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Humkamp K, Costa AS, Reetz K, Walders J. [Post-COVID-19 condition-Clinical phenotyping in practice]. DER NERVENARZT 2024:10.1007/s00115-024-01753-y. [PMID: 39365441 DOI: 10.1007/s00115-024-01753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND The high number and clinical heterogeneity of neurological impairments in patients with a post-COVID-19 condition (PCC) poses a challenge for outpatient care. OBJECTIVE Our aim was to evaluate the applicability of the proposed subtypes according to the guidelines "Long/Post-COVID" (30 May 2024) and their phenotyping using clinical and neuropsychological findings from our post-COVID outpatient clinic. METHODS The evaluation was based on cross-sectional neurological and psychological test examinations of the patients, which were carried out using standardized questionnaires and test batteries. In addition, a detailed anamnesis of the current symptoms and a retrospective survey of the acute symptoms up to 4 weeks after the confirmed infection was conducted. The subtypes were classified according to the abovementioned guidelines based on the medical history and selected patient questionnaires, to which we added a 5th subtype with reference to the previous guidelines "Long/Post-COVID" (as of 5 March 2023). RESULTS A total of 157 patients were included between August 2020 and March 2022. The presentation was at a median of 9.4 months (interquartile range, IQR = 5.3) after infection, with a mean age of 49.9 years (IQR = 17.2) and more women (68%) presenting, with a total hospitalization rate of 26%. Subtype 1 (postintensive care syndrome) showed the highest proportion of men, highest body mass index (BMI) scores and the highest rates of subjective complaints of word-finding difficulties (70%). Subtype 2 (secondary diseases) was dominated by cognitive impairment and had the highest depression scores. Subtype 3 (fatigue and exercise-induced insufficiency) was the most common, had the most symptoms and most severe subjective fatigue and the largest proportion of women. Subtype 4 (exacerbation) mainly showed affective symptoms. Subtype 5 (complaints without relevance to everyday life) had the lowest scores for depression, fatigue and BMI. Neurological and psychological conditions were frequently pre-existing in all groups. DISCUSSION The management of PCC can be improved at various levels. A standardized subtype classification enables early individually tailored treatment concepts. Patients at risk should be identified at the primary care level and informed about risk factors and prevention strategies. Regular monitoring of cardiovascular risk factors and physical activity are essential for PCC treatment. In the case of cognitive deficits and concurrent affective symptoms, psychotherapeutic support and drug treatment with selective serotonin reuptake inhibitors (SSRI) should be provided at an early stage.
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Affiliation(s)
- Karen Humkamp
- Klinik für Neurologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Ana Sofia Costa
- Klinik für Neurologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Kathrin Reetz
- Klinik für Neurologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Julia Walders
- Klinik für Neurologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
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Noack EM, Bramesfeld A, Schmid S, Schröder D, Müller F. [Rescue Missions with Patients with Psychiatric and Psychosocial Symptoms: An Analysis from Eastern Lower Saxony]. PSYCHIATRISCHE PRAXIS 2024; 51:367-375. [PMID: 38810903 PMCID: PMC11464165 DOI: 10.1055/a-2310-5534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/28/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Characterization of medical emergencies of patients with psychiatric symptoms or in psychosocial crisis. METHODS Analysis of emergency medical services (EMS) mission logs from four German EMS stations of patients aged 12-65 from 2019 to 2020. RESULTS 23.4% of missions involved patients with psychiatric or psychosocial symptoms (1.6% psychotic, 3.0% suicidal, 7.1% psychosocial crisis, 15.7% intoxicated). On average, these patients were younger than those with other symptoms. 48.9% exhibited additional somatic complaints. The COVID-19 pandemic showed only little impact on the frequency of such emergencies. CONCLUSION Psychiatric and psychosocial symptoms account for a significant proportion of rescue missions in our sample. Managing psychiatric and psychosocial emergencies should be an integral part of the training of medical and paramedical staff.
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Affiliation(s)
- Eva Maria Noack
- Institut für Allgemeinmedizin, Universitätsmedizin
Göttingen
| | - Anke Bramesfeld
- Institut für Epidemiologie, Sozialmedizin und
Gesundheitssystemforschung, Medizinische Hochschule Hannover
| | | | | | - Frank Müller
- Institut für Allgemeinmedizin, Universitätsmedizin
Göttingen
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König L, Breves P, Linnemann GA, Hamer T, Suhr R. Climate change distress and impairment in Germany. Front Public Health 2024; 12:1432881. [PMID: 39381767 PMCID: PMC11458408 DOI: 10.3389/fpubh.2024.1432881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 09/03/2024] [Indexed: 10/10/2024] Open
Abstract
Introduction Climate change has been widely recognized as one of the most challenging problems facing humanity and it imposes serious mental health threats. It is important, however, to differentiate between the affective experience of distress over climate change and the functional impairments associated with climate change. Such a distinction is crucial because not all negative affective states are pathological, and they might even motivate pro-environmental behavior. Functional impairments, like not being able to work or maintaining social relationships, however, might require immediate treatment. This study assesses climate change distress and climate change impairment within the population of Germany using a population-representative sample. The results identify vulnerable subgroups and thereby can help to facilitate the development of target group specific intervention programs. Furthermore, this study explores whether climate change distress and climate change impairment are associated with general health, physical health, mental health, and diverse health behaviors. Methods Study participants were drawn from a panel which is representative of the German-speaking population in Germany with Internet access. Participants answered a series of questionnaires regarding their climate change distress, climate change impairment, general health, physical health, mental health, and diverse health behaviors. To evaluate differences between subgroups, Bayesian independent samples t-tests were calculated. To evaluate associations between constructs, Bayesian correlations were calculated. Results Especially women, younger people, people from West Germany, and people with a high level of formal education seem to experience higher levels of climate change distress. Regarding climate change impairment, the results suggest that especially women, older people, people from West Germany, people with a low level of formal education, people with a low or middle social status, and people with an inadequate/problematic health literacy seem to experience higher levels of climate change impairment. Furthermore, climate change distress and climate change impairment were weakly and differently associated with general health, physical health, mental health, and diverse health behaviors. Discussion Climate change distress and impairment are not evenly distributed within German society. The results of this study provide a starting point for the development of target group specific intervention programs.
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Affiliation(s)
- Lars König
- Stiftung Gesundheitswissen, Berlin, Germany
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Priska Breves
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Gesa Alena Linnemann
- Fachbereich Gesundheit, Katholische Hochschule Nordrhein-Westfalen, Cologne, Germany
| | - Tim Hamer
- Stiftung Gesundheitswissen, Berlin, Germany
| | - Ralf Suhr
- Stiftung Gesundheitswissen, Berlin, Germany
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Riedel O, Braitmaier M, Dankhoff M, Haug U, Klein M, Zachariassen W, Hoyer J. Alcohol use disorders after bariatric surgery: a study using linked health claims and survey data. Int J Obes (Lond) 2024:10.1038/s41366-024-01606-3. [PMID: 39242916 DOI: 10.1038/s41366-024-01606-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/07/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Previous studies have repeatedly reported alcohol use disorders (AUDs) in patients after bariatric surgery (BS). This research field can benefit from studies combining health claims data with survey data. METHODS Based on a combined retrospective cohort and cross-sectional study, 2151 patients with BS identified in a large health claims database received a questionnaire, by which we assessed the presence of AUDs based on a validated instrument (AUDIT) as well as by ICD-10 codes from the health claims data. We described patients with vs. without AUDs regarding sex, time since surgery, satisfaction with weight loss and health care resource utilization (HCRU). RESULTS The majority of patients were female (80.7%) with a median time since surgery of 6 years (Interquartile range: 4-9 years). For the majority of patients, the bariatric intervention was either a RYGB-Bypass (50%) or sleeve gastrectomy (43%). Overall, 3% had at least one AUD diagnosis code in the claims data (men: 5.5%, women: 2.5%). Among men, 43.6% of diagnoses were coded after but not before the surgery (women: 52%). According to AUDIT (completed by 1496 patients), 9.4% of all patients showed at least hazardous/harmful alcohol consumption. Higher scores were associated with sex of the person, longer time since surgery, dissatisfaction with the weight loss and higher HCRU, with contradicting results regarding psychotherapeutic care. CONCLUSIONS The proportion with AUDs in the study population gives rise to concern as alcohol consumption should be restricted after BS. The results suggest the necessity for close monitoring and post-surgical care.
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Affiliation(s)
- Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
| | - Malte Braitmaier
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | | | - Ulrike Haug
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- University of Bremen, Faculty of Human and Health Sciences, Bremen, Germany
| | | | | | - Jana Hoyer
- Adipositas-Zentrum, Städtisches Klinikum Dresden, Dresden, Germany
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Epe-Jungeblodt F, Pauli P, Schwab F, Andreatta M. Trauma history and course of therapy in a naturalistic cognitive behavior therapy outpatient sample: An archive data study. J Clin Psychol 2024; 80:1937-1948. [PMID: 38747513 DOI: 10.1002/jclp.23702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/20/2024] [Accepted: 04/30/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Cognitive Behavior Therapy (CBT) is an effective treatment for anxiety and depression disorders. Nonetheless, nearly 50% of all patients do not respond. Besides other factors, nonresponse may be linked to traumatic life events. This study aims to assess the relationship between trauma history, applied therapy interventions, and therapy outcomes. METHODS We analyzed data from 340 CBT outpatients diagnosed with a depression or anxiety disorder and possibly a trauma history treated under naturalistic conditions. Based on their therapy files, we collected information on trauma history, diagnoses, applied interventions, and severity of depression and anxiety symptoms at the start and end of therapy. The relationship between trauma, diagnoses, and intervention use and the development of depression and anxiety symptoms was analyzed using Linear Mixed Models. RESULTS Patients with a trauma history reported higher pre- and posttreatment symptom severity than those without trauma. No differences in applied interventions or decrease in symptom severity were found between patients with and without a trauma history. Specialized interventions were seldom applied. CONCLUSION Although no differences between patients with and without a trauma history were found in therapy response, patients with a trauma history maintained higher levels of symptom severity. These results indicate a need for more personalized interventions and evidence-based guidelines to personalize CBT for patients with a trauma history and high symptom severity.
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Affiliation(s)
- Franziska Epe-Jungeblodt
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg (JMU), Würzburg, Germany
| | - Paul Pauli
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg (JMU), Würzburg, Germany
| | - Frank Schwab
- Department of Media Psychology, Institute Human-Computer-Media, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg (JMU), Würzburg, Germany
| | - Marta Andreatta
- Department of General Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Rutschmann R, Romanczuk-Seiferth N, Gloster A, Richter C. Increasing psychological flexibility is associated with positive therapy outcomes following a transdiagnostic ACT treatment. Front Psychiatry 2024; 15:1403718. [PMID: 39077631 PMCID: PMC11284814 DOI: 10.3389/fpsyt.2024.1403718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/20/2024] [Indexed: 07/31/2024] Open
Abstract
Objectives Increasing psychological flexibility is considered an important mechanism of change in psychotherapy across diagnoses. In particular, Acceptance and Commitment Therapy (ACT) primarily aims at increasing psychological flexibility in order to live a more fulfilling and meaningful life. The purpose of this study is to examine 1) how psychological flexibility changes during an ACT-based treatment in a transdiagnostic day hospital and 2) how this change is related to changes in symptomatology, quality of life, and general level of functioning. Methods 90 patients of a psychiatric day hospital participated in the study. Psychological flexibility, symptomatology, and quality of life were assessed at three measurement time points (admission, discharge, and 3-month follow-up). The level of functioning was assessed at admission and discharge. Differences in psychological flexibility were tested via two-sided paired samples t-tests. Correlations of residualized change scores were calculated to detect associations between changes in psychological flexibility and other outcomes. Results Psychological flexibility increased significantly from pre-treatment to post-treatment (d = .43, p <.001) and from pre-treatment to follow-up (d = .54, p <.001). This change was significantly correlated to a decrease in symptomatology (r = .60 -.83, p <.001) and an increase in most dimensions of quality of life (r = -.43 - -.75, p <.001) and general level of functioning (r =-.34, p = .003). Discussion This study adds further evidence for psychological flexibility as a transdiagnostic process variable of successful psychotherapy. Limitations are discussed.
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Affiliation(s)
- Ronja Rutschmann
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Nina Romanczuk-Seiferth
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Andrew Gloster
- Faculty of Behavioral Sciences and Psychology, University of Lucerne, Lucerne, Switzerland
| | - Christoph Richter
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Väisänen V, Linnaranta O, Sinervo T, Hietapakka L, Elovainio M. Healthcare use of young finnish adults with mental disorders - profiles and profile membership determinants. BMC PRIMARY CARE 2024; 25:238. [PMID: 38965514 PMCID: PMC11225417 DOI: 10.1186/s12875-024-02497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Comprehensive, timely, and integrated primary care services have been proposed as a response to the increased demand for mental health and substance use services especially among young people. However, little is known about the care utilization patterns of young people with mental and substance use disorders. Our aim was to characterize profiles of care use in young Finnish adults with mental or substance use disorders, and the potential factors associated with the service use profiles. METHODS Primary and specialized care visits of young adults (16-29 years) diagnosed with a psychiatric or a substance use disorder (n = 7714) were retrieved from the national health care register from years 2020 and 2021. K-Means clustering was used to detect different profiles based on the utilization of care services. Multinomial logistic regression was used to analyze the factors associated with different profiles of care use. RESULTS Five different profiles were identified: low care use (75%), and use of principally primary health care (11%), student health services (9%), psychiatric services (5%), or substance use services (1%). Female gender was associated with membership in the primary health care focused profiles (OR 2.58 and OR 1.99), and patients in the primary health care and student health services profiles were associated with a better continuity of care (OR 1.04 and OR 1.05). Substance use disorders were associated with psychiatric service use (OR: 2.51) and substance use services (OR: 58.91). Living in smaller municipalities was associated with lower service use when comparing to the largest city. CONCLUSIONS Young adults diagnosed with a psychiatric or a substance use disorder had remarkably different and heterogeneous care patterns. Most of the participants had low care utilization, indicating potential gaps in service use and care needs. Measures should be taken to ensure equal access to and availability of mental health services. The profiles that utilized the most services highlights the importance of integrated services and patient-oriented improvement of treatment.
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Affiliation(s)
- Visa Väisänen
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland.
- Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Yliopistonranta 8 E, Kuopio, 70210, Finland.
| | - Outi Linnaranta
- Finnish Institute for Health and Welfare, Equality unit, Mental health team, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Laura Hietapakka
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland
- Faculty of Medicine, Research Program Unit, Department of Psychology, University of Helsinki, Haartmaninkatu 3, Helsinki, 00014, Finland
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Walter N, Rupp M, Lambert-Delgado A, Mena AEC, Hinterberger T, Loew T. Waning waves of mood: The declining trend of hospitalized patients with affective disorders in Germany. J Affect Disord 2024; 356:162-166. [PMID: 38588728 DOI: 10.1016/j.jad.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/30/2024] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Affective disorders profoundly affect individuals' emotional well-being and quality of life. This study investigates the epidemiology of affective disorders in Germany from 2011 to 2021, focusing on incidence rates, age- and sex-standardized rates, and developmental trends. METHODS Using nationwide data of ICD-10 diagnosis codes from 2011 to 2021, this cross-sectional study analyzed inpatient cases of affective disorders in individuals aged 20 years or older. Age- and sex-standardized incidence rates were calculated based on the population size of each birth cohort in the 16 German federal states. Incidence rate ratios (IRRs) for 2011 to 2021 and 2019 to 2021 were compared with a two-sample z-test. RESULTS Between 2011 and 2021, F30 (manic episode) showed a decline of 42.8 % to an incidence of 4.9 per 100,000 inhabitants, even though not statistically significant (p = 0.322). F31 (bipolar affective disorder) remained relatively stable with a reduction of 15.3 % to an incidence of 13.6 per 100,000 inhabitants in 2021 (p = 0.653). F32 (depressive episode) decreased statistically significant by 25.7 % to an incidence of 64.1 per 100,000 inhabitants (p = 0.072). F33 (recurrent depressive disorder) slightly increased by 18.3 % to an incidence of 94.6 per 100,000 inhabitants (p = 0.267). No statistically significant differences were found when comparing the COVID-19 pandemic year 2021 to 2019 incidences (p ≥ 0.529). CONCLUSION The study provides valuable insights into the changing landscape of affective disorders in Germany over the past decade. The observed decline in incidence rates underscores the importance of continued efforts to promote mental health awareness and access to care.
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Affiliation(s)
- Nike Walter
- Department for Psychosomatic Medicine, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
| | - Markus Rupp
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | | | | | - Thilo Hinterberger
- Department for Psychosomatic Medicine, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Thomas Loew
- Department for Psychosomatic Medicine, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Reinhard J, Mittermeier A, Brandstetter L, Mowat K, Slyschak A, Reiter AMF, Gamer M, Romanos M. Fear conditioning and fear generalization in children and adolescents with anxiety disorders. Eur Child Adolesc Psychiatry 2024; 33:2163-2172. [PMID: 37794273 PMCID: PMC11255079 DOI: 10.1007/s00787-023-02304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/10/2023] [Indexed: 10/06/2023]
Abstract
Overgeneralization of conditioned fear is associated with anxiety disorders (AD). Most results stem from studies done in adult patients, but studies with children are rare, although the median onset of anxiety disorders lies already in childhood. Thus, the goal of the present study was to examine fear learning and generalization in youth participants, aged 10-17 years, with AD (n = 39) compared to healthy controls (HC) (n = 40). A discriminative fear conditioning and generalization paradigm was used. Ratings of arousal, valence, and US expectancy (the probability of an aversive noise following each stimulus) were measured, hypothesizing that children with AD compared to HC would show heightened ratings of arousal and US expectancy, and decreased positive valence ratings, respectively, as well as overgeneralization of fear. The results indicated that children with AD rated all stimuli as more arousing and less pleasant, and demonstrated higher US expectancy ratings to all stimuli when compared to HC. Thus, rather than displaying qualitatively different generalization patterns (e.g., a linear vs. quadratic slope of the gradient), differences between groups were more quantitative (similar, but parallel shifted gradient). Therefore, overgeneralization of conditioned fear does not seem to be a general marker of anxiety disorders in children and adolescents.
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Affiliation(s)
- Julia Reinhard
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
| | - Anna Mittermeier
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Lisa Brandstetter
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Kimberly Mowat
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Anna Slyschak
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Andrea M F Reiter
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Matthias Gamer
- Department of Psychology (Experimental Clinical Psychology), University of Würzburg, Würzburg, Germany
| | - Marcel Romanos
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
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Schuler M, Gerlich C, Leven L, Renz S, Pamperin I, Vorsatz N, Vogel H. [The Blaufeuer measure for employees with mental stress and simultaneous workplace problems-Is the target group being reached?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:806-814. [PMID: 38896151 DOI: 10.1007/s00103-024-03907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Employees with mental burden and simultaneous workplace problems have an increased risk of chronification and disability pension. To support this group of people, the German Pension Insurance (Deutsche Rentenversicherung Bund) developed the Systemic Integration Management for People with Mental Impairments (SEMpsych) project as part of the rehapro federal program. The Blaufeuer counselling service was implemented in three model regions (Berlin, Cologne, and Nuremberg). The measure usually comprises up to 12 counselling sessions in 12 months. This article describes the characteristics of the participants and examines whether they belong to the intended target group. METHOD During September 2020 and June 2022, the participants completed a questionnaire between the first and second counselling sessions. Socio-demographic-, clinical- and work-related variables were assessed. The data were analysed using descriptive statistics and 95% confidence intervals. RESULTS Data from n = 482 participants (66.4% female; MAge = 45.2 years (±10.2 years); 64.1% working full-time; 49.8% currently on sick leave) were included. The participants have high psychological impairments (e.g. PHQ-9: M = 14.6 (±5.4)) and low subjective work ability (e.g. WAS: M = 3.2 (±2.6)). Most participants report overload at work and problems with superiors. DISCUSSION Participants exhibit mental burden values that correspond to those of patients at the beginning of outpatient psychotherapy or the first contact in an inpatient psychiatric clinic. Blaufeuer addresses a highly stressed group of people who have not yet received adequate treatment. Further studies on process and outcome evaluation will follow.
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Affiliation(s)
- Michael Schuler
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg (Bayern), Deutschland.
- Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum (Nordrhein-Westfalen), Deutschland.
| | - Christian Gerlich
- Arbeitsgruppe Rehabilitationswissenschaften im Zentrum Psychische Gesundheit, Universitätsklinikum Würzburg, Würzburg (Bayern), Deutschland
| | - Lorenz Leven
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg (Bayern), Deutschland
| | - Silvan Renz
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg (Bayern), Deutschland
| | - Ina Pamperin
- Deutsche Rentenversicherung Bund, Berlin, Deutschland
| | | | - Heiner Vogel
- Arbeitsgruppe Rehabilitationswissenschaften im Zentrum Psychische Gesundheit, Universitätsklinikum Würzburg, Würzburg (Bayern), Deutschland
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Bechdolf A, Hanser S, Baumgardt J, Brose A, Jäckel D, Döring S, Holzner L, Aliakbari N, von Hardenberg L, Shmuilovich O, Gencaggi D, Schellong M, Izat Y, Leopold S, Ituarte BP, Leopold K. soulspace: Integrated youth mental health care in Berlin, Germany-An introduction to the program and a description of its users. Early Interv Psychiatry 2024; 18:571-577. [PMID: 38486399 DOI: 10.1111/eip.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/04/2024] [Indexed: 07/11/2024]
Abstract
AIM A substantial gap between young people's need for mental health care services and their actual access to such services led worldwide organizations (e.g., the WHO) to recommend the implementation of early intervention programs and youth mental health services. Some countries around the world have established structures to meet this recommendation. In this paper, we describe soulspace as the first integrated youth mental health service for young people aged between 15 and 35 years in Berlin, Germany. METHODS We introduce soulspace as easily accessible mental health care for young people, and we characterize soulspace along the lines of the internationally established eight key principles of integrated youth mental health services (Killackey, et al., 2020, World Economic Forum). Soulspace is a cooperation between clinical outpatient units of psychiatric clinics for adolescents and young adults as well as a community-based counselling service. It provides initial contact, counselling, diagnostics, and treatment. RESULTS Our analyses of the pathways to soulspace and the characteristics of the soulspace users suggest that the low threshold is a facilitator to help finding for young people in comparison to more conventional early intervention models. That is, having transferred the early intervention center in a youth-facing counselling service as was done in soulspace seems to have reduced the threshold to seek help for families and for young people in need for support. CONCLUSIONS In summary, with soulspace, an easily accessible mental health care service was established that integrates counselling and specialized psychiatric treatment if needed.
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Affiliation(s)
- Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
| | - Sinah Hanser
- Department of Neoantology and Child and Adolescent Medicine, Bülach Hospial, Bülach, Switzerland
| | - Johanna Baumgardt
- Research Institute of the Local Healthcare Funds (WIdO), Berlin, Germany
| | - Annette Brose
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Dorothea Jäckel
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Germany
| | - Sophia Döring
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Laura Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Navid Aliakbari
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Laura von Hardenberg
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Olga Shmuilovich
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Dilek Gencaggi
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Mario Schellong
- ajb gmbh - Gemeinnützige Gesellschaft für Jugendberatung und psychosoziale Rehabilitation, Berlin, Germany
| | - Yonca Izat
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Stephanie Leopold
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Begoña Petuya Ituarte
- Bezirksamt Friedrichshain-Kreuzberg, Planungs- und Koordinierungsstelle Gesundheit, Berlin, Germany
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatics including FRITZ am Urban and soulspace, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Szymczak H, Brandstetter S, Blecha S, Dodoo-Schittko F, Rohr M, Bein T, Apfelbacher C. Potential risk factors for reduced quality of life and increased health care utilization in ARDS survivors: results from the multicenter cohort study DACAPO. Crit Care 2024; 28:201. [PMID: 38898469 PMCID: PMC11188221 DOI: 10.1186/s13054-024-04992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024] Open
Abstract
AIM To analyze the association of individual pre-ICU risk factors (obesity, physical and mental comorbidity, smoking status) on the long-term recovery process in survivors of the acute respiratory distress syndrome (ARDS; outcomes: health related quality of life, health care utilization; measured at 12, 24, and 36 months after ICU discharge). FINDINGS Results show a possible causal link between pre-ICU risk factors and subsequent recovery of survivors of ARDS, especially with regard to mental health related quality of life. PURPOSE Identifying relevant pre-existing risk factors, such as mental health problems, will enable the identification of at-risk patients, thus aiding in the improvement of long-term healthcare for survivors of critical illness.
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Affiliation(s)
- Hermann Szymczak
- Medical Faculty, Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Hospital St. Hedwig of the Order of St. John, Steinmetzstrasse 1-3, 93051, Regensburg, Germany
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Sebastian Blecha
- Department for Anesthesiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Frank Dodoo-Schittko
- Medical Faculty, Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Magdalena Rohr
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Hospital St. Hedwig of the Order of St. John, Steinmetzstrasse 1-3, 93051, Regensburg, Germany
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Thomas Bein
- Medical Faculty, University of Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christian Apfelbacher
- Medical Faculty, Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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13
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Nohr L, Dumke L, Klein EM, Wilker S. [Current Outpatient Psychotherapeutic Care for People with Migration and Refugee Experience in Germany - An Overview]. Psychother Psychosom Med Psychol 2024; 74:205-213. [PMID: 38865996 DOI: 10.1055/a-2304-8902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Although mental health is a human right, even in a country with a well-developed healthcare system like Germany, it is not possible to ensure non-discriminatory access to mental health care for all people, regardless of their origin. For individuals with a history of flight or migration it is particularly difficult to gain access to adequate psychotherapeutic care. This review addresses key barriers contributing to the lack of outpatient care for people with a history of flight or migration. Lack of knowledge about the treatment system, fear of stigma, structural barriers, language barriers, lack of networking of healthcare providers, lack of knowledge of mental health practitioners, as well as stereotypes, discrimination, and racism towards people with a refugee or migration history were identified as the most important barriers with sufficient evidence. Innovative concepts such as peer support can enable non-discriminatory treatment access. In addition, there is an urgent need to train the profession of psychotherapists in racism- and discrimination-sensitive work and to integrate these aspects into psychotherapeutic education and training.
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Affiliation(s)
- Laura Nohr
- Klinisch-Psychologische Intervention, Freie Universität Berlin Fachbereich Erziehungswissenschaft und Psychologie, Berlin
| | - Lars Dumke
- Klinische Psychologie und Psychotherapie, Universität Bielefeld Fakultät für Psychologie und Sportwissenschaft, Bielefeld
| | - Eva M Klein
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Freiburg
| | - Sarah Wilker
- Klinische Psychologie und Psychotherapie, Universität Bielefeld Fakultät für Psychologie und Sportwissenschaft, Bielefeld
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14
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Thom J, Jonas B, Reitzle L, Mauz E, Hölling H, Schulz M. Trends in the Diagnostic Prevalence of Mental Disorders, 2012-2022. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:355-362. [PMID: 38686592 DOI: 10.3238/arztebl.m2024.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Evaluations by the statutory health insurance carriers in Germany have revealed a rising prevalence of diagnoses of mental disorders, at varying levels and to varying extents. For mental health surveillance purposes, we analyzed prevalence trends across health insurance carriers, before and during the COVID-19 pandemic and stratified by diagnosis group, sex and age. METHODS Nationwide outpatient claims data of all statutorily insured individuals for the years 2012-2022 (Nmin = 68.7 million people, Nmax = 73.7 million people) were used to determine the diagnostic prevalence of mental disorders (ICD-10 F00-F99 and five selected diagnosis groups), with stratification by sex and age. Changes over time in the spectrum of all documented mental disorders are described. RESULTS Over the period 2012-2022, the percentage of people with outpatient diagnoses of mental disorders rose from 33.4% to 37.9% (a relative increase of 13.4%). In the selected diagnosis groups, the trends ranged from -11.6% to +115.8% and were generally steady over time, though stronger or stagnating trends were seen in some groups from 2020 onward. Diagnostic prevalence rose to a greater extent in male (+18.3%) than in female individuals (+10.8%) over the period 2012-2022. The greatest increases (> +15%) were seen among 11- to 17-yearolds and in 60- to 84-year-olds. The composition of the diagnosis spectrum was more stable in adults than in children and adolescents. CONCLUSION Trends in diagnostic prevalence differ across mental disorders and population subgroups and have changed in some diagnosis groups since the COVID-19 pandemic. Contextualizing research is needed for a better understanding of these developments.
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Affiliation(s)
- Julia Thom
- Robert Koch Institute, Department of Epidemiology and Health Monitoring; Central Research Institute of Ambulatory Health Care in Germany
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15
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Jedamzik J, Kampling H, Christoffer A, Szardenings C, Heuft G, Friederich HC, Kruse J. Do the elderly and those with comorbid chronic physical conditions have improved access to outpatient psychotherapy post structural reforms in Germany? Results of the ES-RiP study. Front Psychiatry 2024; 15:1349603. [PMID: 38742126 PMCID: PMC11090099 DOI: 10.3389/fpsyt.2024.1349603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Background In 2017, a reform of the German outpatient psychotherapy guideline was carried out, aiming to reduce waiting times and facilitate low-threshold access. This study analyzes the extent to which the implementation of the two new service elements 'psychotherapeutic consultation times' and 'acute short-term psychotherapeutic interventions' improved psychotherapeutic care for patients with mental disorders and chronic physical conditions (cMPs), for patients with mental disorders without chronic physical conditions (MnoP), and elderly patients. Methods In a quantitative secondary analysis, we analyzed health insurance data of patients with psychotherapy billing codes obtained from the National Association of Statutory Health Insurance Physicians (KBV) for the years 2015-2019, evaluating descriptive statistical parameters for specific patient groups and care services. Results Between 2015 and 2019, the number of mentally ill receiving psychotherapy at least once in the corresponding year increased by 30.7%. Among these, the proportion of cMPs-patients increased from 26.8% to 28.2% (+1.4%), while that of MnoP-patients decreased from 68.3% to 66.4% (-1.9%). The number of elderly people receiving treatment also increased. Conclusion Since increases and decreases in the percentage shares occur evenly over the years investigated, it is questionable whether the reform in 2017 has had a direct influence on these changes. Study registration ID DRKS00020344, URL: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html.
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Affiliation(s)
- Johanna Jedamzik
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Andrea Christoffer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Carsten Szardenings
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
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16
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Brown DMY, Lerner I, Cairney J, Kwan MY. Independent and Joint Associations of Physical Activity and Sleep on Mental Health Among a Global Sample of 200,743 Adults. Int J Behav Med 2024:10.1007/s12529-024-10280-8. [PMID: 38532194 DOI: 10.1007/s12529-024-10280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Previous research has demonstrated that both sleep and physical activity (PA) are independently associated with various indicators of mental health among adults. However, their joint contribution to mental health has received limited attention. The present study used cross-sectional data from the Mental Health Million Project to examine the independent and joint effects of sleep and PA on mental health among a global sample of adults, and whether these effects differ among individuals receiving mental health treatment. METHOD The sample included 200,743 participants (33.1% young adults, 45.6% middle-aged adults, 21.3% older adults; 57.6% females, 0.9% other) from 213 countries, territories, and archipelagos worldwide that completed a comprehensive 47-item assessment of mental health including both problems (i.e., ill-being) and assets (i.e., well-being): the Mental Health Quotient. Participants also reported their weekly frequency of PA and adequate sleep, and mental health treatment status. A series of generalized linear mixed models were computed. RESULTS Independent dose-response associations were observed, whereby greater amounts of PA and adequate sleep were each associated with better mental health. In addition, a synergistic interaction was observed in which the positive correlation of PA with mental health was strengthened with greater frequency of adequate sleep. These benefits were less pronounced among adults receiving mental health treatment. CONCLUSION While findings suggest sleep can help to offset the negative influence of a physically inactive lifestyle (and vice versa), our results point to a "more is better" approach for both behaviors when it comes to promoting mental health.
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Affiliation(s)
- Denver M Y Brown
- Department of Psychology, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, USA.
| | - Itamar Lerner
- Department of Psychology, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, USA
| | - John Cairney
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Matthew Y Kwan
- Department of Child and Youth Studies, Brock University, St. Catherines, Canada
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Behr S, Fenski F, Boettcher J, Knaevelsrud C, Hammelrath L, Kovacs G, Schirmer W, Petrick H, Becker P, Schaeuffele C. TONI - One for all? Participatory development of a transtheoretic and transdiagnostic online intervention for blended care. Internet Interv 2024; 35:100723. [PMID: 38370289 PMCID: PMC10874715 DOI: 10.1016/j.invent.2024.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/13/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
Background Internet-based interventions offer a way to meet the high demand for psychological support. However, this setting also has disadvantages, such as the lack of personal contact and the limited ability to respond to crises. Blended care combines Internet-based interventions with face-to-face psychotherapy and merges the benefits of both settings. To ensure the uptake of blended care in routine care, Internet-based interventions need to be suitable for different therapeutic approaches and mental disorders. Objective This paper describes the participatory development process of the Internet-based intervention "TONI" using a common therapeutic language and content on various transdiagnostic topics to be integrated into routine outpatient psychotherapy. Methods To develop this intervention in a participatory manner, we followed the Integrate, Design, Assess, and Share (IDEAS) framework. In a multilevel development process, we used a combination of interviews, focus groups, and proofreading to optimally tailor online modules to routine outpatient psychotherapy. Building on well-established cognitive-behavioral online content, we included expert interviews with psychodynamic (n = 20) and systemic psychotherapists (n = 9) as well as focus groups with psychotherapists of different approaches (n = 10) and persons with lived experience of mental illness (PWLE; n = 10). Results We describe the development process of TONI step-by-step, outlining the specific requirements that therapists from different therapeutic approaches as well as PWLE have and how we implemented them in our intervention. This includes the content and specific exercises in the online modules, aspects of data protection, language, design, and usability. Conclusion Internet-based interventions that use a common therapeutic language and address therapeutic principles across different approaches have the potential to advance digitalization in psychotherapy. Involving psychotherapists and PWLE in intervention development may positively impact acceptance and usage in practice. This study shows how participatory intervention development involving both psychotherapists and PWLE can be carried out.
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Affiliation(s)
- S. Behr
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - F. Fenski
- Department of Psychology and Psychotherapy, Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179 Berlin, Germany
| | - J. Boettcher
- Department of Psychology and Psychotherapy, Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179 Berlin, Germany
| | - C. Knaevelsrud
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - L. Hammelrath
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - G. Kovacs
- Berlin School of Design and Communications, SRH Berlin University of Applied Sciences, Prinzenstraße 84.1, 10969 Berlin, Germany
| | - W. Schirmer
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - H. Petrick
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - P. Becker
- Department of Psychology and Psychotherapy, Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179 Berlin, Germany
| | - C. Schaeuffele
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
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Bister MD. Making un/equal: reassessing inequality and mental health through a praxeographic approach on welfare categorization processes. Soc Psychiatry Psychiatr Epidemiol 2024; 59:467-473. [PMID: 37715812 PMCID: PMC10944380 DOI: 10.1007/s00127-023-02550-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 08/15/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE In recent decades, Europe has seen a steady increase in psychiatric diagnoses, which, besides affecting the population in many ways, also challenges the organization of welfare. This paper explores how welfare classification processes impact the contemporary production of mental (ill) health and social inequality in the German welfare state. METHODS Based on comprehensive ethnographic research in the public mental healthcare landscape in Berlin between 2011 and 2017, this paper discusses in detail the case of a mandatory prescription of a psychosocial rehabilitation measure for Ms Reisch, a psychiatric service user and ethnographic research partner. The analysis draws on the methodological approach of praxeography to examine how this case challenges the social determinants of mental health framework and the conceptual work of the sociology of inequality on which the categories of welfare are largely built. RESULTS The paper highlights the essentializing properties of social categories, whether in the sociology of inequality or in social and mental health policy. It also demonstrates the strength of praxeography to expose how multiple welfare categorization processes shape experiences and events of dis/ability in practice, potentially contradicting the stated intentions of social policy. CONCLUSION The results suggest that the attachment of categories to people in public welfare needs to be changed to make public administration more flexible to responding to the situated processes that bring about differentiations of equal and unequal in practice. The paper, therefore, encourages social inquiry into the potentialities of a post-categorical social policy framework.
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Affiliation(s)
- Milena D Bister
- Institute of European Ethnology, Humboldt-Universität zu Berlin, Berlin, Germany.
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19
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Hajduk M, Tiedemann E, Romanos M, Simmenroth A. Neuroenhancement and mental health in students from four faculties - a cross-sectional questionnaire study. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc9. [PMID: 38504866 PMCID: PMC10946206 DOI: 10.3205/zma001664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/31/2023] [Accepted: 11/29/2023] [Indexed: 03/21/2024]
Abstract
Background Students face great challenges at the beginning of and during their studies. Competitive experience, exam anxiety, and especially the new performance requirements often cause test anxiety and stressful experiences. The extent of substance use in terms of neuroenhancement (NE) is unclear. Evidence shows associations between NE, increased stress levels, and mental health. Objectives We aim to determine the prevalence of NE and alcohol and tobacco use among college students. We also investigate the associations between NE and ADHD, anxiety, depression, and stress experience. Methods In spring 2021, an anonymous online cross-sectional survey was conducted among students of medicine, dentistry, business economics, and business informatics in Würzburg. The survey included the instruments ASRS (ADHD), PSS-10 (stress), PHQ-4 (depression and anxiety), and AUDIT-C (alcohol comsumption), as well as questions about consumption patterns, prior knowledge, and reasons for NE. Results Of the 5564 students who were invited to participate, 1010 completed the questionnaire (18.2%). Of these, 12.4% indicated NE for the studied period. NE was used in particular during preparations for exams, to enhance performance, and/or to regulate emotions, most commonly through caffeine tablets, cannabis, and methylphenidate. NE was associated with risky use of alcohol or tobacco, and to a lesser extent with ADHD symptoms and stress experience.Conclusions: Students are at risk of substance abuse and NE. Effective stress management and prevention approaches as well as low-threshold services are needed to identify and support students with risk profiles.
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Affiliation(s)
- Maurice Hajduk
- University Medical Centre Würzburg, Institute of General Practice, Würzburg, Germany
| | - Elena Tiedemann
- University Medical Centre Würzburg, Institute of General Practice, Würzburg, Germany
| | - Marcel Romanos
- University Medical Centre Würzburg, Clinic and Polyclinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Würzburg, Germany
| | - Anne Simmenroth
- University Medical Centre Würzburg, Institute of General Practice, Würzburg, Germany
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20
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Otten D, Heller A, Schmidt P, Beutel ME, Brähler E. Gender differences in the prevalence of mental distress in East and West Germany over time: a hierarchical age-period-cohort analysis, 2006-2021. Soc Psychiatry Psychiatr Epidemiol 2024; 59:315-328. [PMID: 37041297 PMCID: PMC10089379 DOI: 10.1007/s00127-023-02479-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/30/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE Mental distress has become a major public health concern. Temporal trends in psychological distress are complex and depend on numerous factors. In this study, we examined age-period-cohort effects for mental distress including gender and German region over a 15 years' time span. METHODS Data on mental distress from ten cross-sectional surveys of the general German population, covering the years from 2006 to 2021, was used. Hierarchical age-period-cohort analyses including gender and German region as predictors were performed to disentangle age, period, and cohort effects. The Patient Health Questionnaire-4 was used as a brief screener for mental distress. RESULTS We found significant period and cohort effects, with peek values for mental distress in the years 2017 and 2020 and for the oldest birth cohort (born before 1946). Age did not affect mental distress when cohort- and period effects as well as gender and German region were considered. An interaction effect for gender and the German region was found. Women in West Germany reported significantly higher mental distress compared to women in East Germany. Compared to men, women reported the highest prevalence in both regions. CONCLUSION Important political events as well as major crises can lead to an increase of mental distress in societies. Furthermore, an association between birth cohort and mental distress could be linked to socialization effects of that certain time, causing traumatic experiences or a specific coping style within this cohort group. Prevention and intervention strategies could benefit from acknowledging structural differences linked to period and cohort effects.
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Affiliation(s)
- Daniëlle Otten
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Ayline Heller
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Peter Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
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Meidl V, Dallmann P, Leonhart R, Bretthauer B, Busch A, Kubosch EJ, Wrobel N, Hirschmüller A. Validation of the Patient Health Questionnaire-4 for longitudinal mental health evaluation in elite Para athletes. PM R 2024; 16:141-149. [PMID: 37294844 DOI: 10.1002/pmrj.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/02/2023] [Accepted: 05/11/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite the increasing amount of research regarding mental health in elite athletes in recent years, athletes with impairments are hardly represented. Due to this lack of data and the significant need of athlete-specific mental health screening tools, a continuous mental health monitoring program for elite Para athletes was implemented. OBJECTIVE Validation of the Patient Health Questionnaire-4 (PHQ-4) as a suitable tool for continuous mental health evaluation in elite Para athletes. DESIGN A 43-week prospective observational cohort study. SETTING Online questionnaire, provided weekly via web browser and mobile app. PARTICIPANTS Seventy-eight Para athletes preparing for Paralympic Summer and Winter Games. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Weekly PHQ-4 scores, stress level, and mood. RESULTS With a mean weekly response rate of 82.7% (SD = 8.0), 2149 PHQ-4, 2159 stress level and 2153 mood assessments were completed. Mean PHQ-4 score among all participating athletes was 1.2 (SD = 1.8; 95% confidence interval [CI], [1.1-1.3]). Individual weekly scores ranged from 0 to 12 and showed significant floor effects, with 54% of the scores being zero. PHQ-4 scores were significantly higher among female athletes and team sport members (p < .001). Internal consistency of the PHQ-4 was satisfying, Cronbach's α being 0.839. There were significant cross-sectional as well as longitudinal correlations of PHQ-4 and stress level as well as mood values (p < .001). 39.7% of all athletes (n = 31) had at least one positive screen for mental health symptoms. CONCLUSIONS The PHQ-4 was shown to be a valid tool for mental health surveillance in elite Para athletes. Significant correlations of the PHQ-4 and stress level as well as mood were shown. High weekly response rates among participating athletes indicated good acceptance of the program. The weekly monitoring allowed for the identification of individual fluctuations and could identify potential athletes at risk for mental health problems when combined with clinical follow-up.
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Affiliation(s)
- Verena Meidl
- Department of Orthopedics and Trauma Surgery, Center of Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Petra Dallmann
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Rainer Leonhart
- Department of Psychology, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Berit Bretthauer
- Department of Orthopedics and Trauma Surgery, Center of Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Aglaja Busch
- Department of Orthopedics and Trauma Surgery, Center of Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Outpatient Clinic, Sport Medicine & Sports Orthopedics, University of Potsdam, Potsdam, Germany
- Division Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Eva Johanna Kubosch
- Department of Orthopedics and Trauma Surgery, Center of Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Nina Wrobel
- Institute for Exercise and Occupational Medicine, Center for Medicine, Medical Center-Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Anja Hirschmüller
- Department of Orthopedics and Trauma Surgery, Center of Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- ALTIUS Swiss Sportmed Center AG, Rheinfelden, Switzerland
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22
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Wirkner J, Brakemeier EL. The crisis is over, long live the crisis: mental health in emerging adulthood during the course of the COVID-19 pandemic. Front Psychol 2024; 15:1283919. [PMID: 38356763 PMCID: PMC10864646 DOI: 10.3389/fpsyg.2024.1283919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction As a multidimensional stressor, the COVID-19 pandemic posed a significant threat to mental health, with studies showing younger age groups to be particularly vulnerable. Thus, this study aimed to monitor mental health, potential risk/protective factors, and pandemic-related variables among young university students during the pandemic. Methods Students of the University of Greifswald (M age = 23.0 years, 73.9% female) participated in five cross-sectional online surveys in December 2020 (N = 1,127), March 2021 (N = 760), June/July 2021 (N = 531), December 2021 (N = 1,226), and December 2022 (N = 814). Sociodemographic data, depression and anxiety severity, loneliness, quality of life, coping strategies, resilience, self-esteem, and emotion regulation were measured. First, results from December 2020 were compared to pre-pandemic normative data. Second, the time course during the pandemic was analyzed. Third, linear models were calculated to examine the influence of risk and protective factures on depression and anxiety severity. Results Higher levels of depression, anxiety, and loneliness, as well as lower levels of self-esteem, physical and mental health, social relationships and well-being were found in December 2020 compared to pre-pandemic. Levels of depression and anxiety severity peaked in December 2022. Female sex, loneliness, and previous mental treatment showed associations with higher depression and anxiety severity, while higher self-esteem, resilience and use of reappraisal strategies appeared to act as protective factors. Discussion The study indicates the pandemic's detrimental impact on students' mental health and quality of life. Identified risk and protective factors provide guidance for tailored prevention and treatment, as well as the design of measures for future pandemics and other crisis.
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Affiliation(s)
| | - Eva-Lotta Brakemeier
- Department for Clinical Psychology and Psychotherapy, Institute for Psychology, University of Greifswald, Greifswald, Germany
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23
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Maier L, Engesser D, Paul R, Reuter K, Petermann-Meyer A, Singer S. [The Structural Reform of The Psychotherapy Guidelines in Germany]. PSYCHIATRISCHE PRAXIS 2024; 51:31-38. [PMID: 37678409 DOI: 10.1055/a-2112-3549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Our study investigates how psychotherapists implement and assess the newly introduced elements of the structural reform of the psychotherapy guideline in Germany. METHODS We asked psychotherapists about their experiences with the structural reform in semi-structured interviews. The data was analysed using qualitative content analysis. RESULTS A total of 37 h of audio material from 41 psychotherapists were available. The interviews showed that acute treatment and relapse prevention are welcomed by psychotherapists. However, due to lack of appointment capacity as well as conceptual barriers, these are rarely used. Concerning psychotherapeutic assessment consultations, the opinions were heterogeneous. CONCLUSION Individual aspects of the new care elements are assessed positively. However, these can only be implemented to a limited extent and are not sufficient to significantly improve the strained supply situation.
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Affiliation(s)
- Lena Maier
- Institut für Medizinische Biometrie, Epidemiologie und Versorgungsforschung, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Deborah Engesser
- Institut für Medizinische Biometrie, Epidemiologie und Versorgungsforschung, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | | | | | | | - Susanne Singer
- Institut für Medizinische Biometrie, Epidemiologie und Versorgungsforschung, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
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24
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Schulz W, Hahlweg K, Job AK, Supke M. Prevalence, persistence, and course of symptoms of depression, anxiety, and stress of mothers and fathers. Results of an 18-year longitudinal study. J Affect Disord 2024; 344:301-310. [PMID: 37805157 DOI: 10.1016/j.jad.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/30/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Mental health problems in mothers and fathers are common. This longitudinal study analyzed the prevalence, course, and persistence of symptoms of depression, anxiety, and stress over 18 years in parents based on a sample from the Future Family project (N = 316). METHODS At pre-assessment the children were on average 4.2, the mothers 35.3, and the fathers 38.1 years old. Over time, the parents repeatedly filled out the "Depression, Anxiety, Stress Scales" (DASS). Analyses included descriptive methods, Chi2-tests, binary logistic regression models, and different analytical approaches (number chains, transition probability). RESULTS Approximately 6.2 % of mothers and 8.2 % of fathers suffered from borderline clinical or clinically relevant depression (anxiety: 5.4 %/6.3 %, stress: 12.6 %/14.2 %). The largest proportion of the sample was stable healthy over the 18-year period (depression: 89.1 %/86.8 %; anxiety: 90.2 %/86.2 %; stress: 75.3 %/75.7 %), whereas 2.2 % of mothers and 3.9 % of fathers showed chronic symptoms of depression (anxiety: 1.8 %/3.9 %; stress: 5.1 %/9.2 %). The remaining mothers and fathers were distributed among positive, negative, and transient courses. Child's mental health problems and mother's traumatic experiences in childhood were found to be important predictors of maternal chronic symptoms of depression, anxiety, and stress. Based on the selected models, no significant prediction was found for fathers. The average short-term persistence (from one assessment to the next) was 42 % in mothers and 44 % in fathers, the average long-term persistence rates (over 18 years) were somewhat lower (35 %/38 %). CONCLUSION Prevention programs and psychotherapy should be considered as an effective and economic approach to reduce mothers' and fathers' psychopathology in Germany.
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Affiliation(s)
- Wolfgang Schulz
- Institute for Psychology, Technische Universität Braunschweig, Germany.
| | - Kurt Hahlweg
- Institute for Psychology, Technische Universität Braunschweig, Germany
| | - Ann-Katrin Job
- Institute for Psychology, Technische Universität Braunschweig, Germany
| | - Max Supke
- Institute for Psychology, Technische Universität Braunschweig, Germany
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25
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Margraf J, Lavallee KL, Zhang XC, Schneider S. Three-wave longitudinal prediction of positive mental health in Germany and China. PLoS One 2023; 18:e0287012. [PMID: 38127973 PMCID: PMC10735011 DOI: 10.1371/journal.pone.0287012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 05/29/2023] [Indexed: 12/23/2023] Open
Abstract
The present study is a follow-up of a prior study examining a broad range of longitudinal predictors of dimensional positive mental health (PMH) and negative mental health (NMH), using cross-cultural data from the Bochum Optimism and Mental Health (BOOM) study. The present study sought to expand prior findings on positive mental health predictors to a longer longitudinal timeframe. The analysis, specifically, tests our prior model using a third time point, The following positive constructs were examined in relation to later positive mental health: resilience, social support, social rhythm, family affluence, physical health and expectations for fertility. Negative predictors depression, anxiety, and stress were also examined in relation to time 3 positive mental health. Participants included university student samples from Germany (N = 591) and China (N = 8,831). Structural equation modeling was used to examine the effects of predictors on mental health. In China, three of the six salutogenic predictors (social rhythm regularity, positive mental health, resilience) at baseline were predictive of positive mental health at both follow-ups with generally small, but significant effects. Social support at baseline predicted more, and stress and anxiety predicted less positive mental health at follow-up 1, with generally small effects. Depression at baseline predicted less positive mental health at follow-up 2. In Germany, two of the six salutogenic predictors (positive mental health, social support) at baseline were predictive of positive mental health at both follow-ups, with generally small effects. Pathogenic predictors were not predictive of positive mental health at either follow-up. According to multi group analysis, the paths from positive mental health baseline to positive mental health follow-up 1 (FU1) as well as the path positive mental health FU1 to positive mental health follow-up 2 (FU2) were found to differ between Germany and China. All other paths could be seen as equivalent in Germany and China. Results indicate prediction of positive mental health over an extended period of time, and in particular by salutogenic predictors. Pathogenic predictors were also (negatively) predictive of PMH, but with more mixed results, underscoring the differential prediction of PMH from salutogenic and pathogenic factors.
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Affiliation(s)
- Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Kristen L. Lavallee
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Xiao Chi Zhang
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
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Szymczak H, Dodoo-Schittko F, Brandstetter S, Rohr M, Blecha S, Bein T, Apfelbacher C. Trajectories of quality of life, return to work, psychopathology, and disability in survivors of the acute respiratory distress syndrome (ARDS): A three-year prospective cohort study (DACAPO). J Crit Care 2023; 78:154356. [PMID: 37385044 DOI: 10.1016/j.jcrc.2023.154356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/24/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Describe the long-term development of outcomes for survivors of the Acute Respiratory Distress Syndrome (ARDS). MATERIAL AND METHODS A cohort study with N = 877 ARDS survivors was conducted. Health related quality of life (HRQoL, Physical and Mental Component Scale: PCS, MCS of the SF-12), return to work (RtW), panic disorder, depressive symptoms (PHQD), and post-traumatic-stress-disorder (PTSD, PTSS-14) were assessed at 3, 6, 12, 24, and 36 months after discharge from ICU. RESULTS PCS, MCS, and RtW increased during the first 12 months [e.g. PCS: Md = 36 (IQR 31-43) at 3 months, Md = 42 (IQR 34-52) at 12 months; MCS: Md = 44 (IQR 32-54) at 3 months, Md = 47 (IQR 33-57) at 12 months, RtW = 23.2% at 3 months, 54.5% at 12 months], and remained relatively stable afterwards. Proportion of major depressive syndrome decreased from 3 (14.2%) to 36 months (8.9%). Proportions of panic disorder (5.3% to 7.4%) and PTSD (27.1% to 32.6%) varied only slightly. CONCLUSIONS Most of recovery in HRQoL and RtW occur during the first 12 months, after which a plateau is reached, indicating a chronification for many patients. Contrary to this, however, psychopathological symptoms remain stable, except for depressive symptoms. [200 words].
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Affiliation(s)
- Hermann Szymczak
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Frank Dodoo-Schittko
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany; Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Susanne Brandstetter
- Medical Sociology, University of Regensburg, Regensburg, Germany; University Children's Hospital Regensburg (KUNO), University of Regensburg, Regensburg, Germany
| | - Magdalena Rohr
- Medical Sociology, University of Regensburg, Regensburg, Germany; University Children's Hospital Regensburg (KUNO), University of Regensburg, Regensburg, Germany
| | - Sebastian Blecha
- Department for Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Bein
- Medical Faculty, University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany; Medical Sociology, University of Regensburg, Regensburg, Germany
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27
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Gumz A, Reuter L, Löwe B, Voderholzer U, Schwennen B, Fehrs H, Wünsch-Leiteritz W, Brunner R, Kästner D, Zapf A, Weigel A. Factors influencing the duration of untreated illness among patients with anorexia nervosa: A multicenter and multi-informant study. Int J Eat Disord 2023; 56:2315-2327. [PMID: 37814447 DOI: 10.1002/eat.24069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION The duration of untreated illness (DUI), that is, the interval between the onset of anorexia nervosa (AN) symptoms and start of specialized treatments, has a strong influence on the prognosis. OBJECTIVE To quantify modifiable predictors of the DUI and to derive recommendations for secondary prevention strategies. METHODS Within a multicenter, multi-informant study, DUI was assessed in interviews with patients undergoing first specialized AN treatment. Modifiable factors were assessed perspectives of AN-patients, their relatives, and primary care practitioners [PCPs]) with the FABIANA-checklist (Facilitators and barriers in anorexia nervosa treatment initiation). The effect of FABIANA-items on the DUI for each perspective was calculated using Cox Regression (control variables: age, eating disorder pathology, health care status, migration background, body mass index [BMI]). RESULTS We included data from N = 125 female patients with AN (72 adults, 53 adolescents, Mage = 19.2 years, SD = 4.2, MBMI = 15.7 kg/m2 , SD = 1.9), N = 89 relatives (81.8% female, 18.2% male, Mage = 46.0 years, SD = 11.0) and N = 40 PCPs (Mage = 49.7 years, SD = 9.0). Average DUI was 12.0 months. Watching or reading articles about the successful treatment of other individuals with AN (patients' perspective) and regular appointments with a PCP (PCPs' perspective) were related to a shorter DUI (HR = 0.145, p = .046/ HR = 0.395, p = .018). Patients whose relatives rated that PCPs trivialized patients' difficulties had a longer DUI (HR = -0.147, p = .037). PCPs and relatives rated PCPs' competence higher than patients did. DISCUSSION It is recommended (a) to incorporate treatment success stories in prevention strategies, (b) to inform PCPs about potential benefits of regular appointments during the transition to specialized care, and (c) to train PCPs in dealing with patients' complaints. PUBLIC SIGNIFICANCE Many individuals with AN seek treatment very late. Our study shows that a promising approach to facilitate earlier AN treatment is to inform patients about successful treatments of affected peers, to foster regular appointments with a PCP and, to motivate these PCPs to take individuals' with AN difficulties seriously. Thus, our study provides important suggestions for interventions that aim to improve early treatment in AN.
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Affiliation(s)
- Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Laurence Reuter
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Voderholzer
- Schön Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| | | | - Helge Fehrs
- Department of Psychosomatic Medicine and Psychotherapy, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | | | - Romuald Brunner
- Department for Paediatric and Adolescent Medicine, Medical University Center Regensburg, Hamburg, Germany
| | - Denise Kästner
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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28
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Thoma MV, Salas Castillo AN, Maercker A. [Psychotherapy for elderly patients]. Psychother Psychosom Med Psychol 2023; 73:516-528. [PMID: 38048814 DOI: 10.1055/a-1993-9570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
A particular feature of the demographic change is the growing proportion of elderly and very elderly people. In Western countries, this is largely due to improved medical care for age-associated diseases. There is still comparatively little knowledge about mental health disorders in old age, their age-typical clinical presentation and specific psychotherapeutic treatment.
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29
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Heck J, Noltemeyer N, Schulze Westhoff M, Deest-Gaubatz S, Schröder S, Krichevsky B, Simon N, Gerbel S, Friedrich M, Stichtenoth DO, Bleich S, Frieling H, Groh A. Adverse drug reactions in geriatric psychiatry-retrospective cohort study of a 6-year period. Ir J Med Sci 2023; 192:2917-2927. [PMID: 36807758 PMCID: PMC10692025 DOI: 10.1007/s11845-023-03300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/29/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To investigate the frequency and characteristics of adverse drug reactions (ADRs) that occurred on the gerontopsychiatric ward of Hannover Medical School over a 6-year period. DESIGN Retrospective monocentric cohort study. RESULTS Six hundred thirty-four patient cases (mean age 76.6 ± 7.1 years; 67.2% female) were analysed. In total, 92 ADRs in 56 patient cases were registered in the study population. The overall ADR prevalence, the ADR prevalence upon hospital admission, and the ADR prevalence during hospitalisation were 8.8%, 6.3%, and 4.9%, respectively. The most frequent ADRs were extrapyramidal symptoms, alterations in blood pressure or heart rate, and electrolyte disturbances. Of note, two cases of asystole and one case of obstructive airway symptoms related to general anaesthesia in the context of electroconvulsive therapy (ECT) were detected. The presence of coronary heart disease was associated with an increased risk of ADR occurrence (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.37-6.22), while the presence of dementia was associated with a decreased risk of ADR development (OR 0.45, 95% CI 0.23-0.89). CONCLUSIONS Type and prevalence of ADRs in the present study were largely in accordance with previous reports. By contrast, we did not observe a relationship between advanced age or female sex and ADR occurrence. We detected a risk signal for cardiopulmonary ADRs related to general anaesthesia in the context of ECT that warrants further investigation. Elderly psychiatric patients should be carefully screened for cardiopulmonary comorbidities before initiation of ECT.
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Affiliation(s)
- Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
| | - Nina Noltemeyer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stephanie Deest-Gaubatz
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Benjamin Krichevsky
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
- Medical Service of the German Armed Forces, Kiel, Germany
| | - Nicolas Simon
- Hannover Medical School, MHH Information Technology, Hannover, Germany
| | - Swetlana Gerbel
- Hannover Medical School, MHH Information Technology, Hannover, Germany
| | | | - Dirk O Stichtenoth
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Drug Commissioner of Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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30
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Hebestreit H, Lapstich AM, Brandstetter L, Krauth C, Deckert J, Haas K, Pfister L, Witt S, Schippers C, Dieris-Hirche J, Maisch T, Tüscher O, Bârlescu L, Berger A, Berneburg M, Britz V, Deibele A, Graeßner H, Gündel H, Heuft G, Lücke T, Mundlos C, Quitmann J, Rutsch F, Schubert K, Schulz JB, Schweiger S, Zeidler C, Zeltner L, de Zwaan M. Effect of the addition of a mental health specialist for evaluation of undiagnosed patients in centres for rare diseases (ZSE-DUO): a prospective, controlled trial with a two-phase cohort design. EClinicalMedicine 2023; 65:102260. [PMID: 37855024 PMCID: PMC10579280 DOI: 10.1016/j.eclinm.2023.102260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
Background People with complex symptomatology but unclear diagnosis presenting to a centre for rare diseases (CRD) may present with mental (co-)morbidity. We hypothesised that combining an expert in somatic medicine with a mental health specialist working in tandem will improve the diagnostic outcome. Methods Patients aged 12 years and older who presented to one of the 11 participating German CRDs with an unknown diagnosis were recruited into this prospective cohort trial with a two-phase cohort design. From October 1, 2018 to September 30, 2019, participants were allocated to standard care (SC, N = 684), and from October 1, 2019 to January 31, 2021 to innovative care (IC, N = 695). The cohorts consisted mainly of adult participants with only a minority of children included (N = 67). IC included the involvement of a mental health specialist in all aspects of care (e.g., assessing medical records, clinic visits, telehealth care, and case conferences). Clinicaltrials.gov identifier: NCT03563677. Findings The proportion of patients with diagnoses established within 12 months after the first visit to the CRD explaining the entire symptomatology (primary outcome) was 19% (N = 131 of 672) in the SC and 42% (N = 286 of 686) in the IC cohort (OR adjusted for centre effects 3.45 [95% CrI: 1.99-5.65]). The difference was mainly due to a higher prevalence of mental disorders and non-rare somatic diseases in the IC cohort. The median time to explaining diagnoses was one month shorter with IC (95% CrI: 1-2), and significantly more patients could be referred to local regular care in the IC (27.5%; N = 181 of 659) compared to the SC (12.3%; N = 81 of 658) cohort (OR adjusted for centre effects 2.70 [95% CrI: 2.02-3.60]). At 12-month follow-up, patient satisfaction with care was significantly higher in the IC compared to the SC cohort, while quality of life was not different between cohorts. Interpretation Our findings suggested that including a mental health specialist in the entire evaluation process of CRDs for undiagnosed adolescents and adults should become an integral part of the assessment of individuals with a suspected rare disease. Funding The study was funded by the Global Innovation Fund from the Joint Federal Committee in Germany (Innovationsfonds des Gemeinsamen Bundesausschusses), grant number 01NVF17031.
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Affiliation(s)
- Helge Hebestreit
- Centre for Rare Diseases - Reference Centre Northern Bavaria (ZESE), University Hospital Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Anne-Marie Lapstich
- Centre for Health Economics Research Hannover and Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Lilly Brandstetter
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Christian Krauth
- Centre for Health Economics Research Hannover and Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, University Hospital, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Kirsten Haas
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Lisa Pfister
- Centre for Rare Diseases - Reference Centre Northern Bavaria (ZESE), University Hospital Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Stefanie Witt
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christopher Schippers
- Center for Rare Diseases and Department of Digitalization and General Practice, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jan Dieris-Hirche
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany
| | - Tim Maisch
- Centre for Rare Diseases Regensburg, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Oliver Tüscher
- Centre for Rare Diseases and Department of Psychiatry and Psychotherapy, University Medical Centre. Johannes Gutenberg University, and Institute for Molecular Biology, 55131, Mainz, Germany
| | - Lavinia Bârlescu
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Alexandra Berger
- Frankfurt Reference Centre for Rare Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Mark Berneburg
- Centre for Rare Diseases Regensburg, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Britz
- Frankfurt Reference Centre for Rare Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Anna Deibele
- Central German Competence Network for Rare Diseases, University Hospital Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Holm Graeßner
- Centre for Rare Disease, University Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Albert.-Einstein-Allee 23, 89081, Ulm, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine Und Psychotherapy, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Thomas Lücke
- University Hospital of Paediatrics and Adolescent Medicine, Ruhr-University Bochum, Alexandrinenstr. 5, 44791, Bochum, Germany
| | - Christine Mundlos
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e.V., c/o DRK Kliniken Berlin Mitte, Dronheimer Str. 39, 13359, Berlin, Germany
| | - Julia Quitmann
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Frank Rutsch
- Department of General Paediatrics, Muenster University Children's Hospital and Centre for Rare Diseases, Muenster University Hospital, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Katharina Schubert
- Central German Competence Network for Rare Diseases, University Hospital Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Jörg Bernhard Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Susann Schweiger
- Centre for Rare Diseases and Institute for Human Genetics, University Medical Centre, Johannes Gutenberg University, and Institute for Molecular Biology, 55131, Mainz, Germany
| | - Cornelia Zeidler
- Centre for Rare Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Lena Zeltner
- Department of Psychosomatics and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Kohl F, Angerer P, Weber J. Determinants of the intention to seek psychotherapeutic consultation at work - a cross-sectional study in Germany. BMC Public Health 2023; 23:1945. [PMID: 37805517 PMCID: PMC10559521 DOI: 10.1186/s12889-023-16852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Psychotherapeutic consultation at work (PT-A) provides employees with mental illnesses or subclinical symptoms a short-term and low-threshold access to psychotherapeutic care. However, practical experience shows that the utilisation rate seems low compared to expected demand. Therefore, this study aimed to identify determinants of utilisation by exploring associations between sociodemographic characteristics, psychological well-being, stigma-related barriers and psychosocial safety climate and the intention to seek PT-A. METHODS Within a cross-sectional study, 658 participants were recruited via various social media channels in Germany. Participants answered an online questionnaire on potential determinants of (1) intention to seek PT-A in general and of intention to seek PT-A to specifically discuss (2) occupational burden and (3) private burden. Multiple ordinal regression analyses were conducted for the whole study sample and for the subgroups of participants screened positive and negative for current depression. RESULTS Lower stigma-related barriers were associated with higher general intention to seek PT-A among all study groups. Lower psychological well-being was associated with higher general intention to seek PT-A and with higher intention to seek PT-A to discuss occupational and private burden, but only so in the subgroup of employees who were screened negative for current depression. Treatment experience was associated with higher intention to seek PT-A for occupational burden among participants screened negative but not among participants screened positive for current depression. No associations were found between age, gender, education or psychosocial safety climate and any variable of intention to seek PT-A. CONCLUSION Those results give an overview on potential determinants for the intention to seek PT-A, but future research with longitudinal designs is needed to confirm that those factors also determine actual utilisation of PT-A. Based on the results, practical implications might include antistigma campaigns and promotion of PT-A adapted to the aims of the consultation.
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Affiliation(s)
- Fiona Kohl
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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Engesser D, Maier L, Schepers M, Singer S. [Psychotherapeutic appointments given by Associations of Statutory Health Insurance Physicians in 2019 : An analysis differentiated by appointment type and region]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1163-1171. [PMID: 37594498 PMCID: PMC10539429 DOI: 10.1007/s00103-023-03756-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND One provision of the Care Provision Strengthening Act in Germany was that psychotherapeutic appointments (psychotherapeutic consultation, acute care, and probatory sessions) are now arranged through the Association of Statutory Health Insurance Physicians organizations. We examined how many appointments were requested and given in 2019, differentiated by appointment type and by city state versus areal state organizations. METHODS The frequency of requests and appointments made in 2019 were collected from the Association of Statutory Health Insurance Physicians organizations in Germany using a questionnaire. Statistical analysis comprised descriptive evaluations and a Kruskal-Wallis test. RESULTS Data for appointments were available from 17 and information on requests from 16 Association of Statutory Health Insurance Physicians organizations. A total of 134,578 appointments were given. The number of granted appointments ranged from 193 to 21,810, revealing substantial differences between the individual organizations. The share of psychotherapeutic consultations among all psychotherapeutic appointments granted amounted to a median of 92%. Per organization, appointments were given for a median of 87% of requests for a psychotherapeutic consultation (range 56-100%), 96% for acute care requests (range 29-100%), and 97% for probatory session requests (range 27-100%) (n = 16, respectively). There were minor differences between city states and areal states in granting acute care and probatory sessions. DISCUSSION There are deficits both in city state and areal state Association of Statutory Health Insurance Physicians organizations in terms of granting acute care and probatory sessions. Our results do not allow conclusions about distance to the practices or waiting times.
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Affiliation(s)
- Deborah Engesser
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Abteilung Epidemiologie und Versorgungsforschung, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Rhabanusstr. 3, Turm A, 55118, Mainz, Deutschland.
| | - Lena Maier
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Abteilung Epidemiologie und Versorgungsforschung, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Rhabanusstr. 3, Turm A, 55118, Mainz, Deutschland
| | - Markus Schepers
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Abteilung Biometrie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Rhabanusstr. 3, Turm A, 55118, Mainz, Deutschland
| | - Susanne Singer
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Abteilung Epidemiologie und Versorgungsforschung, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Rhabanusstr. 3, Turm A, 55118, Mainz, Deutschland
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Markser A, Blaschke K, Meyer I, Jessen F, Schubert I, Albus C. Claims data analysis of the health care utilization for patients with coronary heart disease and mental comorbidity. J Psychosom Res 2023; 172:111430. [PMID: 37421747 DOI: 10.1016/j.jpsychores.2023.111430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Mental disorders (MD) are a common comorbidity in patients with coronary heart disease (CHD) and have a significant impact on morbidity and mortality. The aim of this study was to determine to what extent mental disorders are diagnosed as comorbidity in patients with CHD and whether adequate therapeutic measures are taken. METHODS Claims data from 4435 Cologne citizens with diagnosed CHD and a hospital stay due to CHD in 2015 were examined through a longitudinal analysis. The data were analyzed descriptively with regard to mental disorders, investigating diagnostic examinations performed, prescriptions for psychotropic drugs, and utilization of psychotherapy. We differentiated between pre-existing MD, existing in the year before the CHD-related hospital stay, and incident MD with new onset during or within six months after hospitalization. RESULTS Psychodiagnostic examinations for mental disorders occurred very rarely during cardiological hospitalization (0.04%) and psychiatric/psychosomatic consultation sessions rarely (5%). The longitudinal analysis showed a high rate of pre-existing MDs (56%, n = 2490) and a new diagnosis of mental disorders in 7% (n = 302) of the patients. Within one year after inpatient treatment for CHD, psychotropic medication was prescribed in 64-67% of patients with newly diagnosed affective or neurotic, adjustment/somatoform disorder and 10-13% received outpatient psychotherapy. CONCLUSION The results indicate low rates of inpatient diagnostic examinations and low rates of adequate treatment of mental disorders in patients from Cologne with CHD and new onset mental disorders. The rate of prescriptions of psychopharmacotherapy after hospitalization due to CHD exceeds that of the utilization of outpatient psychotherapy.
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Affiliation(s)
- Anna Markser
- Dept. of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Germany.
| | - Katja Blaschke
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
| | - Ingo Meyer
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
| | - Frank Jessen
- Dept. of Psychiatry and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, North Rhine-Westphalia, Germany.
| | - Ingrid Schubert
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
| | - Christian Albus
- Dept. of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Germany.
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Gryksa K, Schmidtner AK, Masís-Calvo M, Rodríguez-Villagra OA, Havasi A, Wirobski G, Maloumby R, Jägle H, Bosch OJ, Slattery DA, Neumann ID. Selective breeding of rats for high (HAB) and low (LAB) anxiety-related behaviour: A unique model for comorbid depression and social dysfunctions. Neurosci Biobehav Rev 2023; 152:105292. [PMID: 37353047 DOI: 10.1016/j.neubiorev.2023.105292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 06/25/2023]
Abstract
Animal models of selective breeding for extremes in emotionality are a strong experimental approach to model psychopathologies. They became indispensable in order to increase our understanding of neurobiological, genetic, epigenetic, hormonal, and environmental mechanisms contributing to anxiety disorders and their association with depressive symptoms or social deficits. In the present review, we extensively discuss Wistar rats selectively bred for high (HAB) and low (LAB) anxiety-related behaviour on the elevated plus-maze. After 30 years of breeding, we can confirm the prominent differences between HAB and LAB rats in trait anxiety, which are accompanied by consistent differences in depressive-like, social and cognitive behaviours. We can further confirm a single nucleotide polymorphism in the vasopressin promotor of HAB rats causative for neuropeptide overexpression, and show that low (or high) anxiety and fear levels are unlikely due to visual dysfunctions. Thus, HAB and LAB rats continue to exist as a reliable tool to study the multiple facets underlying the pathology of high trait anxiety and its comorbidity with depression-like behaviour and social dysfunctions.
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Affiliation(s)
- Katharina Gryksa
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Anna K Schmidtner
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Marianella Masís-Calvo
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Odir A Rodríguez-Villagra
- Centro de Investigación en Neurosciencias, Universidad de Costa Rica, San Pedro, San José, Costa Rica.
| | - Andrea Havasi
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Gwendolyn Wirobski
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Rodrigue Maloumby
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Herbert Jägle
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Oliver J Bosch
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - David A Slattery
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Heinrich-Hoffmann-Straße 10, 60528 Frankfurt am Main, Germany.
| | - Inga D Neumann
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
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Altwaijri YA, Al-Subaie AS, Al-Habeeb A, Galea S, Akkad M, Naseem MT, Bilal L. Urbanization and mental health: A perspective from Riyadh City, Kingdom of Saudi Arabia. Int J Soc Psychiatry 2023; 69:1121-1133. [PMID: 36825615 DOI: 10.1177/00207640231152202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND While global studies demonstrated that features of urban living are associated with the risk of developing mental disorders, there remains a significant knowledge gap surrounding this topic in the Middle East and North Africa region. AIMS This study aims to assess the prevalence, severity, correlates, and treatment of mental disorders in Riyadh City by examining certain aspects of urban living such as exposure to traumatic events, early exposure to urbanization, and seeking treatment. METHODS The Saudi National Mental Health Survey is a community epidemiological survey in a nationally representative sample of citizens aged 15 to 65 in KSA. The World Health Organization Composite International Diagnostic Interview (CIDI 3·0) was used to estimate the 12-month prevalence of common mental disorders. RESULTS The prevalence of any mental disorder in Riyadh City was 29.2%. The most common disorders were anxiety disorders and mood disorders. Female, young, and previously married respondents were at higher risk for developing mental disorders. Exposure to traumatic events was associated with all types of mental disorders. Only 2.9% of those with any mental disorder sought mental health treatments. CONCLUSIONS We found a high prevalence of mental disorders in Riyadh City that could be attributed to certain features of urban living. These results may point to potential interventions in urban areas that can mitigate the adverse consequences of urban living and promote the salutogenic aspects of cities.
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Affiliation(s)
- Yasmin A Altwaijri
- King Salman Center for Disability Research, Riyadh, Saudi Arabia
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah S Al-Subaie
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Edrak Medical Center, Riyadh, Saudi Arabia
| | - AbdulHameed Al-Habeeb
- National Center for Mental Health Promotion, Ministry of Health, Riyadh Saudi Arabia
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
| | - Marya Akkad
- King Salman Center for Disability Research, Riyadh, Saudi Arabia
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Talal Naseem
- King Salman Center for Disability Research, Riyadh, Saudi Arabia
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lisa Bilal
- King Salman Center for Disability Research, Riyadh, Saudi Arabia
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Meinlschmidt G, Stalujanis E, Grisar L, Borrmann M, Tegethoff M. Anticipated fear and anxiety of Automated Driving Systems: Estimating the prevalence in a national representative survey. Int J Clin Health Psychol 2023; 23:100371. [PMID: 36937334 PMCID: PMC10018559 DOI: 10.1016/j.ijchp.2023.100371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/13/2023] [Indexed: 03/09/2023] Open
Abstract
Background Automated Driving Systems (ADS) may reshape mobility. Yet, related fear and anxiety are largely unknown. We estimated the prevalence and risk factors of anticipated anxiety towards ADS. Method In a nationally representative face-to-face household survey, we assessed anticipated levels of anxiety towards ADS based on DSM-5 specific phobia criteria, using structured diagnostic interviews. We estimated weighted prevalences and conducted adjusted logistic regression models. Results Of N = 2076 respondents, 40.82% (95%-confidence interval (CI) 37.73-43.98) anticipated experiencing some symptoms of phobia of ADS, 15.22% (CI 13.19-17.51) anticipated subthreshold phobia, and 3.39% (CI 2.42-4.75) anticipated full-blown phobia of ADS. Of subjects anticipating subthreshold phobia, 74.02% showed no strong, enduring fears of driving non-automated cars and 65.07% presented no other specific phobias (full-blown anticipated phobia: 50.37% and 50.03%, respectively). Anticipated phobia highly overlapped with anticipating marked or strong fears of passively encountering ADS in traffic (odds ratio 312.4-1982.2). Conclusion About 20% of subjects anticipated at least subthreshold and 4% of subjects anticipated full-blown phobia of ADS. It appears to be distinct from fears related to non-automated driving and other specific phobias. Our findings call for prevention and treatment of phobia of ADS as they become increasingly ubiquitous.
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Affiliation(s)
- Gunther Meinlschmidt
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse 3b, D-10555, Berlin, Germany
- Department of Psychosomatic Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 60/62, CH-4055, Basel, Switzerland
| | - Esther Stalujanis
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse 3b, D-10555, Berlin, Germany
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Missionsstrasse 60/62, CH-4055, Basel, Switzerland
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Culmannstrasse 8, 8091 Zürich, Switzerland
| | - Laura Grisar
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse 3b, D-10555, Berlin, Germany
| | - Moritz Borrmann
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse 3b, D-10555, Berlin, Germany
| | - Marion Tegethoff
- Institute of Psychology, RWTH Aachen, Jägerstrasse 17-19, D-52056 Aachen, Germany
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Asselmann E, Zenker M, Rückert F, Kische H, Pieper L, Beesdo-Baum K. Ecological momentary assessment and applied relaxation: Results of a randomized indicated preventive trial in individuals at increased risk for mental disorders. PLoS One 2023; 18:e0286750. [PMID: 37289760 PMCID: PMC10249886 DOI: 10.1371/journal.pone.0286750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/19/2023] [Indexed: 06/10/2023] Open
Abstract
Applied Relaxation (AR) is an established behavioral mental health intervention, but its efficacy in real life contexts remains unclear. Using randomized controlled trial data, we examined whether AR can effectively reduce mental health problems in daily life. A sample of 277 adults with increased psychopathological symptoms but without 12-month DSM-5 mental disorders at study entry was randomly assigned to an intervention group receiving AR training (n = 139) and an assessment-only control group (n = 138). Ecological momentary assessments were used to assess psychological outcomes in daily life over a period of seven days at baseline, post, and 12-month follow-up, respectively. Multilevel analyses indicated that all psychopathological symptoms decreased more in the intervention group than in the control group from baseline to post (range β = -0.31 for DASS-depression to β = -0.06 for PROMIS-anger). However, from post to follow-up, psychopathological symptoms decreased more in the control group than in the intervention group, so that only the intervention effects for PROMIS-depression (β = -0.10) and PROMIS-anger (β = -0.09) remained until follow-up. Moreover, positive affect (β = 0.19), internal control beliefs (β = 0.15), favorable coping (β = 0.60), and unfavorable coping (β = -0.41) improved more in the intervention group than in the control group, and these effects were mostly maintained in the long term. Some effects were stronger among women, older individuals, and individuals with higher initial symptoms. These findings suggest that AR can effectively reduce mental health problems in daily life. Trial registration. The trial has been registered at ClinicalTrials.gov (NCT03311529).
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Affiliation(s)
- Eva Asselmann
- Department of Psychology, Institute for Mental Health and Behavioral Medicine, HMU Health and Medical University, Potsdam, Germany
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Monique Zenker
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Frank Rückert
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Hanna Kische
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Lars Pieper
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Katja Beesdo-Baum
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
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Groß SE, Schellartz I, Zielasek J, Schlomann L, Klee I, Ritschel C, Engemann S, Steffens B, Jänner M, Funken O, Juckel G, Gouzoulis-Mayfrank E. The somatic care of patients with comorbid mental disorders: protocol of a mixed-methods study aiming to identify barriers to and enablers of utilization of somatic healthcare (SoKo). BMC Health Serv Res 2023; 23:589. [PMID: 37286990 DOI: 10.1186/s12913-023-09525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Healthcare for people with somatic and comorbid mental diseases can pose a challenge to the healthcare system. The aim of the SoKo study (the Somatic care of patients with mental Comorbidity) is to assess the current state of care and the facilitators and barriers of somatic care of people with somatic disorders and comorbidity of a mental disorder. METHODS The study is conducted as a mixed-methods approach and will include (a) descriptive and inferential analysis of secondary claims data of persons insured by a German statutory health insurance company in North Rhine-Westphalia (Techniker Krankenkasse, TK-NRW), (b) qualitative individual interviews and group discussions, and (c) based on (a) and (b), quantitative surveys of both patients and physicians. We intend to analyse a sample of claims data of about 2.6 million persons insured by TK-NRW (group comparisons between TK-NRW insured persons with a diagnosis of a prevalent somatic disease [ICD-10-GM E01-E07, E11, E66, I10-I15, I20-I25, I60-I64] with and without comorbidity of a mental disorder [F00-F99]), in order to assess the uptake of somatic care by people with mental and somatic comorbidity. In addition, primary data from patients with the aforementioned somatic illnesses and a mental comorbidity as well as primary data from physicians (general practitioners and medical specialists) will be collected. The focus here will be on support factors and barriers in the somatic care of people with mental comorbidity. DISCUSSION Up to now, there have been no published results of a systematic collection of both secondary and primary data on the utilisation of different care services of somatically ill patients with mental comorbidity for Germany. The present mixed-methods study aims to address this gap. TRIAL REGISTRATION The trial is registered with the German Clinical Trials Register DRKS: DRKS00030513. The trial was registered on 3rd February 2023.
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Grants
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
- 01VSF19052 The study is publicly funded by the German Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)
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Affiliation(s)
- Sophie E Groß
- Rhineland State Council - Institute of Healthcare Research (LVR-IVF), Cologne, Germany.
| | - Isabell Schellartz
- Rhineland State Council - Institute of Healthcare Research (LVR-IVF), Cologne, Germany
| | - Jürgen Zielasek
- Rhineland State Council - Institute of Healthcare Research (LVR-IVF), Cologne, Germany
- Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lara Schlomann
- Rhineland State Council - Institute of Healthcare Research (LVR-IVF), Cologne, Germany
| | - Inna Klee
- Rhineland State Council - Institute of Healthcare Research (LVR-IVF), Cologne, Germany
| | - Careen Ritschel
- Rhineland State Council - Institute of Healthcare Research (LVR-IVF), Cologne, Germany
| | - Sandra Engemann
- Rhineland State Council - Institute of Healthcare Research (LVR-IVF), Cologne, Germany
| | - Barbara Steffens
- Techniker Krankenkasse North Rhine-Westphalia, German Statutory Health Insurance Company (TK-NRW), Hamburg, Germany
| | - Michaela Jänner
- Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Oliver Funken
- General Practitioners Association North Rhine, North Rhine, Germany
| | - Georg Juckel
- LWL University Hospital, Bochum, Germany
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University, Bochum, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- Rhineland State Council - Institute of Healthcare Research (LVR-IVF), Cologne, Germany
- LVR-Clinics Cologne, Cologne, Germany
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Böttger SJ, Förstner BR, Szalek L, Koller-Schlaud K, Rapp MA, Tschorn M. Mood and anxiety disorders within the Research Domain Criteria framework of Positive and Negative Valence Systems: a scoping review. Front Hum Neurosci 2023; 17:1184978. [PMID: 37333832 PMCID: PMC10272468 DOI: 10.3389/fnhum.2023.1184978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction While a growing body of research is adopting Research Domain Criteria (RDoC)-related methods and constructs, there is still a lack of comprehensive reviews on the state of published research on Positive Valence Systems (PVS) and Negative Valence Systems (NVS) in mood and anxiety disorders consistent with the RDoC framework. Methods Five electronic databases were searched to identify peer-reviewed publications covering research on "positive valence" and "negative valence" as well as "valence," "affect," and "emotion" for individuals with symptoms of mood and anxiety disorders. Data was extracted with a focus on disorder, domain, (sub-) constructs, units of analysis, key results, and study design. Findings are presented along four sections, distinguishing between primary articles and reviews each for PVS, NVS, and cross-domain PVS and NVS. Results A total of 231 abstracts were identified, and 43 met the inclusion criteria for this scoping review. Seventeen publications addressed research on PVS, seventeen on NVS, and nine covered cross-domain research on PVS and NVS. Psychological constructs were typically examined across different units of analysis, with the majority of publications incorporating two or more measures. Molecular, genetic, and physiological aspects were mainly investigated via review articles, primary articles focused on self-report, behavioral, and, to a lesser extent, physiological measures. Conclusions This present scoping review shows that mood and anxiety disorders were actively studied using a range of genetic, molecular, neuronal, physiological, behavioral, and self-report measures within the RDoC PVS and NVS. Results highlight the essential role of specific cortical frontal brain structures and of subcortical limbic structures in impaired emotional processing in mood and anxiety disorders. Findings also indicate overall limited research on NVS in bipolar disorders and PVS in anxiety disorders, a majority of self-report studies, and predominantly observational studies. Future research is needed to develop more RDoC-consistent advancements and intervention studies targeting neuroscience-driven PVS and NVS constructs.
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Affiliation(s)
- Sarah Jane Böttger
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
- DZPG (German Center of Mental Health), partner site Berlin/Potsdam, Potsdam, Germany
| | - Bernd R. Förstner
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
- DZPG (German Center of Mental Health), partner site Berlin/Potsdam, Potsdam, Germany
| | - Laura Szalek
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Kristin Koller-Schlaud
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, Neuruppin, Germany
| | - Michael A. Rapp
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
- DZPG (German Center of Mental Health), partner site Berlin/Potsdam, Potsdam, Germany
| | - Mira Tschorn
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
- DZPG (German Center of Mental Health), partner site Berlin/Potsdam, Potsdam, Germany
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Li R, Liu S, Huang C, Darabi D, Zhao M, Heinzel S. The influence of perceived stress and income on mental health in China and Germany. Heliyon 2023; 9:e17344. [PMID: 37408921 PMCID: PMC10318459 DOI: 10.1016/j.heliyon.2023.e17344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
Background Mental health issues affect rich and poor, young and old, and are widespread in Asia as well as in Europe. However, few studies have investigated the influence of perceived stress and income on mental health among general population in China and in Germany. Methods We conducted an online survey from December 2021 to February 2022 to investigate how perceived stress and income affect mental health among the general population in China (N = 1123) and in Germany (N = 1018). Accordingly, we used the 10-item Perceived Stress Scale (PSS-10) and the 12-item General Health Questionnaire (GHQ-12). We ran a multiple linear regression model to investigate the relationship between perceived stress, income, and mental health. Results Overall, we found that 53.4% participants reported mental health issues (GHQ-12 score ≥12). The proportion of our sample who reported mental health issues was higher in Germany (60.3%) than in China (44.8%). The regression model revealed that a higher perceived stress score was associated with more mental health issues in both countries (b = 0.60, p < 0.01). Individuals with a low income reported poorer mental health in Germany than those in China. Interestingly, the situation was reversed when incomes were high: individuals with a high income reported worse mental health in China than in Germany (b = -0.40, p < 0.01). Conclusion Perceived stress has a negative impact on mental health, while income has differential effects. Mental health promotion programmes may involve teaching stress management, while considering differences in mental health outcomes in developed and developing countries.
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Affiliation(s)
- Ruihua Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shandong Mental Health Center, Shandong University, Jinan, China
| | - Shuyan Liu
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin (Campus Charité Mitte), Berlin, Germany
| | - Chuanning Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Debora Darabi
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin (Campus Charité Mitte), Berlin, Germany
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China
| | - Stephan Heinzel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Godara M, Rademacher J, Hecht M, Silveira S, Voelkle MC, Singer T. Heterogeneous Mental Health Responses to the COVID-19 Pandemic in Germany: An Examination of Long-Term Trajectories, Risk Factors, and Vulnerable Groups. Healthcare (Basel) 2023; 11:1305. [PMID: 37174848 PMCID: PMC10177770 DOI: 10.3390/healthcare11091305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Abundant studies have examined mental health in the early periods of the COVID-19 pandemic. However, empirical work examining the mental health impact of the pandemic's subsequent phases remains limited. In the present study, we investigated how mental vulnerability and resilience evolved over the various phases of the pandemic in 2020 and 2021 in Germany. Data were collected (n = 3522) across seven measurement occasions using validated and self-generated measures of vulnerability and resilience. We found evidence for an immediate increase in vulnerability during the first lockdown in Germany, a trend towards recovery when lockdown measures were eased, and an increase in vulnerability with each passing month of the second lockdown. Four different latent trajectories of resilience-vulnerability emerged, with the majority of participants displaying a rather resilient trajectory, but nearly 30% of the sample fell into the more vulnerable groups. Females, younger individuals, those with a history of psychiatric disorders, lower income groups, and those with high trait vulnerability and low trait social belonging were more likely to exhibit trajectories associated with poorer mental well-being. Our findings indicate that resilience-vulnerability responses in Germany during the COVID-19 pandemic may have been more complex than previously thought, identifying risk groups that could benefit from greater support.
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Affiliation(s)
- Malvika Godara
- Social Neuroscience Lab, Max Planck Society, 10557 Berlin, Germany; (J.R.); (S.S.); (T.S.)
| | - Jessie Rademacher
- Social Neuroscience Lab, Max Planck Society, 10557 Berlin, Germany; (J.R.); (S.S.); (T.S.)
| | - Martin Hecht
- Department of Psychology, Helmut Schmidt University, 22043 Hamburg, Germany;
| | - Sarita Silveira
- Social Neuroscience Lab, Max Planck Society, 10557 Berlin, Germany; (J.R.); (S.S.); (T.S.)
| | - Manuel C. Voelkle
- Institute of Psychology, Humboldt University of Berlin, 10117 Berlin, Germany;
| | - Tania Singer
- Social Neuroscience Lab, Max Planck Society, 10557 Berlin, Germany; (J.R.); (S.S.); (T.S.)
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42
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Kuhn J, Klosterkötter J. [Running amok: Can psychiatry do anything about it?]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:188-190. [PMID: 37192609 DOI: 10.1055/a-2054-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
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Mugambwa KA, Lutchmun W, Gach J, Bader C, Froeschl G. Mental health of people with limited access to health services: a retrospective study of patients attending a humanitarian clinic network in Germany in 2021. BMC Psychiatry 2023; 23:270. [PMID: 37076828 PMCID: PMC10114436 DOI: 10.1186/s12888-023-04727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/29/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Germany has a statutory health insurance system. However, a substantial part of the population still suffers from limited access to regular health services. While humanitarian organizations are partially filling this gap, people with limited access show a high prevalence of mental disorders. This study investigates the prevalence, and social determinants of mental disorders in patients attending the clinics of a humanitarian health network in three major cities in Germany, as well as perceived barriers to healthcare access in this population. METHODS We performed a descriptive, retrospective study of individuals attending the outpatient clinics of the humanitarian organization Ärzte der Welt, in Berlin, Hamburg and Munich, in 2021. Medico-administrative data was collected using a digital questionnaire at first presentation to the clinics. We report the prevalence of both perceived altered mental health and diagnosed mental disorders, as well as the perceived barriers to healthcare access in this population. We performed a logistic regression analysis to identify the socio-demographic factors associated with mental disorders. RESULTS Our study population consisted of 1,071 first presenters to the clinics in 2021. The median age at presentation was 32 years and 57.2% of the population were male. 81.8% experienced a form of homelessness, 40% originated from non-EU countries and only 12.4% had regular statutory health insurance. 101 (9.4%) patients had a diagnosed mental disorder. In addition, 128 (11.9%) patients reported feeling depressed, 99 (9.2%) reported a lack of interest in daily activities, and 134 (12.5%) lacked emotional support in situations of need on most days. The most reported barrier to accessing health services was high health expenses, reported by 61.3% of patients.In the bivariate logistic regression analysis age, insurance status and region of origin were significantly associated with mental disorders. In the multivariable analysis, only age groups 20-39 and 40-59 years remained significant. CONCLUSIONS People with limited access to regular health services have a high need for mental health services. As a chronic condition, this is even more difficult to manage outside of regular services, where humanitarian clinics are only filling the gap in serving basic health needs.
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Affiliation(s)
- Kashung Annie Mugambwa
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.
- Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Wandini Lutchmun
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Janina Gach
- Ärzte der Welt Deutschland e.V, Munich, Germany
| | | | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany
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Singer S, Sievers L, Scholz I, Taylor K, Blanck J, Maier L. Who seeks psychodynamic psychotherapy in community-based practices? Patient characteristics examined in a large sample of applications for reimbursement of psychotherapy in Germany. PSYCHODYNAMIC PRACTICE 2023. [DOI: 10.1080/14753634.2023.2182702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Affiliation(s)
- Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - Luisa Sievers
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - Ida Scholz
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - Katherine Taylor
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - Julian Blanck
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - Lena Maier
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University, Mainz, Germany
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Kohl F, Angerer P, Weber J. Employees' preferences on organisational aspects of psychotherapeutic consultation at work by occupational area, company size, requirement levels and supervisor function - a cross-sectional study in Germany. BMC Public Health 2023; 23:347. [PMID: 36797723 PMCID: PMC9932407 DOI: 10.1186/s12889-023-15255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Common mental disorders affect a significant proportion of the population worldwide at any given time. Psychotherapeutic consultation at work offers employees with mental distress short-term and low-threshold access to psychotherapeutic treatment. However, this offer is only accepted by one to two percent of the employees to whom it is offered. Taking into account employees ' preferences regarding organisational aspects might increase the use of psychotherapeutic consultation at work. This study therefore aimed to identify preferences on organisational aspects of psychotherapeutic consultation at work among employees of diverse occupational areas, company sizes, supervisor functions and job requirement levels. METHODS A total of 755 employees were recruited via advertisements on social media (Instagram, Facebook and LinkedIn). Participants rated on a 5-point Likert scale their agreement to different implementation options of psychotherapeutic consultation at work: type (in-person/video/telephone), location (on/outside company premises), time (within/outside working hours), scope (diagnostic/diagnostic + treatment) and purpose (private/occupational). Additionally, the maximum accepted distance to the location of consultation was assessed. Various analyses of variances (ANOVA) were conducted to determine differences in agreement to implementation options within each organisational aspect and to analyse differences between occupational areas, company sizes, requirement levels and between employees with and without supervisor function. RESULTS Participants indicated a preference for in-person psychotherapeutic consultation that takes places outside company premises and outside working hours. Furthermore, they preferred offers including diagnostic and treatment sessions compared to offers including diagnostic sessions only. Even though participants agreed that consultation should be offered for all purposes, agreement for occupational issues was stronger than for private issues. For some implementation options, the level of agreement varied according to occupational field, company size, supervisor function and level of requirement. However, these differences did not affect the key findings mentioned above. CONCLUSION Those findings give practical indications on the organisational design of psychotherapeutic consultation at work. The results suggest that in-person consultation outside company premises and working hours combining diagnostic and treatment sessions will be accepted by employees regardless of their occupational area, company size, supervisor function and requirement level.
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Affiliation(s)
- Fiona Kohl
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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Depression Is Associated with an Increased Risk of Subsequent Cancer Diagnosis: A Retrospective Cohort Study with 235,404 Patients. Brain Sci 2023; 13:brainsci13020302. [PMID: 36831845 PMCID: PMC9954234 DOI: 10.3390/brainsci13020302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Background: Depression and cancer share common risk factors and mechanisms of disease. The current literature has not explored the effect of depression on cancer risk. We assessed the difference in cancer risk in patients with and without depression in a large cohort in Germany. Methods: We compared cancer risk and incidence in patients with and without depression aged 18 or above diagnosed between 2015 and 2018 documented in the Disease Analyzer Database. Patients from a comparator group were matched 1:1 to patients with depression based on propensity scores. Patients with previous bipolar disorder (F31), mania (F30) or schizophrenia (F20-29) and cancer diagnosis 3 years prior to index date were excluded. Analyses were stratified by cancer type, age group, and gender. Results: A total of 117,702 patients with depression were included and matched 1:1, resulting in a cohort overall of 235,404. 4.9% of patients with depression compared to 4.1% without depression received at least one cancer diagnosis over 3.9 years median follow-up. The depression group showed an 18% increase in risk for a cancer diagnosis overall, with largest increased risk in lung cancer (HR: 1.39 [1.21-1.60], p < 0.0001), cancers of the gastro-intestinal-tract (HR: 1.30 [1.15-1.46], p < 0.0001), breast (HR: 1.23 [1.12-1.35], p < 0.0001) and urinary (HR: 1.23 [1.06-1.43], p < 0.01). Similarly, the incidence of cancer diagnosis overall increased by 22% for depressed patients. IRs showed no difference across cancer types. Conclusions: Depression increased the risk for cancer diagnosis consistently independent of the comparison method used. The potential mediating factors or shared mechanisms of the disease require further investigation.
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Maier L, Blanck J, Singer S. Unipolare Depression – psychodynamische Vielfalt. FORUM DER PSYCHOANALYSE 2023. [DOI: 10.1007/s00451-022-00496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ZusammenfassungVersorgungsengpässe in der ambulanten Psychotherapie haben in den letzten Jahren zu diversen Gesetzesinitiativen geführt. Eine davon war die Einführung von diagnosespezifischen Behandlungskontingenten. Ausgehend von diesem gesundheitspolitischen Vorhaben fragten wir uns, inwiefern empirische Daten für oder gegen eine solche Praxis sprechen, das heißt, wie „homogen“ Patient:innen mit derselben ICD-10-Diagnose aus psychodynamischer Sicht sind. Mithilfe der qualitativen Inhaltsanalyse wurden 13 Berichte von Patient:innen mit der Erstdiagnose F33.1 (Rezidivierende depressive Störung, gegenwärtig mittelgradige Episode) ausgewertet, die im Rahmen des Gutachtenverfahrens geprüft wurden. Zusätzlich schätzten wir das generelle Funktionsniveau ein und verglichen die Reife der Abwehr mit dem Vorliegen komorbider psychischer Diagnosen. Es wurden 56 Seiten Textmaterial analysiert. Wir identifizierten 4 Konflikttypen (Selbstwert, Nähe-Distanz, Unterwerfung, Schuld) sowie strukturelle Beeinträchtigungen in 4 Bereichen (Selbst- und Objektwahrnehmung, Selbstregulierung, Bindung und Identität), bei Vorliegen verschiedener Therapieziele und Interaktionsformen. Die Abwehr bewegte sich auf unreifem bis neurotischen Niveau, was nicht im Zusammenhang mit dem Vorliegen komorbider Diagnosen stand. Das Funktionsniveau ließ auf ein breites Spektrum genereller Beeinträchtigung schließen. Unsere Ergebnisse legen nahe, dass Depressionen vielfältige psychodynamische Hintergründe haben. Dies steht im Widerspruch zu der Idee einer Zuordnung von ICD-10-Diagnose und Behandlungskontingent.
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Hackenberg B, Döge J, O’Brien K, Bohnert A, Lackner KJ, Beutel ME, Michal M, Münzel T, Wild PS, Pfeiffer N, Schulz A, Schmidtmann I, Matthias C, Bahr K. Tinnitus and Its Relation to Depression, Anxiety, and Stress-A Population-Based Cohort Study. J Clin Med 2023; 12:1169. [PMID: 36769823 PMCID: PMC9917824 DOI: 10.3390/jcm12031169] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Tinnitus is a common symptom reported in otolaryngologic practice. Although the pathophysiology of tinnitus has not been fully understood, clinical studies suggest that psychological symptoms of depression, anxiety, and somatization are increased in tinnitus patients. However, patients seeking medical treatment for tinnitus may be especially vulnerable. Population-based studies reporting on the association between tinnitus and psychological distress are still lacking. The aim of this study was to investigate the correlation of tinnitus with depression, anxiety, or somatization in a large population-based cohort. The Gutenberg Health Study is a population-based cohort study. Participants were asked about the occurrence of tinnitus (yes/no) and how much they were bothered by it. In addition, they completed the PHQ-9, GAD-7, and SSS-8 questionnaires to assess depressive symptoms, anxiety, and somatic symptom disorders. A total of 8539 participants were included in the study cohort. Tinnitus prevalence was 28.0% (2387). The prevalence of depression/anxiety/somatic symptom disorders was significantly higher among participants with tinnitus than among participants without tinnitus (7.9%/5.4%/40.4% participants with tinnitus vs. 4.6%/3.3%/26.9% participants without tinnitus, p-value < 0.0001). Logistic regression results showed that participants with tinnitus were more likely to suffer from depression (OR = 2.033, 95% CI [1.584; 2.601], p-value < 0.0001), anxiety (OR = 1.841, 95% CI [1.228; 2.728], p-value = 0.0027), or somatic symptom disorders (OR = 2.057, 95% CI [1.799; 2.352], p-value < 0.0001). Symptoms of depression, anxiety, and somatic symptom disorders were increased in participants with tinnitus. This must be taken into account when treating these patients.
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Affiliation(s)
- Berit Hackenberg
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Julia Döge
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Karoline O’Brien
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Andrea Bohnert
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Karl J. Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, 55131 Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, 55131 Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, 55131 Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology—Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine—Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, 55131 Mainz, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, 55131 Mainz, Germany
- Institute of Molecular Biology (IMB), 55128 Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine—Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, 55131 Mainz, Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Katharina Bahr
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
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Eichler J, Schmidt R, Bartl C, Benecke C, Strauss B, Brähler E, Hilbert A. Self-regulation profiles reflecting distinct levels of eating disorder and comorbid psychopathology in the adult population: A latent profile analysis. Int J Eat Disord 2023; 56:418-427. [PMID: 36420839 DOI: 10.1002/eat.23857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous research showed that individuals with eating disorders (EDs) can be subtyped by their levels of psychopathology and self-regulation abilities. However, nothing is known about whether self-regulation abilities are solely suited to depict the heterogeneity in ED and comorbid psychopathology in nonclinical samples. Therefore, this study sought to explore self-regulation profiles and their ability to discriminate ED, depression and anxiety disorders, and personality dysfunction in the adult population. METHODS Within a German representative sample, N = 2391 adults (18-92 years) were examined using latent profile analysis to identify profiles based on established cognitive and emotional self-regulation scales including attention control, cognitive reappraisal, and difficulties in identifying feelings. Profiles were validated with ED, depression, anxiety, and personality dysfunction measures. RESULTS The final solution selected as best balancing goodness of fit and interpretability included four profiles-High-Functioning, Moderate-Functioning, Dysregulated, and Alexithymic-with high explanatory power of R2 = .99. Profiles were characterized primarily by differences in difficulties in identifying feelings followed by differences in attention control and differed significantly regarding ED, depression and anxiety disorders, and personality dysfunction, with the Dysregulated profile showing the most unfavorable correlates. CONCLUSIONS This study uniquely revealed that low cognitive and emotional self-regulation were indicators for ED, depression, anxiety, and personality dysfunction in the adult population. Future research should investigate whether the identified profiles predict the development of ED and comorbid psychopathology longitudinally. PUBLIC SIGNIFICANCE Individuals with eating disorders present with difficulties in cognitive and emotional self-regulation, likely maintaining their symptoms. This representative study in the German adult population sought to build profiles based on cognitive and emotional self-regulation that differed in eating disorder and comorbid psychopathology. We discuss the potential to detect individuals with elevated eating disorder and comorbid psychopathology based on the identified profiles in nonclinical settings.
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Affiliation(s)
- Janina Eichler
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Carl Bartl
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Cord Benecke
- Department of Psychology, Clinical Psychology and Psychotherapy, Human Sciences, University of Kassel, Kassel, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Elmar Brähler
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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50
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Hamann J, Lang A, Riedl L, Blank D, Kohl M, Brucks A, Goretzko D, Bühner M, Waldmann T, Kilian R, Falkai P, Hasan A, Keck ME, Landgrebe M, Heres S, Brieger P. Supporting return to work after psychiatric hospitalization-A cluster randomized study (RETURN-study). Eur Psychiatry 2023; 66:e9. [PMID: 36621009 PMCID: PMC9879869 DOI: 10.1192/j.eurpsy.2022.2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND If people with episodic mental-health conditions lose their job due to an episode of their mental illness, they often experience personal negative consequences. Therefore, reintegration after sick leave is critical to avoid unfavorable courses of disease, longer inability to work, long payment of sickness benefits, and unemployment. Existing return-to-work (RTW) programs have mainly focused on "common mental disorders" and often used very elaborate and costly interventions without yielding convincing effects. It was the aim of the RETURN study to evaluate an easy-to-implement RTW intervention specifically addressing persons with mental illnesses being so severe that they require inpatient treatment. METHODS The RETURN study was a multi-center, cluster-randomized controlled trial in acute psychiatric wards addressing inpatients suffering from a psychiatric disorder. In intervention wards, case managers (RTW experts) were introduced who supported patients in their RTW process, while in control wards treatment, as usual, was continued. RESULTS A total of 268 patients were recruited for the trial. Patients in the intervention group had more often returned to their workplace at 6 and 12 months, which was also mirrored in more days at work. These group differences were statistically significant at 6 months. However, for the main outcome (days at work at 12 months), differences were no longer statistically significant (p = 0.14). Intervention patients returned to their workplace earlier than patients in the control group (p = 0.040). CONCLUSIONS The RETURN intervention has shown the potential of case-management interventions when addressing RTW. Further analyses, especially the qualitative ones, may help to better understand limitations and potential areas for improvement.
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Affiliation(s)
- Johannes Hamann
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, München, Germany.,Bezirksklinikum Mainkofen, Deggendorf, Germany
| | - Anne Lang
- Kbo-Isar-Amper-Klinikum, Haar, Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | - Monika Kohl
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Adele Brucks
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - David Goretzko
- Psychological Methods and Assessment, Ludwig-Maximilians-Universität München, München, Germany
| | - Markus Bühner
- Psychological Methods and Assessment, Ludwig-Maximilians-Universität München, München, Germany
| | - Tamara Waldmann
- Klinik für Psychiatrie II am BKH Günzburg, Sektion Gesundheitsökonomie und Versorgungsforschung, Günzburg, Germany
| | - Reinhold Kilian
- Klinik für Psychiatrie II am BKH Günzburg, Sektion Gesundheitsökonomie und Versorgungsforschung, Günzburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Alkomiet Hasan
- Medical Faculty, Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Martin E Keck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Klinik Seewis, Seewis, Switzerland
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, kbo Lech-Mangfall-Hospital, Agatharied, Germany
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