Iris Tatjana Calliess

Depressive symptoms in first-and second-generation migrants: A cross-sectional study of a multi-ethnic working population

Background: Migrants in Europe may suffer from depression more often than the native-born population of the particular host country. Reports about the prevalence of depression in migrants are, however, heterogeneous and the possible causes are the subject of controversial discussion. Aims: The aims of this study are to determine the incidence of depressiveness in a large multi-ethnic working population with and without a history of migration, and to investigate possible connections with migration status and acculturation criteria. Methods: The cross-sectional study asked 7062 employees of a university hospital to complete a self-rating questionnaire concerning socio-demographic data, migration status and indicators of acculturation. Depressiveness was assessed by means of the German version of the Center of Epidemiological Studies Depression Scale (CES-D). Results: The response rate was 41.7% (N = 2932); 14.9% of the participants (n = 419) reported a history of migration, 275 (65.8%) of whom were first-generation (M1) and 143 (34.2%) second-generation (M2) migrants. According to the CES-D scores, 8.7% of non-migrants (n = 207) suffered from clinically relevant depressive symptoms, compared to 16% (n = 44) of the M1 group (OR = 2.10, 95% CI: 1.44–3.04, p < .001) and 14% (n = 20) in M2 (OR = 1.68, 95% CI: 1.01–2.79, p = .048). Taking gender into consideration revealed that only the female migrants showed a statistically significant increased rate of depressiveness (χ 2 = 16.68, p < .001). Conclusions: Our results suggest that first- and second-generation female migrants are more likely to suffer from depressiveness than non-migrant females. In this model a history of migration is shown to be an independent risk factor for depressiveness.

Psychiatric Expert Opinions on Asylum Seekers in Germany

OBJECTIVE To investigate the frequency of traumatisation, suicidality and given diagnoses in expert opinions on asylum seekers and to describe the sociodemographic characteristics of this population. METHODS The psychiatric expert opinions on asylum seekers, furnished in an 8-year-period at Hannover Medical School, were analysed retrospectively for qualitative and quantitative characteristics. RESULTS 62 psychiatric expert opinions on asylum seekers were included in this study. The asylum seekers originated from 18 different countries, mainly from Turkey and former Yugoslavia. Most expert opinions were given in secondary asylum procedures, i. e. after the initial asylum request had been rejected. The asylum seekers reported on traumatisation in 82.3 %. The most frequently reported forms of traumatisation were rape in female, and torture in male persons. According to ICD-10 or DSM-IV-R criteria posttraumatic stress disorder (PTSD) was the most frequent diagnosis (74.1 %) in this study. The second most common diagnoses were depressive disorders (ICD-10: F32.x in 33.9 % and ICD-10: F33.x in 25.9 %). Suicidal tendency was found in 56.5 % of the asylum seekers. CONCLUSIONS Cultural differences, language barriers, a heavy burden by psychological symptoms, and clinical severity are difficulties in the process of psychiatric assessment of refugees in legal asylum procedures.

Gleichbehandlung ohne gleiche Behandlung: Zur Notwendigkeit der Modifikation therapeutischer Strategien für die Arbeit mit Migranten

Given an increased knowledge for the special requirements of patients with a history of migration in mental health care, different approaches varying between an adaptation of existing systems and the implementation of specialized institutions are being discussed. The present study investigates the treatment courses of 55 first generation immigrants and a control sample of 55 native patients treated in a psychiatric day clinic of a university clinic. Besides the application of questionnaires concerning treatment outcome, a detailed content analysis of treatment records was performed investigating the preference for different therapeutic approaches, migration- and culture-related aspects as well as language problems. Treatment outcome and the reactions to different therapeutic strategies (i. e., verbal-oriented vs. body-centered approaches) suggest a good fit of a common treatment concept also for patients from different countries of origin and ethnic backgrounds. Qualitative analyses, however, imply that migration biography and cultural diversity should be included in diagnostic and therapeutic considerations to a much bigger extent. Language problems, in contrast, appeared to be less salient in the present study.

Personality Disorders in a Cross-Cultural Perspective: Impact of Culture and Migration on Diagnosis and Etiological Aspects

The diagnosis of personality disorders is highly dependent on how a society views certain behavior. Self concept, adaptation and social context are important aspects of the cultural dimensions of personality disorders. However, the relevance and implications of the influence of sociocultural factors are seen differently. Accordingly, there are very distinct conceptional, nosological and diagnostic approaches for classifying personality dispositions and personality disorders in a cross-cultural perspective. The present paper describes the social and cultural context of migration from an European perspective. A review of the literature on mental health risk in immigrants is given, and special focus is placed on the impact of culture on the development of personality in general and on the emergence and manifestation versus prevention of personality disorders in specific. Due to globalization and migration processes clinicians and therapists are increasingly called upon to assess the level of personality functioning, not only in patients from different ethnic backgrounds, but also in traumatized refugees and migrants. Multiple social and cultural factors have an influence on each level of the diagnostic and therapeutic process. In addition to thorough background knowledge concerning trauma, migration and culture specific issues, cultural sensitivity and cultural competence are requisite for clinicians and therapists.

Construct Validity of the Questionnaire on Experience with Skin Complaints (Short Form)

Abstract. Introduction: Feelings of stigmatization can strongly influence quality of life in individuals with chronic skin diseases. The Short-Form of the Questionnaire on Experience with Skin Complaints (SF-QES) differentiates four factors of stigmatization: self-esteem and retreat, experienced refusal, concealment, and composure. The current study aimed to investigate the construct validity of the SF-QES. Method: The analysis was based on the complete SF-QES records of a clinical psoriasis trial, which yielded 1,005 records at baseline, 1,010 records at the end of therapy, and 885 and 827 records, respectively, at two follow-ups. Factor analyses and corresponding structural equation models (SEMs) using robust maximum likelihood estimation (RML) were applied. Additionally, the responsiveness of the scales to judgments of treatment success and two different interventions were compared. Results: The factor analyses provided results that widely agreed with the supposed four factors. SEM, however, showed mod...

Networking, Leadership, Empowerment - Young psychiatrists forging their own destiny

As society’s expectations of mental health professional change radically, educational programs and policies need to keep pace with this change. Trainees and young psychiatrists have established their distinct identity and assured that educational policies are reformed to create competent mental health professionals who are fit for purpose in tomorrow’s world. In order for this to happen, it has taken over a decade of dedication, hard work and motivation from past and present psychiatric trainees and young psychiatrists to travel the journey from having a vision of an international network to develop the existing highly structured network. Networking and empowerment facilitated by national and international young psychiatrists’ organizations has allowed young psychiatrists to participate in decision-making processes and create frameworks for their own professional development. This paper outlines the principles and objectives that underpin the existing networks of national and international young psychiatrists’ organizations. It also describes the various educational and networking activities undertaken by these organizations and uses the case study from Croatia to describe the role of these networks in the formation of national associations of young psychiatrists and trainees.

Evaluation of therapy outcome on a psychiatric admission ward. Background, methods and first results of a project on quality management

SummaryBACKGROUND: Quality management is an important management tool in modern health care systems. This applies also to the mental health care system, where in the past decade many concepts have been developed on how to implement quality management appropriately and successfully. However, for the German speaking countries there are only very few studies on the evaluation of therapy outcome in psychiatric inpatient populations available, furthermore they deal primarily with diagnostic subgroups. The aim of this study was to develop a method to assess the quality of therapy on regular psychiatric admission wards. An important aspect was to include all diagnostic subgroups of a psychiatric inpatient population. METHODS: In an explorative field study and by means of a specially designed evaluation method, therapy courses of a psychiatric inpatient population were assessed. Indicators of therapy outcome were: psychopathology, level of psychosocial functioning, motivation of the patient for therapy, suicide attempts, legal status of the patient, patient violence and coercive treatment of the patient. The following assessment and rating scales were used: Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HAMD), Global Assessment of Function (GAF), Social and Occupational Functioning Assessment Scale (SOFAS) and the Symptom-Checklist SCL-9. RESULTS: Changes in the courses of therapy of a psychiatric inpatient population in all diagnostic subgroups in the dimensions psychopathology and level of social functioning could be reproduced significantly using BPRS, HAMD and GAF scales. Difference values T1–T2 were 6.6 ± 6.9 (p = 0.019) in BPRS, 5.1 ± 8.1 (p = 0.029) in HAMD and −5.5 ± 10.1 (p = 0.028) in GAF. The entire battery of rating scales was successfully applied in 32% of all patients (drop out rate: 68%). In the subgroup of immigrant patients the entire battery of rating scales could be applied only in 17.4%, which accounts for a significantly higher drop out rate (82.6%; p = 0.067). DISCUSSION: Using the presented evaluation system therapy outcome and quality of therapy are easy to assess. The results of the quality assessment can be used in further therapeutic processes.ZusammenfassungHINTERGRUND: Qualitätssicherung und Qualitätsmonitoring erlangen in allen Bereichen der Medizin zunehmend an Bedeutung, und auch die Psychiatrie muss sich in all ihren Aufgabenbereichen diesen Fragen stellen. Im deutschsprachigen Bereich liegen für den vollstationären Bereich der psychiatrischen Versorgung bisher nur wenige Studien zur Evaluation von Behandlungsergebnissen, -strukturen und -prozessen vor, welche sich zumeist auf einzelne Diagnosegruppen beschränken. Ziel der vorliegenden Studie war, ein Instrument zu entwickeln, um die Behandlungsqualität auf den Regelstationen einer nach dem Sektorprinzip arbeitenden psychiatrischen Klinik zu evaluieren. Ein wesentlicher Aspekt war hierbei die Erfassung der gesamten Patientenpopulation unter Einbezug aller Diagnosegruppen. METHODE: Mittels einer explorativen Feldstudie wurden anhand eines eigens entwickelten Evaluationssystems Behandlungsverläufe von Patienten erfasst. In unserer Untersuchung wurden als Ergebnisindikatoren neben Psychopathologie und psychosozialem Funktionsniveau auch Gewaltanwendung von Seiten des Patienten, Zwangmaßnahmen, Suizidversuche und rechtlicher Status sowie Therapiemotivation des Patienten erfasst. Folgende Instrumentarien wurden eingesetzt: Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HAMD), Global Assessment of Function (GAF), Social and Occupational Functioning Assessment Scale (SOFAS) und die Symptom-Checkliste SCL-9. ERGEBNISSE: Ein wichtiges Ergebnis der vorliegenden Studie ist, dass die zur Messung der Behandlungsqualität im Hinblick auf Psychopathologie und soziales Funktionsniveau eingesetzten Instrumentarien (BPRS, HAMD, GAF) über alle Diagnosegruppen hinweg eine potentielle Veränderung signifikant abbilden. Die Differenzwerte T1 – T2 betrugen für BPRS 6,6 ± 6,9 (p = 0,019), HAMD 5,1 ± 8,1 (p = 0,029) und GAF −5,5 ± 10,1 (p = 0,028). 32% aller Patienten wurden vollständig erfasst; von den im selben Zeitraum behandelten Migranten wurden signifikant weniger vollständig erfasst (17,4%, p = 0,067). DISKUSSION: Behandlungsergebnisse lassen sich mit dem vorgestellten Datenerhebungsinstrument einfach erfassen, so dass die Befunde in die therapeutische Arbeit zurückfließen können.

Evaluation der Behandlungsergebnisse einer psychiatrischen Aufnahmestation@@@Evaluation of therapy outcome on a psychiatric admission ward: Ziele, Methodik und erste Ergebnisse eines Projektes zur Qualitätssicherung@@@Background, methods and first results of a project on quality management

SummaryBACKGROUND: Quality management is an important management tool in modern health care systems. This applies also to the mental health care system, where in the past decade many concepts have been developed on how to implement quality management appropriately and successfully. However, for the German speaking countries there are only very few studies on the evaluation of therapy outcome in psychiatric inpatient populations available, furthermore they deal primarily with diagnostic subgroups. The aim of this study was to develop a method to assess the quality of therapy on regular psychiatric admission wards. An important aspect was to include all diagnostic subgroups of a psychiatric inpatient population. METHODS: In an explorative field study and by means of a specially designed evaluation method, therapy courses of a psychiatric inpatient population were assessed. Indicators of therapy outcome were: psychopathology, level of psychosocial functioning, motivation of the patient for therapy, suicide attempts, legal status of the patient, patient violence and coercive treatment of the patient. The following assessment and rating scales were used: Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HAMD), Global Assessment of Function (GAF), Social and Occupational Functioning Assessment Scale (SOFAS) and the Symptom-Checklist SCL-9. RESULTS: Changes in the courses of therapy of a psychiatric inpatient population in all diagnostic subgroups in the dimensions psychopathology and level of social functioning could be reproduced significantly using BPRS, HAMD and GAF scales. Difference values T1–T2 were 6.6 ± 6.9 (p = 0.019) in BPRS, 5.1 ± 8.1 (p = 0.029) in HAMD and −5.5 ± 10.1 (p = 0.028) in GAF. The entire battery of rating scales was successfully applied in 32% of all patients (drop out rate: 68%). In the subgroup of immigrant patients the entire battery of rating scales could be applied only in 17.4%, which accounts for a significantly higher drop out rate (82.6%; p = 0.067). DISCUSSION: Using the presented evaluation system therapy outcome and quality of therapy are easy to assess. The results of the quality assessment can be used in further therapeutic processes.ZusammenfassungHINTERGRUND: Qualitätssicherung und Qualitätsmonitoring erlangen in allen Bereichen der Medizin zunehmend an Bedeutung, und auch die Psychiatrie muss sich in all ihren Aufgabenbereichen diesen Fragen stellen. Im deutschsprachigen Bereich liegen für den vollstationären Bereich der psychiatrischen Versorgung bisher nur wenige Studien zur Evaluation von Behandlungsergebnissen, -strukturen und -prozessen vor, welche sich zumeist auf einzelne Diagnosegruppen beschränken. Ziel der vorliegenden Studie war, ein Instrument zu entwickeln, um die Behandlungsqualität auf den Regelstationen einer nach dem Sektorprinzip arbeitenden psychiatrischen Klinik zu evaluieren. Ein wesentlicher Aspekt war hierbei die Erfassung der gesamten Patientenpopulation unter Einbezug aller Diagnosegruppen. METHODE: Mittels einer explorativen Feldstudie wurden anhand eines eigens entwickelten Evaluationssystems Behandlungsverläufe von Patienten erfasst. In unserer Untersuchung wurden als Ergebnisindikatoren neben Psychopathologie und psychosozialem Funktionsniveau auch Gewaltanwendung von Seiten des Patienten, Zwangmaßnahmen, Suizidversuche und rechtlicher Status sowie Therapiemotivation des Patienten erfasst. Folgende Instrumentarien wurden eingesetzt: Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HAMD), Global Assessment of Function (GAF), Social and Occupational Functioning Assessment Scale (SOFAS) und die Symptom-Checkliste SCL-9. ERGEBNISSE: Ein wichtiges Ergebnis der vorliegenden Studie ist, dass die zur Messung der Behandlungsqualität im Hinblick auf Psychopathologie und soziales Funktionsniveau eingesetzten Instrumentarien (BPRS, HAMD, GAF) über alle Diagnosegruppen hinweg eine potentielle Veränderung signifikant abbilden. Die Differenzwerte T1 – T2 betrugen für BPRS 6,6 ± 6,9 (p = 0,019), HAMD 5,1 ± 8,1 (p = 0,029) und GAF −5,5 ± 10,1 (p = 0,028). 32% aller Patienten wurden vollständig erfasst; von den im selben Zeitraum behandelten Migranten wurden signifikant weniger vollständig erfasst (17,4%, p = 0,067). DISKUSSION: Behandlungsergebnisse lassen sich mit dem vorgestellten Datenerhebungsinstrument einfach erfassen, so dass die Befunde in die therapeutische Arbeit zurückfließen können.

[The 5 year Young Psychiatrist Program: A contribution for the young generation in psychiatry in Germany].

Einleitung Zum 5. Mal jährt sich auf dem diesjährigen Hauptkongress der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) das Young Psychiatrists Program, welches mittlerweile einen integralen Bestandteil der jährlichen Kongresse unserer Fachgesellschaft darstellt. Das freut die Initiatoren, deren wesentliches Anliegen bei der Gründung vor 5 Jahren eine Signalwirkung war: Während psychische Erkrankungen weltweit an Bedeutung zunehmen und diese Entwicklung nach Lösungen verlangt [1] lässt sich eine zunehmende Nachwuchsproblematik im Bereich der Weiterbildungsassistenten und jungen Fachärzte verzeichnen [2, 3]. Nicht nur veränderte gesundheitspolitische und –ökonomische Rahmenbedingungen, sondern auch die rasante Entwicklung der Neurowissenschaften hatten zwischenzeitlich zu einer Identitätskrise der traditionellen Psychiatrie geführt. Das Referat „Young Psychiatrists“ der DGPPN, welches nunmehr jährlich das Young Psychiatrists Program organisiert, möchte im Kern, dass das Fach Psychiatrie und Psychotherapie als Weiterbildungsoption nach dem 3. Staatsexamen nicht an Attraktivität verliert. Grundsätzlich soll verdeutlicht werden, dass die Belange junger Kollegen in unserem Fach – und das sind immerhin noch circa 3.800 Weiterbildungsassistenten gerade in Zeiten zunehmenden Ärztemangels eine besondere Aufmerksamkeit verdienen [4]. Wichtig ist neben der inhaltlichen Seite der Ausund Weiterbildung sowie deren Qualitätssicherung und den beruflichen Karrierechancen auch ganz wesentlich der Aspekt der Identität des Faches sowie der Nachwuchsförderung: Im Rahmen derer gilt es, spezielle Belange der Ausbildungssituation zu thematisieren, persönliche Entwicklungsmöglichkeiten zu reflektieren und professionelles Potential zu diskutieren. Das Young Psychiatrists Program