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Zusammenfassung Ziel der Studie Mobbing am Arbeitsplatz gilt als interpersoneller Stressfaktor. Beruflicher Stress und mentale Gesundheit bei Ärztinnen und Ärzten rücken zunehmend in den Fokus der Öffentlichkeit. Inwiefern Mobbing dabei eine Rolle spielt ist noch kaum untersucht. Die Studie soll daher Daten zu Prävalenz von Mobbing unter KlinikärztInnen in Deutschland und möglichen Zusammenhängen mit beruflichem Stress und mentaler Gesundheit liefern. Methoden Im Rahmen zweier Querschnittstudien wurden 692 KlinikärztInnen des Fachgebietes Psychiatrie/Psychotherapie (P/PT) und 667 KlinikärztInnen der Intensivmedizin (IM) auf Kongressen befragt. Zum Einsatz kamen standardisierte Fragebögen zu Mobbingerfahrung, Berufsstress und mentaler Gesundheit (Einzelitem aus dem COPSOQ, BDI-II, ERI, MBI). Ergebnisse Mobbing erlebten 4,6% (N=61) der Befragten. In der Tendenz sind IM und Frauen häufiger betroffen (nicht signifikant) und es zeigten sich Korrelationen mit Berufsstress (ERI), Overcommitment (OC), Emotionaler Erschöpfung (MBI) und Depressivität (BDI-II). Schlussfolgerung Unsere Daten an einer großen Kohorte von Ärztinnen und Ärzten in Fachgebieten mit unterschiedlichem Belastungsprofil zeigen, dass ein nicht unerheblicher Anteil von Mobbing betroffen ist und Mobbing in Zusammenhang mit dem Erleben von Berufsstress sowie Beeinträchtigungen der mentalen Gesundheit stehen. Daraus lassen sich Implikationen zu institutionellen und individuellen Präventions- und Unterstützungsangeboten ableiten.

Zusammenfassung Ziel der Studie Untersuchung von Erfahrungen depressiv erkrankter Väter zum Umgang mit der Erkrankung in der Familie. Methoden 17 teilstrukturierte Interviews wurden entlang der Grounded Theory Methodology durchgeführt und analysiert. Ergebnisse Väter beschreiben überwiegend Strategien im Umgang mit ihrer depressiven Erkrankung, die eine Bewältigung unabhängig von der Familie vorsehen (Selbstmanagement, [Nicht-]Sprechen über die Erkrankung). Schlussfolgerung Väter brauchen Unterstützung in der (Entscheidung zur) Offenlegung ihrer Erkrankung gegenüber der Familie sowie für die Entwicklung von Bewältigungsstrategien, die Bedarfe der Familie stärker berücksichtigen.

Zusammenfassung Hintergrund Laut Studienlage leiden ÄrztInnen häufig an Arbeitsstress und Burn-out. Gründe dafür liegen v. a. in den Arbeitsbedingungen. Daneben spielen „intrinsische“ Faktoren eine Rolle. Frühe maladaptive Schemata (MS) können als Marker für intrinsische Belastungen dienen. Ein Schema umfasst dauerhafte, ungünstige Muster von Gefühlen, Gedanken und Erinnerungen, die das Verhalten in einer konkreten Situation steuern. Der Beitrag soll eine systematische Übersicht über die internationale Studienlage zu Gratifikationskrisen und MS bei ÄrztInnen/PsychotherapeutInnen (PT) geben. Material und Methoden Systematische Literaturrecherche von 2000 bis 2020 in PubMed, Psyndex und Google Scholar. Eine Registrierung erfolgte bei OSF-Registries (osf.io/jxhga/). Suchbegriffe waren: „schema“, „maladaptive schema“, kombiniert mit „physician“, „psychiatrist“, „psychotherapist“, „psychologist“, als weitere Suche verknüpft mit „effort reward (imbalance)“ bzw. „effort-reward (imbalance)“. Ergebnisse In der ersten Suche wurden 906 Publikationen, in der zweiten 1088 Veröffentlichungen gefunden. Durch Filtern von Duplikaten, Screening von Abstracts und Inhalten dezimierte sich die Zahl auf 2 Publikationen. Mithilfe vor- und rückwärts gerichteter Suche wurden 5 weitere Arbeiten und damit insgesamt 7 relevante Publikationen identifiziert. Schlussfolgerung Bislang gibt es wenige Untersuchungen, die sich mit MS im Zusammenhang mit beruflichem Stress und mentaler Gesundheit bei ÄrztInnen/PT beschäftigen. Insbesondere das vielschichtige Konzept der Schemata erscheint aussagekräftiger als eher eindimensionale Persönlichkeitszüge. Intrinsische Faktoren haben eine große Bedeutung, wenn es um die Entwicklung von Präventions- und Hilfsmaßnahmen für belastete ÄrztInnen/PT geht.

Psychological stress caused by epidemics among health care workers and implications for coping with the corona crisis: a literature review Objectives: COVID-19 has significantly changed the working and living conditions within a short period. Despite the milder course of the disease in comparison to other countries, employees in the German health care system are particularly affected by the massive impact of the disease on their professional and private lives. From a scientific point of view, summarized empirical evidence made during other epidemics and at the beginning of the COVID-19-pandemic is largely missing. Methods: Narrative review article, literature search on PubMed database. Results: A total of 56 studies were included, 35 of them on the SARS epidemic and seven on COVID-19; included studies reported overall increased stress levels, anxiety and PTSD symptoms due to health care work during various epidemics. Direct contact with patients, quarantine experiences and perceived health risks were further stress factors in epidemics. Participation in intervention studies enabled better management of epidemic-related situations. Conclusions: Healthcare workers are exposed to high workloads because of epidemics, which can have a variety of adverse effects. Recommendations are made for dealing with periods of high exposure during the COVID-19-pandemic.

ZusammenfassungIm Zuge der zunehmenden Arbeitsverdichtung sowie Schichtdienstarbeit sind Beschäftigte im Medizinsektor häufig einem Interrollenkonflikt ausgesetzt. Gerade die Vereinbarkeit von Beruf und Familie ist ein wichtiger Faktor für nachhaltige Mitarbeiterzufriedenheit, Leistungsfähigkeit und Gesundheit. Im Rahmen des Qualitätsmanagements erfolgte im Sommer 2017 eine anonyme und freiwillige Befragung aller Beschäftigten der Universitätsfrauenklinik Ulm. Dabei wurde ein standardisierter Fragebogen zur Arbeitszufriedenheit sowie Vereinbarkeit von Familie und Beruf ausgegeben, indem u.a die Work-Family-Conflict (WFC) und Family-Work-Conflict (FWC) Scale verwendet wurde. Die Rücklaufquote betrug 63% (n=136). Als „Medizinisches Personal“ (n=115) wurde der Zusammenschluss aus Arzt/Ärztin (n=33), Pflege (n=53) und Hebammen (n=31) definiert. Zwischen Beschäftigten mit (n=73) und ohne Kind (n=59) fand sich kein signifikanter Unterscheid im WFC sowie FWC. Die Gruppe der Pflegekräfte/Hebammen sowie Ärzte hatte einen signifikant höheren Interrollenkonflikt (p

Zusammenfassung Ziel der Studie Befragung psychiatrischer Fachkräfte zu geschlechtsspezifischen Bedarfen depressiver Männer und Behandlungsziele für die stationäre Versorgung. Methodik Semistrukturierte Interviews. Ergebnisse Männergruppen ermöglichen die Reflexion von Geschlechtsrollenerwartungen. Aktivitätsbezogene Angebote helfen betroffenen Männern, ihre Leistungsfähigkeit einzuschätzen und bieten Erfolgserlebnisse. Sie sind im Behandlungsspektrum unzureichend abgebildet. Schlussfolgerung Die Bedeutung normativer Rollenerwartungen sollte in der Ausbildung psychiatrischer Fachkräfte berücksichtigt werden.

Bullying in the workplace is considered an interpersonal stress factor. Occupational stress and mental health among physicians is increasingly becoming the focus of public attention. The extent to which mobbing plays a role in this has hardly been investigated yet. The aim of this study is to provide data on the prevalence of bullying among hospital physicians in Germany and possible correlations with occupational stress and mental health.Within the framework of two cross-sectional studies, 692 hospital physicians in the field of psychiatry/psychotherapy (P/PT) and 667 hospital physicians in intensive care (IM) were interviewed at conferences. Standardized questionnaires on mobbing experience, occupational stress and mental health (single item from COPSOQ, BDI-II, ERI, MBI) were used.Bullying was experienced by 4.6% (n=61) of the respondents. IM and women physicians were more often affected (not significant) and correlations with occupational stress (ERI), overcommitment (OC), emotional exhaustion (MBI) and depression (BDI-II) were found.Our data on a large cohort of physicians in specialties with different exposure profiles show that a relevant proportion is affected by bullying and that bullying is related to the experience of occupational stress as well as mental health impairments. From this, implications for institutional and individual prevention and support services can be derived.Mobbing am Arbeitsplatz gilt als interpersoneller Stressfaktor. Beruflicher Stress und mentale Gesundheit bei Ärztinnen und Ärzten rücken zunehmend in den Fokus der Öffentlichkeit. Inwiefern Mobbing dabei eine Rolle spielt ist noch kaum untersucht. Die Studie soll daher Daten zu Prävalenz von Mobbing unter KlinikärztInnen in Deutschland und möglichen Zusammenhängen mit beruflichem Stress und mentaler Gesundheit liefern.Im Rahmen zweier Querschnittstudien wurden 692 KlinikärztInnen des Fachgebietes Psychiatrie/Psychotherapie (P/PT) und 667 KlinikärztInnen der Intensivmedizin (IM) auf Kongressen befragt. Zum Einsatz kamen standardisierte Fragebögen zu Mobbingerfahrung, Berufsstress und mentaler Gesundheit (Einzelitem aus dem COPSOQ, BDI-II, ERI, MBI).Mobbing erlebten 4,6% (N=61) der Befragten. In der Tendenz sind IM und Frauen häufiger betroffen (nicht signifikant) und es zeigten sich Korrelationen mit Berufsstress (ERI), Overcommitment (OC), Emotionaler Erschöpfung (MBI) und Depressivität (BDI-II).Unsere Daten an einer großen Kohorte von Ärztinnen und Ärzten in Fachgebieten mit unterschiedlichem Belastungsprofil zeigen, dass ein nicht unerheblicher Anteil von Mobbing betroffen ist und Mobbing in Zusammenhang mit dem Erleben von Berufsstress sowie Beeinträchtigungen der mentalen Gesundheit stehen. Daraus lassen sich Implikationen zu institutionellen und individuellen Präventions- und Unterstützungsangeboten ableiten.

Zusammenfassung

Investigation of the experiences of depressed fathers in dealing with their depressive disorder in the family.17 semi-structured narrative interviews were conducted and analyzed following a Grounded Theory Approach.Fathers describe individual coping strategies in dealing with their depressive disorder that aim at independently coping from their family (self-management, [non])disclosure of the disorder).Fathers should be supported in (the decision-making process of) disclosing their illness to the family and developing coping strategies that take family needs further into account.Untersuchung von Erfahrungen depressiv erkrankter Väter zum Umgang mit der Erkrankung in der Familie.17 teilstrukturierte Interviews wurden entlang der Grounded Theory Methodology durchgeführt und analysiert.Väter beschreiben überwiegend Strategien im Umgang mit ihrer depressiven Erkrankung, die eine Bewältigung unabhängig von der Familie vorsehen (Selbstmanagement, [Nicht-]Sprechen über die Erkrankung).Väter brauchen Unterstützung in der (Entscheidung zur) Offenlegung ihrer Erkrankung gegenüber der Familie sowie für die Entwicklung von Bewältigungsstrategien, die Bedarfe der Familie stärker berücksichtigen.

Objective: The present study aimed to investigate the correlation between moral distress and mental health symptoms, socio-demographic, occupational, and COVID-19-related variables, and to determine differences in healthcare workers’ (HCW) moral distress during the first wave of the COVID-19 pandemic. Method: Data from 3,293 HCW from a web-based survey conducted between the 20th of April and the 5th of July 2020 were analyzed. We focused on moral distress (Moral Distress Thermometer, MDT), depressive symptoms (Patient Health Questionnaire-2, PHQ-2), anxiety symptoms (Generalized Anxiety Disorder-2, GAD-2), and increased general distress of nurses, physicians, medical-technical assistants (MTA), psychologists/psychotherapists, and pastoral counselors working in German hospitals. Results: The strongest correlations for moral distress were found with depressive symptoms, anxiety symptoms, occupancy rate at current work section, and contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nurses and MTA experienced significantly higher moral distress than physicians, psychologists/psychotherapists, and pastoral counselors. The average level of moral distress reported by nurses from all work areas was similar to levels which before the pandemic were only experienced by nurses in intensive or critical care units. Conclusion: Results indicate that moral distress is a relevant phenomenon among HCW in hospitals during the COVID-19 pandemic, regardless of whether they work at the frontline or not and requires urgent attention., publishedVersion

Background Adverse childhood experiences (ACEs) increase the risk for mental health problems. However, there is a lack of data targeting the role of ACEs for one of the most prevalent mental health problems in health-care professionals: burnout. Objective We aimed to assess the relationship between ACEs and the core burnout dimension ‘emotional exhaustion’ (EE). As health-care professionals have been facing particular challenges during the COVID-19 pandemic, we furthermore aimed to assess the role of COVID-19 associated burden in the interplay between ACEs and EE. Methods During the first lockdown in Germany, a total of 2500 medical healthcare professionals were questioned in a cross-sectional online survey. Questions targeted, among others, sociodemographics, ACEs, COVID-19-associated problems (e.g. increase of workload, worries about relatives and patients) and emotional exhaustion, measured by the respective dimension of the Maslach Burnout Inventory (MBI). Results In German health-care professionals, ACEs were associated with a higher EE score. The number of experienced ACEs was associated with the majority of assessed COVID-19-associated problems. An increasing number of ACEs predicted higher EE scores, controlling for gender. The association between ACEs and EE was mediated significantly by COVID-19-associated problems. These included maladaptive coping strategies such as increased smoking, drinking and use of antidepressants/tranquilizers, feeling less protected by measures of the employee or the state, a greater feeling of being burdened by COVID-19-associated problems and greater exhaustion and sleep problems. Conclusion Our findings suggest ACEs as significant risk factor for EE in German health-care professionals. The current pandemic means a significant burden that further pronounces this risk., HIGHLIGHTS Adverse childhood experiences (ACEs) predicted higher scores of emotional exhaustion (EE) in German healthcare professionals during the COVID-19 pandemic.COVID-19 associated problems mediated the association between ACEs and EE.COVID-19 and ACEs add to the risk of EE in healthcare professionals.

Background The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers, even those who have not been directly involved in the care of acutely ill patients. The aims of this study were to identify the overall burden and mental health status of healthcare workers in pediatric developmental services under the influence of the COVID-19 pandemic, and to identify the risk and protective factors associated with mental health. Methods This cross-sectional web-based study was part of a large multicenter VOICE study conducted among employees ((neuro-)pediatricians, psychologists, speech therapists, occupational therapists, etc.) from various pediatric developmental services between June and July 2020. A total of 1291 questionnaires regarding overall burden, mental health status (depression, generalized anxiety disorder and emotional exhaustion) and risk and protective factors for mental health (working conditions, potential problems during the COVID-19 pandemic and psychological resources) were analyzed. Descriptive statistics and multiple linear regression were used for data analysis. Results A total of 44.5% (574/1291) participants felt a high or very high overall burden during the COVID-19 pandemic. Of all the participants, 14.6% (171/1173) reported clinically significant levels of depressive symptoms, 17.0% (199/1173) reported generalized anxiety disorder symptoms and 44.6% (532/1192) reported emotional exhaustion. Multiple linear regression analyses identified several common risk and protective factors for mental health status variables. The burden of an increase in the quantity of work, fear of work and fear of becoming infected showed the strongest negative associations, whereas psychological resources and sufficient relaxation in leisure time exhibited the strongest positive associations. Conclusion Employees who were not directly involved in the care of acutely ill patients were also exposed to considerable stress, some of which was not different from that experienced by professionals who were directly affected. These employees should not be lost sight of and must be offered appropriate support.

The prevalence rates of psychiatric disorders show a high risk for psychological impairment among physicians in Germany. There is evidence that the mental health of physicians exerts a significant influence on the quality of patient care. The estimated prevalence rates for burnout among physicians in Germany vary between 4% and 20% and for depression between 6% and 13%. In addition, there is evidence for impairment in the context of anxiety, suicidal tendencies and substance abuse. Importantly, work-related stress factors play an important role in the development of mental disorders among physicians. In addition to individual prevention and interventions, institutional measures have been shown to be effective as a preventive strategy. It is therefore important to establish effective interventions specifically tailored to physicians to reduce stress factors at work.

Background: The COVID-19 pandemic is impacting mental health worldwide, particularly among healthcare workers (HCWs). Risk and protective factors for depression and generalized anxiety in healthcare workers need to be identified to protect their health and ability to work. Social support and optimism are known protective psychosocial resources, but have not been adequately studied in the context of the COVID-19 pandemic among healthcare workers in Germany. Methods: Within the first wave of the VOICE study (n = 7765), a longitudinal web-based survey study among healthcare workers in Germany, we assessed symptoms of depression (PHQ-2) and generalized anxiety (GAD-2), social support (ENRICHD Social Support Inventory; ESSI), and generalized optimism as well as sociodemographic, occupational, and COVID-19 related variables. Multiple linear regression analyses were conducted to examine associations between the constructs. Results: The analyses revealed that higher levels of social support and optimism were associated with lower levels of depression and generalized anxiety. They showed a higher association with depression and generalized anxiety than demographic or occupational risk factors such as female gender and direct contact with infected individuals. Conclusion: Psychosocial resources such as social support and optimism appear to contribute to successful coping with the COVID-19 pandemic and should be considered in future studies., publishedVersion

IntroductionThe COVID-19 pandemic resulted in severe detrimental effects on the mental well-being of health care workers (HCW). Consequently, there has been a need to identify health-promoting resources in order to mitigate the psychological impact of the pandemic on HCW.ObjectiveOur objective was to investigate the association of sense of coherence (SOC), social support and religiosity with self-reported mental symptoms and increase of subjective burden during the COVID-19 pandemic in HCW.MethodsOur sample comprised 4324 HCW of four professions (physicians, nurses, medical technical assistants (MTA) and pastoral workers) who completed an online survey from 20 April to 5 July 2020. Health-promoting resources were assessed using the Sense of Coherence Scale Short Form (SOC-3), the ENRICHD Social Support Inventory (ESSI) and one item on religiosity derived from the Scale of Transpersonal Trust (TPV). Anxiety and depression symptoms were measured with the PHQ-2 and GAD-2. The increase of subjective burden due to the pandemic was assessed as the retrospective difference between burden during the pandemic and before the pandemic.ResultsIn multiple regressions, higher SOC was strongly associated with fewer anxiety and depression symptoms. Higher social support was also related to less severe mental symptoms, but with a smaller effect size, while religiosity showed minimal to no correlation with anxiety or depression. In professional group analysis, SOC was negatively associated with mental symptoms in all groups, while social support only correlated significantly with mental health outcomes in physicians and MTA. In the total sample and among subgroups, an increase of subjective burden was meaningfully associated only with a weaker SOC.ConclusionPerceived social support and especially higher SOC appeared to be beneficial for mental health of HCW during the COVID-19 pandemic. However, the different importance of the resources in the respective occupations requires further research to identify possible reasons.

Background: Physicians, especially psychiatrists, have a high risk of job-related stress, and mental impairment. In our study we examined changes in private and occupational stress factors and mental health within a decade. The legislative reduction of physicians' working hours in Germany during this period made it possible to investigate the impact of working hours in particular. Methods: Questionnaires were administered at two psychiatrist meetings (2006 and 2016) about job and family situation, depressiveness, burnout and effort-reward imbalance. A total of N = 1,797 datasets were analyzed. Results: Working hours and free weekends were associated with mental health indices. Correlation analyses showed that a reduction in weekly working hours and working days at weekends was related to reduced scores for effort-reward-imbalance, burnout and depression. Conclusions: Our data show changes in workplace stress and mental health in psychiatrists in a decade in which a reduction in working hours has been required by law. These results can provide indications of effective prevention strategies in the professional context of physicians working in psychiatry.

Introduction: The COVID-19 pandemic generated a significant burden on the German health care system, affecting the mental health of health care workers (HCW) in particular. Resilience may serve as an essential protective factor for individuals’ well-being. Objective: Our objective was to identify demographic and work-related correlates of individual resilience and to investigate the association between pandemic-related stress, resilience and mental health using different resilience models. Methods: Our sample comprised 1034 German HCW in different medical professions who completed an online survey from 20 April to 1 July 2020. Resilience was assessed using the Resilience Scale-5 (RS-5). The pandemic-related self-reported stress burden was captured by a single item, while depression and anxiety symptoms were measured with the PHQ-2 and GAD-2, respectively. Additionally, various sociodemographic and work-related factors were assessed. Results: Overall, we found high levels of resilience in the sample compared to a German sample before the pandemic, which were significantly associated only with the older age of participants and having children in both univariate and multivariate analyses. Regarding mechanisms of resilience, moderation analysis revealed that low individual resilience and high pandemic-related stress burden independently contributed to both anxiety and depression symptoms while resilience additionally moderated the relationship between stress burden and anxiety symptoms. The link between self-reported stress burden and mental health symptoms was also partially mediated by individual resilience. Conclusion: Taken together, the findings based on the present sample during the COVID-19 pandemic suggest that resilience plays a central role in the mental health of healthcare workers and that resilience-building interventions should be expanded, especially with a focus on younger employees.

Zusammenfassung

Reconciliation of family and work life is an important topic for employees. Due to common work in shifts within the health care sector, this is even more essential for health care workers and has great implications in work satisfaction and individuals ́ health. Within all employees of the department of OB/GYN of the German university hospital Ulm, an anonymous and voluntary survey on compatibility of work and family was performed in the summer of 2017. The questionnaires consisted of established and newly designed tools to assess reconciliation of family/work life as well as work-family (WFC) and family-work conflict (FWC). Return rate of questionnaires was 63% (n=136). Physicians (n=33), nurses (n=53), and midwives (n=31) were grouped together as "medical staff" (n=115). There was no significant difference between employees with (n=73) or without children (n=59) regarding WFC and FWC. The group of nurses/midwives and the group of physicians had a significantly higher inter-role conflict (p0.001) than the group of administrative staff. A negative correlation with "work satisfaction" was found for WFC and FWC. The group of nurses/midwives has significantly higher inter-role conflicts than the administrative staff. Especially the negative correlation of work satisfaction and inter-role conflicts shows the enormous need for improvement in sufficient compatibility of work and family life of employees in the health care sector. This needs to be addressed quickly and effectively as there is an alarming deficit of nurses and midwives in the German health care system.Im Zuge der zunehmenden Arbeitsverdichtung sowie Schichtdienstarbeit sind Beschäftigte im Medizinsektor häufig einem Interrollenkonflikt ausgesetzt. Gerade die Vereinbarkeit von Beruf und Familie ist ein wichtiger Faktor für nachhaltige Mitarbeiterzufriedenheit, Leistungsfähigkeit und Gesundheit. Im Rahmen des Qualitätsmanagements erfolgte im Sommer 2017 eine anonyme und freiwillige Befragung aller Beschäftigten der Universitätsfrauenklinik Ulm. Dabei wurde ein standardisierter Fragebogen zur Arbeitszufriedenheit sowie Vereinbarkeit von Familie und Beruf ausgegeben, indem u.a die Work-Family-Conflict (WFC) und Family-Work-Conflict (FWC) Scale verwendet wurde. Die Rücklaufquote betrug 63% (n=136). Als „Medizinisches Personal“ (n=115) wurde der Zusammenschluss aus Arzt/Ärztin (n=33), Pflege (n=53) und Hebammen (n=31) definiert. Zwischen Beschäftigten mit (n=73) und ohne Kind (n=59) fand sich kein signifikanter Unterscheid im WFC sowie FWC. Die Gruppe der Pflegekräfte/Hebammen sowie Ärzte hatte einen signifikant höheren Interrollenkonflikt (p0,001) als die Gruppe Verwaltung/Sonstige. Es zeigte sich sowohl für den WFC als auch den FWC ein signifikanter negativer Zusammenhang mit dem Faktor Arbeitszufriedenheit. Vor allem die Gruppe Pflege/Hebammen weist hinsichtlich des Interrollenkonflikts eine signifikant höhere Belastung als die Gruppe der Verwaltung auf. Der negative Zusammenhang von WFC/FWC mit dem Faktor Arbeitszufriedenheit deutet auf einen hohen Handlungsbedarf hin. Gerade vor dem Hintergrund des Pflege- und Hebammenmangels in Kliniken muss dies effektiv und zeitnah geschehen.

Homesickness is a phenomenon of many cultures. International research deals with this topic, not so in Germany. The aim of this work is to bring the phenomenon of homesickness closer to the reader from a scientific and psychiatric point of view, to provide evidence and to create an awareness of its actuality.Systematic literature research in the databases "Psyndex", "Pubmed" and "google scholar".Data on the incidence in different populations vary from 20 to 90 %, which is mainly due to inconsistent definitions of homesickness and the different measuring instruments. The clinical consequences range from sleep disorders to depression and social anomalies.Migration movements, increasing prevalence of mental illness and impairments resulting from homesickness make clear how important a modern understanding of homesickness is.Heimweh ist ein Phänomen vieler Kulturen. Die internationale Forschung beschäftigt sich mit diesem Thema, nicht so in Deutschland. Ziel dieser Arbeit ist, das Phänomen Heimweh dem Leser aus wissenschaftlicher und psychiatrischer Sicht näherzubringen, Evidenz zu vermitteln und ein Bewusstsein für die Aktualität zu schaffen.Systematische Literaturrecherche in den Datenbanken „Psyndex“, „Pubmed“ und „google scholar“.Die Angaben zur Häufigkeit schwanken in unterschiedlichen Populationen von 20–90 %, was v. a. an uneinheitlichen Definitionen von Heimweh und den unterschiedlichen Messinstrumenten liegt. Die klinischen Folgen reichen von Schlafstörungen über Depressivität bis hin zu sozialen Auffälligkeiten.Migrationsbewegungen, steigende Prävalenz psychischer Erkrankungen und aus Heimweh resultierende Beeinträchtigungen machen deutlich, wie wichtig ein modernes Verständnis von Heimweh ist.

To meet mental health needs in men with depression, gender sensitive services are needed and recommended. Therefore, mental health professionals' views on care needs among men with depression that should be met by gender-sensitive services were assessed and consequences for inpatient treatment are considered.Semi-structured interviews were conducted with 33 mental health professionals focusing on men's specific needs in depression treatment against the background of male gender role expectations. Qualitative Content Analysis was performed using MAXqda-Software.Men with depression benefit from individual talk with staff and structured activity during treatment. Men-only groups are assessed as enabling critical reflection of aspects of masculinity. Physical activities and handicraft enable men to examine their performance level. Services focusing on men's specific needs are assessed as helpful but largely inexistent.Expectations of social gender roles and their implications for mental health treatment should be considered in both mental health professional training and mental health treatment.Befragung psychiatrischer Fachkräfte zu geschlechtsspezifischen Bedarfen depressiver Männer und Behandlungsziele für die stationäre Versorgung.Semistrukturierte Interviews.Männergruppen ermöglichen die Reflexion von Geschlechtsrollenerwartungen. Aktivitätsbezogene Angebote helfen betroffenen Männern, ihre Leistungsfähigkeit einzuschätzen und bieten Erfolgserlebnisse. Sie sind im Behandlungsspektrum unzureichend abgebildet.Die Bedeutung normativer Rollenerwartungen sollte in der Ausbildung psychiatrischer Fachkräfte berücksichtigt werden.

BackgroundThe underestimation of depression among men may result from atypical depression symptoms and male help-seeking behaviour. However, higher suicide rates among men than among women indicate a need for gender-specific services for men with depression. In order to develop gender-specific services, it is essential to examine professionals’ attitudes towards men’s depressive symptoms and treatment needs as well as barriers to and facilitators of treatment. This study examined gender-specific treatment needs in male patients and treatment approaches to male patients from a professional perspective.MethodsSemi-structured face-to-face interviews were conducted with 33 mental health professionals (MHPs) from five German psychiatric institutions. The study assessed the characteristics and attributes of male patients with depression risk factors for the development of depression among men, their condition at the beginning of treatment, male patients’ depressive symptoms, the needs and expectations of male patients, the importance of social networks in a mental health context, and MHPs’ treatment aims and treatment methods. Transcripts were analysed using qualitative content analysis.ResultsThe professionals’ reference group of male patients were men who were characterised in accordance with traditional masculinity. Attributes reported as in line with this type of men were late initiations of inpatient treatment after crisis, suicidal ideation or attempted suicide, and high expectations towards treatment duration, success rate in recovery and therapeutic sessions. In contrast, male patients who deviate from these patterns were partially described with reference to female stereotypes. Professionals referred to psychosocial models in their explanations of the causes of depression and provided sociological explanations for the development of masculine ideals among men. The consequences of these for treatment were discussed against the background of normative expectations regarding the male gender. From the professionals’ point of view, psychoeducation and the acceptance of depression (as a widespread mental illness) were the most important goals in mental health treatment.ConclusionsIn order to improve mental health among men, gender-specific services should be offered. Awareness of the role of gender and its implications on mental health treatment should be an integral part of MHPs’ education and their daily implementation of mental health treatment practices.

Purpose A traditional male role orientation is considered to increase the risk of depression and preventing men from disclosing symptoms of mental illness and seeking professional help. Less is known about the variance of masculinity orientations in men already treated for depression and their role in the treatment process. In this study, patterns of masculinity norms and work role orientations will be identified among men treated for depression. Associations of these patterns with depressive symptoms, stigma and delay in professional help-seeking will be investigated. Methods In a cross-sectional study, male role orientations (MRNS), work-related attitudes (AVEM), symptoms of mental disorders (PHQ), and attitudes related to stigma of mental illness (DSS) were assessed by standardized methods in a sample of 250 men treated for depression in general medical, psychiatric and psychotherapeutic services. Data were analyzed by means of latent profile analysis (LPA), by multinomial and linear regression models, and by path analysis. Results The results of LPA revealed three latent classes of men treated for depression. Men assigned to class one reported a less traditional male role orientation, low professional ambitions and low coping capacities; men assigned to class two reported a traditional masculinity orientation, high professional ambitions but low coping capacities; men assigned to class three reported less traditional masculinity tended orientations, medium professional ambitions and high coping capacities. Men assigned to classes one and two to have more stigmatizing attitudes, longer periods of untreated illness and more severe symptoms of mental disorders, in comparison to men assigned to class three. Conclusions Overall, this study reveals that traditional masculinity norms and work-role orientations in men treated for depression are associated with a worse mental health status. Our study results also suggest that a slackening of traditional masculinity norms is associated with improved psychological well-being if it does not coincide with a complete distancing from professional ambitions and a lack of ability to cope with professional stress.

Theoretical models of dopamine function stemming from reinforcement learning theory have emphasized the importance of prediction errors, which signal changes in the expectation of impending rewards. Much less is known about the effects of mean reward rates, which may be of motivational significance due to their role in computing the optimal effort put into exploiting reward opportunities. Here, we used a reinforcement learning model to design three functional neuroimaging studies and disentangle the effects of changes in reward expectations and mean reward rates, showing recruitment of specific regions in the brainstem regardless of prediction errors. While changes in reward expectations activated ventral striatal areas as in previous studies, mean reward rates preferentially modulated the substantia nigra/ventral tegmental area, deep layers of the superior colliculi, and a posterior pontomesencephalic region. These brainstem structures may work together to set motivation and attentional efforts levels according to perceived reward opportunities.

In order to develop gender-sensitive services, there is a need to better understand coping among men with depression. The study aims to analyze the meaning of gender- and work-related roles for illness theories and coping among men with depression.Based on a latent class analysis of three types of masculinities, biographical interviews were conducted with men with depression (n = 12). Transcripts were analyzed using a hermeneutic-reconstructive approach that includes subjective constructions of meaning related to (1) illness theories, (2) coping and (3) help-seeking behavior.Whereas most interviewees reported the role of family-related career orientation as a cause of depression, results differ in terms of coping. While participants partly distanced themselves from external expectations, some tried to keep up their employability. Others perceived their depression as a chance as well as an opportunity to change harmful attitudes.Psychiatric services might consider different priorities referring to work and life and their impact on coping with depression among men.Analyse der Bedeutung von männlichkeits- und berufsrollenbezogenen Orientierungsmustern für Krankheitstheorien und Bewältigung bei depressiv erkrankten Männern.Rekonstruktive Auswertung biografisch-narrativer Interviews von 12 Männern mit depressiver Erkrankung.Die berufsrollenbezogene Orientierung wird generell als Ursache der depressiven Erkrankung genannt. Gleichzeitig zeigen sich Unterschiede im Verständnis sowie in der Bewältigung der depressiven Erkrankung. Während ein Teil der Befragten trotz der berufsbedingten Krisenerfahrung an der beruflichen Orientierung festhält, nutzen andere die Depression als Chance zur Veränderung gesundheitsschädlicher Lebens- und Arbeitsentwürfe.Prioritäten in Bezug auf Arbeits- und Lebensentwürfe und deren Bedeutung für die Krankheitsbewältigung sollten in der Behandlung thematisiert werden.