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The health-related quality of life (HrQoL) and the recovery process of persons with mental health conditions can be assessed with the Recovering Quality of Life questionnaires (ReQoL-20 and ReQoL-10). The aim of this study was to assess the psychometric properties of the German version of the ReQoL measures in patients with anxiety, obsessive-compulsive, stress-related, and somatoform disorders and in patients with disorders of adult personality and behavior. This study was based on a sub-sample of patients that were included in a randomized controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER). The internal consistency was assessed using Cronbach's Alpha and the test-retest reliability was assessed by the intra-class correlation coefficient (ICC). Concurrent validity was assessed by Pearson's Correlation Coefficient and the known-group validity was assessed using the Cohen's d. The internal consistency of the ReQoL-20 and ReQoL-10 was excellent and good with Cronbach's alpha of α = 0.91 and α = 0.83 for all items. The test-retest reliability of the ReQoL measures was moderate with ICC of r = 0.72 to 0.74. The concurrent validity of the ReQoL measures with the Global Severity Index was overall high with a correlation coefficient of r = -0.70. In conclusion, for patients with anxiety, obsessive-compulsive, stress-related, somatoform and personality disorders, the German version of the ReQoL measures is valid and reliable for the assessment of HrQoL and the recovery process.

Zusammenfassung Ein Migrationshintergrund kann als individueller prädisponierender Faktor für die Inanspruchnahme von medizinischen Leistungen betrachtet werden. Es gibt einen negativen Zusammenhang zwischen einem direkten Migrationshintergrund und der Inanspruchnahme von hausärztlicher und fachärztlicher Versorgung sowie der Hospitalisierung. Der Zugang zur Gesundheitsversorgung von Menschen mit direktem Migrationshintergrund sollte durch gesundheitspolitische Maßnahmen vermehrt adressiert werden.

Depression contributes to disability more than any other mental disorder and is associated with a reduced health-related quality of life. However, the impact of depression on the social environment is relatively unknown. The current study determined differences in the health-related quality of life between co-living household members of depressed persons and persons in households without depression. Furthermore, factors influencing the health-related quality of life of co-living household members of depressed persons were evaluated. Using a sample of the German Socio-Economic Panel, health-related quality of life was measured longitudinally with the 12 item Short Form health survey. In addition to descriptive statistics, differences in health-related quality of life and factors influencing the health-related quality of life of co-living household members of depressed persons were determined by mixed effects beta regressions. Mental health-related quality of life was reduced for co-living household members of depressed persons compared with persons of households without depressed persons. Health-related quality of life of co-living household members of depressed persons was lower for women compared to men as well as for widowed persons compared to married persons. Overall, the health-related quality of life of co-living household members of depressed persons was reduced, which might be due to increased stress levels. It is therefore important to focus on support services for people in the social environment of depressed persons.

Zusammenfassung Ziel der Studie Darstellung der Erwerbssituation und Suche nach Determinanten der Erwerbstätigkeit in Abhängigkeit der Symptomschwere bei geflüchteten Menschen mit posttraumatischer Belastung. Methodik Befragung 133 geflüchteter, in Deutschland lebender Menschen syrischer Herkunft mit posttraumatischer Belastungssymptomatik und explorative Datenanalyse. Ergebnisse Nach knapp 4 Jahren im Asylland ist ein Viertel der Teilnehmenden (27,1 %) erwerbstätig. Dabei stehen einer erwerbstätigen Frau 6 erwerbstätige Männer gegenüber (13,9 % vs. 86,1 %; p = 0,001). Zusammenhänge zwischen psychischer Gesundheit und Erwerbstätigkeit ließen sich darstellen (posttraumatische Belastung p = 0,039, Depressivität p = 0,020, Somatisierung p = 0,026). Hinsichtlich sozialer Unterstützung, Traumaerleben sowie Aufenthaltsstatus und -dauer zeigten sich keine Unterschiede zwischen Geflüchteten mit und ohne Erwerbstätigkeit. Schlussfolgerung Die aktuelle Analyse zur Erwerbssituation einer umschriebenen Gruppe syrischer Geflüchteter stellt die Bedeutung der psychischen Symptombelastung in den Mittelpunkt.

The purpose of this study was to estimate the health-related quality of life (HrQoL) of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017. The analysis was based on the 2016 and 2017 refugee samples of the German Socio-Economic Panel (n = 6821). HrQoL was measured using a modified version of the SF-12v2 questionnaire and presented as physical (PCS) and mental (MCS) component summary scores. PCS and MCS scores for the total sample, males and females were calculated by sociodemographic characteristics. Associations between PCS and MCS scores and sociodemographic variables were examined by a linear regression with bootstrapped standard errors. The mean PCS and MCS scores of the sample were 53.4 and 47.9, respectively. Female sex was statistically significantly associated with lower PCS and MCS scores. The SF-12 subscale general health was valued highest with a score of 55.4, whereas the subscale role emotional was valued lowest with a score of 46.9. Employment was statistically significantly associated with higher PCS and MCS scores. Persons from Afghanistan had statistically significantly lower MCS scores than persons from Syria, whereas MCS scores were statistically significantly higher for persons from Eritrea. Physical and mental HrQoL of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017 was higher and lower than the German norm, respectively. Female sex, older age, unemployment and being separated, divorced or widowed were negatively associated with HrQoL. The three largest ethnical groups of asylum seekers and refugees, Syrians, Afghans and Eritreans, differ inherently in their HrQoL.

IntroductionLiving in an area with no or deficient structures for trans health care is disadvantageous for trans people. By providing an internet-based health care programme, i²TransHealth aims at reducing structural disadvantages for trans people living in areas lacking specialised care. The e-health intervention consists of video consultations and a 1:1 chat with a study therapist. Additionally, the i²TransHealth network cooperates with physicians, who especially offer crisis intervention close to the participants’ place of residence. The aim of this study is to evaluate the (cost-)effectiveness of the internet-based health care programme for trans people compared with a control (waiting) group. The following research questions will be examined with a sample of 163 trans people: Does a 4-month treatment with the i²TransHealth internet-based health care programme improve patient-reported health-outcomes? Is i²TransHealth cost-effective compared with standard care from a societal or health care payers’ perspective? Does the participation in and support by i²TransHealth lead to an increase of trans-related expertise in the physician network?Methods and analysisIn a randomised controlled trial, the outcomes of an internet-based health care programme for trans people will be investigated. In the intervention group, participants are invited to use i²TransHealth for 4 months. Participants allocated to the control group will be able to start with their transition-related care after 4 months of study participation. The primary outcome measure is defined as the reduction of psychosomatic symptoms, as assessed by the Brief Symptom Inventory-18, 4 months after using the i²TransHealth programme. Participants in both groups will undergo an assessment at baseline and 4 months after using i²TransHealth.Ethics and disseminationPositive ethical approval was obtained from the Hamburg Medical Association (PV7131). The results will be disseminated to service users and their families via media, to health care professionals via professional training and meetings and to researchers via conferences and publications.Trial registration numberNCT04290286.Protocol version22 December 2021 (V.1.0)

Zusammenfassung Ziel Die Rekrutierung von sogenannten seltenen Populationen, dazu zählen Geflüchtete, für Forschungsstudien gilt als schwierig. Deshalb teilen wir Erkenntnisse zu förderlichen und hinderlichen Strategien zur Rekrutierung von Geflüchteten sowie wahrgenommene Barrieren basierend auf unseren Erfahrungen im „Sanadak“-Trial, einer randomisierten kontrollierten Studie zur Evaluation einer Selbsthilfe-App für syrische Geflüchtete mit posttraumatischer Belastung. Methodik Datengrundlage war eine Interimsevaluation der Rekrutierungsstrategien. Im quantitativen Teil analysierten wir, wie Studieninteressierte von „Sanadak“ erfahren haben und über welchen Weg der Erstkontakt stattfand. Diese Ergebnisse wurden durch einen qualitativen Teil ergänzt. Dazu wurden die syrischen Studienassistenten des „Sanadak“-Trials (n=3) mittels problemzentrierter Leitfadeninterviews zu förderlichen und hinderlichen Rekrutierungsstrategien sowie wahrgenommenen Barrieren befragt. Ergebnisse Es lagen Daten zur Rekrutierung von 140 syrischen Geflüchteten vor. Davon wurde fast die Hälfte (44%) über persönlichen Kontakt rekrutiert, rund ein weiteres Drittel (36%) wurde über verschiedene Werbemaßnahmen (z. B. Facebook-Werbung) und rund ein Fünftel (19%) über Multiplikatoren gewonnen. Typische Barrieren waren Bedenken hinsichtlich Datenschutz, Anonymität und Stigmatisierung. Diskussion Das Schneeballprinzip war eine effektive Rekrutierungsstrategie im „Sanadak“-Trial. Weitere Strategien waren ergänzend sinnvoll, v. a. um die Varianz der Stichprobe zu erhöhen. Die Interimsevaluation erwies sich als wertvoll, um Ressourcen auf effektive Rekrutierungsstrategien zu lenken und Barrieren zu adressieren. Schlussfolgerung Ein multistrategischer Rekrutierungsansatz mit Fokus auf persönlichen Kontakt, vielfältigen Kontaktmöglichkeiten und interkulturell kompetenten Projektmitarbeitern hat sich im „Sanadak“-Trial bewährt.

There is ambiguous evidence with regard to the inequalities in health care services utilization (HCSU) among migrants and non-migrants in Germany. The aim of this study was to analyze the utilization of doctors and hospitalization of persons with direct and indirect migration background as well as those without in Germany. This study was based on data of the German Socio-Economic Panel using the adult sample of the years 2013 to 2019. HCSU was measured by self-reported utilization of doctors and hospitalization. Associations between HCSU and migration background were examined using multilevel mixed-effects logistic regression and zero-truncated multilevel mixed-effects generalized linear models. The odds ratios of utilization of doctors and hospitalization for persons with direct migration background compared with persons without migration background were 0.73 (p &lt, 0.001) and 0.79 (p = 0.002), respectively. A direct migration background was associated with a 6% lower number of doctoral visits within three months compared with no migration background (p = 0.023). Persons with direct migration background still have a lower HCSU than persons without migration background in Germany. Access to health care needs to be ensured and health policy-makers are called upon to keep focus on the issue of inequalities in HCSU between migrants and non-migrants in Germany.

Syria has been the main country of citizenship of refugees in Germany since 2013. Syrians face numerous human rights violations in their country that can be accompanied by the experience of potentially traumatic events, loss and displacement. Along the migration process, refugees are exposed to various factors that can have an impact on mental health. The aim of this study is to investigate sociodemographic, war- and flight-related as well as post-migration factors as predictors of posttraumatic stress, depression, somatization and anxiety in Syrian refugees with posttraumatic stress symptoms based in Germany. Data were based on the baseline sample of the “Sanadak” randomized-controlled trial. A total of 133 adult Syrian refugees participated in the study. A questionnaire covered sociodemographic and flight-related questions as well as standardized instruments for symptoms of PTSD (PDS-5), depression (PHQ-9), somatization (PHQ-15), anxiety (GAD-7), generalized self-efficacy (GSE), religiousness (Z-Scale), social support (ESSI) and mental health stigma (SSMIS-SF). Linear regression models were executed to predict mental health outcomes. Sociodemographic predictors (i.e., female sex, higher education) and flight-related predicting factors (i.e., variability of traumatic events) have a negative impact on mental health in Syrian refugees with posttraumatic stress symptoms in Germany. Mental health stigma predicts worse mental health outcomes. Post-migration factors have a major impact on mental health, such as low income, lack of social support, low life satisfaction or a strongly felt connection to Syria. Somatization is an important manifestation of mental distress in Syrian refugees with posttraumatic stress symptoms. Our study showed a range of factors predicting the mental health of Syrian refugees with posttraumatic stress symptoms. Measures to foster mental health could be securing financial security, promoting gender equality and tailored psychosocial programs addressing mental health stigma, loss and social support networks.

Description of employment situation and search for determinants of employment depending on symptom severity in refugees with posttraumatic stress.Standardized interviews with 133 Syrian refugees (18 to 65 years) living in Germany with posttraumatic stress symptoms and exploratory data analysis.27.1 % of the participants were employed; including 13.9 % women and 86.1 % men (p = 0.001). Links between mental health and employment can be shown (posttraumatic stress p = 0.039, depressiveness p = 0.020, somatisation p = 0.026). With regard to social support and type of trauma, as well as residence status and duration of residence, there were no differences between refugees with and without employment.The current analysis on the employment situation of a circumscribed group of Syrian refugees focuses on the importance of psychological symptom burden.Darstellung der Erwerbssituation und Suche nach Determinanten der Erwerbstätigkeit in Abhängigkeit der Symptomschwere bei geflüchteten Menschen mit posttraumatischer Belastung.Befragung 133 geflüchteter, in Deutschland lebender Menschen syrischer Herkunft mit posttraumatischer Belastungssymptomatik und explorative Datenanalyse.Nach knapp 4 Jahren im Asylland ist ein Viertel der Teilnehmenden (27,1 %) erwerbstätig. Dabei stehen einer erwerbstätigen Frau 6 erwerbstätige Männer gegenüber (13,9 % vs. 86,1 %; p = 0,001). Zusammenhänge zwischen psychischer Gesundheit und Erwerbstätigkeit ließen sich darstellen (posttraumatische Belastung p = 0,039, Depressivität p = 0,020, Somatisierung p = 0,026). Hinsichtlich sozialer Unterstützung, Traumaerleben sowie Aufenthaltsstatus und -dauer zeigten sich keine Unterschiede zwischen Geflüchteten mit und ohne Erwerbstätigkeit.Die aktuelle Analyse zur Erwerbssituation einer umschriebenen Gruppe syrischer Geflüchteter stellt die Bedeutung der psychischen Symptombelastung in den Mittelpunkt.

Zusammenfassung Ziel der Studie Ziel dieser Arbeit war es, den Selbstbeurteilungsfragebogen „Recovering Quality of Life (ReQoL)“ zur Messung der gesundheitsbezogenen Lebensqualität von Menschen mit psychischen Erkrankungen in die deutsche Sprache zu übersetzen. Methodik Die Übersetzung des Fragebogens in die deutsche Sprache erfolgte durch 2 voneinander unabhängige qualifizierte Übersetzer. Diskrepanzen in der Bedeutung und Terminologie wurden durch den Vergleich einer Rückübersetzung mit der Originalversion ermittelt. Die deutsche Übersetzung des Fragebogens wurde mit 5 Patienten mit psychischen Erkrankungen vorgetestet. Ergebnisse Die Übersetzung einiger englischer Formulierungen des Fragebogens in die deutsche Sprache gestaltete sich, hauptsächlich aufgrund sprachlicher und kultureller Unterschiede, schwierig. Durch eine Expertendiskussion der Übersetzung und einen Pretest mit psychisch erkrankten Patienten konnten geeignete Formulierungen gefunden werden. Schlussfolgerung Es liegt eine deutsche Version des Selbstbeurteilungsfragebogens ReQoL vor, um die gesundheitsbezogene Lebensqualität von Menschen mit psychischen Erkrankungen zu erfassen.

The generic and preference-based instrument EQ-5D is available in a five-response levels version (EQ-5D-5L). A value set for the EQ-5D-5L based on a representative sample of the German population has recently been developed. The aim of this study was to estimate normative values of the EQ-5D-5L index for Germany, and to examine associations between the EQ-5D-5L and selected sociodemographic factors. The analysis was based on a representative sample (n = 4998) of the German general adult population in 2014. Participants had to rate their health-related quality of life on the EQ-5D-5L descriptive system as well as on a visual analogue scale (EQ-VAS). Normative values of the EQ-5D-5L index were estimated for selected sociodemographic characteristics. For the examination of associations between EQ-5D-5L index scores and selected sociodemographic factors, multivariate regression analyses were used. The mean EQ-5D-5L index score of the total sample was 0.88 (SD 0.18), corresponding to an overall mean EQ-VAS score of 71.59 (SD 21.36). Female gender and increasing age were associated with a lower EQ-5D-5L index score (p

Background:Late-life depression is a highly prevalent disorder that causes a large economic burden. A stepped collaborative care program was set up in order to improve care for patients with late-life depression in primary care in Germany: GermanIMPACT is the adaption of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program that has already been established in primary care in the USA. The aim of this study was to determine the cost-effectiveness of GermanIMPACT compared with treatment as usual from a societal perspective.Methods:This study is part of a 12-month bi-centric cluster-randomized controlled trial aiming to assess the effectiveness of GermanIMPACT compared with treatment as usual among patients with late-life depression. A cost-effectiveness analysis using depression-free days (DFDs) was performed. Net-monetary benefit (NMB) regressions adjusted for baseline differences for different willingness-to-pay (WTP) thresholds were conducted and cost-effectiveness acceptability curves were constructed.Results:In total, n = 246 patients (intervention group: n = 139; control group: n = 107) with a mean age of 71 from 71 primary care practices were included in the analysis. After 12 months, adjusted mean differences in costs and DFDs between intervention group and control group were +€354 and +21.4, respectively. Only the difference in DFDs was significant (p = 0.022). According to the unadjusted incremental cost-effectiveness ratio, GermanIMPACT was dominant compared with treatment as usual. The probability of GermanIMPACT being cost-effective was 80%, 90% or 95% if societal WTP per DFD was ≥€70, ≥€110 or ≥€180, respectively.Conclusion:Evidence for cost-effectiveness of GermanIMPACT relative to treatment as usual is not clear. Only if societal WTP was ≥€180 for an additional DFD, GermanIMPACT could be considered cost-effective with certainty.

Die Versorgung psychischer Storungen stellt eine grose Herausforderung fur das deutsche Gesundheitssystem dar. Wenn Mehrfachdiagnosen vorliegen, leiden die Betroffenen unter einer besonders hohen Krankheitslast. Innovative Behandlungsmodelle fur eine integrierte und gestufte Versorgung (Collaborative Care und Stepped Care) sind bisher nur hinsichtlich ihrer Wirksamkeit fur singulare Storungsbilder untersucht worden. Das Projekt „Integrierte und gestufte Versorgung psychischer Erkrankungen durch Uberwindung sektoraler Behandlungsbarrieren“ (COMET), welches vom Hamburger Netzwerk fur Versorgungsforschung (HAM-NET) von 2017 bis 2020 durchgefuhrt wird, untersucht ein innovatives, leitlinienorientiertes Versorgungsmodell zur Verbesserung der Versorgung von Menschen mit psychischen Storungen unter Einbezug moglicher Komorbiditaten. Dieses neue Stepped- und Collaborative-Care-Modell fur Patienten der Primarversorgung, das Hausarzte, Psychiater und Psychotherapeuten sowie Kliniken vernetzt, wird im vorliegenden Beitrag vorgestellt. Zur Implementierung und Forderung des Modells wurden leitliniengerechte Behandlungspfade, ein tabletgestutztes Programm fur Screening, Diagnostik und leitliniengerechte Behandlungsempfehlungen sowie eine webbasierte Terminvergabeplattform entwickelt. Die aus dem Projekt gewonnenen Erkenntnisse zur Effektivitat und Effizienz des Modells konnen die Entscheidung, ob das Modell zukunftig in die Gesundheitsversorgung ubertragen wird, unterstutzen. Damit konnte ein entscheidender Fortschritt im Hinblick auf eine starker integrierte und sektorenubergreifende Versorgung von Patienten mit psychischen Storungen gelingen.

Global migration towards and within Europe remains high, shaping the structure of populations. Approximately 24% of the total German population had a migration background in 2017. The aim of the study was to analyze the association between migration background and health-related quality of life (HrQoL) in Germany. The analyses were based on 2014 and 2016 data of the German Socio-Economic Panel. Differences in sociodemographic characteristics between migrant and non-migrant samples were equal by employment of the entropy balancing weights. HrQoL was measured using the physical (PCS) and mental (MCS) component summary scores of the SF-12v2. Associations between PCS and MCS scores and migration background were examined using Student’s t-test. The mean PCS and MCS scores of persons with migration background (n = 8533) were 51.5 and 50.9, respectively. Persons with direct migration background had a lower PCS score (−0.55, p &lt, 0.001) and a higher MCS score (+1.08, p &lt, 0.001) than persons without migration background. Persons with direct migration background differed with respect to both physical and mental HrQoL from persons without migration background in the German population. Differences in HrQoL for persons with indirect migration background had p = 0.305 and p = 0.072, respectively. Causalities behind the association between direct migration background and HrQoL are to be determined.

Syrian refugees residing in Germany often develop posttraumatic stress as a result of the Syrian civil war, their escape, and postmigration stressors. At the same time, there is a lack of adequate treatment options. The smartphone-based app Sanadak was developed to provide cognitive behavioral therapy-based self-help in the Arabic language for Syrian refugees with posttraumatic stress.The aim of this study was to evaluate the effectiveness and cost-effectiveness of the app.In a randomized controlled trial, eligible individuals were randomly allocated to the intervention group (IG; app use) or control group (CG; psychoeducational reading material). Data were collected during structured face-to-face interviews at 3 assessments (preintervention/baseline, postintervention/after 4 weeks, follow-up/after 4 months). Using adjusted mixed-effects linear regression models, changes in posttraumatic stress and secondary outcomes were investigated as intention-to-treat (ITT) and per-protocol (PP) analysis. Cost-effectiveness was evaluated based on adjusted mean total costs, quality-adjusted life years (QALYs), and cost-effectiveness acceptability curves using the net benefit approach.Of 170 screened individuals (aged 18 to 65 years), 133 were eligible and randomized to the IG (n=65) and CG (n=68). Although there was a pre-post reduction in posttraumatic stress, ITT showed no significant differences between the IG and CG after 4 weeks (Posttraumatic Diagnostic Scale for DSM-5, Diff -0.90, 95% CI -0.24 to 0.47; P=.52) and after 4 months (Diff -0.39, 95% CI -3.24 to 2.46; P=.79). The same was true for PP. Regarding secondary outcomes, ITT indicated a treatment effect for self-stigma: after 4 weeks (Self-Stigma of Mental Illness Scale/SSMIS-stereotype agreement: d=0.86, 95% CI 0.46 to 1.25; stereotype application: d=0.60, 95% CI 0.22 to 0.99) and after 4 months (d=0.52, 95% CI 0.12 to 0.92; d=0.50, 95% CI 0.10 to 0.90), the IG showed significantly lower values in self-stigma than the CG. ITT showed no significant group differences in total costs and QALYs. The probability of cost-effectiveness was 81% for a willingness-to-pay of €0 per additional QALY but decreased with increasing willingness-to-pay.Sanadak was not more effective in reducing mild to moderate posttraumatic stress in Syrian refugees than the control condition nor was it likely to be cost-effective. Therefore, Sanadak is not suitable as a standalone treatment. However, as the app usability was very good, no harms detected, and stigma significantly reduced, Sanadak has potential as a bridging aid within a stepped and collaborative care approach.German Clinical Trials Register DRKS00013782; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTMLTRIAL_ID=DRKS00013782.RR2-10.1186/s12888-019-2110-y.

UNSTRUCTURED REMOVE

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.

Refugees who have fled from the ongoing civil war in Syria that arrived in Germany often develop post-traumatic stress symptoms (PTSS). The aim of this study was to determine health care services utilization (HCSU), health care costs and health-related quality of life (HrQoL) of Syrian refugees with mild to moderate PTSS without current treatment in Germany. The study was based on the baseline sample of a randomized controlled trial of a self-help app for Syrian refugees with PTSS (n = 133). HCSU and HrQoL based on the EQ-5D-5L and its visual analogue scale (EQ-VAS) were assessed with standardized interviews. Annual health care costs were calculated using extrapolated four-month HCSU and standardized unit costs. Associations between health care costs, HrQoL and PTSS severity were examined using generalized linear models. Overall, 85.0% of the sample utilized health care services within four months. The mean total annual health care costs were EUR 1920 per person. PTSS severity was not associated with health care costs. The EQ-5D-5L index score and the EQ-VAS score was 0.82 and 73.6, respectively. For Syrian refugees with higher PTSS severity, the EQ-5D-5L index score was lower (−0.17, p &lt, 0.001). The HCSU and the resulting health care costs of Syrian refugees with mild to moderate PTSS without current treatment are low and those with a higher PTSS severity had a lower HrQoL.

BACKGROUND Syrian refugees residing in Germany often develop posttraumatic stress as a result of the Syrian civil war, their escape, and postmigration stressors. At the same time, there is a lack of adequate treatment options. The smartphone-based app Sanadak was developed to provide cognitive behavioral therapy–based self-help in the Arabic language for Syrian refugees with posttraumatic stress. OBJECTIVE The aim of this study was to evaluate the effectiveness and cost-effectiveness of the app. METHODS In a randomized controlled trial, eligible individuals were randomly allocated to the intervention group (IG; app use) or control group (CG; psychoeducational reading material). Data were collected during structured face-to-face interviews at 3 assessments (preintervention/baseline, postintervention/after 4 weeks, follow-up/after 4 months). Using adjusted mixed-effects linear regression models, changes in posttraumatic stress and secondary outcomes were investigated as intention-to-treat (ITT) and per-protocol (PP) analysis. Cost-effectiveness was evaluated based on adjusted mean total costs, quality-adjusted life years (QALYs), and cost-effectiveness acceptability curves using the net benefit approach. RESULTS Of 170 screened individuals (aged 18 to 65 years), 133 were eligible and randomized to the IG (n=65) and CG (n=68). Although there was a pre-post reduction in posttraumatic stress, ITT showed no significant differences between the IG and CG after 4 weeks (Posttraumatic Diagnostic Scale for DSM-5, Diff –0.90, 95% CI –0.24 to 0.47; P=.52) and after 4 months (Diff –0.39, 95% CI –3.24 to 2.46; P=.79). The same was true for PP. Regarding secondary outcomes, ITT indicated a treatment effect for self-stigma: after 4 weeks (Self-Stigma of Mental Illness Scale/SSMIS–stereotype agreement: d=0.86, 95% CI 0.46 to 1.25; stereotype application: d=0.60, 95% CI 0.22 to 0.99) and after 4 months (d=0.52, 95% CI 0.12 to 0.92; d=0.50, 95% CI 0.10 to 0.90), the IG showed significantly lower values in self-stigma than the CG. ITT showed no significant group differences in total costs and QALYs. The probability of cost-effectiveness was 81% for a willingness-to-pay of €0 per additional QALY but decreased with increasing willingness-to-pay. CONCLUSIONS Sanadak was not more effective in reducing mild to moderate posttraumatic stress in Syrian refugees than the control condition nor was it likely to be cost-effective. Therefore, Sanadak is not suitable as a standalone treatment. However, as the app usability was very good, no harms detected, and stigma significantly reduced, Sanadak has potential as a bridging aid within a stepped and collaborative care approach. CLINICALTRIAL German Clinical Trials Register DRKS00013782; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013782 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s12888-019-2110-y

Many Syrian refugees residing in Germany have been exposed to traumatizing events, while treatment options are scarce. Therefore, the self-help app &ldquo, Sanadak&rdquo, was developed to target post-traumatic stress in Syrian refugees. We aimed to inspect the recruitment and baseline characteristics of the participants in the trial, which is conducted to evaluate the app. Analyses were based on the recruitment sample (n = 170) and the trial sample (n = 133). Data were collected during structured face-to-face interviews in the Arabic language. Targeted outcomes included post-traumatic stress (primary, Post-traumatic Diagnostic Scale for DSM-5/PDS-5) and depressive symptoms, anxiety, resilience, among others (secondary). Recruited individuals were M = 32.8 (SD = 11.2, range = 18&ndash, 65) years old, 38.8% were women. The average PDS-5 score was 23.6 (SD = 13.2) regarding trauma exposure, which was most frequently related to experiencing military- or combat-related events (32.9%). Moreover, 46.5% had major depression and 51.8% showed low resilience. Anxiety was present in 40.6% of the trial participants. Psychological distress was high in Syrian refugees residing in Germany, enrolled in a trial targeting post-traumatic stress. This underlines the need for intervention. Our results provide important figures on the mental health of a not well-studied population group in Germany.

The aim of this study was to translate the self-reported questionnaire "Recovering Quality of Life (ReQoL)" to measure the health-related quality of life of people with mental disorders into German.The questionnaire was translated into German independently by 2 qualified translators. Discrepancies in meaning and terminology were checked by reviewing a back translation against the original English version. The German translation of the questionnaire was pretested in 5 patients with mental disorders.The translation of several English phrasings of the questionnaire into German was difficult, mainly due to lingual and cultural differences. By expert discussion of the translation and the pretest in patients with mental disorders, appropriate phrasings were found.A German version of the self-reported ReQoL questionnaire is available to measure the health-related quality of life of people with mental disorders.Ziel dieser Arbeit war es, den Selbstbeurteilungsfragebogen „Recovering Quality of Life (ReQoL)“ zur Messung der gesundheitsbezogenen Lebensqualität von Menschen mit psychischen Erkrankungen in die deutsche Sprache zu übersetzen.Die Übersetzung des Fragebogens in die deutsche Sprache erfolgte durch 2 voneinander unabhängige qualifizierte Übersetzer. Diskrepanzen in der Bedeutung und Terminologie wurden durch den Vergleich einer Rückübersetzung mit der Originalversion ermittelt. Die deutsche Übersetzung des Fragebogens wurde mit 5 Patienten mit psychischen Erkrankungen vorgetestet.Die Übersetzung einiger englischer Formulierungen des Fragebogens in die deutsche Sprache gestaltete sich, hauptsächlich aufgrund sprachlicher und kultureller Unterschiede, schwierig. Durch eine Expertendiskussion der Übersetzung und einen Pretest mit psychisch erkrankten Patienten konnten geeignete Formulierungen gefunden werden.Es liegt eine deutsche Version des Selbstbeurteilungsfragebogens ReQoL vor, um die gesundheitsbezogene Lebensqualität von Menschen mit psychischen Erkrankungen zu erfassen.

Recruitment of so called rare populations, including refugees, for participation in research studies is challenging. We aim to share our lessons learned regarding recruitment strategies used in the "Sanadak" trial, a randomized controlled trial for the evaluation of a self-help app for Syrian refugees with posttraumatic stress.We conducted an interim evaluation of our recruitment strategies. A quantitative analysis addressed how potential study participants first learned about "Sanadak" and in which way they made first contact with us. A qualitative part included problem-centered interviews with our Syrian study nurses (n=3) regarding the success of various recruitment strategies and perceived barriers.Data were available for the recruitment of 140 Syrian refugees. Almost half of the sample (44%) was recruited via personal contact, about another third (36%) by means of study promotion (e. g. Facebook ads), and about a fifth (19%) through multipliers. Typical barriers were concerns regarding data protection, anonymity and stigmatization.Snowball sampling was an effective recruitment strategy in our trial. This is also the most acknowledged recruitment strategy for rare populations. In addition, other strategies were useful to increase sample variance. The interim evaluation helped to direct efforts towards effective recruitment strategies and to identify and address barriers.Multi-strategic recruitment with a focus on snowball sampling, multiple options to make contact with the study team, and having culturally sensitive members in the study team contributed towards successful recruitment in the "Sanadak"-trial.ZIEL: Die Rekrutierung von sogenannten seltenen Populationen, dazu zählen Geflüchtete, für Forschungsstudien gilt als schwierig. Deshalb teilen wir Erkenntnisse zu förderlichen und hinderlichen Strategien zur Rekrutierung von Geflüchteten sowie wahrgenommene Barrieren basierend auf unseren Erfahrungen im „Sanadak“-Trial, einer randomisierten kontrollierten Studie zur Evaluation einer Selbsthilfe-App für syrische Geflüchtete mit posttraumatischer Belastung.Datengrundlage war eine Interimsevaluation der Rekrutierungsstrategien. Im quantitativen Teil analysierten wir, wie Studieninteressierte von „Sanadak“ erfahren haben und über welchen Weg der Erstkontakt stattfand. Diese Ergebnisse wurden durch einen qualitativen Teil ergänzt. Dazu wurden die syrischen Studienassistenten des „Sanadak“-Trials (n=3) mittels problemzentrierter Leitfadeninterviews zu förderlichen und hinderlichen Rekrutierungsstrategien sowie wahrgenommenen Barrieren befragt.Es lagen Daten zur Rekrutierung von 140 syrischen Geflüchteten vor. Davon wurde fast die Hälfte (44%) über persönlichen Kontakt rekrutiert, rund ein weiteres Drittel (36%) wurde über verschiedene Werbemaßnahmen (z. B. Facebook-Werbung) und rund ein Fünftel (19%) über Multiplikatoren gewonnen. Typische Barrieren waren Bedenken hinsichtlich Datenschutz, Anonymität und Stigmatisierung. DISKUSSION: Das Schneeballprinzip war eine effektive Rekrutierungsstrategie im „Sanadak“-Trial. Weitere Strategien waren ergänzend sinnvoll, v. a. um die Varianz der Stichprobe zu erhöhen. Die Interimsevaluation erwies sich als wertvoll, um Ressourcen auf effektive Rekrutierungsstrategien zu lenken und Barrieren zu adressieren.Ein multistrategischer Rekrutierungsansatz mit Fokus auf persönlichen Kontakt, vielfältigen Kontaktmöglichkeiten und interkulturell kompetenten Projektmitarbeitern hat sich im „Sanadak“-Trial bewährt.

Background The EuroQuol 5 Dimension (EQ5D) is a validated tool to assess health-related quality of life (HRQoL). The International Prognostic Scoring System (IPSS) and the revised IPSS (R-IPSS) are the gold standards of prognostication in patients (pts) with myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML) and low blast count acute myeloid leukemia (AML). The EQ5D is the most used tool for patient reported outcome measures but is underused in MDS, CMML or AML, with only one report on the use of the updated 5 level (5L) published to date (Yu H, Qual Life Res 2021, 855). Aims 1) Compare HRQoL of pts with MDS, CMML or AML with a German population norm (Grochtdreis T, Eur J Health Econ 2019, 933) matched by age, sex and no. of comorbidities. 2) Assess the impact of baseline HRQoL on azacitidine (AZA) treatment (trt) outcomes. 3) Longitudinal analyses of EQ-5D/lab value pairs per AZA cycle. Methods Pts treated within the Austrian Azacitidine Registry were analyzed (NCT01595295, data cut-off 13 Dec 20). EQ5D and lab values were assessed at the start of AZA trt cycles. The EQ5D-5L German value set (Ludwig K, Pharmacoeconomics 2018, 663) and the reverse crosswalk tool provided by EuroQol were used for calculation of the EQ5D-index. Baseline characteristics with univariate p Results 1456 EQ5D (n=225 3L; n=1231 5L) questionnaires were analyzed; 129, 33 and 110 of 272 pts had MDS, CMML or AML. Pts reported more pronounced restrictions in usual activities (+28%, p Pts with an EQ5D available at AZA start (n=205) were stratified according to their Level Sum Score (LSS), EQ-VAS or EQ5D-index being In univariate logistic regression, LSS (p·0009), EQ-VAS (p=0·0237) and EQ5D-index (p=0·0110) were correlated with response to AZA. After MVA, LSS remained significantly predictive of AZA response (p=0·0160; odds ratio (OR)=0·451 [0·235-0·852]), and the EQ5D-index showed a trend (p=0·0627; OR=0·522 [0·296-1·032]). A LSS of ≥8 at AZA start thus indicates a 0·45 times lower odds of responding to AZA. Increases of the likelihood ratio (LR) were observed after addition of 1) LSS to the IPSS (p=0·0068) or R-IPSS (p=0·0205); 2) EQ-VAS to the IPSS (p=0·0031) or R-IPSS (p=0·0058); 3) EQ5D-index to the IPSS (p=0·0015) or R-IPSS (p=0·0012), indicating that they provide added value to the IPSS and the R-IPSS. Up to 1432 "EQ5D response/clinical parameter" pairs revealed that hemoglobin level, platelet count, transfusion dependence, serum ferritin, creatinine, albumin, adverse events G3-4, AZA days and dose per cycle and hematologic improvement in erythrocytes and platelets significantly correlated with ≥5 of 8 EQ5D parameters. Conclusions These data indicate for the first time that: 1) Patients with MDS, CMML or AML have profound impairments in HRQoL compared to a German population norm. 2) Baseline EQ5D-index predicts adjusted OS, TCB and TTNT. 3) Baseline LSS significantly predicts response to AZA. 4) Baseline LSS, EQ-VAS and EQ5D-index significantly add value to the existing gold standards for prognostication (IPSS, R-IPSS). 5) EQ5D responses during AZA trt correlated significantly with lab values associated with response, toxicity and AZA dose and no. of trt days per cycle. Based on these results, we will continue to use the EQ5D-5L and recommend the longitudinal use of this brief questionnaire in both clinical trial- and real-world settings. Figure 1 Figure 1. Disclosures Pleyer: AbbVie, BMS, Novartis: Honoraria, Other: Travel support. Heibl: BMS: Honoraria. Leisch: Honoraria from BMS, Celgene, Gilead, Takeda and Novartis; Travel support: Celgene and Novartis: Honoraria, Other: Travel support. Melchardt: Abbvie, Celgene, Novartis: Honoraria. Wolf: Roche: Honoraria, Research Funding; MSD: Honoraria, Research Funding; BMS-Celgene: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; Takeda: Honoraria; Gilead: Honoraria; Incyte: Honoraria; GEMOAB: Honoraria. Greil: Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Sandoz: Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; AstraZeneca: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; MSD: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Daiichi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Sankyo: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Amgen: Honoraria, Other: Travel, Accommodations, Expenses, Research Funding. Stauder: Celgene/BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: While azacitidine is approved for all patients with MDS, CMML and AML by the US FDA, it is not approved for all patients subsets by EMA.

Healthcare for mental disorders is a big challenge for the German healthcare system. In cases of comorbid mental diseases, patients suffer from an especially high burden of disease. So far, innovative care models for collaborative and stepped care have only been investigated with respect to their effectiveness for single mental disorders.The project "Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers" (COMET), which is being carried out by the Hamburg Network for Health Services Research (HAM-NET) from 2017 until 2020, examines an innovative, guideline-based healthcare model for the improvement of healthcare for patients with mental illnesses and their potential comorbidities. In this article this new stepped and collaborative care model for patients in primary care that integrates general practitioners, psychiatrists, psychotherapists, and hospitals is presented. For the implementation and facilitation of the model, guideline-based treatment pathways, a tablet-based computer program for screening, diagnostic and guideline-based treatment recommendations, as well as a web-based transferal platform were developed.The results of this project on the effectiveness and efficacy of the model can help determine if the model can be implemented in routine healthcare. This could represent a major step towards more integrated and cross-sectoral healthcare for patients with mental illnesses.

Objective Syrians have been the largest group among asylum seekers in Germany since 2014. Refugees are exposed to various risks along the migration process, indicating the need for adequate psychosocial support. Following the advice of the United Nations High Commissioner for Refugees to consult the target group, this is the first study qualitatively investigating the perspectives on mental health and coping strategies of Syrian refugees in Germany. Methods A qualitative design with semi-structured focus group discussions was applied. Three focus groups with a total of N = 20 participants were conducted. Focus group discussions were analyzed using content-structuring content analysis. Results Hopelessness, fear, and worries were reported most frequently as emotional consequences of war, fleeing, and resettlement, along with cognitive, physical, social, and behavioral consequences. Among the reported consequences, symptoms of PTSD were identified. Contrary to depression and schizophrenia, PTSD was not explicitly mentioned. Possibilities of coping and support referred to meeting basic needs (e.g., mental health care), fostering participation and personal coping, with the social network stated as most important source of support. Barriers of accessing mental health and psychosocial support (MHPSS) services included poor information, stigma, and language difficulties. Conclusion In contrast to earlier research, Syrian refugees reported numerous emotional symptoms as well as mental disorders as consequences of war, fleeing, and resettlement, indicating awareness of mental health sequelae. However, PTSD was not reported as possible consequence. The findings indicate the need for adequate psychoeducation, matching the participants' wish for improved information on mental health to reduce barriers accessing MHPSS.

IntroductionMental healthcare is one of the biggest challenges for healthcare systems. Comorbidities between different mental disorders are common, and patients suffer from a high burden of disease. While the effectiveness of collaborative and stepped care models has been shown for single disorders, comorbid mental disorders have rarely been addressed in such care models. The aim of the present study is to evaluate the effectiveness of a collaborative and stepped care model for depressive, anxiety, somatoform and alcohol use disorders within a multiprofessional network compared with treatment as usual.Methods and analysisIn a cluster-randomised, prospective, parallel-group superiority trial, n=570 patients will be recruited from primary care practices (n=19 practices per group). The intervention is a newly developed collaborative and stepped care model in which patients will be treated using treatment options of various intensities within an integrated network of outpatient general practitioners, psychiatrists, psychotherapists and inpatient institutions. It will be compared with treatment as usual with regard to effectiveness, cost-effectiveness and feasibility, with the primary outcome being a change in mental health-related quality of life from baseline to 6 months. Patients in both groups will undergo an assessment at baseline, 3, 6 and 12 months after study inclusion.Ethics and disseminationThe study has been approved by the ethics committee of the Hamburg Medical Association (No. PV5595) and will be carried out in accordance with the principles of the Declaration of Helsinki. For dissemination, the results will be published in peer-reviewed journals and presented at conferences. Within the superordinate research project Hamburg Network for Health Services Research, the results will be communicated to relevant stakeholders in mental healthcare.Trial registration numberNCT03226743.

Somatoform disorders are highly prevalent mental disorders causing impairment and large economic burden. In order to improve the diagnosis and management of affected patients, a health care network for somatoform disorders (Sofu-Net) was implemented in primary care.The aim of the study was to determine the cost-effectiveness of a stepped, collaborative and coordinated health care network for somatoform and functional disorders (Sofu-Net) compared with regular primary care physician (PCP) practices in German primary care from a societal perspective.This study was part of a 6-month controlled, prospective, non-randomized, observer-blinded cluster cohort trial. Participants were recruited from 33 PCP practices in Hamburg, Germany. The health care network was a collaboration of PCPs, psychotherapists, inpatient clinics and a specialized outpatient clinic. Participants in the control group received usual care. A cost-effectiveness analysis, using treatment response as measure of effectiveness, was performed. Uncertainty in cost-effectiveness was analyzed using cost-effectiveness acceptability curves.In total, n=218 patients (n=119 patients in the intervention group and n=99 patients in the control group) were included in the study. At 6 months, patients within the Sofu-Net group did not differ significantly from the control group with regard to costs (533; standard error 941) and treatment response (--10.3%). For Sofu-Net, the probability of being cost-effective at a willingness-to-pay (WTP) of 10,000 per additional response to treatment was only 31%.Sofu-Net is unlikely to be cost-effective. Even for high WTP, the probability of cost-effectiveness was low. The results were robust to variation of costs included in the analysis as well as when only complete cases were included in the analysis. The most important limitations of the study were that randomization could not be established at patient level and at practice level and that the study design did not allow measurement of costs at baseline.Patients with severe somatic symptoms did not benefit from the health care network. Sofu-Net might have reduced costs in patients with moderate somatic symptoms.Owing to the limitations and due to a short follow-up of this study, further cost-effectiveness analyses with high methodological quality and a follow-up of at least one year are needed in order to produce results that are more reliable.

Im Rahmen des Hamburger Netzes psychische Gesundheit (psychenet) wird die Kosteneffektivitat von neuen Versorgungsmodellen evaluiert, die sich an dem Konzept der Collaborative Care orientieren. Neben einem Uberblick uber die in der internationalen Literatur verfugbare Evidenz zur Kosteneffektivitat von Collaborative Care beschreibt der vorliegende Beitrag die Zielsetzung und Methodik der im Rahmen von psychenet durchgefuhrten Kosteneffektivitatsanalysen. Der Nachweis der Kosteneffektivitat soll die Ubernahme entsprechender Versorgungsmodelle in die Regelversorgung befordern.

Background Anxiety, depressive and somatoform disorders are highly prevalent and cause a huge economic burden. A nurse-led collaborative care intervention has been set up in order to improve self-management of patients with these mental disorders in primary care in Hamburg, Germany. The aim of this study was to determine the cost-utility of this nurse-led intervention from the health care payer perspective. Methods This analysis was part of a 12-month cluster-randomized controlled trial aiming to increase perceived self-efficacy of primary care patients with anxiety, depressive or somatic symptoms by collaborative nurse-led self-management support compared with routine care. A cost-effectiveness analysis using quality-adjusted life years was performed. Net-monetary benefit regressions adjusted for baseline differences for different willingness-to-pay thresholds were conducted and cost-effectiveness acceptability curves were constructed. Results In total, n = 325 patients (intervention group: n = 134; control group: n = 191) with a mean age of 40 from 20 primary care practices were included in the analysis. The adjusted differences in quality-adjusted life years and mean total costs between intervention group and control group were +0.02 and +€1145, respectively. Neither of the two differences was statistically significant. The probability for cost-effectiveness of the complex nurse-led intervention was 49% for a willingness-to-pay of €50,000 per additional quality-adjusted life year. The probability for cost-effectiveness did not exceed 65%, independent of the willingness-to-pay. Conclusion The complex nurse-led intervention promoting self-management for primary care patients with anxiety, depressive or somatic symptoms did not prove to be cost-effective relative to routine care from a health care payer perspective.

Background: For the treatment of depressive disorders, the framework of collaborative care has been recommended which showed improved outcomes in the primary care sector. Yet, an earlier literature review did not find sufficient evidence to draw robust conclusions on the cost-effectiveness of collaborative[for full text, please go to the a.m. URL], 14. Deutscher Kongress für Versorgungsforschung

Within the Hamburg Network for Mental Health, cost-effectiveness analyses of collaborative care models are conducted. After providing an overview of the international literature on the cost-effectiveness of collaborative care for mental disorders, this article describes the rationale, aims and methods of the cost-effectiveness analyses conducted within the Hamburg Network for Mental Health. Proof of cost-effectiveness is expected to promote the transfer of collaborative care models into routine care.

For cost-utility analyses, data on health state utilities, as provided by the EQ-5D-3L, is needed but not always available. This study specified mapping algorithms from the Beck Depression Inventory (BDI) index to the EQ-5D-3L index adjusted for specific socio-demographic variables for patients with depressive disorders.The objective of this study was to specify mapping algorithms from the BDI index to the preference-based EQ-5D index for patients with depressive disorders, adjusting for specific socio-demographic variables.A sample of 1,074 consecutive patients with depressive disorders from a psychotherapeutic outpatient clinic was included in the study. Standardized clinical interviews were applied to establish reliable diagnoses. For the prediction of the EQ-5D-3L index from the BDI index and selected patient socio-demographic characteristics, ordinary least squares regression with robust standard errors was used. Model prediction properties were tested using the root mean squared error and repeated random sub-sampling cross-validation.The BDI index predicted the EQ-5D-3L index with a significant proportion of variance explained. The highest model goodness of fit was estimated for models with the BDI index and age as independent variables. The root mean squared error of the predicted EQ-5D-3L index in the validation samples was 0.23 for all models.The mean observed EQ-5D-3L index values and the mean predicted EQ-5D-3L index values seemed not to differ between models. However, a reduction of variability using cross-validation led to those (rather) accurate mean predicted values. One limitation of this study was the restricted generalizability. Moreover, some uncertainty was introduced in model predictive performance by usage of a dependent estimation sample for validation.The specified mapping algorithms from the BDI index to the EQ-5D-3L index for patients with depressive disorders are acceptable as approximation in cost-utility analyses. A further validation in independent samples is necessary to obtain more confidence in their performance.