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Objective: The bejective was to determine health literacy (HL) and care aspects of those affected by Long-COVID., Method: 407 patients with Long-COVID and long-term neuropsychiatric symptoms were interviewed in the LIFE study center. In addition to descriptive analyses, regression models were calculated to examine the relationships between health literacy (HLS-EU-Q16) and various aspects of care (RehaQ-N1)., Results: The results show that 35.8% had problematic and 17.9% had inadequate HL. The majority of subjective needs were unmet and 47.7% of those affected were dissatisfied with the therapy they received., Discussion: Among those affected by Long-COVID, subjective HL is rather reduced. The healthcare system appears to be unprepared for these patients, which is reflected in unmet needs and low treatment satisfaction. This was even more pronounced among those exhibiting lower HL., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme. All rights reserved.)

Background: Population-based studies on the relationship between social isolation and obesity, which also include younger adults, are still lacking in Germany. The aim of this study is to investigate the prevalence of social isolation in people with and without obesity. In addition, socially isolated people with and without obesity are examined with regard to socio-demographic and socio-economic factors as well as with regard to depressive symptoms., Methods: This study was based on baseline data from the LIFE Adult Study (18-79 years) from the 2011-2014 study period. The sample comprised n = 8350 participants. In addition to socio-demographic characteristics and socio-economic status (SES), data on social isolation (LSNS-6), depression (ADS), and body mass index (BMI) were collected. Evaluations were carried out using inferential statistical analyses., Results: Overall, 13.1% of the total sample were affected by social isolation. Participants with obesity (20.4%) had a significantly (p < 0.001) higher prevalence compared to those without obesity (11.4%). A better social integration was significantly associated with younger age (p < 0.001), female sex (p < 0.001), being married (and cohabiting) (p < 0.001), higher socioeconomic status (p < 0.001), and lower depressive symptoms (p < 0.001)., Discussion: A higher BMI was not associated per se with poorer social integration. However, the present study showed that socially isolated people with obesity represent a special risk group for impaired mental health and had twice the prevalence of social isolation compared to those without obesity., (© 2024. The Author(s).)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Einleitung: In Hinblick auf den immer größer werdenden Ärztemangel und gleichzeitig steigenden Versorgungsbedarf in der Allgemeinbevölkerung war das Ziel der vorliegenden Untersuchung, ein detailliertes Bild über Renteneintrittswünsche der aktiven Hausärztinnen und Hausärzte (N=143) zu erfassen., Methode: Die Daten wurden im Rahmen einer Baseline-Befragung einer Langzeitstudie erhoben (repräsentative Ärztebefragung). Es wurde untersucht, inwiefern soziodemographische als auch berufsbezogene Variablen mit einem vorzeitigen bzw. späteren Renteneintritt in Zusammenhang gebracht werden können und welche Gründe für eine ärztliche Tätigkeit über das Rentenalter hinaus sprechen., Ergebnisse: Die Ergebnisse zeigen, dass die Hälfte der Befragten zwischen 29 und 66 Jahren vorzeitig in den Ruhestand gehen möchte und diese Entscheidung vor allem von Familienstand, aber auch von Arbeitszufriedenheit und Arbeitsbelastung abhängig ist. Zu den Gründen, die für einen späteren Eintritt sprechen, zählen "Freude an der Arbeit", "sich nützlich und gebraucht fühlen" und ein allgemein "berufliches Interesse"., Schlussfolgerung: Renteneintrittswünsche sollten bei der zukünftigen Planung der Versorgung berücksichtigt werden, um Maßnahmen zu ergreifen, die einem ungewollten oder vorzeitigen Ausstieg der Mediziner aus der Versorgung entgegenwirken., Background: There is a steadily increasing shortage of doctors and simultaneously an increasing need for health care of the general population. The aim of the present survey was to investigate retirement planning by family doctors (n=143)., Method: Data was collected as part of a baseline survey (longitudinal design, representative sample of physicians). Possible association between socio-demographic and occupation-related variables with early or later retirement was investigated and also why some physicians may consider continuing in their profession beyond retirement age., Results: The results showed that half of the respondents between 29 and 66 of age would like to retire early and that this decision depended primarily on marital status, but also on job satisfaction and workload. Reasons for late retirement were "enjoying work", "feeling useful and needed" and general "professional interest"., Conclusion: The results indicate that retirement wishes of GPs must be taken into account in the future planning of health care and that measures should be taken to counteract their early retirement from professional activity., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The scientific state of knowledge on modifiable risk factors for dementia has greatly improved in recent years. The established risk and protective factors include physical and social inactivity, hypertension, diabetes mellitus, excessive alcohol consumption and smoking; however, it is assumed that this knowledge is so far insufficiently disseminated among the general population, indicating untapped potential for primary prevention of dementia., Objective: To assess the state of knowledge on established risk and protective factors for dementia in the general population., Material and Methods: Based on a systematic literature search in the PubMed database, international studies that investigated the knowledge on modifiable risk and/or protective factors for dementia in samples from the general population were identified., Results and Conclusion: A total of 21 publications were included in the review. The majority of publications (n = 17) collated risk and protective factors using closed questions, while n = 4 studies used open questions. Lifestyle factors, e.g. cognitive, social and physical activity, were most frequently named as protective against dementia. Furthermore, many participants recognized depression as a risk factor for dementia. Knowledge of cardiovascular risk constellations for dementia, such as hypertension, hypercholesterolemia or diabetes mellitus were much less known among the participants. The results indicate that there is a need for a targeted clarification of the role of pre-existing cardiovascular diseases as risk factors for dementia. Studies assessing the state of knowledge on social and environmental risk and protective factors for dementia are currently scarce., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Changes in the working environment with respect to innovative working time models are also increasingly affecting patient care. The number of physicians working part-time, for example, is continuously rising. At the same time, a general increase in chronic diseases and multimorbid conditions as well as the growing shortage of medical staff, leads to more workload and dissatisfaction among this profession. This short overview summarizes the current study situation and associated consequences regarding working hours of physicians and gives a first explorative overview of possible solutions., (© The Author(s) 2023.)

Background: The elderly population is one of the high-risk groups with regard to a severe course of disease and increased mortality when infected with the coronavirus SARS-CoV‑2 (Severe Acute Raspiratory Syndrom Coronavirus 2). This group may be at higher risk for psychological strains from the COVID-19 pandemic itself but also from the health protection measures. The aim is to examine how symptoms of depressiveness, anxiety, and somatization change over the course of the pandemic and which role social support plays in that., Methods: Using two written surveys of n = 156 elderly participants in the periods May to June 2020 and March to May 2021, sociodemographic data, factors of psychological strain (depressiveness, anxiety, and somatization), as well as the perceived social support were recorded. The mean age of the respondents was 87.20 years (SD = 4.65; age range = 77.68-96.75 years) and 88.03 years (SD = 4.63; age range = 78.52-97.62 years) for 2020 and 2021, respectively. Data were analyzed using Wilcoxon t‑tests and generalized linear regression models., Results: A significant increase in the expression of psychological strain with regards to depressiveness, anxiety, and somatization can be identified. Higher scores of psychological strains in 2020 are associated with a higher psychological strain in 2021. Higher perceived social support in 2020 is associated with lower depressiveness one year later., Conclusion: An increase in psychological strain has been observed in the elderly population over the course of the COVID-19 pandemic until May 2021. This population should be supported by preventive programs to avert a further increase in symptoms. The expansion of social support could be useful, especially in the prevention of depressive symptoms., (© 2023. The Author(s).)

Objective: Comorbid mental conditions affect course and outcome of somatic disorders negatively. Therefore, we aimed to determine the prevalence of depressive disorders in primary care patients with obesity., Methods: 131 primary care patients with obesity who participated in the baseline assessment of the INTERACT study were regularly interviewed with PHQ-9. The prevalence of depression in obesity was determined., Results: 29 % of patients with obesity had a Major Depression, further 31 % showed subclinical depressive symptoms. The prevalence of depression is highest in patients with obesity level III., Conclusion: Obesity is highly associated with comorbid depression and challenges treatment in primary care., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: The loss of a significant other is a stressful life event, especially for older people. The aim of this study was to investigate user acceptance of an internet-based self-help program for mourners aged 60 years and above. Potential access paths as well as barriers of use were to be identified from both users' and experts' perspectives., Methods: This study is following a qualitative design. Two focus groups were formed consisting of elderly people (60+) with loss experience (N=12) and of experts from the medical care system (N=8). The focus groups were conducted using a discussion guide related to the model of the Unified Theory of Acceptance and Use of Technology (UTAUT). Focus group data were recorded by audio tape and fully transcribed. Qualitative content analysis according to Mayring (2015) was applied using MAXQDA., Results: The mean age of elderly participants with loss experience was 64.5 years, 50 % were women. From the user's perspective, an internet-based self-help program should comprise information regarding grieving, suggestions and motivation for behavioral activation, strengthening self-esteem, and suggestions for dealing with other feelings related to grief (such as guilt). Directions for relatives of mourners as well as faith and spirituality were important topics for users. Elderly participants felt confident to be able to use an internet-based self-help program. Processing time and topic selection should be flexible for the user. Potential access paths included general practitioners and specialists, mourning cafés, or local media. A potential barrier was seen for people who prefer a personal relationship. The average age of participants in the expert focus group was 40.1 years, 87.5 % were female. There was a high user acceptance from the perspective of health care experts with regard to the target group of elderly people (60+). Access paths were seen across all specialist groups working with elderly people (e.g., physicians, occupational therapists, nursing facilities). Lack of guidance was discussed as a potential barrier., Discussion: A key aspect and prerequisite for the use and effectiveness of an internet-based self-help intervention for mourners is user acceptance. Judgments from potential users and experts showed a high user acceptance, but also the need to address age group-specific topics for coping with grief., Conclusion: Internet-based self-help interventions can be a promising add-on treatment option for elderly bereaved people. The implementation of such programs should take the access paths mentioned into account in order to inform users and experts about the intervention., (Copyright © 2020. Published by Elsevier GmbH.)

Objective: Assessment of patients' preferences regarding depression treatment using a ranking approach., Methods: 641 primary care patients (mean age 43.9 years) ranked their primary preference for depression treatment out of 9 options. Logistic Regression analyses were used to determine factors associated with the most prioritized treatment options., Results: The most frequently prioritized treatment options were psychotherapy (30 %), combination treatment of psychotherapy and drug treatment (18.4 %) and sole drug treatment (15.4 %). 12.3 % of women prioritized alternative therapy options., Conclusion: Patients with depression report individually different treatment preferences. These findings underline the importance of elucidating patients' preferences within a shared decision making process as recommended by treatment guidelines. There is a need of evidence-based information on the role of alternative therapies in the context of depression treatment., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Die Autoren erklären, dass sie keine Interessenkonflikte in Zusammenhang mit dem vorliegenden Artikel haben.

Objective: To examine the association of diagnosed depression with the utilization of health care services and preventive measures among men and women in the general population in Germany., Methods: Cross-sectional analysis of data from a representative telephone survey (men N = 18,675, women N = 24,518, 18 years and older). Self-reported health professional-diagnosed depression (past 12 months) and the use of a range of health care and preventive services were assessed., Results: Diagnosed depression was associated with increased health care service utilization in both sexes. Diagnosed depression was associated with higher utilization of some preventive services, such as general health check-ups (odds ratio [OR] 1.2), cancer screening (OR 1.2) and flu vaccination (OR 1.3) among women and cancer screening (OR 1.4) among men., Conclusions: Health professional-diagnosed depression is associated with increased health service utilization independent of somatic comorbidity and socio-demographic confounders. There was no indication for specific under-treatment with preventive measures among people with depression diagnosis., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To identify barriers and opportunities of an optimized treatment of depression in late life in Germany. Methods: Qualitative analysis of 12 expert interviews. Results: Experts recognized much room for improvement regarding late life depression care. A number of barriers were identified on the part of individuals affected, caring relatives and physicians and other therapists, as well as at the structural level. Lack of knowledge as well as a number of structural barriers result in diagnostic deficits and limited or inadequate treatment. The potential for improvement is explored. Conclusions: Parallel initiatives at different levels of care are suggested to optimize the treatment of depressed elderly people in Germany., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: The public discourse on depression holds a negative picture of depression as opposed to the widespread normative desire to be a healthy and happy being. This norm strengthens the negative associations with depression and supports the stigmatization process. The aim of this study is to analyse media representations illustrating public opinion on depression and the way in which those representations interact with accounts on the lived experience., Methods: A qualitative discourse analysis was conducted with 22 sources for the media analysis and 9 for the individual accounts., Results: Media representations increasingly portray the norm of the happy individual that is characterized by its energized, motivated and powerful personality. This implicitly underlines that people suffering from depression are diametrically opposed to the desired norm., Conclusion: In order to diminish the negative attitude towards depression and to reduce additional suffering, it is important to demystify the notion depression, especially in the therapeutic context., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Stigmatization of obese patients by health care professionals represents a significant barrier to seek care. The study aims to identify weight-related stigmatizing attitudes of mental and somatic health care professionals., Methods: The data base was derived from a survey of 773 health care professionals using a vignette-based approach. Stigmatizing attitudes were assessed with the Fat Phobia Scale., Results: Health care professionals in the somatic and mental health field stigmatize overweight individuals. Stigmatizing attitudes were associated with the belief in the lack of willpower of obese people and an increased perceived workload caused by overweight patients., Conclusions: The stigmatization of obese people needs to be addressed and mentally ill patients seem to be an especially vulnerable group due to double stigma., (© Georg Thieme Verlag KG Stuttgart · New York.)

Depression in late-life is common and psychosocial and biological factors are proposed. Searching for modifiable risk factors is of utmost importance. However, depression in late life is under-recognized and undertreated. Much room for improvement is determined, especially in utilizing psychotherapeutic interventions and taking advantage of internationally excellent evaluated collaborative care approaches. Late-life depression does have a major public health impact. It is an important field for health service research in Germany to optimize care., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Due to the demographic development depressive disorders in old age are becoming a central and urgent healthcare challenge., Objectives: The article reviews effective approaches towards treatment of depression in the elderly., Methods: A literature review of complex interventions improving depression care was carried out., Results: Robust evidence exists for the use of collaborative care models which incorporate collaboration between mental health and medical providers in the primary care setting (e.g. general practitioners and specialists), regular monitoring, case management, and evidence-based treatment. Staged treatment approaches seem to be appropriate by which initially use treatment strategies of low intensity. For patients with limited mobility, home-based approaches have proven to be particularly practical and effective., Conclusion: Multidisciplinary and multimodal treatment approaches represent an effective and efficient way of healthcare provision for late life depression. In Germany, only few initiatives inspired by successful international models have so far been identified.

Objective: To conduct a systematic review about existing evidence for the effectiveness of psychotherapeutic interventions for depression in older adults., Methods: Electronic databases were systematic searched to identify systematic reviews and meta-analyses., Results: Psychotherapeutic interventions are effective for treating depression in the elderly. Psychotherapy is more effective at reducing depressive symptoms than being on a waiting list or treatment as usual. The strongest evidence exists for approaches of cognitive and behavioral therapy. In head-to-head studies comparing different psychotherapeutic approaches the majority of the interventions did not proof to be superior to others, so far. Psychotherapy is also an effective intervention for reducing depressive symptoms in older adults with sub-threshold depression., Conclusions: Psychological interventions could play an important role in the treatment of late-life depression. However, there is still a need for high-quality studies, in which especially very old adults, older adults with cognitive and sensory impairments or chronic somatic illnesses are included., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The fear of a shortage of physicians in some regions of Germany is growing. A drain of physicians into non-clinical activities is being discussed as a possible reason. To counteract this drain the extent of physicians' thinking about leaving patient care and the corresponding reasons need to be elucidated., Methods: All physicians upto 40 years of age and registered with the State Chamber of Physicians of Saxony (n=5,956) received a paper-pencil questionnaire inquiring about socio-demographics, job satisfaction, thinking about leaving patient care, and corresponding reasons. Reponse rate was 40% (n=2 357)., Results: Nearly a quarter of the physicians working in patient care thought about leaving patient care. Practicing in a hospital and having children were significantly associated with think-ing about leaving patient care. The main reasons were poor compatibility of profession and family, high burden due to shifts, poor compatibility of profession and private interests, high work load, and frequent overtime hours., Conclusions: Development and implementation of measures preventing especially long-term or permanent leave is crucial. Approaches enabling physicians to reconcile work and family play a special role., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Analyses of the reliability and validity of the German version of the Center for Epidemiological Studies Depression Scale (CES-D) and the assessment of normative values., Method: A representative sample of 868 people (German population, 18 to 94 years) was assessed via structured interviews in a telephone survey., Results: According to the cut-off score of 16 points, 8.5 % of the total sample (11.0 % women and 5.6 % men) showed relevant depressive symptoms. When using the cut-off score of 22 points, 3.5 % of the subjects of the total sample, 4.2 % of the women and 2.5% of the men, were classified as depressed. The analysis of the psychometric properties of the instrument such as internal consistency, test-retest reliability, construct validity and factor structure revealed moderate to good results. Percentile standard values were determined., Conclusion: The German version of the CES-D can be described as a reliable and valid instrument for detecting depressive symptoms. The present study offers current normative data for the specific use in telephone surveys., (© Georg Thieme Verlag KG Stuttgart · New York.)

This paper reviews the concepts, evidence and implications regarding mental health at the workplace. The theoretical background with the most common theories (e.g. effort-reward imbalance model and job-demand control model) are briefly reviewed and findings from systematic reviews and from a meta-analysis regarding psychosocial factors at the workplace and common mental disorders, which indicate that psychosocial factors increase the risk of mental disorder are outlined. Implications for primary prevention as well as early intervention and treatment following a stepped care model including a variety of agents from different backgrounds are discussed. Implications to enhance research in the field are outlined.

Objective: To examine the association between depressive symptoms and the use of health services among people aged 50 years or older in Germany., Methods: Data came from the German subsample of the "Survey of Health, Ageing and Retirement in Europe (SHARE)", comprising a nationally representative sample of 2890 German residents aged 50 years or older (mean age 65 years, 55 % women). The cross-sectional association between depressive symptoms (EURO-D scale ≥ 4 points) and health service use was examined by multivariable regression analysis., Results: Depressive symptoms were found in 21 % of respondents and were associated with a higher utilisation of health care services (odds ratio [OR] 2.3, 95 % confidence interval [CI] 1.2 - 4.3) and social care services (OR 2.6, 95 % CI 1.5 - 4.7) even after adjusting for sociodemographic and psychosocial factors, cognitive function and indicators of physical health., Conclusion: Participants with depressive symptoms had a higher service utilisation independent of somatic comorbidity and other potential confounders., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Especially given the different socialization and life conditions of men and women, it could not be assumed that factors leading to nursing home admission (NHA) can be equally applied to both genders. We aimed to determine gender-specific predictors of NHA., Methods: Data were derived from the Leipzig Longitudinal Study of the Aged, a population-based study of individuals aged 75 years and older. 1,058 older adults were interviewed six times on average every 1.4 years. Sociodemographic, clinical, and psychometric variables were obtained. Cox proportional hazards regression was used to determine predictors of NHA., Results: 10.3 % of men and 19.5 % of women (p < 0.001) were admitted to nursing home during the study period. The mean time to nursing home was 7.2 years for men and 6.8 years for women. Characteristics associated with a shorter time to NHA were increased age for men and women; cognitive impairment, poor self-rated health status, and less than two specialist's visits in the preceding 12 months for women, and being unmarried, moderate educational status, and hospitalization in the preceding 12 months were predictors of NHA for men., Conclusions: Gender differences in prediction of NHA do actually exist. The inclusion of gender-specific factors in design and application of interventions to support individuals at home and delay or prevent NHA appears to be warranted., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: The aim of this study was to conduct a systematic literature search in order to assess effectiveness of computer- and internet-based cognitive behavioural therapy (CCBT)., Methods: Medline, Cochrane Library, Web of Science and PsycINFO were searched for relevant articles. Only RCTs were included. Effect sizes were calculated and quality of studies was assessed., Results: 16 studies were retrieved and included. Effect sizes depended on therapist time involvement and control group intervention (waiting list vs. active control group) and ranged between 0.0 and 1.1., Conclusions: CCBT provides an effective and potentially cost-effective interventional strategy for depressive disorders. Effects of no and minimal contact therapies are confounded with conditions of control groups and need further investigation. While patients with Major Depression seem to benefit from computer-based therapy with regular therapist contact, it remains unclear whether unattended self-help interventions over the internet are effective for this patient population. However, these interventions are effective in patients with mild to moderate depressive symptomatology. CCBT may serve as a first step of treatment within stepped care approaches and may help to offer treatment to individuals in remote areas and to decrease barriers to seek psychiatric care caused by stigma perception., (© Georg Thieme Verlag KG Stuttgart · New York.)

In the current discussion on optimizing psychotherapeutic approaches, two important developments have to be considered: a tendency towards integrative and a tendency towards disorder specific approaches. For the years 2005 and 2006, an analysis of three German journals (covering the fields of psychosomatics, psychiatry and clinical psychology) was conducted on the question whether these two developments can be identified in current empirical and conceptual publications. Contrary to the expectations, there are only very few papers dealing with integrative approaches. As expected, there is a major emphasis on psychodynamic and cognitive behavioural approaches; other approaches are only marginally considered. A disorder specific approach can be identified not only for cognitive behavioural, but also for psychodynamic papers.

Objective: The paper reviews psychiatric epidemiological research in Germany focusing on studies conducted over the last two decades., Method: Relevant studies were identified using Medline and Psyndex databanks., Results: Inspired mainly by Anglo-American research, a substantial body of studies demonstrates the constitution of psychiatric epidemiology as a research field in Germany. The paper reviews field studies in children and adolescents, in adults and the elderly concerning scope, design and methods. Also those studies regarding special populations (i. e. homeless, persons living in nursing homes) usually not covered by field studies were included. Selected results of current surveys were reported to illustrate that mental disorders are common., Conclusions: Future challenges of psychiatric-epidemiological research include (1) the provision of internationally comparable data and (2) the description of individual and contextual risk- and protective factors of mental disorders. The latter can only be achieved by employing longitudinal designs where researcher should adopt a multi-level perspective in questioning and analysis.