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ZusammenfassungAusgehend von den gegenwärtigen krisenhaften Zuspitzungen diskutiert der Artikel den anhaltenden gesellschaftspolitischen Rückzug der Psychiatrie auf die Position einer rein medizinisch-kurativen Disziplin ohne Zuständigkeit für wirtschaftliche, soziale und politische Lebensbedingungen ihrer Klientel. Die globalen Krisen verweisen darauf, dass die psychische Gesundheit der Bevölkerung zusammen mit sozialer Kohäsion und Resilienz als wichtigste gesellschaftliche Ressource darüber entscheiden, ob rationale Antworten auf die existentiellen Bedrohungen der Gegenwart und Zukunft gefunden werden. Das stellt Gesellschaft und Psychiatrie vor signifikant andere strukturelle Herausforderungen. Die psychiatrische Expertise z. B. hinsichtlich der Balance von Autonomie und Zwang oder der Beziehung zwischen kognitiven Prozessen und menschlichem Handeln muss von einer krankheitsbezogenen Perspektive auf die gesellschaftliche Ebene transferiert und für gesellschaftspolitische Debatten und die Bekämpfung sozialer und politischer Fehlentwicklungen fruchtbar gemacht werden.

From the perspective of global societal crises, this paper discusses the long-term socio-political withdrawal of psychiatry into a self-defined position of therapy- and rehabilitation-oriented medicine with no responsibility for social, economic or political conditions. Global crises suggest mental health and overall resilience of the population as key societal resources. Only mental health and psychosocial resilience of people and societies worldwide will determine whether our answers to the current and future existential threats will be effective. This challenge requires a radical change of attitudes of both society and psychiatry. The rich expertise of psychiatry, e. g. on on how to balance autonomy and compulsion or regarding the interdependencies of cognition and human behaviour must contribute significantly to the socio-political debate and the fight against undesirable social or political developments.Ausgehend von den gegenwärtigen krisenhaften Zuspitzungen diskutiert der Artikel den anhaltenden gesellschaftspolitischen Rückzug der Psychiatrie auf die Position einer rein medizinisch-kurativen Disziplin ohne Zuständigkeit für wirtschaftliche, soziale und politische Lebensbedingungen ihrer Klientel. Die globalen Krisen verweisen darauf, dass die psychische Gesundheit der Bevölkerung zusammen mit sozialer Kohäsion und Resilienz als wichtigste gesellschaftliche Ressource darüber entscheiden, ob rationale Antworten auf die existentiellen Bedrohungen der Gegenwart und Zukunft gefunden werden. Das stellt Gesellschaft und Psychiatrie vor signifikant andere strukturelle Herausforderungen. Die psychiatrische Expertise z. B. hinsichtlich der Balance von Autonomie und Zwang oder der Beziehung zwischen kognitiven Prozessen und menschlichem Handeln muss von einer krankheitsbezogenen Perspektive auf die gesellschaftliche Ebene transferiert und für gesellschaftspolitische Debatten und die Bekämpfung sozialer und politischer Fehlentwicklungen fruchtbar gemacht werden.

BackgroundThe relationship between schizophrenia and violence is complex. The aim of this multicentre case–control study was to examine and compare the characteristics of a group of forensic psychiatric patients with a schizophrenia spectrum disorders and a history of significant interpersonal violence to a group of patients with the same diagnosis but no lifetime history of interpersonal violence.MethodOverall, 398 patients (221 forensic and 177 non-forensic patients) were recruited across five European Countries (Italy, Germany, Poland, Austria and the United Kingdom) and assessed using a multidimensional standardised process.ResultsThe most common primary diagnosis in both groups was schizophrenia (76.4%), but forensic patients more often met criteria for a comorbid personality disorder, almost always antisocial personality disorder (49.1 v. 0%). The forensic patients reported lower levels of disability and better social functioning. Forensic patients were more likely to have been exposed to severe violence in childhood. Education was a protective factor against future violence as well as higher levels of disability, lower social functioning and poorer performances in cognitive processing speed tasks, perhaps as proxy markers of the negative syndrome of schizophrenia. Forensic patients were typically already known to services and in treatment at the time of their index offence, but often poorly compliant.ConclusionsThis study highlights the need for general services to stratify patients under their care for established violence risk factors, to monitor patients for poor compliance and to intervene promptly in order to prevent severe violent incidents in the most clinically vulnerable.

Versorgungsforschung im Feld der seelischen Gesundheit ist von zunehmender Bedeutung. Angesichts dieser Entwicklung hat die im Oktober 2017 gegrundete DNVF Fachgruppe „Seelische Gesundheit“ ein Diskussionspapier verfasst, welches zentrale Besonderheiten, Herausforderungen und Ziele der Versorgungsforschung im Bereich der seelischen Gesundheit zusammenfasst. Im Einzelnen werden forschungsrelevante Besonderheiten des Versorgungsfeldes, pragmatische Probleme bei der Forschungsorganisation, ethische Herausforderungen und fur dieses Feld besondere Themenstellungen vorgestellt und diskutiert.

Zusammenfassung Ziel der Studie Bundesweite Erfassung von Strukturdaten und der Anwendungshäufigkeit von Zwangsmaßnahmen im Maßregelvollzug in Deutschland. Methodik Quantitative Erhebung von Strukturmerkmalen in Maßregelvollzugseinrichtungen und Häufigkeiten und Arten von Zwangsmaßnahmen mittels postalischer Fragebögen im Rahmen der „ZIPHER“-Studie. Ergebnisse Zwangsmaßnahmen kommen in stationären Maßregelvollzugseinrichtungen bei etwa einem Viertel aller Patienten zur Anwendung, wobei Isolierungen (21,2 %) mehr als 6-mal so häufig wie Fixierungen (3,2 %) sind. Dies steht in Diskrepanz zur Allgemeinpsychiatrie, wo die Rate an Fixierungen höher ist. Schlussfolgerung Die Ergebnisse der vorliegenden Studie zeigen Besonderheiten in der Anwendungshäufigkeit von Zwangsmaßnahmen im Maßregelvollzug auf Bundesebene. Dabei wurde offenbar, dass hinsichtlich der Verfügbarkeit grundlegender Struktur- und Prozessdaten des Maßregelvollzugs in Deutschland ein erhebliches Defizit besteht.

Background The purpose was to systematically investigate which pharmacological strategies are effective to reduce the risk of violence among patients with Schizophrenia Spectrum Disorders (SSD) in forensic settings. Methods For this systematic review six electronic data bases were searched. Two researchers independently screened the 6,003 abstracts resulting in 143 potential papers. These were then analyzed in detail by two independent researchers. Of these, 133 were excluded for various reasons leaving 10 articles in the present review. Results Of the 10 articles included, five were merely observational, and three were pre-post studies without controls. One study applied a matched case-control design and one was a non-randomized controlled trial. Clozapine was investigated most frequently, followed by olanzapine and risperidone. Often, outcome measures were specific to the study and sample sizes were small. Frequently, relevant methodological information was missing. Due to heterogeneous study designs and outcomes meta-analytic methods could not be applied. Conclusion Due to substantial methodological limitations it is difficult to draw any firm conclusions about the most effective pharmacological strategies to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying more rigorous methods regarding case-definition, outcome measures, sample sizes, and study designs are urgently needed.

Zusammenfassung Einleitung Von 2014 bis 2018 hat ein interdisziplinäres Konsortium von Wissenschaftlern das Ausmaß und mögliche Ursachen des sexuellen Missbrauchs von Kindern und Jugendlichen im Verantwortungsbereich der katholischen Kirche in Deutschland untersucht. Nach den Standorten der beteiligten Universitäten trägt die Studie das Akronym MHG (Mannheim / Heidelberg/Gießen). Die dabei vorgenommene Personalaktenanalyse hat für den Zeitraum von 1946 bis 2014 1670 katholische Kleriker ermittelt, die des sexuellen Missbrauchs von Minderjährigen beschuldigt wurden. Die Personalaktenanalyse ergab weiterhin Hinweise darauf, dass es für die katholische Kirche spezifische systemische Bedingungen gibt, die den sexuellen Missbrauch von Minderjährigen begünstigen. Methode Auf der Basis eines Vergleichs von Strafakten beschuldigter Kleriker und von Tätern aus anderen institutionellen Kontexten wird geprüft, ob sich die Hypothesen zu spezifischen systemischen Bedingungen des Missbrauchs in der katholischen Kirche falsifizieren lassen. Ergebnis Taten von Priestern sind nicht weniger schwer und die Anzahl Betroffener pro Verurteiltem sind nicht geringer als bei Tätern in anderen Institutionen, die Dauer des Missbrauchs durch katholische Kleriker ist sogar signifikant länger. Von sexuellem Missbrauch Betroffene im Kontext der katholischen Kirche sind signifikant häufiger männlich. Die katholische Kirche hat bei Vorwürfen gegen Kleriker wegen eines sexuellen Missbrauchs von Kindern oder Jugendlichen umfassender als andere Institutionen versucht, die Taten zu verharmlosen und zu vertuschen. Fazit Präventionskonzepte müssen die spezifischen Bedingungen des sexuellen Missbrauchs in der katholischen Kirche stärker berücksichtigen.

Zusammenfassung Ein Teilprojekt der von der Deutschen Bischofskonferenz in Auftrag gegebenen Studie »Sexueller Missbrauch an Minderjährigen durch katholische Priester, Diakone und männliche Ordensangehörige im Bereich der Deutschen Bischofskonferenz« befasst sich mit der Analyse von Strafakten. Es wurden Strafverfahren wegen sexueller Missbrauchsdelikte gegen Minderjährige durch Kleriker der katholischen Kirche und durch Mitglieder anderer Institutionen, wie z. B. Schulen, ausgewertet. In diesem Beitrag wird untersucht, ob die besonderen Rahmenbedingungen in der katholischen Kirche, insbesondere das Kirchenrecht und der Klerikalismus, einen Einfluss auf Taten, Täter und institutionelle Reaktionen bei Delikten des sexuellen Missbrauchs von Minderjährigen haben. Die Analyse ergab, dass die Besonderheiten in der katholischen Kirche mit spezifischen Tat- und Tätermerkmalen korrespondierten und die Institutionen unterschiedlich auf Missbrauchsvorwürfe reagierten. Obwohl das Normensystem, das einen sexuellen Missbrauch verhindern soll, in der katholischen Kirche viel ausgeprägter ist als in anderen Institutionen, sind keine Unterschiede im Verhalten der Akteure ersichtlich.

BackgroundConsent to treatment is a cornerstone of medical ethics and law. Nevertheless, very little empirical evidence is available to inform clinicians and policymakers regarding the capacities of forensic patients with schizophrenia spectrum disorders (SSDs) to make decisions about their treatment, with the risk of clinical and legal inertia, silent coercion, stigmatization, or ill-conceived reforms.Study DesignIn this multinational study, we assessed and compared with treatment-related decisional capacities in forensic and non-forensic patients with SSD. 160 forensic and 139 non-forensic patients were used in Austria, Germany, Italy, Poland, and England. Their capacity to consent to treatment was assessed by means of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Multiple generalized linear regression models were used to identify the socio-demographic and clinical variables associated with MacCAT-T scores.Study ResultsIn total, 55 forensic (34.4%) and 58 non-forensic patients (41.7%) showed high treatment-related decisional capacity, defined as scoring ≥75% of the maximum scores for the understanding, appreciation and reasoning, and 2 for expressing a choice. Forensic patients showed differences in their capacity to consent to treatment across countries. Of all socio-demographic and clinical variables, only “social support” was directly relevant to policy.ConclusionsForensic patients have treatment-related decisional capacities comparable with their non-forensic counterparts. Social contacts might provide a substantial contribution towards enhancing the decisional autonomy of both forensic and non-forensic patients, hence improving the overall quality and legitimacy of mental health care.

Homelessness has been in the focus of psychiatric research in Germany to a greater or lesser extent since the beginning of the nineteenth century. Recently, increasing numbers of homeless people in Germany due to the consolidation of poverty, the lack of affordable housing, and the processes of immigration have led again to an increased scientific and political interest. Prevalence rates of mental illnesses among homeless people in Germany are comparable to other Western countries, except for a higher prevalence of alcohol abuse. A broad range of social welfare and healthcare is currently not able to prevent the increase of people becoming homeless, mainly because of difficulties in apportioning responsibilities among welfare and healthcare institutions, complex administrative processes, language barriers, and barriers related to mental illness.

Soziale Ungleichheit bezieht sich auf die ungleiche Verteilung gesellschaftlichen Wohlstands, worunter auch die Ressource Gesundheit fallt. Mittels Indikatoren der sozialen Ungleichheit konnen Beziehungen zwischen sozialer Ungleichheit und psychischer Gesundheit fur alle Altersgruppen in Deutschland hergestellt werden. Die psychische Gesundheit der Bevolkerung folgt sozialen Gradienten, worunter die lineare Beziehung zwischen sozialer Statusgruppe und Gesundheitszustand verstanden wird. Grundlegende Determinanten sind kulturelle, soziale, politische und geographische Verhaltnisse, die mit der genetischen Ausstattung und epigenetischen Prozessen wechselwirken. Diese Determinanten beeinflussen auch die Bewaltigung der lebensphasenspezifischen Entwicklungsaufgaben und haben damit eine herausragende Bedeutung fur die Entstehung psychischer Storungen. Die Maladaption auf chronischen Stress ist fur die gesundheitliche Ungleichheit zentral. Techniken zur Stressbewaltigung konnen auf Verhaltensebene Abhilfe schaffen.

Zusammenfassung Anliegen Untersucht wird die Häufigkeit der sexuellen Missbrauchsbeschuldigungen und der einschlägigen Strafanzeigen gegen katholische Priester und Diakone in den Jahren von 2009 – 2015. Methode Für die Jahre 2009 – 2015 wird eine jährliche Quote der Beschuldigungen berechnet. In einem zweiten Schritt wird die Quote der einschlägigen Strafanzeigen gegen Priester mit den Tatverdächtigenbelastungszahlen der männlichen Allgemeinbevölkerung verglichen. Ergebnisse Die Quote des sexuellen Missbrauchs von Kindern beschuldigter Priester im Untersuchungszeitraum liegt zwischen 25,5/100 000 und 55,5/100 000 Priester. Die Tatverdächtigungsbelastungszahl bei Männern der Allgemeinbevölkerung liegt in den Jahren von 2009 – 2015 zwischen 17,6 und 20,0/100 000, die Quote der einschlägigen Strafanzeigen gegen Priester liegt zwischen 8,4 und 31,7/100 000. Diskussion Die Quote katholischer Priester, die für einen sexuellen Missbrauch von Kindern disponiert sind, hat im Untersuchungszeitraum nicht abgenommen.

Der vorliegende Beitrag stellt Befunde einer Strafaktenanalyse dar, die sich mit Strafverfahren wegen sexueller Missbrauchsdelikte an Minderjahrigen in der katholischen Kirche und in anderen Institutionen, wie z. B. Schulen, befasst. Die Analyse ergab, dass die Tatvorwurfe teilweise sehr schwer waren. Vielen Beschuldigten wurde nicht nur ein Ubergriff, sondern eine Mehrzahl von Delikten vorgeworfen. Viele Betroffene mussten mehrfach einen sexuellen Missbrauch erleiden. Die Delikte in der katholischen Kirche und in den anderen Institutionen weisen viele Ahnlichkeiten auf, es bestehen aber auch Unterschiede. Von den Strafverfahren, welche die katholische Kirche betrafen, fuhrten weniger als ein Drittel zu einer Verurteilung. Das lag insbesondere daran, dass viele dieser Verfahren wegen Verjahrung eingestellt werden mussten.

Background Depression is a serious mental health problem and is common in children and adolescents. Online interventions are promising in overcoming the widespread undertreatment of depression and in improving the help-seeking behavior in children and adolescents. Methods The multicentre, randomized controlled E.motion trial is part of the German ProHEAD consortium (Promoting Help-seeking using E-technology for ADolescents). The objective of the trial is to investigate the efficacy and cost-effectiveness of two online interventions to reduce depressive symptomatology in high-risk children and adolescents with subsyndromal symptoms of depression in comparison to an active control group. Participants will be randomized to one of three conditions: (1) Intervention 1, a clinician-guided self-management program (iFightDepression®); (2) Intervention 2, a clinician-guided group chat intervention; and (3) Control intervention, a psycho-educational website on depressive symptoms. Interventions last six weeks. In total, N = 363 children and adolescents aged ≥ 12 years with Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) scores in the range of 5–9 will be recruited at five study sites across Germany. Online questionnaires will be administered before onset of the intervention, at the end of the intervention, and at the six-month follow-up. Further, children and adolescents will participate in the baseline screening and the one- and two-year school-based follow-up assessments integrated in the ProHEAD consortium. The primary endpoint is depression symptomatology at the end of intervention as measured by the PHQ-A score. Secondary outcomes include depression symptomatology at all follow-ups, help-seeking attitudes, and actual face-to-face help-seeking, adherence to and satisfaction with the interventions, depression stigma, and utilization and cost of interventions. Discussion This study represents the first randomized controlled trial (RCT) investigating efficacy and cost-effectiveness of two online interventions in children and adolescents aged ≥ 12 years at risk for depression. It aims to provide a better understanding of the help-seeking behavior of children and adolescents, potential benefits of E-mental health interventions for this age group, and new insights into so far understudied aspects of E-mental health programs, such as potential negative effects of online interventions. This knowledge will be used to tailor and improve future help offers and programs for children and adolescents and ways of treatment allocation. Trial registration German Register for Clinical Trials (DRKS), DRKS00014668. Registered on 4 May 2018. International trial registration took place through the “international clinical trials registry platform” with the secondary ID S-086/2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-3156-8) contains supplementary material, which is available to authorized users.

Research in mental health services in Germany is of increasing relevance. To this end, the recently founded "Mental Health Working Group" as part of the German Network of Health Services Research (DNVF) has written a discussion paper presenting key specifics, challenges, and goals of health service research in the field of mental health. Some research-relevant specifics in the area of mental health care, pragmatic challenges of research organization, ethical problems, and particular research topics in this field are presented and discussed critically.Versorgungsforschung im Feld der seelischen Gesundheit ist von zunehmender Bedeutung. Angesichts dieser Entwicklung hat die im Oktober 2017 gegründete DNVF Fachgruppe „Seelische Gesundheit“ ein Diskussionspapier verfasst, welches zentrale Besonderheiten, Herausforderungen und Ziele der Versorgungsforschung im Bereich der seelischen Gesundheit zusammenfasst. Im Einzelnen werden forschungsrelevante Besonderheiten des Versorgungsfeldes, pragmatische Probleme bei der Forschungsorganisation, ethische Herausforderungen und für dieses Feld besondere Themenstellungen vorgestellt und diskutiert.

BJPsych Open 7(3), e 93 (2021). doi:10.1192/bjo.2021.54, Published by Cambridge University Press, Cambridge

Objective Neurocognitive impairment has been extensively studied in people with schizophrenia spectrum disorders and seems to be one of the major determinants of functional outcome in this clinical population. Data exploring the link between neuropsychological deficits and the risk of violence in schizophrenia has been more inconsistent. In this study, we analyse the differential predictive potential of neurocognition and social cognition to discriminate patients with schizophrenia spectrum disorders with and without a history of severe violence. Methods Overall, 398 (221 cases and 177 controls) patients were recruited in forensic and general psychiatric settings across five European countries and assessed using a standardized battery. Results Education and processing speed were the strongest discriminators between forensic and non-forensic patients, followed by emotion recognition. In particular, increased accuracy for anger recognition was the most distinctive feature of the forensic group. Conclusions These results may have important clinical implications, suggesting potential enhancements of the assessment and treatment of patients with schizophrenia spectrum disorders with a history of violence, who may benefit from consideration of socio-cognitive skills commonly neglected in ordinary clinical practice.

Background: The purpose of this systematic review is to systematically investigate which non-pharmacological interventions are effective in reducing violence risk among patients with schizophrenia spectrum disorders (SSD) in forensic settings.Methods: Six electronic data bases were searched. Two researchers independently screened 6,003 abstracts resulting in 143 potential papers. These were analyzed in detail by two independent researchers yielding 10 articles that could be used.Results: Of the 10 articles, four were non-randomized controlled trials, three were pre-post studies without controls, and one was observational. Only two studies applied a randomized controlled trial design. Cognitive behavioral treatment programs were investigated in three studies. A broad range of other interventions were studied. Often outcome measures were specific to each study and sample sizes were small. Frequently, important methodological information was missing from the papers. It was not possible to carry out a meta-analysis due to the heterogeneity of the study designs and outcome measures.Conclusion: Because of methodological limitations it is difficult to draw firm conclusions about the effectiveness of non-pharmacological interventions to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying better methods in terms of study design, sample sizes and outcome measures are urgently needed.

From 2014 to 2018, an interdisciplinary consortium of scientists investigated the extent and possible causes of the sexual abuse of children in the area of responsibility of the Catholic Church in Germany. The study bears the acronym MHG (Mannheim / Heidelberg/Gießen) after the locations of the participating universities. The personnel file analysis identified 1670 Catholic clerics accused of sexual abuse of minors for the period from 1946 to 2014. For the Catholic Church specific conditions that favour the sexual abuse of minors could be identified.A comparison of criminal records of accused clerics and perpetrators from other institutional contexts has been carried out.Sexual offenses of priests are severe and the number of persons affected per convicted person is not less than that of perpetrators in other institutions; the duration of abuse by Catholic clerics is even significantly longer. Persons affected by sexual abuse in the context of the Catholic Church are significantly more often male. The Catholic Church has tried more extensively than other institutions to cover up accusations of sexual abuse of children or young people by clerics.Prevention concepts must take greater account of the specific conditions of sexual abuse in the Catholic Church.Von 2014 bis 2018 hat ein interdisziplinäres Konsortium von Wissenschaftlern das Ausmaß und mögliche Ursachen des sexuellen Missbrauchs von Kindern und Jugendlichen im Verantwortungsbereich der katholischen Kirche in Deutschland untersucht. Nach den Standorten der beteiligten Universitäten trägt die Studie das Akronym MHG (Mannheim / Heidelberg/Gießen). Die dabei vorgenommene Personalaktenanalyse hat für den Zeitraum von 1946 bis 2014 1670 katholische Kleriker ermittelt, die des sexuellen Missbrauchs von Minderjährigen beschuldigt wurden. Die Personalaktenanalyse ergab weiterhin Hinweise darauf, dass es für die katholische Kirche spezifische systemische Bedingungen gibt, die den sexuellen Missbrauch von Minderjährigen begünstigen.Auf der Basis eines Vergleichs von Strafakten beschuldigter Kleriker und von Tätern aus anderen institutionellen Kontexten wird geprüft, ob sich die Hypothesen zu spezifischen systemischen Bedingungen des Missbrauchs in der katholischen Kirche falsifizieren lassen.Taten von Priestern sind nicht weniger schwer und die Anzahl Betroffener pro Verurteiltem sind nicht geringer als bei Tätern in anderen Institutionen, die Dauer des Missbrauchs durch katholische Kleriker ist sogar signifikant länger. Von sexuellem Missbrauch Betroffene im Kontext der katholischen Kirche sind signifikant häufiger männlich. Die katholische Kirche hat bei Vorwürfen gegen Kleriker wegen eines sexuellen Missbrauchs von Kindern oder Jugendlichen umfassender als andere Institutionen versucht, die Taten zu verharmlosen und zu vertuschen.Präventionskonzepte müssen die spezifischen Bedingungen des sexuellen Missbrauchs in der katholischen Kirche stärker berücksichtigen.

ZusammenfassungDaten zum sexuellen Missbrauch an Kindern können zum einen über die Hellfeldstatistiken gewonnen und zum anderen durch Dunkelfeldforschung erhoben werden. Der vorliegende Beitrag befasst sich mit der längsschnittlichen Entwicklung der Delikte in den vergangenen 63 Jahren in Deutschland. Die Straftaten des sexuellen Missbrauchs von Kindern gemäß § 176 StGB weisen in der Polizeilichen Kriminalstatistik (PKS) seit Veröffentlichung der PKS 1953–2016 einen Rückgang der Häufigkeitszahlen auf. Die Ergebnisse aus der Dunkelfeldforschung sind uneinheitlich, sprechen aber teilweise auch für einen Rückgang. Die Bedeutung dieser Befunde für die Präventionsarbeit und gesundheitspolitische Aktivitäten wird diskutiert.

Zusammenfassung Hintergrund Krankheitskostenstudien sind wichtige Instrumente, um die sozioökonomische Krankheitslast für definierte Erkrankungen abzuschätzen. Sie liefern der Versorgungsforschung sowie der Gesundheitspolitik wichtige Informationen zur Kostenstruktur einer Erkrankung, dem sich daraus ableitenden Forschungsbedarf, Ansätze zur Versorgungsoptimierung sowie zu den monetären Auswirkungen aus unterschiedlichen Perspektiven. Aufgrund der Heterogenität verfügbarer Krankheitskostenstudien entwickelte die Arbeitsgemeinschaft (AG) Gesundheitsökonomie des Deutschen Netzwerks Versorgungsforschung (DNVF) e.V. in Abstimmung mit der Deutschen Gesellschaft für Gesundheitsökonomie (DGGÖ) e.V. für Deutschland ein Instrument zur Planung/Durchführung und Beurteilung von Krankheitskostenstudien. Methodik Aufbau und Inhalt der generischen Checkliste wurden von der AG konzipiert, konsentiert und nachfolgend in einem Pretest überprüft. Die Checkliste basiert auf einer systematischen Literaturrecherche zu nationalen und bereits vorliegenden internationalen Checklisten sowie Leitlinien und Empfehlungen für die Erstellung und Bewertung von Krankheitskostenstudien und gesundheitsökonomischen Evaluationen. Ergebnis Aus der Literaturrecherche (N=2 454) konnten 58 Referenzen zur Identifizierung und Begründung von Kriterien für die Erstellung der Checkliste genutzt werden. Nach Durchführung und Auswertung des Pretests wurden 6 Dimensionen in die Checkliste einbezogen: (i) Allgemeine Aspekte, (ii) Identifikation der Ressourcen, (iii) Beschreibung und Quantifizierung der Ressourcenverbräuche, (iv) Bewertung der Ressourcen (v) Auswertung und Ergebnisdarstellung sowie (vi) Diskussion und Schlussfolgerung. Insgesamt werden die einzelnen Dimensionen über 37 Kriterien operationalisiert. Schlussfolgerung Die Checkliste ist ein erster Ansatz, die transparente Darstellung und das Verständnis von Krankheitskostenstudien im Hinblick auf Ausmaß, Zusammensetzung und Entwicklung der sozioökonomischen Krankheitslast ausgewählter Erkrankungen zu verbessern. Sie unterstützt die Vergleichbarkeit verschiedener Analysen und erleichtert die Studienkonzeption.

Sexual violence against children remains a global public health problem. The health sector has an opportunity and responsibility to be part of the multisector collaboration to prevent and respond to sexual abuse of minors. The following article presents a critical analysis of hitherto published empirical studies that examine the extent and variety of sexual abuse of minors within the Catholic Church and other institutions. The analysis consists of 40 studies concerning the Catholic Church and 13 studies concerning other institutions not belonging to the Catholic Church. We report the characteristics of the offenders and the offenses. Furthermore, the devastating consequences for children abused by members of powerful institutions are discussed. Knowledge on the role of institutions in sexual abuse of minors and psychological distress following these experiences is necessary to point the way to improvements in prevention and intervention strategies. This literature review is part of a larger research project on the sexual abuse of minors in the context of the Catholic Church in Germany (MHG Study) that is conducted by an interdisciplinary team of psychologists, psychiatrists, criminologists, and sociologists and is funded by the German Bishops' Conference.

The association between physical activity and mood is of major importance to increase physical activity as a prevention strategy for noncommunicable diseases and to improve mental health. Unfortunately, existing studies examining how physical activity and mood wax and wane within persons over time in everyday life do show ambiguous findings. Taking a closer look at these studies reveals that the aggregation levels differ tremendously. Whereas mood is conceptualized as a three-dimensional construct, physical activity is treated as a global construct not taking into account its distinct components like exercise (such as jogging) and nonexercise activity (NEA; such as climbing stairs).To overcome these limitations, we conducted an ambulatory assessment study on the everyday life of 106 adults over 7 d continuously measuring NEA via accelerometers and repeatedly querying for mood in real time via GPS-triggered e-diaries. We used multilevel modeling to derive differential within-subject effects of exercise versus NEA on mood and to conduct analyses on the temporal course of effects.Analyses revealed that exercise increased valence (beta = 0.023; P0.05) and calmness (beta = 0.022; P0.05). A tendency of decreasing energetic arousal (beta = -0.029) lacked significance. NEA, parameterized as 15-min episodes of physical activity intensity in everyday life, increased energetic arousal (beta = 0.135; P0.001) and decreased calmness (stand. beta = -0.080; P0.001). A tendency of increasing valence (beta = 0.014) lacked significance. Using longer time intervals for NEA revealed similar findings, thus confirming our findings.Exercise and NEA differed regarding their within-subject effects on mood, whereas exercise increased valence and calmness, NEA increased energetic arousal and decreased calmness. Therefore, it appears necessary to clearly differentiate between exercise and NEA regarding their within-subject effects on mood dimensions in both research and treatment.

This study explores the extent of sexual abuse of minors by members of the Catholic Church in Germany. It is the first comprehensive study to examine this extent in a European country. The goals of this study are as follows: (a) to analyze whether the extent and characteristics of sexual abuse in a European country are comparable to those in the United States and Australia and (b) how discrepancies can be explained. The personnel files of 38,156 Catholic Priests, deacons, and male members of religious orders in the authority of the German Bishops’ Conference were analyzed. The study period lasted from 1946 to 2014. All 27 German dioceses took part in this study. A total of 4.4% of all clerics ( N = 1,670) from 1946 to 2014 were alleged to have committed sexual abuse, and 3,677 children or adolescents were identified as victims. These results are similar to those from comparable studies in the United States. Sexual abuse of minors within the authority of the Catholic Church seems to be a worldwide phenomenon.

Background The link between schizophrenia spectrum disorders (SSD) and violence is a core issue for most forensic psychiatric services. However, the drivers of violence in this population remain unclear, and, to date tools to predict violence risk have a range of limitations. Perhaps because of this uncertainty about the nature of violence risk, treatment programmes and care pathways for mentally disordered offenders vary substantially across the European Union, and differences in legal and policy frameworks are highly relevant. Methods The three-year EU-VIORMED project (Grant Number PP-2-3-2016, November 2017–October 2020) involves forensic centres in Italy, Austria, Germany, Poland, and the U.K. It aims to: (a) identify and compare violence risk factors, clinical needs, and decision making capacity in violent (N = 200, “cases”) and nonviolent patients with SSD (N = 200; “controls”) using a case-control design; (b) test the predictive validity of the HCR-20v3, OxMIS and FoVOx among cases alone (N = 200), using a prospective cohort study; and (c) compare forensic-psychiatric care pathways across the EU, in a continent wide service mapping study. Discussion Data collection started in September 2018 and continues. By September 2019, 333 participants have been enrolled (201 cases and 132 controls were recruited). Experts from 23 countries provided data for the service mapping exercise. Trial registration Retrospectively registered on January 2, 2019 as researchregistry4604 January 2, 2019

This paper explores the frequency of sexual abuse allegations against Catholic priests and deacons in the years 2009 to 2015 in relation to the male general population in Germany.An annual rate of sexual abuse accusations is calculated from the sexual abuse allegations against Catholic priests identified in the MHG-study for the years 2009 to 2015. This is compared to figures of the male general population from the police crime statistics.The number of suspected men in the general population ranged from 17.6 - 20.0/100.000 between 2009 and 2015. For Catholic priests the rate of accusations ranged from 8.4 to 31.7/100.000. A decrease of the quota was not detectable in either group during the study period.The findings suggest that there is a relatively constant rate of people being disposed to child sexual abuse in the group of Catholic priests. These results should be addressed specifically in the prevention work of the Catholic Church.Untersucht wird die Häufigkeit der sexuellen Missbrauchsbeschuldigungen und der einschlägigen Strafanzeigen gegen katholische Priester und Diakone in den Jahren von 2009 – 2015.Für die Jahre 2009 – 2015 wird eine jährliche Quote der Beschuldigungen berechnet. In einem zweiten Schritt wird die Quote der einschlägigen Strafanzeigen gegen Priester mit den Tatverdächtigenbelastungszahlen der männlichen Allgemeinbevölkerung verglichen.Die Quote des sexuellen Missbrauchs von Kindern beschuldigter Priester im Untersuchungszeitraum liegt zwischen 25,5/100 000 und 55,5/100 000 Priester. Die Tatverdächtigungsbelastungszahl bei Männern der Allgemeinbevölkerung liegt in den Jahren von 2009 – 2015 zwischen 17,6 und 20,0/100 000, die Quote der einschlägigen Strafanzeigen gegen Priester liegt zwischen 8,4 und 31,7/100 000.Die Quote katholischer Priester, die für einen sexuellen Missbrauch von Kindern disponiert sind, hat im Untersuchungszeitraum nicht abgenommen.

Background When cases of sexual abuse within the Catholic Church became known, the German Bishops' Conference (Deutsche Bischofskonferenz, DBK) commissioned a study by an interdisciplinary consortium to determine the frequency of sexual abuse by Catholic clergy in Germany (the MHG study). Methods Qualitative and quantitative research methods were used and the subject matter of the study was analyzed in seven component projects. To determine the frequency of sexual abuse, 38 156 personnel files of Catholic clergy from the period 1946 to 2014 were studied, and the epidemiologic findings of these evaluations are presented. Results 1670 persons belonging to the Catholic clergy who were accused of sexual abuse of minors were identified from their personnel files, corresponding to 4.4% of the clergy overall. 3677 victims of sexual abuse could be linked to the accused persons; 62.8% of them were male, and 66.7% were under 14 years old when the abuse took place. The mean duration of the abuse in individual cases was 1.3 years. "Hands-on" abuses (i.e., abuses involving bodily contact) occurred in more than 80% of cases. Many of the affected persons suffered serious consequences for their health and social functioning. The ones most commonly reported were anxiety, depression, mistrust, sexual problems, and difficulties with interpersonal contact. Conclusion The figures reported here should be considered a lower bound to the actual frequency of sexual abuse. Asymmetrical power relationships in a closed system such as the Catholic Church can facilitate sexual abuse. Physicians play an important role in the diagnosis and treatment of the victims of sexual abuse, in the diagnosis and treatment of persons inclined to commit abuses and actual abusers, and in the development and implementation of preventive strategies.

Stress is a mind–body phenomenon, which affects both mental and physical health and is highly relevant to the health care system. Yet, knowledge on the costs of stress and related health problems in adolescence is missing. The present study addresses this gap by investigating direct health care costs in relation to stress, mental health problems and physical health in high school students. The sample comprised 284 pupils from four schools in Heidelberg (mean age 16.75 ± 0.64 years, 59.64% female). Self-reported health care utilization and medication intake within 1 month were translated into costs. We established correlative associations of the dichotomized overall costs (no vs. any) with stress, mental health problems and physical health within generalized structural equation models. In particular, mental health problems and physical health were examined as mediators of the association between stress and costs. An increase of stress by 1 SD corresponded increased chances for costs by OR 1.39 (Odds Ratio; 95% CI 0.13–0.53, p = 0.001). When mediators were analysed separately, both mental and physical health (problems) fully mediated the association. Yet, when examined together, only mental health problems acted as a mediator. Our results indicate the health economic relevance of stress-related mental health problems in high school students. The finding is meant to set the stage for further cost-of-illness studies of stress and related health problems, as well as economic evaluations. Longitudinal research is needed to allow conclusions on directionality.

World Health Organization Trial Registration Data Set. (DOCX 19 kb)

Background The highest incidence and prevalence of mental health problems across the lifespan as well as the first onset of most long-term mental health conditions are reported for youths between 14 and 25 years of age. At the same time, only 25% of adolescents with mental health problems receive professional treatment. One explanation for poor treatment access in youths is their low help-seeking behavior. Barriers that can keep children and adolescents (C&A) from seeking professional help include a lack of perceived need, structural barriers, or stigma. Interventions based on e-technology might present an effective approach, overcoming these barriers by reducing stigma and providing low-threshold access with enhanced reach, ultimately facilitating help-seeking for mental health problems among youths. Methods The study is designed as a multi-center, randomized controlled trial. In total, an estimated number of n = 1,500 C&A with mental health problems, drawn from a school-based sample of n = 15,000 pupils attending school grades 6 to 13 (≥ 12 years of age), recruited in five regions of Germany, will be randomized either to an intervention (ProHEAD online) or a control condition. C&A in the intervention group will receive online access to tailored information and individual advice on where to seek professional help for their specific needs close to their place of living, case reports of and interaction with peers, as well as the opportunity for online and telephone counseling. C&A in the control intervention will receive a recommendation to seek help and online information on where to find professional help. All participants will be asked to complete questionnaires concerning their help-seeking behavior at baseline, during the intervention (monitoring), and also at a 1 and 2 year follow-up. The primary endpoint is the number of C&A seeking conventional face-to-face professional help in the real-world setting within 1 year after their initial screening. Discussion The trial will investigate if an Internet-based intervention can increase professional help-seeking in C&A with mental health problems. With its randomized controlled design and large-scale school-based sampling, the study aims to overcome the shortages of previous research. The intervention has the potential to narrow the treatment gap in C&A and to ultimately improve the mental health care system. Trial registration German Clinical Trials Register, DRKS00014685. Registered on 7 July, 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-3157-7) contains supplementary material, which is available to authorized users.

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 121 kb)

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 121 kb)

Contains fulltext : 208469.pdf (Publisher’s version ) (Open Access) PURPOSE: This study aimed to assess the effectiveness of a care management intervention in improving self-management behavior in multimorbid patients with type 2 diabetes; care was delivered by medical assistants in the context of a primary care network (PCN) in Germany. METHODS: This study is an 18-month, multi-center, two-armed, open-label, patient-randomized parallel-group superiority trial (ISRCTN 83908315). The intervention group received the care management intervention in addition to the usual care. The control group received usual care only. The primary outcome was the change in self-care behavior at month 9 compared to baseline. The self-care behavior was measured with the German version of the Summary of Diabetes Self-Care Activities Measure (SDSCA-G). A multilevel regression analysis was applied. RESULTS: We assigned 495 patients to intervention (n = 252) and control (n = 243). At baseline, the mean age was 68 +/-11 years, 47.8% of the patients were female and the mean HbA1c was 7.1+/-1.2%. The primary analysis showed no statistically significant effect, but a positive trend was observed (p = 0.206; 95%-CI = -0.084; 0.384). The descriptive analysis revealed a significantly increased sum score of the SDSCA-G in the intervention group over time (P = 0.012) but not in the control group (p = 0.1973). CONCLUSION: The sum score for self-care behavior markedly improved in the intervention group over time. However, the results of our primary analysis showed no statistically significant effect. Possible reasons are the high baseline performance in our sample and the low intervention fidelity. The implementation of this care management intervention in PCNs has the potential to improve self-care behavior of multimorbid patients with type 2 diabetes.

Aims This study explored the impact of a care management intervention aiming to improve self-care behavior in multimorbid individuals with Type 2 diabetes mellitus on health-related quality of life (HRQoL). Methods A patient-level randomized parallel-group superiority trial with 32 primary care practice teams, 11 care managers and 495 patients was conducted. The intervention was delivered as add-on to an already implemented disease management program and embedded in a network of primary care practices. Hierarchical linear modeling was used to analyze impacts of the care management approach on HRQoL. Results Small improvements of HRQoL in the intervention arm were found after nine months (r = 0.024; 95%CI = [0.000, 0.047]). However, compared to standard care no significant differences of HRQoL changes were observed (r = 0.022; 95%CI = [−0.011, 0.054]). Subgroup analyses showed effects for female participants favoring the intervention arm (r = 0.059; 95%CI = [0.010, 0.108]). No significant differences between intervention and control arm for several other subgroups were observed, including subgroups defined by comorbidities. Conclusion Additional care management did not influence HRQoL over and above standard disease management. Improving diabetes patients’ self-care behavior in the context of structured disease management programs may be difficult to achieve. Women might benefit from additional care management, but this finding needs to be confirmed in future research.

Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist. (DOCX 49 kb)