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Hintergrund Alkohol wird bei Personen mit Migrationshintergrund, insbesondere ab dem 50. Lebensjahr, zu einem Problem. Praventionsmasnahmen erreichen diese Gruppe aber nur unzulanglich. Vor diesem Hintergrund wurde ein transkulturelles Praventionskonzept zur Primarpravention alkoholbezogener Storungen entwickelt und evaluiert.

Hintergrund: Kulturelle und migrationsspezifische Aspekte scheinen die Inanspruchnahme von Gesundheitsleistungen in dieser Gruppe zu beeinflussen. Es existieren allerdings keine Instrumente, welche solche Einflussfaktoren erfassen. Methoden: Systematische Literaturrecherche zur Identifikation der Schwierigkeiten, welche Migranten bei der Inanspruchnahme von Gesundheitsmasnahmen erleben. Die abgeleiteten Aspekte wurden im Rahmen einer Querschnittbefragung von Menschen mit russischem, turkischem, italienischem und spanischem Migrationshintergrund uberpruft. Zur psychometrischen Testung wurden Faktoren- und Reliabilitatsanalysen durchgefuhrt. Ergebnisse: Es wurde 24 Grunde fur Nicht-Inanspruchnahme identifiziert. Die faktoranalytische Testung zeigte eine Losung mit 2 Subskalen („Sprach- und informationsbezogene Grunde fur Nicht-Inanspruchnahme von Gesundheitsleistungen“; Chronbach’s α=0,928; „Erfahrungen mit bzw. Einstellungen zur Gesundheitsversorgung“; α=0,879) und einer Gesamtskala (α=0,945). Die Akzeptanz lag zwischen 80,0 und 96,3%. Schlussfolgerungen: Die Ergebnisse bestatigen die theoretisch abgeleiteten Aspekte. Zur Generalisierbarkeit ist eine weitere Uberprufungen der psychometrischen Qualitaten des Instruments sowie seine Anwendung in anderen Populationen notwendig.

This study was part of a double-blind randomised controlled trial aimed to evaluate the effects of culture-sensitive patient information materials (PIM) compared with standard translated material. The study aimed to obtain the data for the development of culture sensitive PIM about unipolar depression for the 4 largest migrant groups in Germany (Turkish, Polish, Russian and Italian migration background).A qualitative study using 4 manual-based focus groups (FG), one for each migrant group, with 29 participants (9 with a Turkish (TüG), 8 with a Polish (PoG), 5 with a Russian (RuG) and 7 with an Italian (ItG) migration background) was conducted. The discussions were recorded, transcribed and analyzed using qualitative content analysis.7 categories were identified. For the (1.) development of a good culture-sensitive PIM an easy language, a clear structure, an assessable extent of information and the avoidance of stereotypes were highlighted cross-culturally in all four FG. RuG and PoG had the largest (2.) lack of information about the German health care system. Concerning the (3.) illness perception RuG named problems with recognizing and understanding depression. PoG, RuG and TüG thematized (4.) feared consequences of the illness and of professional helpseeking. ItG, PoG, RuG had fears concerning (5.) psychotropic drugs as a result from insufficient knowledge about medication. For (6.) doctor-patient relationship cultural specifics were identified in RuG and TüG and for (7.) migration or culture specific reasons for depression in RuG, ItG and TüG.Although the identified categories were relevant for all or for the majority of migrant groups, for most categories specific cultural aspects were discovered. These findings show the importance of a culture sensitive adaptation of PIM.Die Studie war ein Teil einer größeren, randomisiert-kontrollierten Studie, in der die Effekte kultursensitiver Patienteninformationsmaterialien (PIM) im Vergleich mit übersetzten PIM evaluiert wurden. Die vorliegende Studie hatte zum Ziel, Daten zur Entwicklung von PIM zu unipolarer Depression für die 4 größten Gruppen von Menschen mit Migrationshintergrund (türkischer, polnischer, russischer und italienischer Migrationshintergrund) in Deutschland zu gewinnen.Im Rahmen einer qualitativen Studie wurde pro Migrantengruppe jeweils eine leitfadenbasierte Fokusgruppe (FG) mit insgesamt n=29 Teilnehmenden (n=9 mit türkischem (TüG), n=8 polnischem (PoG), n=5 russischem (RuG), n=7 italienischem (ItG) Migrationshintergrund) durchgeführt, aufgezeichnet, transkribiert und mittels eines qualitativ-inhaltsanalytischen Analysemodells ausgewertet.Es konnten 7 Kategorien identifiziert werden. Über alle 4 FG wurde kulturübergreifend als wichtig die (1.) Gestaltung einer guten kultursensitiven PIM durch eine einfache Sprache, eine klare Struktur, einen überschaubareren Informationsumfang sowie die Vermeidung von Stereotypien erachtet. (2.) Informationsdefizite über das Gesundheitssystem zeigten sich v. a. bei der RuG und der PoG. Bezogen auf das (3.) Krankheitsbild der Depression wurden von der RuG Schwierigkeiten bzgl. des Erkennens und des Verstehens einer Depression beschrieben. In der PoG, der RuG und der TüG wurde die (4.) befürchteten Folgen der Erkrankung sowie der Inanspruchnahme professioneller Hilfe thematisiert. In den ItG, PoG und RuG wurden Angstgefühle aufgrund von Wissenslücken im Zusammenhang mit (5.) Psychopharmaka beschrieben. In der Kategorie (6.) Arzt-Patienten-Beziehung konnten kulturspezifische Besonderheiten für die RuG und die TüG und in der Kategorie (7.) migrations- und kulturspezifische Depressionsursachen für die RuG, die ItG und die TüG identifiziert werden.Obwohl einige Kategorien kulturübergreifend für alle bzw. für die Mehrheit untersuchter Migrantengruppen eine Relevanz zeigten, waren bei einer Vielzahl von Kategorien kulturelle Spezifika erkennbar. Dies spricht für die Wichtigkeit einer kultursensitiven Anpassung von PIM.

Patienten mit Depression werden in Deutschland vergleichsweise lang stationar behandelt. Ein neues Behandlungsmodell mit symptomorientiertem Entlassmanagement, nachstationarer Behandlung und standardisierter Ubergabe an den ambulanten Therapeuten konnte geeignet sein, die Verweildauer gezielt bei den Patienten zu verkurzen, die bereits ausreichend von einer stationaren Behandlung profitiert haben. Ziel der vorliegenden Studie war es, bei stationar behandelten depressiven Patienten die Effekte eines neuen Behandlungsmodells (Interventionsgruppe) im Vergleich zur Standardbehandlung („Treatment-as-usual“-Kontrollgruppe) auf die Verweildauer in Tagen im Rahmen einer pragmatischen randomisiert-kontrollierten Multicenterstudie zu untersuchen. Die Auswertung erfolgte mittels Kovarianzanalyse. Von 202 randomisierten Patienten gingen 184 in die Analysen ein. Das geschatze Randmittel der Verweildauer lag in der Interventionsgruppe (n = 83) bei 57,3 (Range: 1–305, SE = 3,8) und in der Kontrollgruppe (n = 101) bei 57,6 Tagen (Range: 6–196, SE = 3,5). Der Unterschied war nicht statistisch signifikant (p = 0,966). Effekte des neuen Behandlungsmodells auf die stationare Verweildauer im Krankenhaus bei depressiven Patienten konnten nicht nachgewiesen werden.

Objectives To evaluate the usefulness of culture-sensitive patient information material compared with standard translated material. Design Multicentre, double-blind randomised controlled trial. Setting 37 primary care practices. Participants 435 adult primary care patients with a migration background with unipolar depressive disorder or non-specific chronic low back pain were randomised. Patients who were unable to read in the language of their respective migration background were excluded. Sufficient data were obtained from 203 women and 106 men. The largest group was of Russian origin (202 patients), followed by those of Turkish (52), Polish (30) and Italian (25) origin. Interventions Intervention group: provision of culture-sensitive adapted material. Control group: provision of standard translated material. Main outcome measures Primary outcome: patient-rated usefulness (USE) assessed immediately after patients received the material. Secondary outcomes: patient-rated usefulness after 8 weeks and 6 months, symptoms of depression (PHQ-9), back pain (Back Pain Core Set) and quality of life (WHO-5) assessed at all time points. Results Usefulness was found to be significantly higher (t=1.708, one-sided p=0.04) in the intervention group (USE-score=65.08, SE=1.43), compared with the control group (61.43, SE=1.63), immediately after patients received the material, in the intention-to-treat analysis, with a mean difference of 3.65 (one-sided 95% lower confidence limit=0.13). No significant differences were found for usefulness at follow-up (p=0.16, p=0.71). No significant effect was found for symptom severity in depression (p=0.95, p=0.66, p=0.58), back pain (p=0.40, p=0.45, p=0.32) or quality of life (p=0.76, p=0.86, p=0.21), either immediately after receiving the material, or at follow-up (8 weeks; 6 months). Patients with a lower level of dominant society immersion benefited substantially and significantly more from the intervention than patients with a high level of immersion (p=0.005). Conclusion Cultural adaptation of patient information material provides benefits over high quality translations. Clinicians are encouraged to use culture-sensitive material in their consultations, particularly with low-acculturated patients. Trial registration number German Register for Clinical Trials: DRKS00004241, Universal Trial Number: U1111-1135-8043, Results.

Background Chronic diseases, like diabetes mellitus, heart disease and cancer are leading causes of death and disability. These conditions are at least partially preventable or modifiable, e.g. by enhancing patients’ self-management. We aimed to examine the effectiveness of telephone-based health coaching (TBHC) in chronically ill patients. Methods and Findings This prospective, pragmatic randomized controlled trial compares an intervention group (IG) of participants in TBHC to a control group (CG) without TBHC. Endpoints were assessed two years after enrolment. Three different groups of insurees with 1) multiple conditions (chronic campaign), 2) heart failure (heart failure campaign), or 3) chronic mental illness conditions (mental health campaign) were targeted. The telephone coaching included evidence-based information and was based on the concepts of motivational interviewing, shared decision-making, and collaborative goal setting. Patients received an average of 12.9 calls. Primary outcome was time from enrolment until hospital readmission within a two-year follow-up period. Secondary outcomes comprised the probability of hospital readmission, number of daily defined medication doses (DDD), frequency and duration of inability to work, and mortality within two years. All outcomes were collected from routine data provided by the statutory health insurance. As informed consent was obtained after randomization, propensity score matching (PSM) was used to minimize selection bias introduced by decliners. For the analysis of hospital readmission and mortality, we calculated Kaplan-Meier curves and estimated hazard ratios (HR). Probability of hospital readmission and probability of death were analysed by calculating odds ratios (OR). Quantity of health service use and inability to work were analysed by linear random effects regression models. PSM resulted in patient samples of 5,309 (IG: 2,713; CG: 2,596) in the chronic campaign, of 660 (IG: 338; CG: 322) in the heart failure campaign, and of 239 (IG: 101; KG: 138) in the mental health campaign. In none of the three campaigns, there were significant differences between IG and CG in time until hospital readmission. In the chronic campaign, the probability of hospital readmission was higher in the IG than in the CG (OR = 1.13; p = 0.045); no significant differences could be found for the other two campaigns. In the heart failure campaign, the IG showed a significantly reduced number of hospital admissions (-0.41; p = 0.012), although the corresponding reduction in the number of hospital days was not significant. In the chronic campaign, the IG showed significantly increased number of DDDs. Most striking, there were significant differences in mortality between IG and CG in the chronic campaign (OR = 0.64; p = 0.005) as well as in the heart failure campaign (OR = 0.44; p = 0.001). Conclusions While TBHC seems to reduce hospitalization only in specific patient groups, it may reduce mortality in patients with chronic somatic conditions. Further research should examine intervention effects in various subgroups of patients, for example for different diagnostic groups within the chronic campaign, or duration of coaching. Trial Registration German Clinical Trials Register DRKS00000584

Objective: This study aimed to investigate how patients with chronic conditions evaluate telephone health coaching provided by their health insurance company. Methods: A retrospective survey was conducted among coaching participants ( n=834). Outcomes included the general evaluation of the coaching, the evaluation of process and effects and the impact on patient-physician communication. Results: Participants’ average age was 66.2 years and the majority were women (58.3%). The majority (78.3%) of the insured persons were satisfied with the coaching and 82.3% would recommend it to others. More than half of the participants (53.3%) had learned about new options to influence their health condition. Sub-group differences in the evaluation of the health coaching were found for age, gender and medical condition. Conclusion: Health coaching might be useful in supporting patients with chronic conditions. While the results indicate a general positive appraisal, a possibility for improvement could be a stronger focus on the individual situation and the imparting of specific skills. Target groups might be selected in a specified manner for the coaching, as older participants in need of specific care seem to benefit less from the approach. Longitudinal and controlled studies are needed to investigate clinical effects of health coaching.

Migrations- und kultursensitive Analyse der von Personen mit Migrationshintergrund erlebten Hindernisse bei der Inanspruchnahme von Gesundheitsmasnahmen. Querschnittstudie mit Migranten aus der Turkei (n = 77), Spanien (n = 67), Italien (n = 95) sowie Aussiedlern aus der ehemaligen Sowjetunion (n = 196; Gesamtrucklauf: 13,7%), die uber Migrations- und Suchtdienste des Deutschen Caritasverbandes, der Arbeiterwohlfahrt und Migrantenselbstorganisationen gewonnen wurden. Migranten mit spanischem und italienischem Hintergrund suchen haufiger Unterstutzung in der Familie und im sozialen Umfeld. Personen mit russischem Hintergrund vertrauen mehr auf selbst umzusetzende Masnahmen (Hausmittel) und geben wie Personen mit turkischem Hintergrund sprachliche Probleme als wichtiges Hindernis fur eine gezielte Inanspruchnahme an. Wichtigstes Hindernis bei Turken ist die Einschatzung, Fachkrafte wussten zu wenig uber die turkische Kultur. Auserdem hatten die subjektive Einschatzung der Deutschkenntnisse und das subjektive Wohlbefinden in Deutschland einen Einfluss auf die Auspragung der erlebten Hindernisse. Die Ergebnisse sind ein wichtiger Hinweis, dass kultur- und sprachsensitive Masnahmen einen wesentlichen Beitrag zur Verbesserung der Versorgung von Personen mit Migrationshintergrund leisten konnen.

Anliegen Analyse des Inanspruchnahmeverhaltens von Migranten mit einer psychischen Storung im Vergleich zu Deutschen. Methode Reanalyse des Bundesgesundheitssurveys mit einer gematchten Stichprobe aus Migranten (n = 151) und Deutschen (n = 151). Ergebnisse Hinsichtlich der gesundheitsbezogenen Inanspruchnahme gibt es keine Unterschiede. Schlussfolgerungen Der Migrationshintergrund alleine erklart die in vielen Studien gefundenen Unterschiede nicht. Auszugehen ist von einer multifaktoriellen Entstehung, die neben migrationsbezogenen vor allem auf soziookonomischen Faktoren beruht.

BACKGROUND: To ensure an adequate health care of migrants, differentiated information on the association of cultural background and migration related factors and psychosomatic complaints are necessary. METHOD: Cross-sectional questionnaire based survey regarding psychosomatic complaints of migrants from Turkey (n = 77), Italy (n = 95), and Spain (n = 67) and ethnic German resettled from the states of the former Soviet Union (n = 196). Questionnaires distributed by non-health specific counselling agencies of welfare associations. RESULTS: The cultural background was a relevant factor for psychosomatic complaints, showing higher complaints in Turkish and ethnic German resettled migrants, also compared to a sample of age corresponding Germans. In contrast, Spanish and Italian migrants showed a lower risk for psychosomatic complaints. Also gender, feeling unwell in Germany and fatalism showed a significant association with psychosomatic complaints. CONCLUSION: Migrants in Germany do not have per se a higher risk for psychosomatic complaints. A distinct differentiation by cultural background is necessary.

Zusammenfassung Hintergrund Die Vernetzung zwischen ambulanter und stationarer Versorgung bei der Behandlung von Menschen mit depressiven Storungen ist weiterhin suboptimal. Um die Versorgung von Patienten mit Depressionen zu verbessern, lauft seit Dezember 2008 in der Region Freiburg ein Projekt, in dem zentrale Empfehlungen des Rahmenkonzepts „Integrierte Versorgung Depression“ der Deutschen Gesellschaft fur Psychiatrie und Psychotherapie implementiert werden sollen. Methoden Im Rahmen einer projektbegleitenden Evaluation wurden die Inanspruchnahme der Behandlungsangebote und die Effekte des Modells auf Grundlage von Arzt- und Patientenangaben analysiert. Ergebnisse Am Freiburger Modell beteiligten sich 40 Arzte und 234 Patienten. Die bei weitem haufigsten Storungen waren unipolare Depressionen (91%), zumeist mit mittelgradiger (58%) oder schwerer (36%) Symptomatik und uberwiegend (61%) mit rezidivierendem Verlauf. Rund drei Viertel (75%) der Patienten wurden ausschlieslich ambulant behandelt. 8 Wochen nach Einschluss in das Projekt waren nach Einschatzung der Arzte 58% der Patienten remittiert oder wiesen nur noch subsyndromale Symptome auf. Nach 16 Wochen waren es 70%. Aus Sicht der Patienten waren bei Ende der Behandlung 59% entweder remittiert oder wiesen eine minimale Symptomatik auf. Schlussfolgerung Im Freiburger Modell konnten die zentralen Empfehlungen des Rahmenkonzepts „Integrierte Versorgung Depression“ in die Routineversorgung umgesetzt werden. Die ersten Evaluationsergebnisse sprechen fur eine hohe Versorgungsqualitat im Freiburger Modell.

Sickness leave is a major source of societal costs in depression treatment. However, very little is known about the rationale behind sick leave and their effects on depressive symptoms. Aim of the paper is to evaluate the effect of sick leave on treatment outcome and the association of sick leave with patient, depression and treatment-related factors. For this we compared patients with sick leave and non-sick leave regarding symptom reduction following 6 weeks of treatment. A total of 118 patients of 41 physicians in a controlled clinical trial with a naturalistic prospective design were analysed. After 8 weeks of treatment no significant differences were found between patients who had or did not have sick leave, in terms of improvement of depressive symptoms. The analyses of physician, patient and illness-related variables regarding their predictive value showed no significant effect. No systematic effect of sick leave and no clear criteria were found that were related to receiving a sick leave certificate. It can be assumed that physicians do not only base the decision of whether to sign a depressive patient off sick on illness-specific factors. For a targeted implementation of sick leave as therapeutic measure predictors for effectiveness should be defined.

Unipolare Depressionen zahlen zu den haufigsten Beratungsanlassen und Erkrankungen in der Versorgung. Obwohl die Diagnostik und Therapie der Depression in den letzten Jahren Fortschritte gemacht hat, besteht noch deutliches Optimierungspotenzial. Die Ausrichtung der Behandlung an evidenzbasierten Leitlinien bildet hierbei einen zentralen Ansatzpunkt. Die neue S3- und Nationale Versorgungsleitlinie Unipolare Depression, deren Erstellung von der DGPPN koordiniert und die von 29 Fachgesellschaften und Berufsverbanden konsentiert wurde, stellt den ambitionierten Versuch dar, Evidenz und klinischen Konsens zum „state of the art“ in der Depressionsbehandlung abzubilden. Fur die Pharmakotherapie der Depression konnen differenzierte Empfehlungen, auch in Abgrenzung und in Erganzung zur Psychotherapie, gegeben werden.

OBJECTIVE: The aim of this study was to assess the general attitudes of health insurants with chronic conditions towards a health coaching and their reasons for participation in or refusal of the telephone health coaching provided by their sickness fund. METHOD: The survey was designed as a cross-sectional study on insurants who had either participated in the coaching (n=834), declined participation (n=530) or were members of a control group (n=544). Furthermore, we investigated whether the reasons and attitudes differed with regard to socio-demographic variables of the participants (age, sex, primary condition). RESULTS: The most common reason for participation in health coaching was the feeling of obligation towards the society to take care of one's own health (80.1%). Further reasons included a general interest in prevention (75.4%) and health-related issues (51.1%). The main reason for declining participation was a sufficient care by family members or a general practitioner (96.4%). This was in particular the case with older insured persons. Most people in the control group estimated health coaching as effective and appropriate for them. Those who had declined to participate were more critical in their appraisal. The younger the insured were, the more positive was their attitude towards health coaching. CONCLUSIONS: The results show that, on the one hand, insured feel obligated to participate in prevention programs but, on the other hand, they are also interested in information about their condition and in the possibility to contribute to their treatment. The telephone health coaching by the KKH-Allianz is a new approach in the German health care and can be regarded as a supplement to medical treatment. Specifically, younger insured are highly interested in this new concept. Further studies on its efficacy are required to show the extent to which expectations and needs of insurants can actually be met.

Depressive Storungen gehoren zu den haufigsten Beratungsanlassen und Erkrankungen in der Versorgung. Trotz ihrer guten Behandelbarkeit und Fortschritten in den vergangenen Jahren besteht weiterhin Optimierungsbedarf in Diagnostik und Therapie. Eine geeignete Masnahme, die Versorgung depressiver Patienten zu verbessern, stellt die Implementierung evidenz- und konsensbasierter Leitlinien dar. Fur Deutschland wurde Ende 2009 eine evidenz- und konsensbasierte S3- bzw. Nationale VersorgungsLeitlinie „Unipolare Depression“ erarbeitet und im Konsens der in diesem Versorgungsbereich relevanten Akteure verabschiedet; dies soll ihre Akzeptanz und weite Verbreitung sicherstellen. Bezuglich der Wirksamkeit von Psychotherapie in der Behandlung der Depression liegen zahlreiche empirische Belege vor, und es lassen sich differenzierte evidenzbasierte Behandlungsempfehlungen fur psychotherapeutische Behandlungsmasnahmen, auch hinsichtlich der Kombination mit Antidepressiva oder als Alternative zu einer Pharmakotherapie formulieren. So wird in der Akuttherapie bei leichter depressiver Episode uber 14 Tage eine aktiv-beobachtende Begleitung, bei Fortbestehen der Symptome Psychotherapie empfohlen. Bei mittelgradiger Depression werden Psycho- und Pharmakotherapie gleichwertig, bei schwerer Depression eine Kombinationsbehandlung aus beiden empfohlen.

2006 wurde das sechste nationale Gesundheitsziel „Depressive Erkrankungen: verhindern, fruh erkennen, nachhaltig behandeln“ von einer interdisziplinaren Expert(inn)engruppe entwickelt. Insgesamt sechs Aktionsfelder und Masnahmenvorschlage mit Verbesserungspotenzialen wurden definiert. Im Anschluss wurde eine Expert(inn)engruppe beauftragt, eine Evaluationsstrategie zu erarbeiten, Erfolgsindikatoren zu definieren und die Verfugbarkeit von Datenquellen zur Evaluation zu prufen. Fur die im Gesundheitsziel vorrangig formulierten Startermasnahmen wurden spezifische Erfolgsindikatoren abgeleitet und fur die Evaluation zur Verfugung stehende Routinedaten identifiziert. Im Anschluss wurden die Grenzen dieser Datenquellen analysiert und notwendige Erganzungen beschrieben. Die relevanten Erfolgsindikatoren fur spezifische Aktionsfelder sind beschrieben, die Verfugbarkeit und Nutzbarkeit vorhandener Datenquellen sind gepruft. Weitere Erganzungen beziehungsweise zusatzliche Spezifizierungen im Hinblick auf die Indikatoren sind ausgearbeitet. Aufgrund unzureichend aussagekraftiger Datenquellen sind zusatzliche systematische Erhebungen notwendig, um das Gesundheitsziel und seine Umsetzung evaluieren zu konnen. Bestehende Routineerhebungen in Deutschland sollten um Fragen zu relevanten Masnahmen und Erfolgsindikatoren erweitert und verschiedene Erfolgsindikatoren zusammenfassend analysiert werden.

OBJECTIVE: To analyze patient satisfaction in inpatient depression treatment depending on German language proficiency. METHODS: Documentation of patients in 24 psychiatric hospitals in Baden-Wurttemberg (South Germany). The following three groups were matched according to age, gender, and education: native German speakers, non-native speakers with good German proficiency, and non-native speakers with limited German proficiency (67 in each group). RESULTS: The number of unsatisfied patients was four times higher in the group of non-native speakers with limited German proficiency (24 %) than in the native German speakers group (6,5 %) and more then twice as high as in the group of non-native speakers with good German proficiency (10.2 %). Patient satisfaction was lower in the group of non-native speakers with limited German proficiency independent of treatment outcome than in both other groups, whereas in both groups with good German proficiency, satisfaction was associated with treatment outcome. CONCLUSIONS: Good linguistic understanding is more important for patient satisfaction in inpatient depression treatment than treatment outcome.

Objective. Depressive disorders are of great medical and political significance. Although evidence-based guidelines have been published and educational initiatives have been launched to implement them, they are rarely actually used. The aim of the study was to implement clinical practice guidelines for outpatient care of depression using a practice-oriented and interdisciplinary approach. Design. Controlled clinical trial with a naturalistic design (data collection within routine practice) designed as a prospective pre-post study. Setting. Outpatient care. Participants. 29 general practitioners (intervention: 18; control: 11) and 15 psychiatrists (intervention: 11; control: 4). Overall, the treatment of 698 patients (two samples: pre: 361; post: 337) was documented. Intervention(s). Multifaceted intervention combining benchmarking, continuous medical education and interdisciplinary quality circles for the diagnosis and treatment of depressive disorders. Main outcome measures. Mixed-effects regression models for cluster-adjusted analysis of patients’ symptom reduction. Results. Although physicians in the intervention group improved their clinical effectiveness ( proportion of patients with response/remission) to a greater extent than physicians in the control group (intervention: 48.6% to 66.9%; control: 54.9% to 61.5%), cluster-adjusted analysis failed to prove a statistically significant effect of the intervention on the treatment outcome. Conclusions. Although no statistically significant improvements were found regarding the outcomes, the action programme provides important work, materials and results for an integrated treatment model for depression.

OBJECTIVE To analyse the status quo of depression treatment (procedure, responsibilities, and treatment barriers) from psychiatrists' point of view. METHODS Cross-sectional survey (n = 71 psychiatrists; return rate: 45.5 %). RESULTS Diagnostic and therapeutic knowledge were validated as good. Psychiatrists view their responsibility mainly in identifying depressed patients, in differential diagnosis and medical treatment. The clinical diagnosis corresponded only in 52.7 % to ICD-10 criteria. Pharmacotherapy and referral were according to guidelines. Psychiatrists were less satisfied with cooperation with the psychosocial sector (social service, counselling centres) than with family physicians, psychotherapists and hospitals. The need for continuous medical education was seen specifically regarding therapeutic procedures (prophylaxis of relapse and combined therapy) and less concerning the diagnoses. CONCLUSIONS The results affirm the quality outpatient psychiatric care of depressive patients. Improvement potentials regard evidence-based diagnostic and networking with the psychosocial sector.

Die Wirksamkeit psychotherapeutischer Interventionen bei depressiven Erkrankungen ist vielfaltig belegt. Allerdings fehlen Informationen zum konkreten Vorgehen, zum Zustandigkeitserleben und zur Zufriedenheit mit der Kooperation in der Routineversorgung aus Sicht von Psychotherapeuten. Es wurde eine Querschnittbefragung von verhaltenstherapeutischen (VT-Therapeuten, n=61) und tiefenpsychologisch orientierten Psychotherapeuten (TP-Therapeuten; n=78) durchgefuhrt. Die Ubereinstimmung der klinisch gestellten Diagnose mit der nach den formalen Kriterien der Internationalen Klassifikation psychischer Storungen (ICD-10) war sehr gering. Beide Gruppen erleben sich v. a. zustandig fur die Fruherkennung und die Differenzialdiagnose. Sie unterscheiden sich weder bezuglich der Haufigkeit der Kooperationskontakte mit anderen Leistungserbringern noch hinsichtlich der Zufriedenheit mit diesen oder den erlebten Barrieren in der Versorgung depressiver Patienten. Es besteht eine gute psychotherapeutische Versorgung mit Verbesserungsspielraumen bezuglich diagnostischem Procedere und starkerer Vernetzung.

Depressive Storungen zahlen zu den haufigsten Beratungsanlassen und Erkrankungen in der Versorgung. Obwohl sie gut behandelbar sind, besteht – trotz der Fortschritte in den vergangenen Jahren – weiterhin Optimierungsbedarf hinsichtlich der Diagnostik und Therapie. Die Implementierung evidenz- und konsensusbasierter Leitlinien ist eine geeignete Masnahme, um die Versorgung depressiver Patienten zu verbessern. Zurzeit wird fur Deutschland eine evidenzbasierte Leitlinie Depression erarbeitet. Um ihre Akzeptanz und weite Verbreitung sicherzustellen, wird diese Leitlinie im Konsens aller relevanten Akteure verabschiedet. Zukunftige Aufgabe ist es, eine an Leitlinien orientierte Diagnostik und Behandlung regelhaft in der Versorgung zu verankern.

Unipolare depressive Storungen zahlen zu den Volkskrankheiten und werden in den nachsten Jahren noch deutlich an Bedeutung zunehmen. Obwohl Depressionen in der Regel gut behandelbar sind, besteht hinsichtlich der Diagnostik, der Therapie und der Kooperation auf verschiedenen Versorgungsebenen noch erheblicher Verbesserungsbedarf. Von innovativen und vernetzten Versorgungsformen wie Case-Management, Disease-Management-Programmen (DMP) oder Modellen integrierter Versorgung wird erwartet, dass sie sektorale Versorgungsgrenzen uberwinden helfen, den Krankheits- und Behandlungsverlauf sowie die Lebensqualitat der Patienten positiv beeinflussen und z. B. uber die Verringerung von Fehl-, Unter- oder Uberversorgung und von Chronifizierung auch eine Veranderung der Inanspruchnahme des Gesundheitssystems bewirken. Allerdings mangelt es bislang vielfach noch an Evidenz, welcher Nutzen sich aus diesen neuen Versorgungsmodellen fur Deutschland ergibt.

For migrants who are older than 50, alcohol frequently becomes a problem. Simultaneously alcohol-related prevention measures only reach this group insufficiently. Therefore, a transcultural concept for preventing alcohol-related disorders in elderly (≥ 45 years) migrants has been developed.The transcultural concept, which consisted of a prevention event as well as a cultural and language-sensitive information booklet, was evaluated in a cluster-randomized controlled trial (n = 310 immigrants). As a control condition there was a prevention event with materials from Deutsche Hauptstelle für Suchtfragen (German Centre for Addiction Issues). Data were obtained before and after the event, as well as after 6 months. All materials were available both in German and in Russian, Italian, Spanish and Turkish.Directly after the event, as well as 6 months thereafter, the transcultural approach was rated significantly better than the general prevention event. 73.4 % of the participants read the cultural and migration-sensitive booklet, whereas only 21.2 % in the control condition (p = 0.0001). Furthermore, significantly more participants of the transcultural approach reported a reduced alcohol consumption (49.4 vs. 16.7 %; p = 0.004) after 6 months.The consideration of diversity with respect to cultural, migration-related, socio demographic und linguistic aspects improves the effectiveness of prevention measures.

Die bei Gesunden bereits bestehenden Laientheorien zu Herzinfarkten beeinflussen die Behandlungscompliance und sind kulturell gepragt. Empirische Ergebnisse dazu sind allerdings eher selten. Daher wurden in einer interkulturellen Vergleichsstudie Deutsche, Spanier in Spanien und Spanier der 1. Generation in Deutschland (parallelisiert nach Alter, Geschlecht und Bildung) hinsichtlich Kausalattributionen und Kontrolluberzeugungen zum Herzinfarkt befragt. Insgesamt dominiert in allen drei Gruppen ein eher psychosoziales Krankheitskonzept, das allerdings bei Deutschen ausgepragter ist. Wahrend bei diesen deutlich internale Kausalattributionen dominieren, lassen sich bei Spaniern auch ausgepragte externale Attributionsmuster feststellen. Konsequenzen fur praventive Konzepte und die medizinische Versorgung vor dem Hintergrund kultureller und gesellschaftlicher Zusammenhange werden abgeleitet. Culturally influenced lay theories about myocardial infarction which exist in healthy individuals have an impact on treatment compliance. However, empirical data on the subject is rare. Using healthy subjects, a transcultural survey comparing three different ethnic groups was conducted. The groups were: Germans in Germany, Spaniards in Spain, and 1st generation Spaniards in Germany. Subjects were parallelised according to age, sex, and education. The groups were compared regarding cultural differences in casual attributions and locus of control with respect to myocardial infarction. While all three groups show a psycho-social understanding of myocardial infarction, it is most predominate in the German group. The results show both common factors as well as some significant differences between Germans and Spaniards, the Spaniards reporting more external attributions. Consequences for prevention concepts and medical care in a multicultural society were derived from the results.

ResumenA menudo, se hace caso omiso de los smtomas somáticos y los síntomas de ansiedad en la detección de la depresión en atencion primaria. La presente investigacion examinó en qué medida los síntomas somáticos y de ansiedad registrados en la Entrevista Diagnostica Internacional Compuesta-Version de Atención Primaria (CIDI-PHC) pueden mejorar la detección de la depresión comparado con el Cuestionario de Salud General, versión de 12 elementos, solo. Se utilizaron datos del estudio de la Organización Mundial de la Salud sobre Problemas Psicológicos en Atención Sanitaria General. La muestra de estudio constaba de las personas que acudieron a los servicios de atención primaria de 15 centros de todo el mundo y se sometieron a un examen psiquiátrico con la CIDI-PHC. Los smtomas somáticos sin explicación médica (dolor de espalda, sensaciones de pesadez/ligereza en partes del cuerpo, períodos de debilidad corporal, crisis/convulsiones, cansancio permanente, agotamiento después de un esfuerzo mínimo) y -en menor medidasíntomas de ansiedad diversos (p. ej., sentimientos de ansiedad/nerviosismo, sentimientos de tensión, dificultades para relajarse) contribuyeron significativamente a la detección de la depresión en un análisis de regresión logística. Los resultados confirman la observación de que, en la atención primaria, los síntomas somáticos desempefian un papel importante en la manifestacion de los trastornos depresivos. Los elementos investigados aquí podrían resultar beneficiosos para que futuros instrumentos de deteccion selectiva de la depresivos en la atención primaria.

Background Many of the approximately 15 million people with a migration background living in Germany (19% of the population) are inadequately reached by existing healthcare provision. In the literature, the necessity for cultural adaptation of information material for patients with a migration background is often cited as a measure for improving healthcare. In this study, culturally sensitive information material will be developed and evaluated for patients with a migration background and depression or chronic low back pain. In this respect, it will be examined whether culturally sensitive information material is judged as more useful by the patients than standard translated patient information without cultural adaptation. Methods/Design The implementation and evaluation of culturally sensitive patient information material will occur in the framework of a double-blind randomized controlled parallel-group study in four study centres in Germany. Primary care patients with a Turkish, Polish, Russian or Italian migration background with a diagnosis of depressive disorder or chronic low back pain will be included and randomly allocated to the intervention group or the control group. In the intervention group, culturally sensitive patient information will be handed to the patient at the end of the physician consultation, while in the control group, standard translated patient information material will be provided. The patients will be surveyed by means of questionnaires following the consultation as well as after 8 weeks and 6 months. In addition to the primary outcome (subjective usefulness), several patient- and physician-rated secondary outcomes will be considered. Discussion The study will provide an empirical answer to the question of whether persons with a migration background perceive culturally sensitive patient information material as more useful than translated information material without cultural adaptation. Trial registration Deutsches Register Klinischer Studien (DRKS-ID) DRKS00004241 and Universal Trial Number (UTN) U1111-1135-8043.

Analysis of the health care utilisation of migrants with mental disorders compared to Germans with mental disorders under consideration of migration-related and socio-economic factors.Reanalysis of the supplement survey "Mental Disorders" of the "German Health Survey" 1998 with a matched sample of migrants (n = 151) and Germans (n = 151) with a positive 12-month prevalence of mental disorders.Regarding the prevalence rates for mental disorders and health care utilisation no differences in the sample between Germans and migrants could be found.The migration background alone does not explain the differences in health care utilisation which are found in many studies. It is assumed, that differences arise multifactorial, and can be explained through migration-related factors but especially through socio-economic factors. To provide a better understanding of health care utilisation of migrants it might be necessary to set the focus on socio-economic factors. In addition a differentiated measurement of cultural and migration-related factors is needed in future studies.

Health care for persons with depressive disorders is not networked to an optimal degree in Germany. In order to improve outpatient care, an integrated care model for patients with depressive disorders was initiated in Freiburg in December 2008. The model aims at implementation of central recommendations of the "Conceptual Framework Integrated Care: Depression" of the German Association for Psychiatry and Psychotherapy.Usage of health services and effects of the model were analyzed by means of patient and physician data as part of a continuous project evaluation.Since the launch of the project in December 2008, 40 physicians have been participating, and have included a total of 234 patients. Unipolar depressions constitute by far the most frequent disorders (91%). Most patients showed moderate (58%) or severe (36%) depressive symptoms. Most disorders were recurrent (61%). About three quarters of patients (75%) are treated exclusively by general practitioners. According to the physicians' ratings, 58% of the patients were remitted or showed subsyndromal symptoms in the eighth treatment week following their inclusion in the Freiburg model. After 16 weeks this number rose to 70% of patients. According to the information provided by the patients, in the PHQ-D, 59% of the patients were remitted or showed minimal symptoms.In the Freiburg model the "Conceptual Framework Integrated Care: Depression" could be implemented under current routine conditions. The first evaluation results indicate the success of this model. The results are indicative of a high quality of health care of the Freiburg model.

The objective of this study was a transcultural comparison regarding illness-related causal and control attributes using a survey of healthy Germans in Germany, Spaniards in Spain and Spaniards in Germany. Each group contained 100 persons, matched according to sex, age and education. Germans showed more pronounced internal causal as well as control beliefs while Spaniards in Germany showed fatalistic attribution and Spaniards in Spain placed more emphasis on social aspects. It was possible to correctly assign over 75 percent of persons to a group depending on their characteristics in terms of causal and control attributions. Considerations of cultural and migration-related factors regarding public health appear especially promising.

The paper reflects central recommendations and methodological issues of the new German guidelines for the treatment of depression, as discussed in the article New German Guidelines for the Treatment of Depression - The Central Role of Psychotherapy (Schauenburg et al. 2009). Members of the steering group for these guidelines disagree with the authors' description in several points, especially with reference to the efficacy of pharmacotherapy with antidepressants and psychotherapy, as well as the relationship between both strategies of therapy and their combination in diverse phases of treatment (acute/maintenance). Furthermore, we try to clarify some misunderstandings in matters of the guideline's methodology which arose in the paper cited.

The importance of unipolar depression as a common and widespread illness is continually increasing. With a lifetime prevalence of 16% to 20%, depressive disorders range among the most common pathologies and causes for health consultations in Germany (1). Adequate and timely diagnosis of depressive disorders bear great potential for improvements in health services, and an equally promising approach is to base diagnostic evaluation and treatment on evidence-based recommendations, and stepwise and networked or interdisciplinary health care (2, 3). The S3 clinical practice guideline was initiated by the German Association for Psychiatry and Psychotherapy (Deutsche Gesellschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde, DGPPN), which presided over the guideline development, its funding, and its preparation, in 2005–2009, in collaboration with other medical societies and with the support of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). Further, the guideline was finalized as a German National Clinical Practice Guideline (Nationale VersorgungsLeitlinie, NVL) under the coordination of the German Agency for Quality in Medicine (Arztliches Zentrum fur Qualitat in der Medizin, AZQ) and (4, 5).

To analyse the status quo of outpatient treatment of depression from general practitioners', psychiatrists' and psychotherapists' point of view.Pooled analysis of the outpatient treatment of depression of general practitioners (n=180), psychiatrists (n=71), and psychotherapists (n=160). Survey performed to uncover the clinical process the clinical process, the perceived obstacles, and subjective responsibilities.The diagnosis of all three groups was based primarily on their clinical impression, rather than on formal diagnosis criteria. The cooperation with the medical-psychotherapeutic sector was assessed more favourably than cooperation with the psycho-social sector.Needs for improvements particularly regarding diagnoses and an interdisciplinary cooperation.

Comparison of 4-week, 12-month and lifetime prevalence rates of mental disorders between the German general population and persons without German nationality who were not born in Germany (migrants).A migration-sensitive reanalysis of the supplement survey "mental disorders" of the German Health Survey 1998/1999 was conducted. 143 migrants were compared with 3740 Germans.Results demonstrate significantly higher 4-week, 12-month and lifetime prevalence rates of mental disorders for migrants in comparison to Germans. These differences are highest regarding affective disorders (4-week prevalence: 11.7 vs. 5.8 %; 12-month prevalence: 17.9 vs. 11.3 %; lifetime prevalence: 24.9 vs. 18.2 %) and somatoform disorders (4-week prevalence: 15.5 vs. 6.9 %; 12-month prevalence: 19.9 vs. 10.3 %; lifetime prevalence: 24.1 vs. 15.4 %).The results highlight the importance of a differentiating examination of prevalence rates for migrants. They also serve as a basis for further investigation of the relation between migration and mental health as well as for developing a cultural sensitive health care.

To analyze patient satisfaction in inpatient depression treatment depending on German language proficiency.Documentation of patients in 24 psychiatric hospitals in Baden-Württemberg (South Germany). The following three groups were matched according to age, gender, and education: native German speakers, non-native speakers with good German proficiency, and non-native speakers with limited German proficiency (67 in each group).The number of unsatisfied patients was four times higher in the group of non-native speakers with limited German proficiency (24 %) than in the native German speakers group (6,5 %) and more then twice as high as in the group of non-native speakers with good German proficiency (10.2 %). Patient satisfaction was lower in the group of non-native speakers with limited German proficiency independent of treatment outcome than in both other groups, whereas in both groups with good German proficiency, satisfaction was associated with treatment outcome.Good linguistic understanding is more important for patient satisfaction in inpatient depression treatment than treatment outcome.