[Factors influencing patient competency and health care of service members of the German armed forces with deployment-related mental illness: A patient interview study]

BACKGROUND

The number of service members of the German armed forces suffering from deployment-related mental health problems is steadily rising. Preliminary studies have shown that less than 50 % seek professional help. There is little knowledge about the factors influencing the development of an adequate level of patient competence to cope with the complexity of the clinical picture and the care of people with operational disabilities in the interprofessional network.

METHODS

The article presents data gathered by semi-structured, guided interviews from 14 affected individuals analyzing salient beliefs about the perceived factors influencing their patient competence and care through the interprofessional network of supporters inside and outside the German armed forces. Data evaluation was carried out by means of content-structuring, qualitative content analysis using the method of deductive-inductive category formation.

FINDINGS

Based on the interviews conducted, we identified four groups of salient beliefs having an influence on patient competence: identify changes and limitations, recognize illness, redirect one's life, help shape one's life again, and four groups of salient beliefs having an influence on care: intangible / material support, medical supplies, psychosocial support, third-party support. All main topics could be assigned to three levels of influence (individual, individual-contextual, contextual) and stored with a total of 70 topics (codes).

INTERPRETATION

The development of an effective "social structure" was named by those affected as an important influencing factor. Family members, comrades, superiors, and military GPs appear to have a significant impact on patient competence and care. The respondents' opinions about the importance of internal factors such as the soldier's self-image and fear of stigmatization are consistent with previous findings. Structural factors like supply procedures were mentioned as specific German armed forces phenomena.

[Trauma Disorders - A Relevant Health Problem]

Trauma Disorders - A Relevant Health Problem Abstract. In medical practice traumatic stress disorders are underdiagnosed. Post-traumatic stress disorder (PTSD) must be considered in case of pronounced need for control, severe anxiety and restlessness, jumpiness, mental torpor, dissociative disorders, social withdrawal, distrust or vegetative over-arousal. Simple screening instruments such as the "Primary Care PTSD Screen" are suitable for an initial assessment. As long as symptoms are not serious and long-lasting and there are no risk factors for the development of severe PTSD, it is a matter of creating external and internal security, informing about possible support, acknowledging the suffering and establishing secure interpersonal relationships. In the case of a pronounced PTSD with considerable psychological strain, a referral for further psychiatric or psychotherapeutic clarification and treatment is appropriate.

[Posttraumatic Disorders and Their Impact on the Capacity to Work]

Posttraumatic Disorders and Their Impact on the Capacity to Work Abstract. Posttraumatic disorders include a range of mental illnesses and can have relevant effects on the capacity to work. Work usually is an important resource in treatment. The severity or type of trauma is not decisive for assessing the capacity to work, but the functional limitations caused by the disorder must be carefully assessed and compared with the requirements of the job. The rating by Mini-ICF-APP is a helpful tool for this. A reintegration-oriented attitude can strongly support the treatment.

Violence and Abuse in Competitive Sports

Violence and abuse in competitive sports, such as physical and emotional abuse, physical and emotional neglect and sexual abuse, affect children, adolescents and adults alike and lead to severe physical, psychological and social consequences. In current medical and educational care concepts of athletes, there is a lack of consistent integration of sports/psychiatric, clinical psychological and psychotherapeutic, developmental pediatric and developmental psychological expertise. Problem areas arise from fine lines between harassment, non-physical and physical violence. The present position paper includes recommendations for the development of a concept for the protection of mental health in competitive sports and for coping with mental stress and psychological disorders by qualified medical experts in mental health, i.e., child, adolescent and adult psychiatrists with specific expertise in competitive sports: sports psychiatrists. According to the recommendations, experts should also have and further develop competence in other fields, especially in ethics, child protection, protection against violence and abuse in competitive sports, awareness of and dealing with transgression of boundaries, knowledge about child development, and transparency in training structures and relationships.

[Violence and Abuse in Competitive Sports]

Violence and Abuse in Competitive Sports Abstract. Violence and abuse in competitive sports, such as physical and emotional abuse, physical and emotional neglect and sexual abuse, affect children, adolescents and adults alike and lead to severe physical, psychological and social consequences. In current medical and educational care concepts of athletes, there is a lack of consistent integration of sports/psychiatric, clinical psychological and psychotherapeutic, developmental pediatric and developmental psychological expertise. Problem areas arise from fine lines between harassment, non-physical and physical violence. The present position paper includes recommendations for the development of a concept for the protection of mental health in competitive sports and for coping with mental stress and psychological disorders by qualified medical experts in mental health, i.e., child, adolescent and adult psychiatrists with specific expertise in competitive sports: sports psychiatrists. According to the recommendations, experts should also have and further develop competence in other fields, especially in ethics, child protection, protection against violence and abuse in competitive sports, awareness of and dealing with transgression of boundaries, knowledge about child development, and transparency in training structures and relationships.

[Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial]

Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial Abstract. Unaccompanied minor refugees (UMR) are a group particularly vulnerable to mental illness. They pose a great challenge not only for child and youth psychiatric and psychotherapeutic care, but also for youth-welfare institutions. The study examines the effectiveness of Stabilization Training for Adolescent Refugees with Trauma Induced Disorders in inpatient youth-welfare facilities. Methods: We conducted a randomized controlled trial with pre-post design in a naturalistic setting, randomly assigning 9 housing groups for UMRs to the intervention or waiting control condition. The mental stress of 46 UMRs was assessed by both self-report and educational staff-report. Two educational staff members conducted the Stabilization Training for Adolescent Refugees with Trauma Induced Disorders as an intervention in each of the respective residential groups. Results: Participation in training led to a reduction in subjective general psychological stress. At the end of the training, psychological stress in self-judgment was significantly lower in the intervention group than in the waiting control condition. The effectiveness of the training is apparently not reflected by educational staff assessments. Conclusions: Stabilization training is a suitable instrument for the preclinical care of UMR and thus an essential basis for further psychotherapy.

[Barriers to treatment-seeking among German veterans: expert interviews]

BACKGROUND

The number of service members of the German armed forces suffering from deployment-related mental health problems is increasing. However, less than 50 % seek professional help, and there is little knowledge about the barriers to treatment-seeking.

METHODS

The article presents data gathered by the Delphi technique combined with focus groups from 55 health service experts regarding the evaluated barriers to treatment-seeking among German veterans.

FINDINGS

According to the interviewed experts, major contextual barriers to treatment-seeking include: 1) intimidating processes and structures, 2) actual stigmatization and discrimination, and 3) health service deficits. Major individual barriers to treatment were: 4) health beliefs, self-perception and fear of stigmatization, and 5) avoidance behavior related to psychopathology. In addition, there is another both contextual and individual barrier, i.e., 6) information deficits.

INTERPRETATION

Individual internal factors like the soldiers' self-perception and their fear of being stigmatized were considered important barriers to treatment-seeking. The experts' opinion about avoidance behavior related to psychopathology and deficits in health services and information coincides with international findings. Compared to research in other countries, actual stigmatization and discrimination were regarded to be an important barrier in itself. According to our findings daunting/intimidating processes and structures like time-consuming and complex expert medical reports rather seem to be a German phenomenon.