["StigMa" - Evaluation of a Psychological Therapy Program for Stigma-Management]. / "StigMa" ­ Evaluation eines psychologischen Therapieprogramms zu Stigma-Management.

OBJECTIVE: The project "Stigma Management - StigMa" aims on the evaluation of an adaptive therapy program for patients with psychiatric illness to help them in managing internalized stigma and self-stigmatization. METHODS: The patients for this pilot-study were recruited in day-hospitals of pro mente tirol. 26 patients participated in 11 group sessions, following 6 modules: "Education", "Activation of Resources", "Social Network", "Self-Esteem", "Social competence in public places" and "My personal stigma management". The control group consisted of 20 patients who did not participate in StigMa. Pre-post-evaluation was done by the Internalized Stigma of Mental Illness-Scale 1. RESULTS: No significant interaction effects could be observed, although in the treatment group, the burden of perceived discrimination was significantly less pronounced after training than before it. The program, however, was evaluated as being extremely positive by the participants. CONCLUSIONS: The program StigMa will be adapted in accordance with the suggestions of the participants and reevaluated taking into consideration methodological optimization.

[StigMa--The Development of the Therapy Program Stigma Management]. / StigMa--Die Entwicklung des Therapieprogramms Stigma-Management.

OBJECTIVE: While lots of projects focus on "stigmatization by others" in people with mental diseases, the problem of "self-stigmatization" is rarely considered in their treatment.Thus, the program "Stigma Management" aims on the conception of a therapeutic manual concerning self-stigmatization. As experts on their own, in phase 1 the patients' experiences and needs are assessed by themselves. METHODS: 17 patients with schizophrenia discussed the topic of self-stigmatization in the setting of focus groups. The discussions were analyzed by the documentary method of Bohnsack 1. RESULTS: Ten topics could be identified, such as prejudice, self-help groups, openness and public relations. CONCLUSION: Concerning these 10 topics the program "Stigma Management" was designed (phase 2) and will be evaluated shortly (phase 3).

Celebrity suicide on the railway network: Can one case trigger international effects?

BACKGROUND: After the railway suicide of the German national goalkeeper Robert Enke in 2009, a significant increase of railway suicides was observed nationally. This study analyses whether this incident also triggered copycat effects in other European countries. Additionally, media coverage proxied by Google Trends and long-term changes taking into account general changes in suicide rates and kilometres driven by trains were examined. METHODS: The numbers of railway suicides before and after Enke´s suicide were analysed for short and long-term periods (2 weeks and 2 years post-event) across five European countries. Incidence ratios and resulting percentage changes were computed. RESULTS: Similar to Germany, there were significant short and long-term effects for the combined data of the four other countries (increase of 93.9%; p=0.004 and 16.7%; p=0.003). There was no indication that long-term effects are a mere reflection of an overall increase in suicide frequencies or due to increased numbers of kilometres driven by trains. Analyses on country level revealed heterogeneous results. LIMITATIONS: Due to incomplete data, analyses regarding age and gender were not performed. Media coverage was only proxied by a Google Trends analysis. The study includes a small sample of European countries. CONCLUSIONS: Enke's suicide in 2009 was followed by increasing train suicide numbers in Europe. Although this incident may have reinforced an existing European trend of growing railway suicides, an international copycat effect and/or an increased overall awareness about this particular suicide method appears to be one likely explanation for the changes.

[Mechanical restraint: the clinical practice in a psychiatric university hospital]. / Mechanische Bewegungseinschränkungen: Die klinische Praxis an einer psychiatrischen Universitätsklinik.

BACKGROUND: Public opinion on psychiatric medicine is still dominated by images of repression; in particular, the aspects of involuntary admissions, restraint, isolation, or involuntary administration of medication contribute significantly to public prejudice. Furthermore, violations of individual privacy rights and the use of coercion in psychiatry is an ethical challenge. The aim of this study was to describe the "practice of mechanical restraint" at a university hospital in Austria. METHODS: In this study, all admissions to the closed ward at the Department of Psychiatry of the University Clinic of Innsbruck between July and December 2009 were assessed through retrospective data analysis. RESULTS: 529 admissions were identified during the study period. In 148 admitted patients mechanical restraint was arranged at least once. Mechanical restraint was used most frequently and over the longest period of time in patients of the ICD diagnosis group F0. In most cases, "self- harm" had been the reason for restraint. Fourteen percent of the restraints were due to a "danger to others". In patients with "danger to others", a 5 point fixation was used significantly more often than in patients without danger to others, where a restriction by bedrail and/or abdominal belt was most common. CONCLUSIONS: A comparison of these data with those of other centers is limited due to diverse documentation systems. A unified approach in terms of an effective quality management would be desirable in this regard.

["In psychiatry, nothing more degrading can happen to you"]. / "Etwas Erniedrigenderes kann dir eigentlich in der Psychiatrie nicht passieren"

OBJECTIVE The subjective view of psychiatric patients on mechanical restraint is to be examined and the necessity of dealing with this issue consciously is to be pointed out. METHODS 14 patients, who experienced mechanical restraint during a stay in a psychiatric hospital, were questioned in a problem-centered, semi-structured interview. Data analysis was based on inductive category formation, using Mayring's qualitative content analysis. RESULTS Mechanical restraint is primarily experienced as stressful or traumatizing. Patients complain about a lack of information, support and response when referring to mechanical restraint. CONCLUSION Reports of patients who have experienced coercive measures should be increasingly integrated into clinical practice.

[Coercion in Psychiatry - a taboo?]. / Zwangsmaßnahmen in der Psychiatrie - ein Tabu?

History shows that the discussion concerning coercive measures against mentally ill is as old as psychiatry itself. The dilemma of psychiatry lies in its double role - having both a therapeutic and a regulatory function. Violence against sick and disabled people conflicts with the ethical principles of helping professions. This, however, is where the danger lies: that the violent parts of psychiatric work - which in the opinion of experts cannot be entirely avoided - are repressed or seen as taboo and are therefore more difficult to control. Comparisons between EU countries of the nature, frequency and duration of coercive measures are difficult because of the heterogeneity of regulation and differences in established practice. Scientific examination of this issue seems to be insufficient. There are only a few studies on important issues such as how patients rate these measures. An open and thorough debate about the meaning and meaninglessness of coercion and violence in psychiatric treatment would be necessary to prevent "routine violence" or the excessive use of force against the mentally ill.

[Does education focusing on depression change the attitudes towards schizophrenia? A target-group oriented anti-stigma-intervention]. / Verändert der Unterricht über Depression die Einstellungen gegenüber Schizophrenie? Eine zielgruppenorientierte Anti-Stigma-Intervention.

OBJECTIVE: It should be evaluated, whether two units of education about depression in a secondary school alter the student;s attitude towards patients suffering from depression and whether this intervention could also change the attitude towards patients with schizophrenia. METHODS: A patient with depression - at the moment without symptoms - was involved in the educational program. At three specific times (T0 = some days before the intervention; T1 = some days after the intervention; T2 = 3-4 month follow-up), students have been presented with the same case vignette, one with the description of a fictitious depressive classmate as well as with one fictitious classmate with schizophrenia. The affective, the behavior-related and the cognitive dimensions of attitudes towards the described person were assessed by questionnaires. RESULTS: At T0, the attitudes towards the case vignette "depression" have been significantly more positive than the attitudes to the case vignette "schizophrenia" in all dimensions of attitude. At T1, in the case vignette "depression" the factor "fear" showed a decrease, as well as the opinion this person could be dangerous. At T2, these factors reached the level of T0 again. The opinion, that these fictitious depressive classmates suffer from a treatable illness, was approved significantly more often at T1 and T2 compared to T0. The change of attitude towards the case vignette "schizophrenia" was even more distinctive. Compared to T0 feelings of fear, social distance and stereotypes, that such a person would be dangerous and unpredictable, decreased significantly at T1 as well as T2. CONCLUSIONS: Target group oriented interventions including the contact with patients, may improve the attitude towards patients with mental illnesses. Seeing that some improvements decreased again after three month one may wonder whether a single shortterm educational program would be sufficient in order to provoke a sustainable change in attitudes. Although the intervention focused on a less stigmatized illness (like depression), the attitudes towards a more stigmatized illness (like schizophrenia) could markedly be improved.

Suicide registration in eight European countries: A qualitative analysis of procedures and practices.

OBJECTIVE: To compare suicide registration in eight European countries and provide recommendations for quality improvement. METHOD: Qualitative data were collected from country experts using a structured questionnaire. RESULTS: Suicide registration was based on the medico-legal system in six countries and the coronial system in two. Differences not only between, but also within these two systems emerged. Several elements crucial to the consistency of suicide registration were identified. CONCLUSION: A precise model for recording suicides should include: an accurate legal inquiry and clarification of suicidal intent; obligatory forensic autopsy for injury deaths; reciprocal communication among authorities; electronic data transmission; final decision-makers' access to information; trained coders.

[Research instruments in social psychiatry research]. / Forschungsinstrumente in der sozialpsychiatrischen Forschung.

OBJECTIVE: Are assessment instruments used for social psychiatry research in German-language countries in agreement with international scientific standards? METHODS: Analysis of assessment instruments mentioned in publications of two German-language journals. RESULTS: Most studies concerning social psychiatry used assessment instruments developed previously and for the majority data about their validity and reliability are available. The fact that most of the instruments were originally published in English indicates that they are internationally used. CONCLUSIONS: Most assessment instruments mentioned in German-language papers meet with international scientific standards.

Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach.

BACKGROUND: Suicide and non-fatal suicidal behaviour are significant public health issues in Europe requiring effective preventive interventions. However, the evidence for effective preventive strategies is scarce. The protocol of a European research project to develop an optimized evidence based program for suicide prevention is presented. METHOD: The groundwork for this research has been established by a regional community based intervention for suicide prevention that focuses on improving awareness and care for depression performed within the European Alliance Against Depression (EAAD). The EAAD intervention consists of (1) training sessions and practice support for primary care physicians,(2) public relations activities and mass media campaigns, (3) training sessions for community facilitators who serve as gatekeepers for depressed and suicidal persons in the community and treatment and (4) outreach and support for high risk and self-help groups (e.g. helplines). The intervention has been shown to be effective in reducing suicidal behaviour in an earlier study, the Nuremberg Alliance Against Depression. In the context of the current research project described in this paper (OSPI-Europe) the EAAD model is enhanced by other evidence based interventions and implemented simultaneously and in standardised way in four regions in Ireland, Portugal, Hungary and Germany. The enhanced intervention will be evaluated using a prospective controlled design with the primary outcomes being composite suicidal acts (fatal and non-fatal), and with intermediate outcomes being the effect of training programs, changes in public attitudes, guideline-consistent media reporting. In addition an analysis of the economic costs and consequences will be undertaken, while a process evaluation will monitor implementation of the interventions within the different regions with varying organisational and healthcare contexts. DISCUSSION: This multi-centre research seeks to overcome major challenges of field research in suicide prevention. It pools data from four European regions, considerably increasing the study sample, which will be close to one million. In addition, the study will gather important information concerning the potential to transfer this multilevel program to other health care systems. The results of this research will provide a basis for developing an evidence-based, efficient concept for suicide prevention for EU-member states.

["Schizophrenia has many faces" - evaluation of the Austrian Anti-Stigma-Campaign 2000-2002]. / "Schizophrenie hat viele Gesichter" - Evaluierung der österreichischen Anti-Stigma-Kampagne 2000-2002.

OBJECTIVE: In order to evaluate the effectiveness of the WPA campaign "Open the Doors - against Stigma and Discrimination because of Schizophrenia", five years upon completion of the campaign, a comparative study was performed to assess the possible changes in the general public's attitudes towards schizophrenia. METHODS: Representative population survey, based on a Quota-sampling (n = 988); face-to-face interviews with standardized questionnaires. RESULTS: The results of this study were somewhat sobering, with 22.3 % of the population not having any associations with the term "schizophrenia", 81.3 % not wanting to be further informed about the illness, and 64.1 % agreeing with the statement that patients suffering from schizophrenia are dangerous; compared to the survey in 1998, there was a significant increase within this category. Furthermore, an increase of social distance towards this group of patients has also been noted. CONCLUSION: It is to be asked whether a short intervention can change people's profound attitudes.

[Psycho-educational coping-oriented group therapy for schizophrenia patients]. / Psychoedukative und bewältigungsorientierte Gruppentherapie für SchizophreniepatientInnen.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a psycho-educational, coping-oriented therapy programme for patients with schizophrenia or schizo-affective disorder. METHOD: Controlled, prospective study design. In the experimental group the Therapy Manual for Psycho-education and Coping with Illness (PKB) was used, providing targeted information on the illness, medical treatment, prodromal symptoms, and health behaviour. Controls participated in supportive dialogues or in an occupational rehabilitation programme. Psychopathology, re-hospitalisations, knowledge, functional outcome and coping strategies were assessed before, directly after and 12 months post therapy. RESULTS: 82 patients participated. In both groups (experimental, control) a significant improvement in psychopathology and general functioning level were observed. Specific advantages for patients of the experimental group were limited to a few aspects, including rehospitalizations in the first year and certain coping strategies. CONCLUSION: In the treatment of schizophrenia different forms of psycho-social intervention (experimental, control) can be effective. Identification of subgroups profiting specially from certain types of intervention should be subject of future research.

[Mental health care in Austria: history--developments--perspectives]. / Psychiatrische Versorgung in Osterreich: Rückblick - Entwicklungen - Ausblick.

The reform of psychiatric services in Austria started during the second half of the seventies of the 20th century. During the early phase the reform focussed on dehospitalization and principles of community psychiatry. About 60% of psychiatric hospital beds were closed and the size of psychiatric hospitals was reduced. One of the psychiatric hospitals was closed and psychiatric departments were opened as part of district general hospitals. During this time the number of psychiatric hospital admissions increased markedly and a large proportion of mentally ill are treated as inpatients in non-psychiatric wards. Only about a fifth of self-employed psychiatrists working in their own office have a contract with health insurances. In Austria, the number of psychotherapists is much higher than the number of psychiatrist. A variety of different types of community services provide social and vocational rehabilitation, focussing on consultation, housing, daily structure and employment. Psychiatric services are nowadays fragmented into a number of sub-disciplines such as psychosomatics or child and adolescent psychiatry. This fragmentation and the missing coordination of psychiatric services hamper the enhancements of psychiatric care. This complicates the development of integrated services, i.e. the structured and planned cooperation of the different types of services. Since there are no binding rules for the organisation and planning in entire Austria, financing and organisation of services is fragmented. For establishing an integrated health care, coordination and cooperation between providers, sponsors of health care as well as policy makers are essential.

[Empowerment as a goal of social psychiatric endeavour]. / Empowerment als Ziel sozialpsychiatrischer Bemühungen.

Empowerment is a new concept that has found its way via recognition in liberation theology and feminist movement, in to varied disciplines ranging from psychiatry and psychology through philosophy to political science. Empowerment claims to be both a multi-dimensional and multi-level concept. It can take different forms and its relevance reaches from the individual over organisations to larger systems. In psychiatry empowerment is a Successful self enabling strategy. The boundaries and limitations of its methods must, however, be respected as not every affected person is in a position at all times of using it.