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AIM: To synthesise international findings on the alcohol-dementia relationship, including representation from low- and middle-income countries. METHODS: Individual participant data meta-analysis of 15 prospective epidemiological cohort studies from countries situated in six continents. Cox regression investigated the dementia risk associated with alcohol use in older adults aged over 60 years. Additional analyses assessed the alcohol-dementia relationship in the sample stratified by sex and by continent. Participants included 24,478 community dwelling individuals without a history of dementia at baseline and at least one follow-up dementia assessment. The main outcome measure was all-cause dementia as determined by clinical interview. RESULTS: At baseline, the mean age across studies was 71.8 (standard deviation 7.5, range 60-102 years), 14,260 (58.3%) were female, and 13,269 (54.2%) were current drinkers. During 151,636 person-years of follow-up, there were 2,124 incident cases of dementia (14.0 per 1,000 person-years). When compared with abstainers, the risk for dementia was lower in occasional (hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.68-0.89), light-moderate (HR: 0.78; 95% CI: 0.70-0.87) and moderate-heavy drinkers (HR: 0.62; 95% CI: 0.51-0.77). There was no evidence of differences between lifetime abstainers and former drinkers in terms of dementia risk (HR: 0.98; 95% CI: 0.81-1.18). In dose-response analyses, moderate drinking up to 40g/day was associated with a lower risk of dementia when compared with lifetime abstaining. Among current drinkers, there was no consistent evidence for differences in terms of dementia risk. Results were similar when the sample was stratified by sex. When analysed at the continent level, there was considerable heterogeneity in the alcohol-dementia relationship. CONCLUSIONS: Abstinence from alcohol appears to be associated with an increased risk for all-cause dementia. Among current drinkers, there appears to be no consistent evidence to suggest that the amount of alcohol consumed in later life is associated with dementia risk.

ZusammenfassungIn der nationalen und internationalen Forschung nimmt das noch relativ junge Fach der Public Mental Health einen immer wichtigeren Stellenwert ein. Allerdings bleibt eine zentrale Herausforderung, dieses Fach in seiner Interdisziplinarität abzubilden und den Diskurs im Spannungsfeld von Public Health, psychiatrischer Epidemiologie, psychischer Gesundheitsförderung, Prävention und Versorgungsforschung zu führen, um sein innovatives Potenzial vollständig auszuschöpfen. In diesem Spannungsfeld stellen sich eine Reihe von grundsätzlichen konzeptionellen und methodischen Fragen, die in diesem Essay unter Bezugnahme auf die Populationsstrategie von Geoffrey Rose exemplarisch auch hinsichtlich fundamentaler Ursachen von sozialen und gesundheitlichen Ungleichheiten erörtert und adressiert werden sollen, mit dem letztendlichen Ziel, die Grundlage zur Erfassung und Veränderung von psychischer Gesundheit auf Populationsebene zu verbessern.

Zusammenfassung Ziel der Studie Untersucht werden der subjektive Stellenwert und Erfahrungen mit der Bewegungs- und Sporttherapie (BST) bei Patienten mit schweren psychischen Erkrankungen. Methodik Querschnittserhebung bei Patienten mit schweren psychischen Erkrankungen (18 bis 65 Jahre, N=385). Untersuchung möglicher Zusammenhänge zwischen dem subjektiven Stellenwert der BST und soziodemografischen und krankheitsassoziierten Variablen durch eine binäre logistische Regression. Ergebnisse 84,4% der Befragten (n=325) schätzen den Stellenwert einer BST als hoch ein. Ein noch größerer Anteil der Befragten (90,6%, n=349) konnte bereits Erfahrungen mit einer entsprechenden Therapie sammeln. Studienteilnehmende mit einem höheren Funktionsniveau (höherer GAF-Wert, p=0,041) und wohnhaft in einem großstädtischem Wohnumfeld (p=0,011) maßen der BST einen höheren subjektiven Stellenwert bei. 44,1% (n=143) der Befragten, die den BST einen hohen subjektiven Stellenwert beimessen, treiben regelmäßig Sport. Schlussfolgerung Die meisten der hier befragten schwer psychisch kranken Menschen messen den BST einen überraschend hohen Stellenwert bei. Dies erweist sich vor dem Hintergrund der zunehmenden Evidenz zu den positiven Effekten dieser Therapien als exzellenter Ansatzpunkt, diese im Gesamtbehandlungsplan fester zu verankern. Gleichzeitig gilt es, Strategien für einen Alltagstransfer stärker zu implementieren.

Zusammenfassung Hintergrund Bis 2040 wird mit einer erheblichen Prävalenzzunahme der Parkinson-Erkrankung und damit einhergehend mit einer erheblichen Belastung der Versorgungssysteme gerechnet. Ziel der Studie war es deshalb, eine Veränderung der Anzahl an Parkinson-Patienten bereits im Zeitraum 2010 bis 2019 in deutschen Haus- und neurologischen Facharztpraxen zu untersuchen. Methode Die vorliegende Querschnittstudie basiert auf den Daten von 411 Hausarzt- (HA) und 56 neurologischen Facharzt-Praxen (FA) aus der IQVIA Disease Analyzer Datenbank. Die Anzahl der etablierten und neu diagnostizierten Patienten mit Parkinson-Erkrankung wurde in den Jahren 2010 und 2019 mit Alters- und Geschlechtsstruktur und der Anteil therapierten Patienten untersucht.Ergebnisse Die Zahl der Parkinson-Patienten veränderte sich geringfügig zwischen 2010 bis 2019 von 3352 (0,36% aller Patienten) auf 3541 (0,33%) in den HA-Praxen und von 4976 (3,48%) auf 4826 (3,34%) in den FA-Praxen. Die Anzahl der neu diagnostizierten Fälle fiel bei den HA-Praxen leicht von 862 (0,09% aller Patienten) auf 836 (0,08%) und bei den FA-Praxen von 1818 (1,27%) auf 1372 (0,95% aller Patienten). Der Anteil an Frauen unter allen Parkinson-Erkrankten sank sowohl in HA- und FA- Praxen von 52,0% bzw. 50,2% auf 47,3% bzw. 46,0%. Das Durchschnittsalter stieg bei den HA-Praxen von 77,1 (SD 10,4) im Jahr 2010 auf 77,7 (SD 9,3) Jahre im Jahr 2019 und in FA-Praxen von 74,6 (SD 9,9) auf 75,8 (SD 9,9) Jahre. Diskussion Die prognostizierte Zunahme von Parkinson-Patienten in der ambulanten Versorgung lässt sich für den Zeitraum 2010 bis 2019 nicht bestätigen. Es gab jedoch eine Verschiebung der Altersstruktur zu höheren Altersgruppen und eine Verringerung des Anteils an Frauen mit einer Parkinson-Erkrankung. Neben ätiologischen Erklärungen sollten Besonderheiten des Versorgungssystems und methodische Limitationen berücksichtigt werden.

Zusammenfassung Hintergrund Das Funktionale Basismodell (Steinhart, Wienberg) ist die theoretische Basis des hier vorgestellten pilotartigen Modellprojekts für eine konsequent ambulant gedachte Konzeption psychiatrischer Versorgung. Methodik Teilziele (a) Netzwerkbildung mit in der Studienregion verorteten Anbietern/Einrichtungen/Akteur*innen und (b) Evaluation der vorgehaltenen Angebote und Maßnahmen i. S. eines Versorgungsmappings wurden verfolgt. Ein projektspezifisches Erhebungsinstrument für die Befragung aller Versorgungsakteur*innen wurde entwickelt und eingesetzt. Ergebnis Der Prozess der intensivierten Vernetzung der in der Studienregion adressierten Akteur*innen konnte mit LeiP#netz erfolgreich begonnen werden. Alle für die Versorgung schwer psychisch erkrankter Menschen notwendigen Angebote sind in der Studienregion vorhanden. Während Beratung und Prävention eher gut vorgehaltene Strukturen und Angebote darstellen, mangelt es an niedrigschwelligen Zugängen wie Krisenmanagement, krankenhausalternativen Rückzugsorten und multiprofessioneller komplexer Behandlung im häuslichen Milieu.

Introduction: Different psychotherapeutic interventions for late-life depression (LLD) have been proposed, but their evaluation in large, multicenter trials is rare. Objective: The present study evaluated the efficacy of a specific cognitive behavioral therapy (CBT) for LLD (LLD-CBT) in comparison with a supportive unspecific intervention (SUI), both administered in a specialist psychiatric outpatient setting. Methods: In this randomized, controlled, parallel group trial, we recruited participants (≥60 years) with moderate to severe depression at 7 trial sites in Germany. Participants were randomly assigned to the LLD-CBT or SUI group. The primary outcome was depression severity at the end of treatment measured by change on the Geriatric Depression Scale (GDS). Secondary outcomes included change in observer-rated depression, anxiety, sleep ratings, and quality of life throughout the treatment phase and at 6-month follow-up. Results: Between October 1, 2018, and November 11, 2020, we randomly assigned 251 patients to either LLD-CBT (n = 126) or SUI (n = 125), of whom 229 provided primary-outcome data. There was no significant between-group difference in the change in GDS scores at the end of treatment (estimated marginal mean difference: −1.01 [95% CI: −2.88 to 0.86]; p = 0.287). Secondary analyses showed significant improvements in several outcomes after 8 weeks and at follow-up in both treatment arms. Conclusions: Our data suggest that LLD-specific CBT and a supportive unspecific treatment both provide clinical benefit in patients with moderate to severe LLD without evidence for superiority of LLD-CBT.

In recent years, the field of public mental health has received increasing attention in national and international research. However, a key challenge remains to map this field in its interdisciplinarity across the entire spectrum of mental health and lead the discourse between public health, psychiatric epidemiology, mental health promotion, prevention, and health services research in order to realize more fully its innovative potential for improving mental health at the population level. In this interdisciplinary discourse, a number of fundamental conceptual and methodological issues arise, which will be discussed in this essay in relation to Geoffrey Rose's population strategy. In a national initiative across relevant learned societies that has recently been formed, these issues are currently starting to be addressed, also in relation to fundamental causes of social and health inequalities, which ultimately is geared towards more tangible strategies for improving mental health at the population.In der nationalen und internationalen Forschung nimmt das noch relativ junge Fach der Public Mental Health einen immer wichtigeren Stellenwert ein. Allerdings bleibt eine zentrale Herausforderung, dieses Fach in seiner Interdisziplinarität abzubilden und den Diskurs im Spannungsfeld von Public Health, psychiatrischer Epidemiologie, psychischer Gesundheitsförderung, Prävention und Versorgungsforschung zu führen, um sein innovatives Potenzial vollständig auszuschöpfen. In diesem Spannungsfeld stellen sich eine Reihe von grundsätzlichen konzeptionellen und methodischen Fragen, die in diesem Essay unter Bezugnahme auf die Populationsstrategie von Geoffrey Rose exemplarisch auch hinsichtlich fundamentaler Ursachen von sozialen und gesundheitlichen Ungleichheiten erörtert und adressiert werden sollen, mit dem letztendlichen Ziel, die Grundlage zur Erfassung und Veränderung von psychischer Gesundheit auf Populationsebene zu verbessern.

Assessing the experience with and the attitudes towards exercise therapy in persons with severe mental illness (SMI). Furthermore, potential variables of high preference towards exercise therapy are investigated.Cross-sectional observational study of SMI patients aged between 18 and 65 years (n=385). Patients were interviewed by trained staff using standardised instruments. Potential variables were analysed using a hierarchic binary logistic regression model.84,4% of SMI patients had a high preference for exercise therapy; of these, 44,1% exercised regularly. Among patients with severe mental illness especially a higher value in the GAF-assessment (p=0,041) and living in a metropolitan area (p=0,011) predict a high preference for exercise therapy.Most of the patients with severe mental illness interviewed in this study place a surprisingly high value on sports and exercise therapy. Due to the increasing evidence with regard to positive effects of these therapies, it may be an excellent starting point to expand sports and exercise therapy as part of a comprehensive treatment plan. At the same time, strategies for everyday transfer need to be implemented more rigorously.Untersucht werden der subjektive Stellenwert und Erfahrungen mit der Bewegungs- und Sporttherapie (BST) bei Patienten mit schweren psychischen Erkrankungen.Querschnittserhebung bei Patienten mit schweren psychischen Erkrankungen (18 bis 65 Jahre, N=385). Untersuchung möglicher Zusammenhänge zwischen dem subjektiven Stellenwert der BST und soziodemografischen und krankheitsassoziierten Variablen durch eine binäre logistische Regression.84,4% der Befragten (n=325) schätzen den Stellenwert einer BST als hoch ein. Ein noch größerer Anteil der Befragten (90,6%, n=349) konnte bereits Erfahrungen mit einer entsprechenden Therapie sammeln. Studienteilnehmende mit einem höheren Funktionsniveau (höherer GAF-Wert, p=0,041) und wohnhaft in einem großstädtischem Wohnumfeld (p=0,011) maßen der BST einen höheren subjektiven Stellenwert bei. 44,1% (n=143) der Befragten, die den BST einen hohen subjektiven Stellenwert beimessen, treiben regelmäßig Sport.Die meisten der hier befragten schwer psychisch kranken Menschen messen den BST einen überraschend hohen Stellenwert bei. Dies erweist sich vor dem Hintergrund der zunehmenden Evidenz zu den positiven Effekten dieser Therapien als exzellenter Ansatzpunkt, diese im Gesamtbehandlungsplan fester zu verankern. Gleichzeitig gilt es, Strategien für einen Alltagstransfer stärker zu implementieren.

Bis 2040 wird mit einer erheblichen Prävalenzzunahme der Parkinson-Erkrankung und damit einhergehend mit einer erheblichen Belastung der Versorgungssysteme gerechnet. Ziel der Studie war es deshalb, eine Veränderung der Anzahl an Parkinson-Patienten bereits im Zeitraum 2010 bis 2019 in deutschen Haus- und neurologischen Facharztpraxen zu untersuchen.Die vorliegende Querschnittstudie basiert auf den Daten von 411 Hausarzt- (HA) und 56 neurologischen Facharzt-Praxen (FA) aus der IQVIA Disease Analyzer Datenbank. Die Anzahl der etablierten und neu diagnostizierten Patienten mit Parkinson-Erkrankung wurde in den Jahren 2010 und 2019 mit Alters- und Geschlechtsstruktur und der Anteil therapierten Patienten untersucht.Die Zahl der Parkinson-Patienten veränderte sich geringfügig zwischen 2010 bis 2019 von 3352 (0,36% aller Patienten) auf 3541 (0,33%) in den HA-Praxen und von 4976 (3,48%) auf 4826 (3,34%) in den FA-Praxen. Die Anzahl der neu diagnostizierten Fälle fiel bei den HA-Praxen leicht von 862 (0,09% aller Patienten) auf 836 (0,08%) und bei den FA-Praxen von 1818 (1,27%) auf 1372 (0,95% aller Patienten). Der Anteil an Frauen unter allen Parkinson-Erkrankten sank sowohl in HA- und FA- Praxen von 52,0% bzw. 50,2% auf 47,3% bzw. 46,0%. Das Durchschnittsalter stieg bei den HA-Praxen von 77,1 (SD 10,4) im Jahr 2010 auf 77,7 (SD 9,3) Jahre im Jahr 2019 und in FA-Praxen von 74,6 (SD 9,9) auf 75,8 (SD 9,9) Jahre.Die prognostizierte Zunahme von Parkinson-Patienten in der ambulanten Versorgung lässt sich für den Zeitraum 2010 bis 2019 nicht bestätigen. Es gab jedoch eine Verschiebung der Altersstruktur zu höheren Altersgruppen und eine Verringerung des Anteils an Frauen mit einer Parkinson-Erkrankung. Neben ätiologischen Erklärungen sollten Besonderheiten des Versorgungssystems und methodische Limitationen berücksichtigt werden.

Using genome-wide association data, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s (PD) or Alzheimer’s (AD) disease versus controls across ancestry groups. A shared genetic association was observed across diseases at rs601945 (PD: odds ratio (OR)=0.84; 95% confidence interval, [0.80; 0.88]; p=2.2x10-13; AD: OR=0.91[0.89; 0.93]; p=1.8x10-22), and with a protective HLA association recently reported in amyotrophic lateral sclerosis (ALS). Hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03, and absent for HLA-DRB1*04:05. The same signal was associated with decreased neurofibrillary tangles (but not neuritic plaque density) in postmortem brains and was more strongly associated with tau levels than Aβ42 levels in the cerebrospinal fluid. Finally, protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, but only when acetylated at K311, a modification central to aggregation. An HLA-DRB1*04-mediated adaptive immune response, potentially against tau, decreases PD, AD and ALS risk, offering the possibility of new therapeutic avenues.

Purpose Higher Fit fOR The Aged (FORTA) scores have been shown to be negatively associated with adverse clinical outcomes in older hospitalized patients. This has not been evaluated in other health care settings. The aim of this study was to examine the association of the FORTA score with relevant outcomes in the prospective AgeCoDe–AgeQualiDe cohort of community-dwelling older people. In particular, the longitudinal relation between the FORTA score and mortality and the incidence of dementia was evaluated. Methods Univariate and multivariate correlations between the FORTA score and activities of daily living (ADL) or instrumental activities of daily living (IADL) as well as comparisons between high vs. low FORTA scores were conducted. Results The FORTA score was significantly correlated with ADL/IADL at baseline and at all follow-up visits (p p p p p p p Conclusion In this study, an association between higher FORTA scores and ADL as well as IADL was demonstrated in community-dwelling older adults. Besides, higher FORTA scores appear to be linked to a higher incidence of dementia and even mortality.

BACKGROUND: Numerous studies have reported an increase in mental disorders during the COVID-19 pandemic, but the exact reasons for this development are not well understood. In this study we investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic. METHODS: We analyzed data from the German National Cohort (NAKO) Study. Between May and November 2020, 161 849 study participants answered questions on their mental state and social circumstances. Their responses were compared with data from the baseline survey before the pandemic (2014–2019). Linear fixed-effects models were used to determine whether individual changes in the severity of symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/ financial changes (controlling for various covariates). RESULTS: The prevalence of moderate or severe symptoms of depression and anxiety increased by 2.4% and 1.5%, respectively, during the COVID-19 pandemic compared with the preceding years. The mean severity of the symptoms rose slightly. A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0–27). Increases were also seen for reduced working hours with no short-time allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model. CONCLUSION: Depressive symptoms and anxiety disorders increased slightly in the study population during the first year of the COVID-19 pandemic. Occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the planning of targeted prevention measures.

Contains fulltext : 287762.pdf (Publisher’s version ) (Open Access) BACKGROUND: Poor social connections (eg, small networks, infrequent interactions, and loneliness) are modifiable risk factors for cognitive decline. Existing meta-analyses are limited by reporting aggregate responses, a focus on global cognition, and combining social measures into single constructs. We aimed to investigate the association between social connection markers and the rate of annual change in cognition (ie, global and domain-specific), as well as sex differences, using an individual participant data meta-analysis. METHODS: We harmonised data from 13 longitudinal cohort studies of ageing in North America, South America, Europe, Africa, Asia, and Australia. Studies were eligible for inclusion if they had baseline data for social connection markers and at least two waves of cognitive scores. Follow-up periods ranged from 0 years to 15 years across cohorts. We included participants with cognitive data for at least two waves and social connection data for at least one wave. We then identified and excluded people with dementia at baseline. Primary outcomes were annual rates of change in global cognition and cognitive domain scores over time until final follow-up within each cohort study analysed by use of an individual participant data meta-analysis. Linear mixed models within cohorts used baseline social connection markers as predictors of the primary outcomes. Effects were pooled in two stages using random-effects meta-analyses. We assessed the primary outcomes in the main (partially adjusted) and fully adjusted models. Partially adjusted models controlled for age, sex, and education; fully adjusted models additionally controlled for diabetes, hypertension, smoking, cardiovascular risk, and depression. FINDINGS: Of the 40 006 participants in the 13 cohort studies, we excluded 1392 people with dementia at baseline. 38 614 individual participants were included in our analyses. For the main models, being in a relationship or married predicted slower global cognitive decline (b=0·010, 95% CI 0·000-0·019) than did being single or never married; living with others predicted slower global cognitive (b=0·007, 0·002-0·012), memory (b=0·017, 0·006-0·028), and language (b=0·008, 0·000-0·015) decline than did living alone; and weekly interactions with family and friends (b=0·016, 0·006-0·026) and weekly community group engagement (b=0·030, 0·007-0·052) predicted slower memory decline than did no interactions and no engagement. Never feeling lonely predicted slower global cognitive (b=0·047, 95% CI 0·018-0·075) and executive function (b=0·047, 0·017-0·077) decline than did often feeling lonely. Degree of social support, having a confidante, and relationship satisfaction did not predict cognitive decline across global cognition or cognitive domains. Heterogeneity was low (I(2)=0·00-15·11%) for all but two of the significant findings (association between slower memory decline and living with others [I(2)=58·33%] and community group engagement, I(2)=37·54-72·19%), suggesting robust results across studies. INTERPRETATION: Good social connections (ie, living with others, weekly community group engagement, interacting weekly with family and friends, and never feeling lonely) are associated with slower cognitive decline. FUNDING: EU Joint Programme-Neurodegenerative Disease Research grant, funded by the National Health and Medical Research Council Australia, and the US National Institute on Aging of the US National Institutes of Health.

Background: Little is known about the impact of COVID-19 on mild cognitive disorder. Objective: The aim of this retrospective cohort study was to investigate whether COVID-19 diagnosis is associated with subsequent mild cognitive disorder (MCD) compared to acute upper respiratory infections (AURI). Methods: This retrospective cohort study used data from the Disease Analyzer database (IQVIA) and included 67,046 patients with first-time symptomatic or asymptomatic COVID-19 diagnoses in 1,172 general practices in Germany between March 2020 and September 2021. Diagnoses were based on ICD-10 codes. Patients diagnosed with AURI were matched to 67,046 patients with COVID-19 using propensity scores based on sex, age, index month, and comorbidities. The index date was the diagnosis date for either COVID-19 or AURI. Associations between the COVID-19 and MCD were studied using conditional Poisson regression models. Results: The incidence of MCD was 7.6 cases per 1,000 person-years in the COVID-19 group and 5.1 cases per 1,000 person-years in the AURI group (IRR = 1.49, 95% CI = 1.22–1.82). The incidence rate ratio decreased strongly with increasing age from 10.08 (95% CI = 4.00–24.42) in the age group≤50 to 1.03 (95% CI = 0.81–1.31) in the age group > 70. In addition, the association between COVID-19 and MCD was significant in women (IRR: 1.70, 95% CI: 1.34–2.16) but not in men (IRR: 1.08, 95% CI: 0.75–1.56). Conclusion The incidence of MCD was low but significantly higher in COVID-19 than in AURI patients, especially among younger patients. If a cognitive disorder is suspected, referral to a specialist is recommended.

Purpose The purpose of the study was to investigate the changes in psychosocial and psychiatric services in the German city of Leipzig during the COVID-19-pandemic. Methods A participatory, mixed-methods study was used involving a quantitative online survey and qualitative semi-structured interviews with professionals. Quantitative findings were reported with descriptive statistics, and thematic analysis was conducted for qualitative data. Results Fifty professionals from various mental health services participated in the survey and eleven professionals were interviewed. Quantitative findings showed that some services were closed intermittently and that there was a stiff increase in use of digital/telephonic service and a decrease in face-to-face services. Staff or funding did not change considerably during the pandemic. Psychosocial groups were suspended or reduced, while access to services became more difficult and professional training for staff was stopped. Thematic analysis of the interviews showed that professionals experienced different phases and levels of change during the pandemic, including changes on a structural level, on the users’ level, and on the staff’ level. Professionals particularly criticised the equivocality of COVID-19 regulations, a defective flow of information and lack of attention for mental healthcare in public policies. They also saw positive aspects, such as the capacity of users and the outpatient care system to adapt to the new situation. Conclusion This study suggests directions for policy and service development, such as communicating clearly in infection-control measures, fostering outpatient care and networks between services.

In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action 'Mental health promotion and prevention' indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders.

To date, no studies have examined the pandemic-related stress experience of inpatient versus outpatient psychiatrists. Therefore, the aim is to investigate the extent of Covid-19 exposure, anxiety, stress experience, and coping abilities among psychiatrists in private practice compared to physicians in psychiatric and psychosomatic hospitals.E-mail-based questionnaires with 13 items were used to assess anxiety and stress experience. A total of 105 practicing psychiatrists, and 73 physicians and psychologists from four clinics (including the Clinic for Psychosomatic Medicine and Psychotherapy) were surveyed between early April and mid-May 2020.Compared to hospital psychiatrists, psychiatrists in private practice more often felt severely restricted (52.4 vs. 32.9% p=0.010), at risk of infection (35.2 vs. 13.7%, p0.001) and financially threatened (24.7 vs. 6.9%, p=0.002). The proportion of well-informed practicing psychiatrists was lower (47.6 vs. 63.0%, p=0.043) and the proportion with lack of protective equipment was higher (27.6 vs. 4.1%, p0.001). At the same COVID-19 exposure level (8.6 vs. 8.2%), office-based psychiatrists were more likely to report high anxiety, although not significantly, compared to hospital psychiatrists (18.1 vs. 9.6%, p=0.114). Risk factors for experiencing anxiety in both groups were feeling restricted (OR=5.52, p=0.025) and experienced risk of infection (OR=5.74, p=0.005). Exposure level, clinic or practice affiliation, age, gender, and other dimensions of threat experience and coping behavior had no influence.Psychiatrists in private practice felt more stressed and threatened by the COVID-19 pandemic compared with hospital-based colleagues. The experience of anxiety was dependent on feeling constrained and at risk of exposure, but not on exposure, protective equipment. Objective indicators seem to play less of an important role in the expression of anxiety than subjective experience.Bisher gibt es keine Studien, die das Pandemie bedingte Belastungserleben von stationär im Vergleich zu ambulant tätigen Psychiatern untersucht hat. Es soll deshalb das Ausmaß der Covid-19-Exposition, die Angst, das Belastungserleben und die Bewältigungsmöglichkeiten bei niedergelassenen Psychiatern im Vergleich zu Ärzten in psychiatrischen und psychosomatischen Kliniken untersucht werden.Zur Erfassung von Angst- und Belastungserleben wurden E-Mail-gestützte Fragebögen mit 13 Items genutzt. Insgesamt wurden 105 niedergelassene Psychiater, und 73 Ärzte und Psychologen aus vier Klinikern (inkl. Klinik für Psychosomatische Medizin und Psychotherapie) zwischen Anfang April bis Mitte Mai 2020 befragt.In ihrem Belastungserleben fühlten sich niedergelassene im Vergleich zu Krankenhauspsychiatern häufiger stark eingeschränkt (52,4 vs. 32,9% p=0,010), infektionsgefährdet (35,2 vs. 13,7%, p0,001) und finanziell bedroht (24,7 vs. 6,9%, p=0,002). Der Anteil gut Informierter niedergelassener Psychiater war geringer (47,6 vs. 63,0%, p=0,043) und der Anteil mit fehlender Schutzausrüstung höher (27,6 vs. 4,1%, p0,001). Bei gleichem COVID-19 Expositionsniveau (8,6 vs. 8,2%) berichteten niedergelassene Psychiater im Vergleich zu Krankenhaus-Psychiatern häufiger, wenn auch nicht signifikant, große Angst (18,1 vs. 9,6%, p=0,114). Risikofaktoren für ein Angsterleben waren in beiden Gruppen das Gefühl der Einschränkung (OR=5,52, p=0,025) und die erlebte Infektionsgefahr (OR=5,74, p=0,005). Keinen Einfluss hatten das Expositionsniveau, die Klinik- bzw. Praxiszugehörigkeit, das Alter, das Geschlecht und andere Dimensionen des Bedrohungserlebens und des Bewältigungsverhaltens.Niedergelassene Psychiater fühlten sich im Vergleich zu den Kollegen im Krankenhaus durch die COVID-19 Pandemie mehr belastet und bedroht. Das Erleben von Angst war abhängig vom Gefühl der Einschränkung und der Expositionsgefahr, nicht jedoch von der Exposition, der Ausstattung mit Schutzmitteln. Für die Ausprägung der Angst scheinen weniger objektive Indikatoren als das subjektive Erleben eine wichtige Rolle zu spielen.

Objective: To synthesise international findings on the alcohol-dementia relationship and provide a cross-national comparison of the alcohol-dementia relationship with critical evidence for the relationship between alcohol use and dementia in under-studied populations. Design and setting: Individual participant data meta-analysis of 15 prospective epidemiological cohort studies from countries situated in five continents. Cox regression investigated the dementia risk associated with alcohol use. Sensitivity analyses compared lifetime abstainers with former drinkers, adjusted extensively for demographic and clinical characteristics, and assessed the competing risk of death. Participants: 24,472 community-dwelling individuals without a history of dementia at baseline and at least one follow-up dementia assessment. Main outcome measure: All-cause dementia as determined by clinical interview. Results: During 151,574 person-years of follow-up, there were 2,137 incident cases of dementia (14.1 per 1,000 person-years). In the combined sample, when compared with occasional drinkers (

The orexigenic hormone ghrelin is being increasingly recognized as a stress hormone being involved in anxiety regulation. In animals, ghrelin effects on, and responses to acute stress differed from those in chronic stress, an animal model for anxiety and depression. In humans, elevated ghrelin levels were reported in pathological anxiety (e.g. panic disorder). However, no reports exist on physiological anxiety in mentally healthy subjects. In addition, reports on generalized anxiety symptoms, both in mentally healthy subjects (e.g. worrying) or in adult patients, are lacking. Total serum ghrelin was determined in 1666 subjects of a population-based cross-sectional study ('LIFE'). The 7-item Generalized Anxiety Disorder Scale (GAD-7), detecting also other anxiety disorders, was administered. For multiple linear regression analyses, 1091 subjects were finally included. Serum ghrelin and GAD-7 scores were positively but not significantly associated in the total group (ß=0.00025, standardized β = 0.039, 95%CI: -0.00006;0.0006;p = 0.144), in subjects with no more than mild anxiety, there was a significant positive association (GAD-7 ≤9: n = 1061, 97.25%, β = 0.00032; standardized β = 0.060; 95%CI: 0.000023;0.00062;p = 0.036). In contrast, there was a negative association in subjects with anxiety symptoms above the GAD-7 cut-off (GAD-7 ≥10: n = 30, 2.75%, ß=-0.003, standardized β = -0.462; 95% CI:-0.006;0.0001;p = 0.045). Ghrelin levels were only numerically (p = 0.23) higher in subjects with clinically relevant anxiety symptoms (963.5 ± 399.6 pg/ml; mean±SD) than in those without (901.0 ± 416.4 pg/ml). In conclusion, the positive association between ghrelin and no more than mild anxiety is an initial indication for a role for ghrelin in the regulation of physiological anxiety in humans. This association and the opposed association in pathological anxiety resemble findings in animals showing diverging ghrelin effects in acute and chronic stress.

The COVID-19 pandemic represents an exceptional challenge for the medical fraternity. We examined the differences in experiencing anxiety of general practitioners (GP), psychiatrists (PS) and surgeons (SU) during the COVID-19 pandemic in Germany.E-mail-based survey (April-May 2020) of 608 physicians (GP n = 162, PS n = 299, SU n = 147) on anxiety experience in relation to COVID-19 and potential determinants.High levels of COVID-19-related anxiety were reported by 31.1 % of GP, 19.2 % of PS, and 11.6 % of SU. The frequency of contact with COVID-19 patients was highest in SU (68.5 %), followed by GP (51.0 %) and PS (8.1 %). The experience of COVID-19-related distress was overall highest among GP. SU felt best informed and rated their resilience most highly. A high level of anxiety was positively associated with the perceived risk of infection.Studies on the distress of physicians provide important information to optimize pandemic management.ZIEL: Die COVID-19-Pandemie stellt eine besondere Belastung für die Ärzteschaft dar. Wir untersuchten Unterschiede und Bedingungsfaktoren im pandemiebezogenen Angsterleben von Hausärzten (HA), Psychiatern (PS) und Chirurgen (CH) in Deutschland.Schriftliche Befragung (April–Mai 2020) von 608 Ärzten (HA n = 162, PS n = 299, CH n = 147).Ein hohes Angstniveau im Zusammenhang mit COVID-19 berichteten 31,1 % der HA, 19,2 % der PS und 11,6 % der CH. CH berichteten am häufigsten Kontakt mit COVID-19-Patienten (68,5 %), gefolgt von HA (51,0 %) und PS (8,1 %). Das Belastungserleben war bei HA insgesamt am größten. CH fühlten sich hingegen am besten informiert und schätzten ihre Resilienz am höchsten ein. Innerhalb der Fachdisziplinen war ein hohes Maß erlebter Angst in Bezug auf COVID-19 positiv mit dem Grad der wahrgenommenen Infektionsgefahr assoziiert.Studien zur Belastung von Ärzten verschiedener Fachgruppen geben wichtige Hinweise zur Optimierung des Pandemiemanagements.

Refugees from war zones often have missing significant others. A loss without confirmation is described as an ambiguous loss. This physical absence with simultaneous mental persistence can be accompanied by economic, social or legal problems, boundary ambiguity (i.e., uncertainty about who belongs to the family system), and can have a negative impact on mental health. The aim of this study was to identify sociodemographic and loss-related predictors for prolonged grief, anxiety, depression, post-traumatic stress disorder (PTSD) and somatization in treatment-seeking Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. For the present study, data were based on the treatment-seeking baseline sample of the “Sanadak” randomized-controlled trial, analyzing a subsample of 47 Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. Sociodemographic and loss-related questions were applied, along with standardized instruments for symptoms of prolonged grief (ICG), anxiety (GAD-7), depression (PHQ-9), PTSD (PDS-5) and somatization (PHQ-15). Linear regression models were used to predict mental health outcomes. Having lost a close family member and higher boundary ambiguity showed a statistically significant association with higher severity in prolonged grief. The overall model for somatization reached statistical significance, while no predictor independently did. Boundary ambiguity showed a statistically significant positive association with depression, while the overall model showed no statistically significant associations. Boundary ambiguity and missing family members seemed to be important predictors for prolonged grief. These findings support the importance of reunification programs and suggest an inclusion of the topic into psychosocial support structures, e.g., including psychoeducational elements on boundary ambiguity in support groups for traumatized individuals and families experiencing ambiguous loss. Further research is needed for a more detailed understanding of the impact of ambiguous loss on refugee populations.