[Measurement invariance of the German version of the Center for Epidemiological Studies Depression Scale (CES-D 20) among males and females with and without a history of migration]. / Messäquivalenz der Allgemeinen Depressionsskala (ADS 20) bei Menschen mit und ohne Migrationshintergrund unter geschlechtsspezifischer Perspektive.

OBJECTIVE: The measurement invariance of the German version of the Center of Epidemiological Studies Depression scale (CES-D 20) among men and women with and without migration background has not been studied yet. METHODS: A total of 2786 employed persons without (female n = 1772, male n = 598) and with an immigrant background (female n = 301, male n = 115) were included in the study. The multi-group confirmatory factor analysis was used to test for the strong factorial invariance and to estimate latent mean differences. RESULTS: The factorial structure is invariat 1) across the female sub-sample, full scalar invariance is achieved, 2) compared to male non-migrants and female sub-sample, partial scalar invariance is achieved. 3) The male migrants show a different, three-factor structure with a mix-factor of depressive affect/somatic complaints. 4) Female migrants have significantly higher latent mean values in subscales. CONCLUSION: The measurement invariance of the German CES-D 20 is given to that extent that meaningful comparisons in correlative coefficient and latent mean values can be made.

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.

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]. / Psychiatrische Begutachtung im Asylverfahren.

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.

[Longer-term effects of inpatient vocational and ergotherapeutic measures on the vocational integration of patients with schizophrenia]. / Längerfristige auswirkungen stationärer arbeits--und ergotherapeutischer massnahmen auf die berufliche Integration schizophrener patienten.

OBJECTIVE: Unemployment rates are high in people with schizophrenia, so that considerable importance is attached to measures to improve their ability to work and their vocational integration. METHODS: In a study of the German Research Network on Schizophrenia the long-term effects of four-week vocational and ergotherapeutic measures on in-patients were investigated. The target criteria were the vocational integration, level of general functioning (Global Assessment of Functioning Scale) and psychopathology (Positive and Negative Syndrome Scale). 227 patients were randomized and assigned either to a work-oriented vocational therapy group, or to a creativity-oriented ergotherapy group; 163 patients completed the study. Data was available for 89 patients at the last catamnesis point after two years. RESULTS: No differences were seen between the effects of the two forms of therapy on the development of vocational integration or on general functioning level and psychopathology after two years. The number of patients in regular work declined over this period. CONCLUSIONS: It is assumed from this that short-lasting vocational and ergotherapeutic measures do not have any long-term influence on the vocational integration of patients with schizophrenia.

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

BACKGROUND: 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 T(1)-T(2) 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.

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

BACKGROUND: Long-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. METHODS: Extensive 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 CONCLUSION: Community 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.

[Integration of immigrants into the mental health care system in Germany]. / Integration von Migranten in die psychiatrisch-psychotherapeutische Versorgung in Deutschland.

OBJECTIVE: Due to the effects of globalization there has to be dealt with an increased number of immigrants in the German health care system. However, esp. the mental health care system in Germany is not sufficiently prepared for this challenge. METHODS: It will be given an overview on the current situation of mental health care of immigrants with mental disorders. RESULTS: The aspect of creating specialized care units vs. opening established institutions for immigrants will be discussed. CONCLUSIONS: Examples of good clinical practice will be highlighted. Recommendations for opening the mental health care services for immigrants in Germany will be proposed.

[Reaching migrants for preventive care: optimization of access and utilization]. / Migranten gezielt erreichen: Zugangswege zur Optimierung der Inanspruchnahme präventiver Massnahmen.

Migrants belong to the hard-to-reach group in health and preventive care. Essential criteria for the sustainable effectiveness of preventive and health promotion consist in the proper selection of target groups and successfully approaching them. The knowledge of possible barriers that make the access to preventive care and health promotion more difficult, e. g. low health literacy, that means the difficulties of linguistic understanding or the low acceptance regarding the provider, is necessary in order to select adequate access possibilities to the defined target groups. Up to now, for this and particularly for the ethno-specific health behaviour of migrants in Germany information hardly exist. So far, there are only a few preventive offers which are target group focussed. The use of native speaking preventive consultants is an attempt to improve the access to preventive care for migrants by low threshold come and access-structures.

[Vocational therapy in schizophrenia: effects only with some patients and with which patients?]. / Arbeitstherapie bei schizophrenen Patienten: keine oder doch differenzielle Effekte?

OBJECTIVES: In a previous study the effectiveness of vocational therapy was evaluated using the Osnabrück Profile of Working Abilities (O-AFP). No or only minor effects were detected. The goal of this reanalysis is to identify distinct responder groups. METHODS: Hierarchical cluster analysis of O-AFP-scores before and after treatment, anovas, t-statistics as well as regression and discriminant analyses were applied to specify the clusters. RESULTS: For each of the O-AFP-scales (Learning Ability, Social Communication Ability, Adaptation) three subgroups different in level and slope of abilities could be identified. Improvements with medium to high effect sizes were detected for Social Communication Ability (34 %) and Learning Ability (14 % of the patients), deterioration was found in 30 % of the patients for Adaptation. Subgroups could be described with the help of symptomatology. Further variables and subgroup membership could be predicted above chance by discriminant and regression analysis. CONCLUSION: Targeted and more appropriate design of vocational therapy seems necessary.

Hannover study on long-stay hospitalization - part I: prediction of long-stay hospitalisation in cases of chronic mental illness.

BACKGROUND: The problem of long-stay hospitalization is still a pressing issue. In this study we examined the possibility of detecting and characterising the group at risk of long-stay hospitalization in advance. METHODS: This study examines the data of patients in the urban catchment area of the Medical University of Hannover, capital of Lower Saxony, Germany, during a period of 10 years. RESULTS AND CONCLUSION: The introduced "psychosocial risk-score", calculated at the first institutional contact, was able to predict the risk of long-term hospitalization. Characteristics of social disintegration, especially with regard to employment status, are of particular importance.

[Do the effects of inpatient vocational therapy and ergotherapy approaches differ in schizophrenic patients? Results of a controlled multicenter study of the german research network on schizophrenia]. / Unterscheiden sich die Effekte stationärer arbeits -- und ergotherapeutischer Massnahmen? Ergebnisse einer kontrollierten Multizenterstudie des Kompetenznetzes Schizophrenie.

For some decades, vocational therapy approaches have been an integral part of inpatient psychiatric treatment of patients with schizophrenia. Like most sociotherapeutic measures, they are largely hypothesis-based. So far, their effectiveness has been subjected to very little scientific scrutiny. The results of a multicenter study in which five vocational therapy models were compared with creativity-oriented ergotherapy in a prospective, randomized control group design are presented. Target criteria were job-relevant skills, psychopathology, general level of functioning, quality of life, self-efficacy, and speed of cognitive performance. 227 patients were enrolled in the study, which was carried out within the framework of the German Research Network on Schizophrenia funded by the German Federal Ministry for Education and Research (BMBF). Multicenter analyses in a pre-post comparison revealed only minimum differences between the experimental and the control group over a four-week intervention period. Job-oriented approaches cannot currently be assumed to be superior to creativity-oriented ergotherapy.

Treatment concepts of day hospitals for general psychiatric patients. Findings from a national survey in Germany.

Psychiatric day hospital treatment concepts have to deal with a wide spectrum of mental disorders. We raised the question, if day hospitals can be differentiated concerning their treatment concepts and if so how much this is reflected in their structural and procedural features. In 1999 a survey was initiated concerning structure, concept and method of treatment in psychiatric day hospitals for adults in Germany. Furthermore data concerning rate of utilization, patients' characteristics and aspects of referral and further treatment were ascertained. One hundred and seventy-three (63.4%) of 273-day hospitals contacted took part in the inquiry. The data were interpreted using multivariate as well as non-parametric procedures. The results show that treatment concepts of day hospitals can be specified as three main areas of function (psychotherapy, crisis intervention orientated treatment alternative, rehabilitation) and four therapeutic orientations (psychodynamic social psychiatric, behavioral social psychiatric, psychodynamic, sociotherapeutic). Structural features are predominantly comparable and the differences found concerning the treatment concepts are especially related to patients' characteristics and some procedural features. The conclusion is that the differentiation of day hospital treatment concepts should be taken into consideration in planning psychosocial treatment services as well as in day hospital evaluation research.