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Hintergrund: Die randomisiert-kontrollierte Studie IMPROVE-MH-Förderung der psychischen Gesundheit bei geflüchteten Eltern und ihren Kindern – ist ein Konsortialprojekt, an dem eine psychologische und drei allgemeinmedizinische universitäre Institutionen beteiligt sind. Hauptziel [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Das Chronic Care Model beinhaltet evidenzbasierte Empfehlungen zur Verbesserung der Versorgung von Patienten mit chronischen Erkrankungen. Der Patient Assessment of Chronic Illness Care Questionnaire (PACIC) ist ein weit verbreitetes Instrument zur Beurteilung der ambulanten Versorgung [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Background: Due to strict time management General Practitioners (GPs) prefer short instruments when identifying suicidal behaviour in their patients. We summarize the available studies reporting diagnostic accuracy of brief instruments for suicidal behaviour in primary care. Method: Databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. We included studies on primary care patients or participants from the general population. Suicidal behaviour was the defined target condition. With respect to the applicability in a primary care setting we included only studies assessing brief screening instruments; a brief instrument was defined as having no more than twelve items. We assessed sensitivity, specificity, and positive and negative predictive value. Results: A total of 9,969 studies was identified; of those, six fulfilled all strong criteria and were included. The range of sensitivity was 0.26-1.00, specificity was 0.64-0.99, positive predictive value 0.06-0.91, negative predictive value 0.86-1.00. Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 0.80 and specificity of 0.50 with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions: Brief screening instruments can support ruling-out suicidality, but are less suitable for ruling-in. They may support GPs in an initial assessment, but in case of a positive test result, a valid diagnostic assessment should be done by a structured clinical interview.

Item does not contain fulltext BACKGROUND: We evaluated a team-based program of exercises for patients with panic disorder with or without agoraphobia (PDA) in primary care. METHODS: 419 patients with PDA (mean age 46.2 years, standard deviation 14.4 years; 74% female) were included in this cluster-randomized, controlled intervention trial. The patients were blinded with respect to their group assignment at baseline. Patients in the intervention group (36 primary-care practices, 230 patients) underwent a 23-week exercise program combined with case management, while patients in the control group (37 practices, 189 patients) received standard care. Symptoms of anxiety (according to the Beck Anxiety Inventory, BAI) at six months were the primary endpoint. Patients were followed up at six months (n = 338, 81%) and at twelve months (n = 318, 76%). The analysis was by intention to treat. RESULTS: Symptoms of anxiety improved to a significantly greater extent in the intervention group (p = 0.008). The intergroup dif- ference in the reduction of the BAI score (range: 0-63) was 3.0 points (95% confidence interval [-5.8; -0.2]) at six months and 4.0 points [-6.9; -1.2] at twelve months. In the intervention group, there was a significantly greater reduction in the frequency of panic attacks (p = 0.019), in avoidant behavior (p = 0.016), and in depressiveness (p

Background Panic disorder (PD), frequently occurring with agoraphobia (AG), and depression are common mental disorders in primary care and associated with considerable individual and societal costs. Early detection and effective treatment of depression and PD/AG are of major importance. Cognitive behavioural exposure exercises have been shown to be effective in reducing anxiety and depressive symptoms. Practice team-based case management can improve clinical outcomes for patients with chronic diseases in primary care. The present study aims at evaluating the effects and cost-effectiveness of a primary care team-based intervention using behavioural therapy elements and case management supported by eHealth components in patients with PD/AG or depression compared to treatment as usual. Methods/design This is a two-arm cluster-randomized, controlled trial (cRCT). General practices represent the units of randomisation. General practitioners recruit adult patients with depression and PD ± AG according to the International Classification of Diseases, version 10 (ICD-10). In the intervention group, patients receive cognitive behaviour therapy-oriented psychoeducation and instructions to self-managed exposure exercises in four manual-based appointments with the general practitioner. A trained health care assistant from the practice team delivers case management and is continuously monitoring symptoms and treatment progress in ten protocol-based telephone contacts with patients. Practice teams and patients are supported by eHealth components. In the control group, patients receive usual care from general practitioners. Outcomes are measured at baseline (T0), at follow-up after 6 months (T1), and at follow-up after 12 months (T2). The primary outcome is the mental health status of patients as measured by the Mental Health Index (MHI-5). Effect sizes of 0.2 standard deviation (SD) are regarded as relevant. Assuming a drop-out rate of 20% of practices and patients each, we aim at recruiting 1844 patients in 148 primary care practices. This corresponds to 12.5 patients on average per primary care practice. Secondary outcomes include depression and anxiety-related clinical parameters and health-economic costs. Discussion If the intervention is more effective than treatment as usual, the three-component (cognitive behaviour therapy, case-management, eHealth) primary care-based intervention for patients suffering from PD/AG or depression could be a valuable low-threshold option that benefits patients and primary care practice teams. Trial registration German clinical trials register, DRKS00016622. Registered on February 22nd, 2019.

Hintergrund: In Deutschland sterben jedes Jahr mehr als 10.000 Personen durch Suizid. Ein Großteil der Suizidenten besuchte im Jahr vor dem Suizid einen Hausarzt, welcher oft die einzige Bezugsperson für die Betroffenen darstellt. Aktives Screenen durch den Hausarzt könnte dazu beitragen,[zum vollständigen Text gelangen Sie über die oben angegebene URL], 53. Kongress für Allgemeinmedizin und Familienmedizin

Hintergrund: Die hohe Prävalenz von Suizidversuchen und -gedanken steht einem erheblichen Diagnosedefizit von Suizidalität gegenüber. Hausärzte sind häufig die erste und einzige Anlaufstelle der suizidgefährdeten Patienten. Um schnell und sicher eine Gefährdung des[zum vollständigen Text gelangen Sie über die oben angegebene URL], 53. Kongress für Allgemeinmedizin und Familienmedizin

The authors have requested that this preprint be removed from Research Square.

Hintergrund: Bindungstheoretischen Überlegungen zufolge können Personen, die durch Erfahrungen mit Bezugspersonen Merkmale bindungsbezogener Angst bzw. bindungsbezogener Vermeidung entwickelten, ein höheres Risiko für suizidale Gedanken (suicidal ideation, SID) haben. Fragestellung:[zum vollständigen Text gelangen Sie über die oben angegebene URL], 52. Kongress für Allgemeinmedizin und Familienmedizin

Hintergrund: Angststörungen gehören zu den häufigsten psychischen Krankheitsbildern in der Hausarztpraxis. Hausärzte sind in der Regel der erste und einzige Kontakt für die betroffenen Patienten. Die Suizidalität dieser Patienten wird oft nicht erkannt. Fragestellung:[zum vollständigen Text gelangen Sie über die oben angegebene URL], 52. Kongress für Allgemeinmedizin und Familienmedizin

Der Suizid ist ein multifaktorielles Geschehen, zu dem auch aversive Bedingungen am Arbeitsplatz sowie eine hohe berufliche Belastung beitragen können. Im Allgemeinen geht man davon aus, dass Berufsgruppen mit leichtem Zugang zu Suizidmitteln (Medikamente, Waffen) einerseits und einem hohen Stressfaktor andererseits ein besonders hohes Risiko für Suizid haben. Insbesondere medizinische Berufe, waffentragende Berufe (Polizei, Militär), Banker sowie Land- und Forstwirte haben im Vergleich zur Allgemeinbevölkerung ein erhöhtes Suizidrisiko. Suizidpräventionsprogramme am Arbeitsplatz bestehen hauptsächlich aus Ausbildung und Training des einzelnen Mitarbeiters wie auch der Führungsebene, um das Wissen über Suizid und dessen Risikofaktoren zu vertiefen, dem Unterstützen eines sozialen Netzwerkes unter den Angestellten, der Kooperation von internen und externen Ressourcen, z. B. durch enge Zusammenarbeit zwischen Betriebsärzten, Allgemeinärzten und/oder Spezialisten, Screening nach und Hilfsangebote für Risikopersonen sowie dem Erschweren des Zugangs zu Suizidmitteln. Es bedarf weiterer Forschung, um berufsspezifische Risikofaktoren zu verstehen und Programme zu entwickeln, die in die Arbeitswelt integriert werden könnten.

Psychomentale Stressbelastung, Mobbing, Unsicherheit des Arbeitsplatzes und Überforderung durch Mehrarbeit sind Risikofaktoren für das Auftreten von Koronarer Herzkrankheit.

The pilot tests described in this document were conducted especially to improve the current knowledge about the impacts of selected measures against railway suicides and trespassing accidents, the occurrence of these events or their consequences. The pilot test descriptions are focused on the monitoring of the implementation process and collection of data for the evaluation of the effects. Therefore this document provides important information about the implementation process for those planning to implement similar measures. The results of the evaluation of the effectiveness of these piloted measures will be reported in D5.2.

This document presents the main results obtained from evaluation of the piloted measures implemented in WP5 of the RESTRAIL project. The final list of tested measures was: - Warnings signs and posters (Spain), - Railway safety education programme (Spain), - Education in schools for 8-11 year old children (Finland), - Video enforcement and sound warning (Finland), - A combination of measures at Aydin station (Turkey), - Mid-platform fencing (United Kingdom), - Societal collaboration to prevent railway suicides (Sweden), - Gatekeeper programme (Germany), - Gatekeeper programme: "Contact with a (possibly) suicidal person" (The Netherlands), - Computer based training (Israel), - Forward Facing CCTV (FFCCTV) in trains. The main purpose of these evaluations was to estimate quantitatively the effect of all these measures or combination of measures on railway suicides and (fatal) trespassing accidents. In addition, two of them have pursued mitigation of the consequences of these events on train traffic. A set of general conclusions about the results gained for the evaluations can be found at the end of the document, as well as several recommendations.

Constant high-level numbers of railway suicides indicate that prevention strategies against railway suicides are urgently needed. The main question of the present study was whether pre-crash railway suicide behaviour can be identified, using German Federal Police officers experience with suicidal events in railway related environments. To collect information on pre-crash railway suicide behaviour, a questionnaire was used and made available on the German Federal Police intranet. A total of 202 subjects (mean age: 41 years, sex: 84.9% male) were included in the analysis. Multivariate logistic regression analyses were performed to predict the prevention of suicide (first model) or demand for counselling (second model) as outcomes. Sex, age, years of service, number of experienced suicides, suicides personally observed, information on suicides obtained from witnesses and finally either counselling/debriefing (first model) or whether officers had prevented a suicide (second model) were used as predictors.A considerable proportion of police officers reported behavioural patterns preceding a suicide. Half of them observed the dropping or leaving behind of personal belongings or the avoidance of eye contact, more than a third erratic gesture, mimic or movement. Erratic communication patterns and general confusion were each reported by about one quarter. One fifth indicated the influence of alcohol. Less frequently observed behaviour was aimlessly wandering (14.3%) and out of the ordinary clothing (4%). About one third of all railway suicide victims committed suicide in stations. Of those, 70% had chosen an eminent spot. The multivariate logistic regression model using prevented suicides as the outcome identified the number of suicides experienced, counselling/debriefing and having personally observed a suicide as variables with significant impact. The model using counselling/debriefing as the outcome identified age and having prevented a suicide as variables with a significant association.Our results provide evidence that railway suicides are preceded by identifiable behavioural patterns. This emphasizes the importance of educational efforts, taking into account the knowledge and skills of experienced police officers.