Niklaus Stulz

Mental health literacy in an educational elite – an online survey among university students

BackgroundMental health literacy is a prerequisite for early recognition and intervention in mental disorders. The aims of this paper are to determine whether a sample of university students recognise different symptoms of depression and schizophrenia and to reveal factors influencing correct recognition.MethodsBivariate and correspondence analyses of the results from an online survey among university students (n = 225).ResultsMost participants recognised the specific symptoms of depression. The symptoms of schizophrenia were acknowledged to a lower extent. Delusions of control and hallucinations of taste were not identified as symptoms of schizophrenia. Repeated revival of a trauma for depression and split personality for schizophrenia were frequently mistaken as symptoms of the respective disorders. Bivariate analyses demonstrated that previous interest in and a side job related to mental disorders, as well as previous personal treatment experience had a positive influence on symptom recognition. The correspondence analysis showed that male students of natural science, economics and philosophy are illiterate in recognising the symptoms depression and schizophrenia.ConclusionAmong the educational elite, a wide variability in mental health literacy was found. Therefore, its important for public mental health interventions to focus on the different recognition rates in depression and schizophrenia. Possibilities for contact must be arranged according to interest and activity (e.g., at work). In order to improve mental health literacy, finally, education and/or internship should be integrated in high school or apprenticeship curricula. Special emphasis must be given towards the effects of gender and stereotypes held about mental illnesses.

The severity of ADHD and eating disorder symptoms: a correlational study.

BackgroundAttention deficit/hyperactivity disorders (ADHD) and eating disorders (ED) share several clinical features. Research on the association between ADHD and ED is still quite sparse and findings are ambiguous.MethodsCorrelations between the severity of ADHD key features (Barratt Impulsiveness Scale, and Attention Deficit/Hyperactivity Disorder-Self-Rating questionnaire) and the severity of specific ED symptoms (Structured Interview for Anorexia and Bulimia Nervosa) were examined in 32 female patients diagnosed with ED.ResultsMost correlations between the severity of ADHD features and the severity of ED symptoms were low (r<0.30) and did not reach statistical significance. The only exception was a statistically significant, but counterintuitive association between impulsivity and the avoidance of fattening food.ConclusionsThe findings in this small sample suggest a weak link between the severity of ADHD key features and the severity of single ED symptoms in female patients with ED. The role of ADHD features for the development, maintenance, and treatment of EDs seems to be intricate and requires further study.

Reappraisal of the interplay between psychosis and depression symptoms in the pathogenesis of psychotic syndromes: results from a twenty-year prospective community study

The interplay of psychotic and affective symptoms is a crucial challenge in understanding the pathogenesis of psychosis. In this study, we analyzed the interplay between two subclinical psychosis symptoms dimensions, and one depression symptoms dimension, using longitudinal data from Zurich. The Zurich study started in 1979 with a representative sample of 591 participants who were aged 20/21. Follow-up interviews were conducted at age 23, 28, 30, 35, and 41. The psychiatric symptoms were assessed with a semi-structured interview and the SCL 90-R. In this study, we analyzed three SCL-90-R subscales: the depression symptoms dimension and two distinct symptoms dimensions of subclinical psychosis, one representing a schizophrenia nuclear symptom dimension, the other representing a schizotypal symptoms dimension. Modeling was done with hybrid latent growth models, thereby including simultaneous and cross-lagged effects. The interplay between the two subclinical psychosis symptoms dimensions and the depression symptoms dimension includes several intertwined pathways. The schizotypal symptoms dimension has strong direct effects on the schizophrenia nuclear symptoms dimension, but also on the depression symptoms dimension. The latter has for its part an effect on the schizophrenia nuclear symptoms dimension. The main driving force within the dynamic interplay between depression and psychosis symptoms is a schizotypal symptoms dimension, which represents social and interpersonal deficiencies, ideas of reference, suspiciousness, paranoid ideation, and odd behavior. It does not only directly influence subclinical nuclear schizophrenia symptoms but also the symptoms of depression.

Heavy use of psychiatric hospitals and the use of outpatient services in Switzerland

OBJECTIVE To identify user groups of inpatient psychiatry. METHODS Retrospective cohort study over two years (n = 1295). Identification of patient subgroups based on the number of inpatient admissions and inpatient days by means of latent class analysis. RESULTS Two patient groups were identified: 28 % heavy users and 72 % ordinary users. Heavy users were often diagnosed with schizophrenia and they also showed increased use of outpatient services. CONCLUSIONS Integrated service models should be developed and tested for patients with schizophrenia and HU.

Return to work following unintentional injury: a prospective follow-up study.

Objective The aim of this study was to predict time off work following unintentional injuries due to accidents leading to hospital admission. Design Prospective 6-month follow-up study. Setting Department of Trauma Surgery of a University Hospital. Participants Consecutively recruited victims of unintentional injuries (n=221) hospitalised for a minimum of 32 h including two consecutive nights. All the participants were aged 18–65 years and were able to participate in an assessment within 30 days of the accident. Main outcome measures Interview-assessed number of days off work during the 6 months immediately following the accident. Results The patients’ subjective appraisals of (1) accident severity and (2) their ability to cope with the resulting injury and its job-related consequences predicted time off work following the accident beyond the impact of the objective severity of their injury and the type of accident involved. Conclusions The patients’ subjective appraisals of the accident severity and of their ability to cope with its consequences are highly relevant for return to work after accidents. Extending the findings from previous studies on severely injured and otherwise preselected accident victims, this seems to apply to the whole spectrum of patients hospitalised with unintentional injuries.

The “Suicide Guard Rail”: a minimal structural intervention in hospitals reduces suicide jumps

BackgroundJumping from heights is a readily available and lethal method of suicide. This study examined the effectiveness of a minimal structural intervention in preventing suicide jumps at a Swiss general teaching hospital. Following a series of suicide jumps out of the hospital’s windows, a metal guard rail was installed at each window of the high-rise building.ResultsIn the 114 months prior to the installation of the metal guard rail, 10 suicides by jumping out of the hospital’s windows occurred among 119,269 inpatients. This figure was significantly reduced to 2 fatal incidents among 104,435 inpatients treated during the 78 months immediately following the installation of the rails at the hospital’s windows (χ2 = 4.34, df = 1, p = .037).ConclusionsEven a minimal structural intervention might prevent suicide jumps in a general hospital. Further work is needed to examine the effectiveness of minimal structural interventions in preventing suicide jumps.

Aptitude–Treatment interaction effects in psychooncological interventions

OBJECTIVE To examine aptitude-treatment interaction (ATI) effects in cancer patients receiving psychooncological interventions (POIs). METHOD N=36 cancer patients were treated with POI. Hierarchical linear regression was used to test two interaction effects between patient baseline characteristics (aptitudes) and process analyses of therapy sessions (treatment) on change in mental health during POI. RESULTS Patients with high emotional distress did best when their therapy reduced arousal, and patients with lower emotional distress benefited most if therapists emphasized arousal induction. The interaction between the coping style of the patient (internalizing vs. externalizing) and the focus of the treatment (emotion vs. behavior) did not predict POI outcomes. CONCLUSIONS The ATI effect of patients distress and therapists arousal induction/reduction may help therapists to make differential treatment decisions in POI. Tailoring treatments to cancer patients based on their personal characteristics may enhance the effectiveness of POI.

Patient-Identified Priorities Leading to Attempted Suicide

Background: Attempted suicide is a major public health problem. Aim: The aim of this study was to identify patient-identified problems and triggers typically leading to attempted suicide. Method: A representative sample of 66 adult patients was recruited from all clinical sites and psychiatrists who treat patients after attempted suicide in the Canton of Basel-City (Switzerland). Patients were diagnosed using the Structured Clinical Interview for DSM-IV (SCID) and interviewed with a local adaptation of the Explanatory Model Interview Catalogue (EMIC) to study underlying problems and triggers of attempted suicide. Results: Of the patients, 92.4% had at least one DSM-IV disorder, with depressive disorders being the most prevalent disorder. Although half (50.0%) of the patients identified a health problem, 71.2% identified an interpersonal conflict as underlying problem leading to the suicide attempt. Furthermore, an interpersonal conflict was identified as the trigger of the suicide attempt by more than half of the patients (54.5%). Limitations: The study included German-speaking patients only. Conclusion: According to patients, interpersonal problems often amplify underlying psychiatric problems, leading to suicide attempts. Social and interpersonal stressors should be acknowledged with integrated clinical and social interventions to prevent suicidal behavior in patients and populations.

Subjektive Faktoren sind die besten Prädiktoren: Arbeitsunfähigkeit nach Unfallverletzungen

Unfälle sind häufig: Rund 10 % der Bevölkerung erleiden pro Jahr einen Unfall, rund 1 % wird wegen Unfallverletzungen hospitalisiert. Die unfallbedingte Arbeitsunfähigkeit trägt maßgeblich zu den Unfallkosten bei. Die Wiedererlangung der Arbeitsfähigkeit ist vom Verletzungsschweregrad, von unfallbezogenen Faktoren und von psychosozialen Faktoren abhängig. Die subjektive Einschätzung des Unfallschweregrades und der Bewältigungsfähigkeit erwiesen sich — unabhängig vom Verletzungsschweregrad — als die besten Prädiktoren für die langfristige Wiederaufnahme der Arbeit.