Elisabeth Kohls

Synergistic effects of multi-level suicide preventive interventions: Important, but difficult to disentangle

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Public attitudes toward depression and help-seeking: Impact of the OSPI-Europe depression awareness campaign in four European regions

BACKGROUND Public attitudes toward depression and help-seeking behaviour are important factors influencing depressed people to obtain professional help and adequate treatment. OSPI-Europe is a multi-level suicide prevention programme including a public awareness campaign. It was implemented in four regions of four European countries (Germany, Hungary, Ireland and Portugal). This paper reports the results of the evaluation of the campaign, including its visibility and effects of the campaign on stigma associated with depression and help-seeking behaviour. METHODS A representative general population survey (N=4004) including measures on personal stigma, perceived stigma, openness to help, perceived value of help, and socio-demographic variables was conducted in the four intervention and four control regions in a cross-sectional pre-post design. RESULTS The public awareness campaign was considerably more visible in Germany and Portugal compared to Ireland and Hungary. Visibility was further affected by age and years of schooling. Personal stigma, perceived stigma and openness toward professional help varied significantly across the four countries. Respondents in the intervention regions showed significantly less personal depression stigma than respondents in the control regions after the campaign. Respondents of the intervention region who were aware of the campaign reported more openness toward seeking professional help than respondents who were unaware of it. CONCLUSION The OSPI-Europe awareness campaign was visible and produced some positive results. At the same time, it proved to be difficult to show strong, measurable and unambiguous effects, which is in line with previous studies. Public awareness campaigns as conducted within OSPI-Europe can contribute to improved attitudes and knowledge about depression in the general public and produce synergistic effects, in particular when the dissemination of awareness campaign materials is simultaneously reinforced by other intervention levels of a multi-level intervention programme. LIMITATIONS The survey was cross-sectional and based on self-report, so no causal inferences could be drawn.

Research Recommendations for Improving Measurement of Treatment Effectiveness in Depression

Background: Despite the steadily escalating psychological and economic burden of depression, there is a lack of evidence for the effectiveness of available interventions on functioning areas beyond symptomatology. Therefore, the main objective of this study was to give an insight into the current measurement of treatment effectiveness in depression and to provide recommendations for its improvement. Materials and Methods: The study was based on a multi-informant approach, comparing data from a systematic literature review, an expert survey with representatives from clinical practice (130), and qualitative interviews with patients (11) experiencing depression. Results: Current literature places emphasis on symptomatic outcomes and neglects other domains of functioning, whereas clinicians and depressed patients highlight the importance of both. Interpersonal relationships, recreation and daily activities, communication, social participation, work difficulties were identified as being crucial for recovery. Personal factors, neglected by the literature, such as self-efficacy were introduced by experts and patients. Furthermore, clinicians and patients identified a number of differences regarding the areas improved by psychotherapeutic or pharmacological interventions that were not addressed by the pertinent literature. Conclusion: Creation of a new cross-nationally applicable measure of psychosocial functioning, broader remission criteria, report of domain-specific information, and a personalized approach in treatment decision-making are the first crucial steps needed for the improvement of the measurement of treatment effectiveness in depression. A better measurement will facilitate the clinical decision making and answer the escalating burden of depression.

Ernährung und Depression: Die MooDFOOD Präventions-Studie

Zusammenfassung: In einer aktuellen Europäischen Studie (MooDFOOD) wird die präventive Wirkung von Nahrungsergänzungsmitteln und einer gezielten psychologischen Ernährungsberatung auf Depression untersucht. Die Ergebnisse sollen genutzt werden, um eine innovative und wirksame Public-Health Ernährungsstrategie zur Vorbeugung von Depression zu entwickeln.

Predictive factors of depression and its therapy

ZusammenfassungPrädiktoren für das Auftreten depressiver Episoden schließen psychosoziale und biologische Risikofaktoren ein. Diese reflektieren die Heterogenität und Vielschichtigkeit der Erkrankung. Sie können außerdem dazu dienen, Gruppen zu identifizieren, die von präventiven Maßnahmen profitieren, und Hinweise darauf geben, welche Art der Prävention sinnvoll ist. In den letzten Jahrzehnten wurden – beispielsweise im Bereich der psychiatrischen Genetik – erhebliche wissenschaftliche Anstrengungen unternommen, um prädiktive Faktoren zur individuellen Therapieresponse bei Depression und als Hilfe für individuelle Therapieentscheidungen zu identifizieren. Aus den bisherigen Erkenntnissen konnten jedoch größtenteils noch keine klinisch verwertbaren Schlüsse gezogen werden. In der Praxis sind klinische Faktoren wie charakteristische Symptomcluster einer depressiven Erkrankung und Eigenschaften des Antidepressivums, individuelle Faktoren und Kontextfaktoren wie die Art der Behandlungseinrichtung, Entscheidungshilfen und ökonomische Aspekte Faktoren für die Entscheidung für eine spezifische antidepressive Behandlung. Die frühe klinische Verbesserung unter antidepressiver Medikation innerhalb der ersten zwei Behandlungswochen ist einer der besten Prädiktoren für den langfristigen Therapieerfolg bei Patienten mit depressiver Erkrankung.SummaryPredictive factors of for the occurrence of depressive episodes include psychosocial and biological risk factors. These factors reflect the heterogeneity and complexity of the disease. They can identify groups that would benefit from preventive measures and provide indications for suitable preventive strategies. In recent decades considerable scientific effort, for example in the field of psychiatric genetics, has been undertaken to identify predictive factors for individual antidepressant therapy response and as an aid for individual treatment decisions. However, no clinically usable conclusions could yet be drawn from the respective findings. In practice clinical factors, such as symptom cluster of the depressive disorder and specific properties of the antidepressant, individual factors and contextual factors, such as the type of treatment facility, decision support and economic aspects, are factors influencing the choice of a specific antidepressant. Early clinical improvement under antidepressant medication in the first 2 weeks of treatment is one of the best predictors for the long-term treatment outcome in patients with major depressive disorder.

Prädiktive Faktoren der Depression und ihrer Therapie@@@Predictive factors of depression and its therapy

ZusammenfassungPrädiktoren für das Auftreten depressiver Episoden schließen psychosoziale und biologische Risikofaktoren ein. Diese reflektieren die Heterogenität und Vielschichtigkeit der Erkrankung. Sie können außerdem dazu dienen, Gruppen zu identifizieren, die von präventiven Maßnahmen profitieren, und Hinweise darauf geben, welche Art der Prävention sinnvoll ist. In den letzten Jahrzehnten wurden – beispielsweise im Bereich der psychiatrischen Genetik – erhebliche wissenschaftliche Anstrengungen unternommen, um prädiktive Faktoren zur individuellen Therapieresponse bei Depression und als Hilfe für individuelle Therapieentscheidungen zu identifizieren. Aus den bisherigen Erkenntnissen konnten jedoch größtenteils noch keine klinisch verwertbaren Schlüsse gezogen werden. In der Praxis sind klinische Faktoren wie charakteristische Symptomcluster einer depressiven Erkrankung und Eigenschaften des Antidepressivums, individuelle Faktoren und Kontextfaktoren wie die Art der Behandlungseinrichtung, Entscheidungshilfen und ökonomische Aspekte Faktoren für die Entscheidung für eine spezifische antidepressive Behandlung. Die frühe klinische Verbesserung unter antidepressiver Medikation innerhalb der ersten zwei Behandlungswochen ist einer der besten Prädiktoren für den langfristigen Therapieerfolg bei Patienten mit depressiver Erkrankung.SummaryPredictive factors of for the occurrence of depressive episodes include psychosocial and biological risk factors. These factors reflect the heterogeneity and complexity of the disease. They can identify groups that would benefit from preventive measures and provide indications for suitable preventive strategies. In recent decades considerable scientific effort, for example in the field of psychiatric genetics, has been undertaken to identify predictive factors for individual antidepressant therapy response and as an aid for individual treatment decisions. However, no clinically usable conclusions could yet be drawn from the respective findings. In practice clinical factors, such as symptom cluster of the depressive disorder and specific properties of the antidepressant, individual factors and contextual factors, such as the type of treatment facility, decision support and economic aspects, are factors influencing the choice of a specific antidepressant. Early clinical improvement under antidepressant medication in the first 2 weeks of treatment is one of the best predictors for the long-term treatment outcome in patients with major depressive disorder.

Prädiktive Faktoren der Depression und ihrer Therapie

ZusammenfassungPrädiktoren für das Auftreten depressiver Episoden schließen psychosoziale und biologische Risikofaktoren ein. Diese reflektieren die Heterogenität und Vielschichtigkeit der Erkrankung. Sie können außerdem dazu dienen, Gruppen zu identifizieren, die von präventiven Maßnahmen profitieren, und Hinweise darauf geben, welche Art der Prävention sinnvoll ist. In den letzten Jahrzehnten wurden – beispielsweise im Bereich der psychiatrischen Genetik – erhebliche wissenschaftliche Anstrengungen unternommen, um prädiktive Faktoren zur individuellen Therapieresponse bei Depression und als Hilfe für individuelle Therapieentscheidungen zu identifizieren. Aus den bisherigen Erkenntnissen konnten jedoch größtenteils noch keine klinisch verwertbaren Schlüsse gezogen werden. In der Praxis sind klinische Faktoren wie charakteristische Symptomcluster einer depressiven Erkrankung und Eigenschaften des Antidepressivums, individuelle Faktoren und Kontextfaktoren wie die Art der Behandlungseinrichtung, Entscheidungshilfen und ökonomische Aspekte Faktoren für die Entscheidung für eine spezifische antidepressive Behandlung. Die frühe klinische Verbesserung unter antidepressiver Medikation innerhalb der ersten zwei Behandlungswochen ist einer der besten Prädiktoren für den langfristigen Therapieerfolg bei Patienten mit depressiver Erkrankung.SummaryPredictive factors of for the occurrence of depressive episodes include psychosocial and biological risk factors. These factors reflect the heterogeneity and complexity of the disease. They can identify groups that would benefit from preventive measures and provide indications for suitable preventive strategies. In recent decades considerable scientific effort, for example in the field of psychiatric genetics, has been undertaken to identify predictive factors for individual antidepressant therapy response and as an aid for individual treatment decisions. However, no clinically usable conclusions could yet be drawn from the respective findings. In practice clinical factors, such as symptom cluster of the depressive disorder and specific properties of the antidepressant, individual factors and contextual factors, such as the type of treatment facility, decision support and economic aspects, are factors influencing the choice of a specific antidepressant. Early clinical improvement under antidepressant medication in the first 2 weeks of treatment is one of the best predictors for the long-term treatment outcome in patients with major depressive disorder.