Wielant Machleidt

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.

The development of a clinical syndrome of asymptomatic pancreatitis and eosinophilia after treatment with clozapine in schizophrenia: implications for clinical care, recognition and management.

Clozapine, the first atypical antipsychotic, is indicated for the treatment of therapy-resistant schizophrenia. It needs to be monitored closely because of its well-known potential side-effects, especially agranulocytosis. We present a case of a middle-aged woman with chronic schizophrenia, who was treated with clozapine and developed a clinical syndrome of asymptomatic pancreatitis and eosinophilia within the fifth week of treatment. Asymptomatic pancreatitis has rarely been reported up to now and is not recognized as a typical side-effect of clozapine. In our opinion, pancreatic enzymes should be monitored especially in the first 6 weeks of clozapine treatment.

From Kraepelin to a modern and integrative scientific discipline: The development of transcultural psychiatry in Germany

The roots of transcultural psychiatry in Germany can be traced back to Emil Kraepelin, who made the first culturally comparative observations on mental disorders in Southeast Asia at the start of the 20th century. Since the beginning of the 1970s, contributors to the literature of transcultural psychiatry in Germany have been predominantly concerned with the mental health of migrant workers from Mediterranean countries, particularly the practical difficulties and therapeutic implications of inpatient psychiatric treatment of these migrant groups. The inauguration of the Section on Transcultural Psychiatry of the German Association for Psychiatry and Psychotherapy 20 years ago reflected an increasing scientific interest in this topic. In addition to the psychic impact of migration, research into transcultural care is currently focused on disparities in the utilization of health care and conjectured barriers to access to health and mental health care among migrants. Furthermore, studies based on epidemiological approaches have been carried out in order to resolve the question of whether migrants are as affected by mental disorders as the ethnic German population, and which issues contribute to the so-called “healthy migrant” effect. Other topics that have been explored in the last 10 years are the particular psychosocial situation of asylum seekers and refugees in Germany, and the effects of inadequate integration and discrimination on their mental health. In summary, after a short historical and theoretical overview, this article reviews the current major themes in transcultural research in German contemporary psychiatry, and concludes with an overview of future developments in this field.

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.

Hannover study on long-stay hospitalization – part II: Characteristics and care conditions of long-stay hospitalization in cases of chronic mental illness

BackgroundLong-stay hospitalization is often a consequence of insufficient care structures. This article examines the characteristics and care conditions of long-stay hospitalization (LSH) in an urban area in Germany.MethodsExtensive data of patients in the urban catchment area of the Medical School of Hannover, capital of Lower Saxony, were evaluated during a 10 years period.Results and conclusionCommunity psychiatric efforts certainly help to reduce long-stay hospitalization, but cannot fully prevent it. Reference figures are given for comparable urbanized areas: consequently 500 chronically mentally ill persons per 100.000 inhabitants must be expected, 20% of which must be considered as long stay hospitalized according to a given definition. We estimate 250 places per 100.000 inhabitants to be required for institutionalised outpatient care, further 30 places for day clinic and full-time in-patient treatment and 40 places for residential home treatment. We suggest these results as a guidance for psychiatric planning in comparable communities.

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.