TextLink reference="10"></TextLink> and more health impairments, for instance through depression <TextLink reference="28"></TextLink>, <TextLink reference="50"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="99"></TextLink>, <TextLink reference="117"></TextLink>. This does not necessarily apply to women with lower levels of education or a fear of making mistakes as, in these cases, personal responsibility can also be a health risk <TextLink reference="7"></TextLink>. </Pgraph><SubHeadline2>Financial factors</SubHeadline2><Pgraph>Low income is a particular challenge when it comes to reconciling work and family life <TextLink reference="91"></TextLink>. Financial stress is the most reliable predictor of physical <TextLink reference="114"></TextLink> and mental health <TextLink reference="17"></TextLink>, <TextLink reference="114"></TextLink> as well as stress and depression <TextLink reference="71"></TextLink>, <TextLink reference="100"></TextLink>. Consequently, financial stress is a stronger factor of influence than low income when it comes to poor health. This particularly applies to single mothers, irrespec<TextGroup><PlainText>tive</PlainText></TextGroup> of their employment status <TextLink reference="2"></TextLink>. Only one Swedish study found that the group of high-earning mothers showed a higher probability of impaired health <TextLink reference="44"></TextLink>. </Pgraph></TextBlock> <TextBlock language="de" linked="yes" name="Diskussion"> <MainHeadline>Diskussion</MainHeadline><Pgraph>Positive Auswirkungen auf die Gesundheit von M&#252;ttern entstehen haupts&#228;chlich, wenn eine berufliche T&#228;tigkeit pers&#246;nlich gew&#252;nscht ist, die berufliche Rolle positiv und ausf&#252;llend wahrgenommen wird und diese mit dem Familienleben als gut vereinbar eingesch&#228;tzt wird <TextLink reference="26"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="38"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="59"></TextLink>, <TextLink reference="108"></TextLink>, <TextLink reference="116"></TextLink>. Individuell scheint dabei zu sein, zu welchem Zeitpunkt der berufliche Wiedereinstieg erfolgt <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="104"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="120"></TextLink>, in welchem Umfang gearbeitet wird <TextLink reference="6"></TextLink>, <TextLink reference="15"></TextLink>, <TextLink reference="16"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="46"></TextLink>, <TextLink reference="50"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="62"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="118"></TextLink> und wie hoch das Einkommen ist <TextLink reference="2"></TextLink>, <TextLink reference="17"></TextLink>, <TextLink reference="34"></TextLink>, <TextLink reference="61"></TextLink>, <TextLink reference="71"></TextLink>, <TextLink reference="91"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="114"></TextLink>, <TextLink reference="121"></TextLink>. Entscheidend ist die insgesamt positive subjektive Einsch&#228;tzung der Berufsaus&#252;bung bez&#252;glich der eigenen Lebenssituation <TextLink reference="10"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="65"></TextLink>, <TextLink reference="95"></TextLink>. Die grunds&#228;tzliche Heterogenit&#228;t der Ergebnisse kann begr&#252;ndet werden sowohl durch die unterschiedliche Operationalisierung von Gesundheit und Wiedereinstieg als auch durch unterschiedliche politische, finanzielle und gesellschaftliche Rahmenbedingungen <TextLink reference="80"></TextLink>, <TextLink reference="81"></TextLink>, <TextLink reference="83"></TextLink>, <TextLink reference="84"></TextLink>. </Pgraph><Pgraph>Eine gelungene und den Erwartungen entsprechende &#220;bergangsphase vom Frausein zum Muttersein stellt eine wichtige langfristige Ressource f&#252;r die M&#252;tter- und Familiengesundheit dar <TextLink reference="36"></TextLink>, <TextLink reference="68"></TextLink>. Des Weiteren ist f&#252;r die Gesundheit von M&#252;ttern bedeutend, welcher Aufwand im Alltag betrieben werden muss, damit die Vereinbarkeit von Beruf und Familie gelingt <TextLink reference="6"></TextLink>, <TextLink reference="35"></TextLink>, <TextLink reference="41"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="106"></TextLink>. Dabei sind die individuellen Lebenslagen besonders relevant <TextLink reference="41"></TextLink>, <TextLink reference="44"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="56"></TextLink>, <TextLink reference="74"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="102"></TextLink>, <TextLink reference="103"></TextLink>, <TextLink reference="106"></TextLink>. Das Wohlbefinden steigt, wenn die Anforderungen mit den zur Verf&#252;gung stehenden Ressourcen bew&#228;ltigt werden. Reichen die Ressourcen nicht aus oder passen die Ressourcen nicht zu den Anforderungen, so leidet das Wohlbefinden insbesondere, wenn die eigenen Bed&#252;rfnisse zur&#252;ckgestellt werden <TextLink reference="10"></TextLink>, <TextLink reference="42"></TextLink>, <TextLink reference="96"></TextLink>, <TextLink reference="101"></TextLink>. </Pgraph><Pgraph>Als eine weitere, eng mit den individuellen Lebenslagen verbundene Komponente zeigt sich die subjektive Rollenqualit&#228;t und -zufriedenheit: M&#252;tter, die eine st&#228;rkere Identifikation mit ihrer Mutterrolle haben, verf&#252;gen &#252;ber eine bessere Gesundheit, wenn sie weniger arbeiten und zu einem sp&#228;teren Zeitpunkt in den Beruf zur&#252;ckkehren <TextLink reference="6"></TextLink>, <TextLink reference="15"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="105"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="123"></TextLink>, wohingegen M&#252;tter mit st&#228;rkerer beruflicher Identit&#228;t h&#228;ufig von einer zunehmenden Stundenzahl <TextLink reference="46"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="62"></TextLink> und einem fr&#252;heren beruflichen Wiedereinstieg <TextLink reference="69"></TextLink>, <TextLink reference="120"></TextLink> profitieren <TextLink reference="5"></TextLink>, <TextLink reference="38"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="89"></TextLink>, <TextLink reference="90"></TextLink>. Welche Konsequenzen sich langfristig aus dem Zeitpunkt der R&#252;ckkehr in den Beruf f&#252;r die M&#252;ttergesundheit ergeben, wird kontrovers diskutiert <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="70"></TextLink>, <TextLink reference="104"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="117"></TextLink>, <TextLink reference="120"></TextLink>. Bezahlte Elternzeit erm&#246;glicht die Selbstbestimmung der M&#252;tter &#252;ber den Zeitpunkt der R&#252;ckkehr und f&#246;rdert dar&#252;ber einen positiven Einfluss auf die Gesundheit <TextLink reference="69"></TextLink>, <TextLink reference="105"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="114"></TextLink>, <TextLink reference="120"></TextLink>, <TextLink reference="123"></TextLink>. </Pgraph><Pgraph>Die Relevanz des Umfangs der Besch&#228;ftigung, des Zeitpunkts der R&#252;ckkehr in den Beruf sowie der erlebten Kontrolle &#252;ber den Wiedereinstieg und im beruflichen und familialen Alltag f&#252;r die Gesundheit sind abh&#228;ngig vom Gesamtkontext und k&#246;nnen nicht losgel&#246;st von nationalen systemspezifischen Rahmenbedingungen analysiert werden. Grund daf&#252;r sind l&#228;nderspezifische Regelungen zu Mutterschutz, Elternzeit und Elterngeld sowie unterschiedliche Definitionen von Voll- und Teilzeitbesch&#228;ftigung <TextLink reference="1"></TextLink>, <TextLink reference="9"></TextLink>, <TextLink reference="30"></TextLink>, <TextLink reference="42"></TextLink>, <TextLink reference="66"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="79"></TextLink>, <TextLink reference="81"></TextLink>, <TextLink reference="82"></TextLink>, <TextLink reference="85"></TextLink>. </Pgraph><Pgraph>Aufgrund der unterschiedlichen Operationalisierung der Einflussfaktoren und insbesondere der gesundheitlichen Zielgr&#246;&#223;en ist die Ergebnisdichte zu den einzelnen Ziel- und Einflussgr&#246;&#223;en bzw. der Abstraktionsgrad der Studien unterschiedlich. Nur wenige Studien bilden die Komplexit&#228;t der Fragestellung ab. Aus diesem Grund sind auch Studien mit begrenzter Reichweite insbesondere bei sehr spezifischen Fragestellungen in die Analyse eingeflossen. Insgesamt zeigt sich eine gro&#223;e Heterogenit&#228;t im Hinblick auf die Operationalisierung von Gesundheit sowie eine ambivalente Diskussion, aus welcher Perspektive (&#8222;Bereicherung&#8220; versus &#8222;Konflikt&#8220;) die Vereinbarkeit von Beruf und Familie unter Nutzung welcher Parameter (&#8222;Belastung&#8220;, &#8222;Ressource&#8220;, &#8222;Zeit&#8220;, &#8222;Kontrolle&#8220;) valide gemessen werden kann <TextLink reference="53"></TextLink>. Insbesondere die Richtung der Kausalit&#228;ten, d.h. beeinflussen berufliche und familiale Faktoren die Gesundheit und&#47;oder resultieren aus dem Gesundheitszustand auch berufliche und familiale Bedingungen, kann oft nicht zweifelsfrei bestimmt werden &#91;119&#93;. Hinzu kommt, dass die pers&#246;nlichen, familialen und arbeitsbezogenen Faktoren individuell gewichtet werden und in der Konsequenz eine kontextabh&#228;ngige Priorisierung dieser Faktoren erfolgt <TextLink reference="4"></TextLink>, <TextLink reference="17"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="59"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="94"></TextLink>, <TextLink reference="116"></TextLink>, <TextLink reference="120"></TextLink>. </Pgraph><Pgraph>Um konkrete Handlungsempfehlungen f&#252;r die versorgende Praxis geben zu k&#246;nnen sind aufbauend auf dieses Scoping-Review, das keine evidenzbasierten Ergebnisse f&#252;r die Praxis intendiert <TextLink reference="119"></TextLink>, weitere Analysen erforderlich, welche die Qualit&#228;tskriterien der Einzelstudien st&#228;rker einbeziehen und ggf. Studien mit geringer Reichweite ausschlie&#223;en. Auffallend ist, dass es nur wenige Studien gibt, welche die durchschnittliche Mutter in Deutschland widerspiegeln, die 12 bis 36 Monate nach der Geburt in Teilzeit mit 20 bis 32 Stunden in den Beruf zur&#252;ckkehrt <TextLink reference="19"></TextLink>, <TextLink reference="81"></TextLink>. Aus diesem Grund ist eine &#220;bertragung der Ergebnisse auf die Situation von M&#252;ttern in Deutschland nur eingeschr&#228;nkt m&#246;glich. Es wurde bewusst darauf verzichtet, j&#252;ngere Studien nachtr&#228;glich in die Analyse aufzunehmen, um eine m&#246;gliche Verzerrung aufgrund der durch SARS-CoV-2 (Severe Acute Respiratory Syndrome-related Coronavirus 2) ausgel&#246;sten Pandemie auszuschlie&#223;en. Somit gibt das vorliegende Scoping-Review einen &#220;berblick &#252;ber die Art der international verf&#252;gbaren Evidenz zwischen 2007 und 2018.</Pgraph></TextBlock> <TextBlock language="en" linked="yes" name="Discussion"> <MainHeadline>Discussion</MainHeadline><Pgraph>The return to work has positive effects on maternal health principally if that job is something that is personally desired, the role is perceived as positive and fulfilling and is considered to be compatible with family life <TextLink reference="26"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="38"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="59"></TextLink>, <TextLink reference="108"></TextLink>, <TextLink reference="116"></TextLink>. What seems to vary from individual to individual is the timing of the return to work <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="104"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="120"></TextLink>, the number of hours worked <TextLink reference="6"></TextLink>, <TextLink reference="15"></TextLink>, <TextLink reference="16"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="46"></TextLink>, <TextLink reference="50"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="62"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="118"></TextLink> and the income level <TextLink reference="2"></TextLink>, <TextLink reference="17"></TextLink>, <TextLink reference="34"></TextLink>, <TextLink reference="61"></TextLink>, <TextLink reference="71"></TextLink>, <TextLink reference="91"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="114"></TextLink>, <TextLink reference="121"></TextLink>. A crucial factor is the overall positive subjective view of going out work in terms of the woman&#8217;s own life circumstances <TextLink reference="10"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="65"></TextLink>, <TextLink reference="95"></TextLink>. The fundamental heterogeneity of the findings can be explained both by the different ways in which health and the return to work is operationalised and the different political, financial and social conditions <TextLink reference="80"></TextLink>, <TextLink reference="81"></TextLink>, <TextLink reference="83"></TextLink>, <TextLink reference="84"></TextLink>. </Pgraph><Pgraph>A successful transition to becoming a mother, which fulfils women&#8217;s expectations, is an important long-term resource for maternal and family health <TextLink reference="36"></TextLink>, <TextLink reference="68"></TextLink>. Also important for mothers&#8217; health is the amount of time and effort they have to put into everyday life to successfully reconcile work and family life <TextLink reference="6"></TextLink>, <TextLink reference="35"></TextLink>, <TextLink reference="41"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="106"></TextLink>. Here, individual life situations are of particular relevance <TextLink reference="41"></TextLink>, <TextLink reference="44"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="56"></TextLink>, <TextLink reference="74"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="102"></TextLink>, <TextLink reference="103"></TextLink>, <TextLink reference="106"></TextLink>. Well-being increases if demands can be met with the existing resources. If there are insufficient resources or the resources are not suited to the demands, well-being suffers, in particular if women&#8217;s own needs have to take a back seat <TextLink reference="10"></TextLink>, <TextLink reference="42"></TextLink>, <TextLink reference="96"></TextLink>, <TextLink reference="101"></TextLink>. </Pgraph><Pgraph>Another component that is closely related to individual life situations was shown to be subjective quality of and satisfaction with roles. Mothers who identify with their maternal role more strongly are in better health if they work fewer hours and return to work at a later stage <TextLink reference="6"></TextLink>, <TextLink reference="15"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="105"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="123"></TextLink>, while mothers who have a stronger professional identity frequently benefit <TextLink reference="5"></TextLink>, <TextLink reference="38"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="89"></TextLink>, <TextLink reference="90"></TextLink> from working an increasing number of hours <TextLink reference="46"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>, <TextLink reference="62"></TextLink> and returning to work earlier <TextLink reference="69"></TextLink>, <TextLink reference="120"></TextLink>. The long-term consequences of the timing of the return to work for maternal health is the subject of heated debate <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="70"></TextLink>, <TextLink reference="104"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="117"></TextLink>, <TextLink reference="120"></TextLink>. Paid parental leave allows mothers to decide when they go back to work and also promotes a positive impact on maternal health <TextLink reference="69"></TextLink>, <TextLink reference="105"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="114"></TextLink>, <TextLink reference="120"></TextLink>, <TextLink reference="123"></TextLink>. </Pgraph><Pgraph>The relevance of the number of hours worked, the timing of the return to work as well as the experienced control over the return to work and in daily professional and family life for health depends on the overall context and cannot be analysed in isolation from national system-specific conditions. The reasons behind this are country-specific regulations on maternity leave, parental leave and parental benefits, as well as different definitions of full and part-time employment <TextLink reference="1"></TextLink>, <TextLink reference="9"></TextLink>, <TextLink reference="30"></TextLink>, <TextLink reference="42"></TextLink>, <TextLink reference="66"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="79"></TextLink>, <TextLink reference="81"></TextLink>, <TextLink reference="82"></TextLink>, <TextLink reference="85"></TextLink>. </Pgraph><Pgraph>As a result of the different ways in which the factors of influence are operationalised and in particular the independent variables related to health, the density of findings on the individual dependent and independent variables and&#47;or the degree of abstraction of the studies differed. Only a small number of studies depicted the complexity of the research question. This is why studies with a limited scope were included in the analysis, especially when it came to very specific questions. Overall, there was considerable heterogeneity with regard to the operationalisation of health and an ambivalent discussion regarding how to obtain a valid measurement of the reconciliation of work and family life, i.e. from which perspective (&#8216;fulfilment&#8217; versus &#8216;conflict&#8217;) and using which parameters (&#8216;strain&#8217;, &#8216;resources&#8217;, &#8216;time&#8217;, &#8216;control&#8217;) <TextLink reference="53"></TextLink>. The direction of causality in particular, that is whether work and family factors affect health, or whether work and family conditions result from the state of an individual&#8217;s health, are often impossible to determine beyond doubt <TextLink reference="118"></TextLink>. Added to this is the fact that personal, family and work-related factors are weighted differently from individual to individual&#47;individually weighted and as a consequence, the prioritisation of the factors depends on the context <TextLink reference="4"></TextLink>, <TextLink reference="17"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="59"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="94"></TextLink>, <TextLink reference="116"></TextLink>, <TextLink reference="120"></TextLink>. </Pgraph><Pgraph>In order to be able to formulate specific recommendations for action in healthcare practice, building on this scoping review, which was not intended to provide evidence-based findings to be implemented in practice <TextLink reference="119"></TextLink>, further analyses are required that better incorporate the quality criteria of the individual studies and possibly exclude those studies of more limited scope. One striking finding is that there are very few studies that reflect average mothers in Germany, who return to work between 12 and 36 months after the birth of their child to a part-time position working 20 to 32 hours a week <TextLink reference="19"></TextLink>, <TextLink reference="81"></TextLink>. Transferring our findings to the situation of mothers in Germany is therefore only possible to a limited extent. We deliberately refrained from including more recent studies in the analysis retrospectively to avoid possible bias caused by the SARS-CoV-2 (Severe Acute Respiratory Syndrome-related Coronavirus 2) pandemic. The present scoping view thus provides an overview of the type of evidence available between 2007 and 2018.</Pgraph></TextBlock> <TextBlock language="de" linked="yes" name="Schlussfolgerungen"> <MainHeadline>Schlussfolgerungen</MainHeadline><Pgraph>Es ist bisher nicht ausreichend untersucht, welche Konsequenzen sich aus den individuellen Lebenslagen durch das Zusammenspiel von Erwerbsarbeit und Familie f&#252;r die Gesundheit von M&#252;ttern in Deutschland ergeben <TextLink reference="23"></TextLink>, <TextLink reference="67"></TextLink>. Aus diesem Grund ist die Entwicklung eines Instrumentes zur Messung der Gesundheit von M&#252;ttern &#8211; unter Einbezug der dargelegten gesundheitlich relevanten Einzelfaktoren f&#252;r die Vereinbarkeit von Beruf und Familie &#8211; von besonderer Bedeutung f&#252;r die weitere Forschung <TextLink reference="14"></TextLink>. Dieses bildet die Basis f&#252;r weitere notwendige Untersuchungen unter Ber&#252;cksichtigung der Lebenswelt der M&#252;tter, damit daran anschlie&#223;ende passgenaue politische Ma&#223;nahmen die Frauen- und Familiengesundheit nachhaltig st&#228;rken k&#246;nnen. Neben der Schaffung von bedarfs- und bed&#252;rfnisorientierten Angeboten, gilt es auch die Schaffung von Aus-, Fort- und Weiterbildungsangeboten f&#252;r die Leistungserbringenden in den Blick zu nehmen. Hebammen als Expert&#42;innen f&#252;r die Lebensphase &#8222;Familienplanung, Schwangerschaft, Geburt, Wochenbett und Stillzeit bzw. Begleitung in der fr&#252;hen Elternzeit&#8220; k&#246;nnten durch die Implementierung von gesundheitsbezogenen Beratungsangeboten im Kontext der Vereinbarkeit von Beruf und Familie erste Ansprechpartner&#42;innen f&#252;r M&#252;tter sein. Hierf&#252;r ist es erforderlich, dass diese Angebote im Leistungskatalog der gesetzlichen Krankenkasse hinterlegt werden. Im Wissen um die individuellen Lebenslagen der Frauen und Familien, k&#246;nnten Hebammen durch ein solches zeitlich an den Wiedereinstieg in den Beruf angepasstes Format, einen Beitrag zum Gesundheitsschutz von M&#252;ttern und ihren Familien auch &#252;ber das erste Lebensjahr des Kindes hinaus leisten <TextLink reference="13"></TextLink>.</Pgraph></TextBlock> <TextBlock language="en" linked="yes" name="Conclusion"> <MainHeadline>Conclusion</MainHeadline><Pgraph>Within the different individual life situations of mothers in Germany, the interaction between work and family life has consequences for maternal health. To date, there has been insufficient research on this for mothers in Germany <TextLink reference="23"></TextLink>, <TextLink reference="67"></TextLink>. For this reason, the development of an instrument to measure maternal health &#8211; taking into account the individual health-relevant factors impacting the reconciliation of work and family life &#8211; is of particular importance for future research <TextLink reference="14"></TextLink>. This serves as a basis for further necessary studies, taking the living environment of mothers into account, so that subsequent political measures can be tailored to strengthen women&#8217;s and family health in the long term. As well as developing demand and needs-based services, it is also important to consider creating various training programmes for service providers. Midwives are experts on this phase of women&#8217;s lives &#8211; including family planning, pregnancy, birth, postpartum and breastfeeding period, and support during early parenthood &#8211; and as such could, by implementing health-related advisory services in the context of reconciling work and family life, be the first point of contact for mothers. Here it is important that these services are added to the catalogue of benefits covered by statutory health insurance. In light of their knowledge about the individual life circumstances of women and families, using a format like this to enable women to prepare for the return to work, midwives could help protect the health of mothers and their families, even beyond the first year of the child&#8217;s life <TextLink reference="13"></TextLink>.</Pgraph></TextBlock> <TextBlock language="de" linked="yes" name="Anmerkungen"> <MainHeadline>Anmerkungen</MainHeadline><SubHeadline>Interessenkonflikte</SubHeadline><Pgraph>Die Autorinnen erkl&#228;ren, dass sie keine Interessenkonflikte in Zusammenhang mit diesem Artikel haben.</Pgraph></TextBlock> <TextBlock language="en" linked="yes" name="Notes"> <MainHeadline>Notes</MainHeadline><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that they have no competing interests.</Pgraph></TextBlock> <References linked="yes"> <Reference refNo="1"> <RefAuthor>Abramson Z</RefAuthor> <RefTitle>Masked Symptoms: Mid-life women, health, and work</RefTitle> <RefYear>2007</RefYear> <RefJournal>Can J Aging</RefJournal> <RefPage>295-304</RefPage> <RefTotal>Abramson Z. 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DOI: 10.1007&#47;s00127-009-0044-2</RefTotal> <RefLink>http:&#47;&#47;dx.doi.org&#47;10.1007&#47;s00127-009-0044-2</RefLink> </Reference> </References> <Media> <Tables> <Table format="png"> <MediaNo>1</MediaNo> <MediaID language="de">1de</MediaID> <MediaID language="en">1en</MediaID> <Caption language="de"><Pgraph><Mark1>Tabelle 1: Suchstrategie</Mark1></Pgraph></Caption> <Caption language="en"><Pgraph><Mark1>Table 1: Search strategy</Mark1></Pgraph></Caption> </Table> <Table format="png"> <MediaNo>2</MediaNo> <MediaID language="de">2de</MediaID> <MediaID language="en">2en</MediaID> <Caption language="de"><Pgraph><Mark1>Tabelle 2: Eingeschlossene Studien</Mark1></Pgraph></Caption> <Caption language="en"><Pgraph><Mark1>Table 2: Included studies</Mark1></Pgraph></Caption> </Table> <NoOfTables>2</NoOfTables> </Tables> <Figures> <Figure format="png" height="762" width="389"> <MediaNo>1</MediaNo> <MediaID language="de">1de</MediaID> <MediaID language="en">1en</MediaID> <Caption language="de"><Pgraph><Mark1>Abbildung 1: Suchhistorie (eigene Darstellung in Anlehnung an PRISMA-Statement &#91;77&#93;)</Mark1></Pgraph></Caption> <Caption language="en"><Pgraph><Mark1>Figure 1: Search history (own representation based on PRISMA statement &#91;77&#93;)</Mark1></Pgraph></Caption> <AltText language="de">Abbildung 1</AltText> <AltText language="en">Figure 1</AltText> </Figure> <Figure format="png" height="1141" width="739"> <MediaNo>2</MediaNo> <MediaID language="de">2de</MediaID> <MediaID language="en">2en</MediaID> <Caption language="de"><Pgraph><Mark1>Abbildung 2: Ergebnisdarstellung nach Systematik des Anforderungs-Ressourcen-Modells (eigene Darstellung)</Mark1></Pgraph></Caption> <Caption language="en"><Pgraph><Mark1>Figure 2: Presentation of results according to the systematics of the demands-resources model (own representation)</Mark1></Pgraph></Caption> <AltText language="de">Abbildung 2</AltText> <AltText language="en">Figure 2</AltText> </Figure> <NoOfPictures>2</NoOfPictures> </Figures> <InlineFigures> <NoOfPictures>0</NoOfPictures> </InlineFigures> <Attachments> <NoOfAttachments>0</NoOfAttachments> </Attachments> </Media> </OrigData> </GmsArticle>