Thèses sur le sujet « Mental-health classification »

The psychological sciences offer a large spectrum of theories, principles, and methodological approaches to understand mental health, normal and abnormal functions and behaviours, as well as mental disorders. Based on continued research progress, psychology has derived a wide range of effective interventions for behaviour change and the prevention, treatment and rehabilitation of mental disorders. Thus, psychology and clinical psychology in particular should be regarded as the ‘mother’ science for psychotherapy and psychotherapeutic practice. This paper provides a selective overview of the scope, strengths and gaps in psychological research to depict the advances needed to inform future research agendas on mental disorders and psychological interventions in the context of psychotherapy. Most maladaptive health behaviours and mental disorders can be conceptualised as the result of developmental dysfunctions of psychological functions and processes, and as associated neurobiological and genetic processes in interaction with behaviour and the environment. An integrative translational model, linking basic and experimental research with clinical research and population-based prospective longitudinal studies is proposed for improving identification of critical core vulnerability and risk factors and core pathogenic mechanisms. The proposed framework is expected to allow a more stringent delineation of targeted preventive and therapeutic psychological interventions and an optimisation and better understanding of cognitive-behavioural therapies and other psychological interventions. Based on a European consultation process, a ‘Science of Behaviour Change’ programme with the promise of improved diagnosis, treatment and prevention of both healthrisk behaviour constellations and mental disorders is proposed.
Psychologie als «Mutterwissenschaft» für Psychotherapie und psychische Gesundheit Psychologie als Wissenschaft bietet ein breites Spektrum an Theorien, Grundlagen und methodischen Ansätzen, um psychische Gesundheit, normale und gestörte Funktionen und Verhaltensweisen sowie psychische Störungen zu erforschen und zu «verstehen». Auf dieser Grundlage haben sich in der Klinischen Psychologie vielfältige effektive, psychologisch begründete Interventionen für die Prävention, Behandlung und Rehabilitation von psychischen Störungen ausdifferenziert. Damit ist die Psychologie als «Mutterwissenschaft » der Psychotherapie und psychotherapeutische Praxis anzusehen. Der Beitrag versucht auf der Grundlage einer Stärken-/Schwächen-Analyse der psychologischen Forschung diejenigen Themenbereiche zu definieren, die für Erkenntnisfortschritte bei psychischen Störungen und die psychotherapeutische Interventionsforschung besonders vielversprechend sein könnten. Dysfunktionale bzw. abweichende Verhaltensweisen wie auch psychische Störungen lassen sich als entwicklungsbezogene Störungen psychologischer Funktionen und Prozesse und damit assoziierter neurobiologischer und genetischer Prozesse konzeptualisieren. Für eine verbesserte Identifikation von zentralen Vulnerabilitäts- und Risikofaktoren sowie ätiologisch relevanten Schlüsselprozessen wird ein integratives translationales Modell vorgeschlagen, welches die Grundlagen- und experimentelle Forschung mit klinischer Forschung, Translation und Public-health-Implikationen verknüpft. Damit soll auf der einen Seite eine stringentere Ableitung gezielter Interventionen erleichtert werden, andererseits aber auch eine bessere Identifikation der zentralen Wirkfaktoren und Wirkprozesse psychologischer Therapien ermöglicht werden. Basierend auf einem europäischen Experten-Beratungsprozess wird ein EU-Programm ‘The science of behavior change’ angeregt.

The aim of the study is to compare health outcomes of migrants and the native German population, testing for the existence of a Healthy Immigrant Effect (HIE). The study contributes a broad theoretical analysis of the HIE and makes use of a wide spectrum of variables to model health (using the SF-12). The HIE is marked by an observed health advantage for migrants, when compared to the host population, which declines with the years since migration. Assessing different types of selection processes, it is assumed that mass migration to post-industrial countries is characterized by favouring the inflow of healthy individuals from weaker economies working in the low-wage sector due to the cost aspect of migration and differences in wages for adequate work. Socioeconomic and -structural differences of migrant and host population as well as psychosocial stressors like acculturation cause the deteroriation of the health adavantage with increasing years since migration. Using cross-sectional data from the 2016 wave of the Socio-Economic Panel this study compares health outcomes (generated from the SF-12) between recent migrants (≤ 10 years since migration), non-recent migrants (> 10 years since migration) and the German native population. Propensity score matching analyses reveal a health advantage for recent migrants compared to non-recent migrants as well as to the German native population, while non-recent migrants remain statistically indistinguishable from the native German population, implying a health assimilation effect.

Background: The Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods: Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons. Results: 337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%). Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p < 0.01), search for mental health services (p = 0.017) and usage of platforms with mental health professionals (p = 0. 048). The analysis of differences in Internet use depending on the participants’ type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet’s role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary. Conclusions: Most psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.

Background: Empirical data on the use of services due to mental health problems in older adults in Europe is lacking. The objective of this study is to identify factors associated with service utilization in the elderly. Methods: As part of the MentDis_ICF65+ study, N = 3,142 people aged 65–84 living in the community in six European and associated countries were interviewed. Based on Andersen’s behavioral model predisposing, enabling, and need factors were analyzed with logistic regression analyses. Results: Overall, 7% of elderly and 11% of those with a mental disorder had used a service due to mental health problems in the last 12 months. Factors significantly associated with underuse were male sex, lower education, living in the London catchment area, higher functional impairment and more comorbid mental disorders. The most frequently reported barrier to service use was personal beliefs, e.g. “I can deal with my problem on my own” (90%). Conclusion: Underutilization of mental health services among older people in the European community is common and interventions are needed to achieve an adequate use of services.

Background: The consideration of impairment plays a crucial role in detecting significant mental health problems in children whose symptoms do not meet diagnostic criteria. The assessment of impairment may be particularly relevant when only short screening instruments are applied in epidemiological surveys. Furthermore, differences between childrens’ and parents’ perceptions of present impairment and impairing symptoms are of interest with respect to treatment-seeking behaviour. Objectives: The objectives were to assess parent- and self-reported impairment due to mental health problems in a representative sample of children and adolescents; to describe the characteristics of highly impaired children with normal symptom scores; and to investigate the associations between symptoms in different problem areas and impairment. Methods: The mental health module of the German Health Interview and Examination Survey for Children and Adolescents (the BELLA study) examined mental health in a representative sub-sample of 2,863 families with children aged 7–17. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children 11 years and older. Results: Considerable levels of distress and functional impairment were found with 14.1% of the boys and 9.9% of the girls being severely impaired according to the parental reports. However, self-reported data shows a reversed gender-difference as well as lower levels of severe impairment (6.1% in boys; 10.0% in girls). Six percent of the sampled children suffer from pronounced impairment due to mental health problems but were not detected by screening for overall symptoms. Childrens’ and parents’ reports differed in regard to the association between reported symptom scores and associated impairment with children reporting higher impairment due to emotional problems. Conclusions: The assessment of impairment caused by mental health problems provides important information beyond the knowledge of symptoms and helps to identify an otherwise undetected high risk group. In the assessment of impairment, gender-specific issues have to be taken into account. Regarding the systematic differences between childrens’ and parents’ reports in the assessment of impairment, the child’s perspective should be given special attention.

Objective: As long-term results of conservative treatment for obesity are discouraging, bariatric surgery is becoming a treatment option for extremely obese adolescents. However, mental and behavioral problems need to be respected when treating this vulnerable target group. Methods: A detailed systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, PubMed and Medline electronic databases. Results: Twelve studies met the inclusion criteria. Although strength of evidence was limited, results suggested that pre-operatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while a substantial number showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Original articles on outcomes of eating and anxiety disorder symptoms after weight loss surgery were not found. Conclusions: Further attention is needed on consistent clinical assessment of mental health disturbances and their consecutive treatment in adolescents. Future research should also focus on psychological and psychosocial predictors of weight loss after bariatric surgery.

Background: Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany. Objectives: The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation. Methods: The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7–17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/ hyperactivity disorder (FBBHKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined. Results Overall, 14.5% of the children and adolescents aged 7–17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed. Conclusions: The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

Background. The German National Health Interview and Examination Survey (GHS) is the first government mandated nationwide study to investigate jointly the prevalence of somatic and mental disorders within one study in the general adult population in Germany. This paper reports results from its Mental Health Supplement (GHS-MHS) on 4-week 12-month, and selected lifetime prevalence of a broad range of DSM-IV mental disorders, their co-morbidity and correlates in the community. Methods. The sample of the GHS-MHS (n=4181; multistage stratified random sample drawn from population registries ; conditional response rate: 87.6%) can be regarded as representative for the German population aged 18–65. Diagnoses are based on fully structured computer assisted clinical interviews (M-CIDI), conducted by clinically trained interviewers. Results. 12-month prevalence for any DSM-IV study disorder is 31% (lifetime: 43%; 4-week: 20%) with anxiety disorders, mood disorders and somatoform syndromes being the most frequent diagnoses. Retrospective age of onset information reveals that most disorders begin early in life. Comorbidity rates among mental disorders range from 44% to 94%. Correlates of increased rates of mental disorders and co-morbidity were: female gender (except for substance disorders), not being married, low social class, and poor somatic health status. Health care utilization for mental disorders depended on co-morbidity (30% in ‘pure’, 76% in highly co-morbid cases) and varied from 33% for substance use disorders to 75% for panic disorder. Conclusions. Results confirm and extend results from other national studies using the same assessment instruments with regard to prevalence, co-morbidity and sociodemographic correlates, covering a broader range of DSM-IV disorders [i.e. somatoform disorders, all anxiety disorders (except PTSD), mental disorders due to substance or general medical factor, eating disorders]. Intervention rates were higher than in previous studies, yet still low overall.

How do people discuss mental health on social media? Can we train a computer program to recognize differences between discussions of depression and other topics? Can an algorithm predict that someone is depressed from their tweets alone? In this project, we collect tweets referencing “depression” and “depressed” over a seven year period, and train word embeddings to characterize linguistic structures within the corpus. We find that neural word embeddings capture the contextual differences between “depressed” and “healthy” language. We also looked at how context around words may have changed over time to get deeper understanding of contextual shifts in the word usage. Finally, we trained a deep learning network on a much smaller collection of tweets authored by individuals formally diagnosed with depression. The best performing model for the prediction task is Convolutional LSTM (CNN-LSTM) model with a F-score of 69% on test data. The results suggest social media could serve as a valuable screening tool for mental health.

Despite a wealth of studies on differences regarding the biobehavioral and social–psychological bases of mental disorders in men and women and repeated calls for increased attention, women-specific issues have so far not been comprehensively addressed in past diagnostic classification systems of mental disorders. There is also increasing evidence that this situation will not change significantly in the upcoming revisions of ICD-11 and DSM-V. This paper explores reasons for this continued failure, highlighting three major barriers: the fragmentation of the field of women's mental health research, lack of emphasis on diagnostic classificatory issues beyond a few selected clinical conditions, and finally, the “current rules of game” used by the current DSM-V Task Forces in the revision process of DSM-V. The paper calls for concerted efforts of researchers, clinicians, and other stakeholders within a more coherent and comprehensive framework aiming at broader coverage of women-specific diagnostic classificatory issues in future diagnostic systems.

This dissertation presents an interdisciplinary work aimed at investigate the discursive construction of otherness in mental health domain in the Western culture, and in detail the role of Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the APA, in this process. Critical psychology perspective oriented the research and the data collection. The analysis is conducted through a multi-method approach (Critical Discourse Analysis, Semiotic Analysis and Lacanian Discourse Analysis), which integrates several traditions with a particular concern about the ways in which power and ideology are discursively enacted, produced and resisted by text and talk and shape the concept of mental disorders. The study (1) examines how legitimisation and hegemony have been discursively constructed, legitimised and consolidated over time. The study (2) aims to investigate the scientific debate around the deletion of NPD in order to reconstruct and deconstruct the decisional process through which the boundaries between normality and pathology are constructed. The study (3) aims to investigate how the discourse of DSM was contested by discourse of other social actors involved in the mental-health domain in order to analyze the effect on shaping subjectivity of patients and mental-health professionals.

Despite a wealth of studies on differences regarding the biobehavioral and social–psychological bases of mental disorders in men and women and repeated calls for increased attention, women-specific issues have so far not been comprehensively addressed in past diagnostic classification systems of mental disorders. There is also increasing evidence that this situation will not change significantly in the upcoming revisions of ICD-11 and DSM-V. This paper explores reasons for this continued failure, highlighting three major barriers: the fragmentation of the field of women's mental health research, lack of emphasis on diagnostic classificatory issues beyond a few selected clinical conditions, and finally, the “current rules of game” used by the current DSM-V Task Forces in the revision process of DSM-V. The paper calls for concerted efforts of researchers, clinicians, and other stakeholders within a more coherent and comprehensive framework aiming at broader coverage of women-specific diagnostic classificatory issues in future diagnostic systems.

Self-compassion, typically operationalized as the total score of the Self-Compassion Scale (SCS; Neff, 2003b), has been shown to be related to increased psychological well-being and lower depression in students of the social sciences, users of psychology websites and psychotherapy patients. The current study builds on the existing literature by examining the link between self-compassion and depressive symptomatology in a sample representative of the German general population (n = 2,404). The SCS subscales of self-judgment, isolation, and over-identification, and the “self-coldness”, composite score, which encompass these three negative subscales, consistently differed between subsamples of individuals without any depressive symptoms, with any depressive syndromes, and with major depressive disorder. The contribution of the positive SCS subscales of self-kindness, common humanity, and mindfulness to the variance in depressive symptomatology was almost negligible. However, when combined to a “self-compassion composite”, the positive SCS subscales significantly moderated the relationship between “self-coldness” and depressive symptoms in the general population. This speaks for self-compassion having the potential to buffer self-coldness related to depression—providing an argument for interventions that foster self-caring, kind, and forgiving attitudes towards oneself.

The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD-1Oand DSM-IlI-R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the inter-rater agreement for the different types of questions used. Of 590 subjects interviewed across all sites and rated by an interviewer and observer, 575 were eligible for analysis. The CIDI was judged to be acceptable for most subjects and was appropriate for use in different kinds of settings. Many subjects fulfilled criteria for more than one diagnosis (lifetime and six-month). The most frequent lifetime disorders were generalised anxiety, major depression, tobacco use disorders, and agoraphobia. Percentage agreements for all diagnoses were above 90% and the kappa values were all highly significant. No significant numbers of diagnostic disconcordances were found with lifetime, six-month, and four-week time frames.

Aims. Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders. Method. 1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples. Results. Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5–0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1–0.6; NS: OR: 0.2, 95% CI: 0.1–0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3–0.6; NS: OR: 0.5, 95% CI: 0.3–0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4–5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3–8.0) were observed in DS with high combat exposure compared with civilians. Conclusions. Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.

Nach Befunden des Bundes-Gesundheitssurveys 1998/99 (Zusatzsurvey „Psychische Störungen“) litten im Jahr der Erhebung 32% (=15,6 Millionen) der erwachsenen deutschen Bevölkerung im Alter von 18–65 unter einer oder mehreren psychischen Störungen. Jeder dritte Betroffene (36%) steht oder stand im Jahr vor der Erhebung wegen der psychischen Störung in Kontakt mit ambulanten oder stationären psychiatrisch/psychotherapeutischen Diensten oder seinem Hausarzt. Der Anteil von Betroffenen, die eine im weitesten Sinne adäquate Therapie nach modernen wissenschaftlichen Kriterien erhalten, kann konservativ auf ca.10% geschätzt werden. Die niedrige Versorgungsquote betrifft dabei nicht alle spezifischen Störungsgruppen in gleichem Ausmaß; niedrige Versorgungsraten ergaben sich insbesondere für somatoforme und Suchterkrankungen. Ferner ergaben sich zum Teil markante regionale Unterschiede (z.B. besonders schlechte Versorgungslage in Regionen, die weder über eine nahe Universität noch über psychotherapeutische Weiterbildungsinstitutionen verfügen).Ungeachtet unterschiedlich weiter oder enger Definitionen des Begriffs Behandlungsbedarf, zeigt sich eine gravierende Unterversorgung von Personen mit psychischen Erkrankungen. Quantitativ bedeutsame Hinweise auf eine Fehl- oder Überversorgung von Betroffenen lassen sich nicht aufzeigen.
Data from the German Health Interview and Examination Survey, Mental Health Supplement (N=4181) reveal that 32% (15,6 million people) of the adult population between 18 and 65 years of age suffer from one or more mental disorders. Among those only 36% receive treatment which also varies in type, duration, and adequacy. The proportion of cases receiving “adequate evidence- based treatments” was estimated to be about 10%.Lowest treatment rates were found for somatoform disorders and substance abuses, highest for psychotic disorders, panic disorder, generalised anxiety disorder, and dysthymia. The data reveal substantial regional differences with regard to treatment rates (e.g. lower rates in regions without universities or institutions offering postgraduate mental health education).The paper concludes that, depending on the diagnosis, a considerable degree of unmet medical needs exist for the majority of people affected by mental disorders. No evidence was found for an excessive supply of health care for the patients suffering from mental disorders or for treatments without an existing clinical need.

The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD-1Oand DSM-IlI-R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the inter-rater agreement for the different types of questions used. Of 590 subjects interviewed across all sites and rated by an interviewer and observer, 575 were eligible for analysis. The CIDI was judged to be acceptable for most subjects and was appropriate for use in different kinds of settings. Many subjects fulfilled criteria for more than one diagnosis (lifetime and six-month). The most frequent lifetime disorders were generalised anxiety, major depression, tobacco use disorders, and agoraphobia. Percentage agreements for all diagnoses were above 90% and the kappa values were all highly significant. No significant numbers of diagnostic disconcordances were found with lifetime, six-month, and four-week time frames.

INTRODUÇÃO: Com o rápido processo de envelhecimento populacional, a incapacidade funcional em idosos tem se tornado um importante problema de saúde pública globalmente. Depressão é uma morbidade bastante prevalente nessa fase da vida e pode estar associada com uma proporção significativa da incapacidade funcional na população de idosos. OBJETIVOS: Avaliar os níveis de incapacidade funcional, os principais fatores associados e o impacto dos transtornos mentais na incapacidade funcional de idosos vivendo na comunidade; examinar os fatores preditores de incapacidade funcional em um período de dois anos. MÉTODO: A presente investigação é parte da coorte prospectiva de base populacional \"São Paulo Ageing & Health Study\" (SPAH), que incluiu idosos com 65 anos ou mais, residentes de uma área economicamente menos favorecida na região Oeste da cidade de São Paulo. Os participantes foram identificados por arrolamento domiciliar e entrevistados em seus domicílios seguindo protocolo padronizado de pesquisa. A avaliação de incapacidade funcional foi realizada com o instrumento \"World Health Organization Disability Assessment Schedule 2.0\", criado para avaliar níveis de incapacidade conforme as definições e critérios da International Classification of Functioning, Disability and Health da Organização Mundial de Saúde, na sua versão com 12 itens. Depressão pelos critérios diagnósticos da CID-10 e sintomas depressivos foram avaliados com o instrumento Geriatric Mental State. Foram examinadas as associações independentes entre os transtornos mentais e incapacidade funcional através de modelos de regressão multivariada e modelos longitudinais multinível. Também foi calculada a Fração Atribuível na População dos transtornos mentais na incapacidade funcional dos idosos. RESULTADOS: Foram incluídos 2.072 idosos no período de 2003 a 2005. Mobilidade, atividades de vida diárias e participação na sociedade foram os domínios de incapacidade funcional mais afetados nessa população. A prevalência de depressão clinicamente significativa foi 26,2% (IC 95% 24,3 - 28,1), sendo 4,8% para depressão CID-10 e 21,4% para sintomas depressivos. Demência, depressão CID-10 e problema em membros apresentaram as associações de maior magnitude com as médias dos escores totais padronizados de incapacidade funcional, seguidos por sintomas depressivos, AVC e DPOC. Sintomas depressivos e depressão CID-10 foram responsáveis por 25,0% do total de incapacidade funcional grave nessa população. Dos idosos incluídos no SPAH, 1.661 foram reavaliados após dois anos. No seguimento, 56,1% dos idosos permaneceram com o mesmo nível de incapacidade funcional, 21,8% melhoraram e 22,1% pioraram. Os idosos que apresentaram sintomas depressivos, depressão CID-10 e demência na inclusão tiveram maior chance de piora da incapacidade funcional após dois anos, independentemente da categoria de incapacidade na inclusão do estudo e das morbidades físicas presentes. CONCLUSÃO: Os transtornos mentais em idosos, principalmente os sintomas depressivos e a depressão CID-10, apresentam associações e impacto importantes na incapacidade funcional. Além disso, são fatores preditores de piora na incapacidade funcional em idosos. Sabe-se que depressão e sintomas depressivos são doenças potencialmente preveníveis e tratáveis, e que sua adequada abordagem em idosos pode culminar com a diminuição da incapacidade funcional, melhora da qualidade de vida e diminuição dos custos em saúde
BACKGROUND: With the fast population aging, functional disability in the elderly has become a major public health issue globally. Depression is a very prevalent morbidity in this life period and may be associated with a significant proportion of functional disability in the elderly population. AIMS: To assess the level of functional disability, the main comorbidities associated and the impact of mental disorders on functional disability in the elderly living in the community; to investigate the predictors of functional disability in a period of two years. METHOD: The present investigation is part of a population-based prospective cohort study \"São Paulo Ageing & Health Study\" (SPAH), which included participants aged 65 or older living in an economically underprivileged area in the western region of São Paulo city. Participants were identified by household enrollment and interviewed in their homes using a standardized research protocol. The assessment of disability was performed with the 12-item version of the \"World Health Organization Disability Assessment Schedule 2.0,\" created to assess levels of disability according to the definitions and criteria of the International Classification of Functioning, Disability and Health of the World Health Organization. ICD-10 depression and depressive symptoms were assessed with the Geriatric Mental State instrument. We examined the independent associations between mental disorders and functional disability through multivariate regression models and longitudinal multilevel models. We also calculated the Population Attributable Fraction of mental disorders on functional disability in elderly. RESULTS: We included 2072 elderly from 2003 to 2005. Mobility, activities of daily living and participation in society were the most affected domains of functional disability in this population. The prevalence of clinically significant depression was 26,2% (CI 95% 24,3 to 28,1), 4,8% for ICD-10 depression and 21,4% for depressive symptoms. Dementia, ICD-10 depression and limb problems were highly associated with the mean of functional disability overall standardized scores, followed by depressive symptoms, stroke and COPD. Depressive symptoms and ICD-10 depression accounted for 25,0% of severe functional disability in this population. Among the elderly included in SPAH, 1661 were reassessed after two years. In this follow-up, 56,1% of the elderly remained with the same level of functional disability, 21,8% improved and 22,1% worsened. The elderly who presented depressive symptoms, ICD-10 depression and dementia at baseline had a higher risk of worsening disability after two years, independently of the category of disability and physical morbidities at baseline. CONCLUSION: Mental disorders in older adults, particularly depressive symptoms and ICD-10 depression, have significant associations and impact on functional disability. Also, they are predictive factors of worsening disability. It is known that depression and depressive symptoms are potentially preventable and treatable diseases and a proper approach may lead to a decreased functional disability, improved quality of life and decreased healthcare costs

Background: It is well known that web-based interventions can be effective treatments for various conditions. Less is known about predictors, moderators, and mediators of outcome and especially interrelations between participant and interventions characteristics, process variables and outcomes in online interventions. Clinical trials often lack statistical power to detect variables that affect intervention effects and their interrelations. Within ICare, we can investigate the interrelation of potential predictor and process variables in a large sample. Method: The ICare consortium postulated a model of interrelations between participant and intervention characteristics, process variables and outcomes in online interventions. We will assess general and disorderspecific interrelations between characteristics of the intervention, characteristics of the participants, adherence, working alliance, early response, and intervention outcomes in a sample of over 7500 participants from seven clinical trials evaluating 15 online interventions addressing a range of mental health conditions and disorders, using an individual participant data meta-analyses approach. Discussion/conclusion: Existing research tends to support the efficacy of online mental health interventions, but the knowledge base regarding factors that affect intervention effects needs to be expanded. The overarching analyses using data from the ICare intervention trials will add considerably to the evidence.

Hintergrund: Untersuchungen zum Zusammenhang von Arbeitslosigkeit und Gesundheit zeigen, dass sowohl eine erwartete als auch eine tatsächliche Arbeitslosigkeit insbesondere auf das psychische Befinden deutlich negative Auswirkungen hat. Metaanalysen kamen zu dem Ergebnis, dass bislang keine Gruppe von Personen gefunden wurde, die von diesen Belastungen durch Arbeitslosigkeit verschont bleibt. Die seelische Gesundheit hochrangiger Fach- und Führungskräfte, deren Arbeitsverhältnis sich in der Aufhebung befindet und die ein häufig vom Arbeitgeber finanziertes Outplacement erhalten, ist kaum erforscht. Ein Outplacement beinhaltet individuelle Unterstützungsleistungen in Form von Beratung, Training und Coaching im Zuge der beruflichen Neuorientierung. Fragestellung / Hypothese: In der vorliegenden Studie wurde untersucht, ob die vielfach veri-fizierte Kausalitätshypothese, wonach eine drohende oder faktische Arbeitslosigkeit zu ge-sundheitlichen Belastungsstörungen führt, auch für Personen zutrifft, die sich im Einzelout-placement befinden. Des Weiteren sollte erforscht werden, ob sich bei dieser Untersu-chungsgruppe bestimmte Merkmale identifizieren lassen, die als individuelle Resilienzfaktoren eine moderierende, protektive Wirkung für den Erhalt der psychischen und psychosomatischen Gesundheit in dieser beruflichen Übergangssituation (Transition) haben könnten. Material und Methode: Die 115 Fach- und Führungskräfte, die an der Studie teilnahmen, ließen sich drei Gruppen zuordnen: (G1) bei Antritt des Einzeloutplacements, (G2) während dessen, (G3) die berufliche Neuorientierung ist in Aussicht oder bereits erfolgt. Das Konstrukt Resilienz, hier definiert als „psychische Gesundheit“, wurde im Kontext eines Fragebogens operationalisiert, mit dem auch zahlreiche sozio-demografische Daten erhoben wurden. Der Fragebogen beinhaltete ökonomische, valide und reliable Screeninginstrumente, die aufgrund ihrer überzeugenden Gütekriterien wissenschaftlich anerkannt sind. Gemessen wurden u. a. das subjektive Wohlbefinden (WHO-Five), der psychische Beschwerdedruck (SCL-9) und das subjektive Erleben körperlicher Beschwerden (GBB-24). Zur Operationalisierung von Resilienzfaktoren wurden das NEO Persönlichkeitsinventar (NEO-PI-R), der Fragebogen zu Kompetenz- und Kontrollüberzeugungen (FKK) und die Oslo Social Support Scale (Oslo-3) eingesetzt. Ergebnisse: Der sozio-demografische und situative Rahmen der 115 Studienteilnehmer war u.a. dadurch gekennzeichnet, dass diese ein hohes Bildungsniveau (überzufällig mehr Akademiker) besaßen und verantwortungsvolle, hierarchisch übergeordnete berufliche Positionen innehatten (hohes Qualifikationsniveau). Als besser Verdienende verfügten sie über überdurchschnittliche finanzielle Mittel. Es zeigte sich, dass die Kausalitätshypothese nicht zutrifft. Die seelische und somatische Gesundheit der Outplacement-Klienten war im Querschnitt über Zeit stabil. Weniger als ein Viertel berichtete von einem schlechteren Wohlbefinden. Ansonsten waren ihre Gesund-heitsindikatoren überwiegend unauffällig. Das von ihnen wahrgenommene Interesse und die Anteilnahme anderer Menschen nahmen im Outplacement deutlich zu. Insgesamt bewerteten die Klienten ihre soziale Unterstützung nur in den wenigsten Fällen als gering ausgeprägt. Sie hatten nach ihrer Selbstbeschreibung u.a. niedrige Neurotizismuswerte und eine ausgeprägte Gewissenhaftigkeit. Des Weiteren attribuierten die Klienten sich ein hohes Selbstkonzept eigener Fähigkeiten und eine durchschnittliche bzw. hohe Selbstwirksamkeit. Auch waren ihre internalen Kontrollüberzeugungen ausgeprägt. In psychosomatischer Hinsicht korrelierte eine emotionale Labilität mit einer höheren Erschöpfungsneigung, verstärkten Magenbeschwerden, Herzbeschwerden und einem erhöhten allgemeinen körperlichen Beschwerdedruck. Zudem gingen hohe Neurotizismuswerte mit mehr Depressivität, mehr Ängsten, größerem globalem Distresserleben und einem geringeren Wohlbefinden einher. Ein positives Selbstkonzept eigener Fähigkeiten war verbunden mit weniger Depressivität, weniger Angst, weniger globalem Distress, einer geringeren Erschöpfungsneigung und einem geringeren Beschwerdedruck. Eine erhöhte Externalität in Kontrollüberzeugungen korrelierte positiv mit Depressivität, Ängstlichkeit, globalem Distress, Magenbeschwerden und Herzbeschwerden, was in plausibler Weise mit einem geringeren Wohlbefinden einherging. Klienten, die von ihrer Selbstwirksamkeit überzeugter waren, waren weniger durch Depressionen, Ängste, Distress und Erschöpfung belastet – sie fühlten sich wohler. Auf der bipolaren Skala Internalität versus Externalität korrelierte Internalität in generalisierten Kontrollüberzeugungen positiv mit seelischer Gesundheit und war verbunden mit einer geringeren Erschöpfungsneigung und einem geringeren somatischen Beschwerde-druck. Eine besonders ausgeprägte Vorhersagekraft für Resilienz hatten in Summe diejenigen Core Traits, die das Modell Core Self-Evaluations beinhaltet. Diese Core Traits wurden in der vorliegenden Studie als Resilienzfaktoren definiert (Selbstwertgefühl, Selbstwirksamkeit, Kontrollüberzeugung und Neurotizismus – mit den impliziten Resilienzfaktoren Positive Emotionen, Optimismus, Hoffnung). Der Resilienzfaktor soziale Unterstützung konnte bei positiver Ausprägung ein höheres Wohlbefinden, niedrige Depressivität und einen geringeren Distress vorher sagen. Schlussfolgerungen: Einige schützende Faktoren scheinen bei Outplacement-Klienten das Leid der Antizipation von Arbeitslosigkeit bzw. von bereits eingetretener Arbeitslosigkeit deutlich abzuwenden. Ausgestattet mit günstigen sozio-demografischen Merkmalen und im Kontext eines förderlichen situativen Umfeldes (Sozialer Konvoi) gelingt es den Klienten, adaptierende und zugleich zielführende Verhaltens- und Erlebensweisen im Hinblick auf die berufliche Änderungssituation und auf ihre Wiederbeschäftigung zu aktualisieren. Die diesen Verhaltens- und Erlebensweisen zugrunde liegenden Personenmerkmale sind für das emotions- und problemzentrierte Coping wahrscheinlich sehr dienlich und als individuelle Resilienzfaktoren seelischer Gesundheit im hier untersuchten situativen Kontext zu werten. Damit werden Handlungsansätze zur Gesundheitsförderung bekräftigt, die auf Aufbau und Stabilisierung von Resilienzfaktoren bei Menschen in beruflichen Änderungssituationen abzielen. Insgesamt dürften Erkenntnisse über Personenvariablen, die im Zuge beruflicher Transitionen eher immunisierend wirken, sowie Erkenntnisse über die situativen Bedingungen, die dieses befördern, für die inhaltliche Ausgestaltung präventiver und kurativer Programme auch für Personengruppen nützlich sein, die nicht das Privileg eines Einzeloutplacements erhalten
Background: Investigations into the relationship between unemployment and health shows that both an expected period of unemployment and an actual period of unemployment have an extremely negative impact, especially on mental health. Meta-analytic results have shown that to date no group of persons has been found that remains untouched by the stress of being unemployed. The mental health of top experts and managerial staff whose contracts are in the process of being cancelled (voluntarily or involuntary terminations), and who enter an outplacement program often financed by their employers, has hardly been examined. An outplacement program includes individual support in the form of consultation, training and coaching during the course of the professional transition. Questions/hypothesis: The present study examined whether the frequently verified hypothesis of causality, according to which an expected period of unemployment or a real period of unemployment leads to health complaints, also applies to persons who are in individual out-placement programs. Furthermore, it is to be investigated whether it is possible to identify certain features in this group that, as individual resiliency factors, have a moderating, protec-tive effect on the maintenance of mental and psychosomatic health during this period of vo-cational transition. Materials/method: The sample investigated consists of 115 experts and managerial staff. The study was narrowed down to three groups classified as follows: (G1) participants at the be-ginning of their individual outplacement, (G2) during the programme, (G3) the professional reorientation is well underway or is already complete. The construct “resilience”, defined here as “mental health”, was operationalized using a questionnaire, which was also used to collect a large number of socio-demographic parameters. The questionnaire included economic, valid and reliable screening instruments, which are scientifically recognised due to their convincing quality criteria. Measured, for example, were subjective well-being (WHO-Five), psychological complaints (SCL-9) and the subjective perception of physical ailments (GBB-24). To operationalize resiliency factors, the NEO Personality Inventory (NEO PI-R), the questionnaire of expectancies for control and competence beliefs (FKK) and the Oslo Social Support Scale (Oslo-3) were used. Results: Socio-demographic characteristics of the 115 study participants and their situational framework were characterised by a high level of education (non-random majority of college graduates) and held responsible positions at the upper levels of the professional hierarchy (highly qualified). Being high earners, they had above-average financial resources at their disposal. The results indicated that the hypothesis of causality did not apply. The mental and somatic health of the outplacement participants was, on average, stable over time. Less than a quarter reported a worse state of well-being. Otherwise, their health indicators were predominantly inconspicuous. The interest that they themselves perceived and the concern shown by others increased significantly during the outplacement. Overall, only in a few cases did the outplacement clients evaluate their social support as being limited. According to their self-evaluations, they had, inter alia, low levels of neuroticism and high levels of conscientiousness. Furthermore, the clients considered themselves to have a strong self-concept of their own abilities and an average and high level of self-efficacy. In addition, their internal control beliefs were pronounced. From a psychosomatic point of view, emotional lability correlated with a higher tendency to be exhausted, more frequent stomach problems, more frequent heart-related complaints as well as more somatic complaints pressure (GBB sum score). In addition, high scores in neuroticism were accompanied by depression and subjective global distress. A positive self-concept correlated with less depression, less anxiety, lower global distress, a distinct feeling of well-being, a lower level of exhaustion, fewer stomach problems and heart-related complaints, and thus overall a lower degree of physical complaints (sum score). A higher degree of externality in locus of control correlated positively with depression, global distress, stomach problems and heart-related complaints, and thus correlated in a plausible manner with a lower level of well-being. Clients who were convinced of their self-efficacy were less troubled by depression, anxiety and distress. They were more at ease, less exhausted, had fewer stomach and heart-related complaints, and in total fewer physical complaints. In sum, those core traits included in the core self-evaluation model had the best predictive power for resilience. In this study the core traits were defined as resiliency factors (self-esteem, self-efficacy, locus of control and neuroticism – with the implicit resiliency factors positive emotions, optimism, hope). A positive social support as a resiliency factor could predict a higher degree of well-being, a lower level of depression and a less distress. Conclusions: It appears that some factors protect outplacement clients from the negative effects of anticipated or actual unemployment. Equipped with favourable socio-demographic features and in the context of a positive social convoy during the job transition, the clients can successfully develop coping strategies in view of job change requirements and reemployment. The underlying personality traits of this behaviour are probably very useful when developing emotion- and problem-oriented coping strategies and could be evaluated as individual resiliency factors in the context examined. In this manner, approaches to health promotion are strengthened, which target the setting up and stabilisation of resiliency factors for persons in the professional transition phase. Knowledge about personality traits and situational conditions that have an immunizing effect during a period of professional change could be also useful for the contents of preventive and curative programs for groups of persons who do not enjoy the privilege of taking part in an individual outplacement

Hintergrund: Der Einfluss von rheumatoider Arthritis auf Psyche, Lebensqualität und Alltag der Patienten ist groß. Für eine positive Langzeitprognose sind frühzeitige Diagnosestellung und Therapieeinleitung entscheidend. Diese werden maßgeblich von den strukturellen Gegebenheiten der ambulanten rheumatologischen Versorgung beeinflusst. Hier zeigen sich trotz großer Fortschritte in den letzten Jahren weiterhin Defizite. Anhand einer Patientenbefragung in Leipzig sowie ländlichen Gebieten Sachsens sollen regionale Unterschiede und eventuelle Mängel in der ambulanten Versorgung sowie deren Einfluss auf die Lebensqualität, psychische Gesundheit und Entscheidungsfindungsprozesse untersucht werden. Methoden: Aus sechs Praxen in der Stadt Leipzig und drei Praxen in Kleinstädten (Naunhof, Plauen und Hoyerswerda) wurden Patienten mit der Erstdiagnose rheumatoide Arthritis im ersten Quartal 2011 mittels Fragebögen zu psychischer Gesundheit (Hospital Anxiety and Depression Scale und Short-Form-36-Health-Survey) sowie Entscheidungsfindungsprozessen (Decision Making Preference Scale) befragt. Ein eigens entwickelter Fragebogen erhob Beschwerde- und Behandlungsdauer sowie allgemeine medizinische Daten und Medikation. Ergebnisse: 19 Land- und 38 Stadtpatienten wurden eingeschlossen. Landpatienten suchten signifikant später den Hausarzt auf (Land 15, Stadt 12 Monate, p= .023). Die hausärztliche Behandlungsdauer bis zur Überweisung zum Rheumatologen betrug auf dem Land 5,4 und in der Stadt 2,4 Monate. Bei 70% der Stadt- und 40% der Landpatienten erfolgte die Überweisung innerhalb der ersten sechs Wochen. Die Gesamtdauer von Beschwerdebeginn bis zur Überweisung zum Rheumatologen war mit 20 Monaten auf dem Land signifikant länger als in der Stadt (15 Monate, p= .043). Die Wahl der Medikation durch den Rheumatologen hing signifikant mit der Herkunft der Patienten zusammen (p= .006). Nach Erstkontakt erhielten 65% der Land- und 55% der Stadtpatienten ein DMARD. In beiden Regionen wurde überwiegend mit Glukokortikoiden behandelt (Stadt 82%, Land 71%). Auf dem Land zeigten die Patienten weniger Interesse an Mitwirkung im partizipativen Entscheidungsfindungsprozess und waren mehrheitlich bereit, sich der Meinung des Arztes auch gegen den eigenen Willen anzuschließen. In der Stadt war der Wunsch nach aktiver Teilhabe an medizinischen Entscheidungen bei jüngeren und höher gebildeten Patienten signifikant größer als bei älteren oder bildungsfernen Erkrankten. Mit 21% wiesen tendenziell mehr Landpatienten depressive Symptome auf als in der Stadt (14%). Auf dem Land bestand häufiger der Verdacht auf krankheitsassoziierte Angststörungen. Zusätzlich litten die Patienten hier signifikant stärker unter ihren Schmerzen als in der Stadt (p= .026), wobei sich kein grundsätzlicher Unterschied in der gesundheitsbezogenen Lebensqualität ergab. Schlussfolgerung: In Stadt und Land zeigen sich Defizite in der ambulanten rheumatologischen Versorgung, wobei der Grad der Unterversorgung mit der Herkunft assoziiert ist und Landpatienten signifikant länger bis zum ersten Rheumatologenkontakt brauchen. Maßgeblich verantwortlich hierfür ist die verspätete Vorstellung der Patienten beim Hausarzt ebenso wie die ungleiche Facharztverteilung in Stadt und Land. Patienten auf dem Land sind tendenziell depressiver, passiver und schmerzgeplagter, wobei sich keine grundsätzlichen Unterschiede in der gesundheitsbezogenen Lebensqualität ergeben. Die Ergebnisse spiegeln Ärztemangel und infrastrukturelle Probleme wider. Weiterer Schulungs- und Aufklärungsbedarf zur verstärkten Bildung eines öffentlichen Bewusstseins für die Erkrankung rheumatoide Arthritis wird ebenso deutlich wie die Notwendigkeit für die Bahnung schnellerer Zugangswege zu rheumatologischer Behandlung.

Zum gesellschaftlich relevanten Thema des Arbeitsmarktes findet sich kaum arbeitspsychologische Empirie. Erste Hinweise auf ein die Gesundheit Erwerbstätiger gefährdendes Potenzial einer schlechten Arbeitsmarktlage geben Studien aus den Bereichen der Freiwilligkeit in der Erwerbsarbeit und der Arbeitsplatzunsicherheit. Alle diese Studien sind jedoch Befragungen mit dem methodenimmanenten Interpretationsproblem der gemeinsamen Methodenvarianz. Unter Ausschluss dieses Methodenproblems wird zunächst ein Beitrag zur Klärung der Bedeutung der Arbeitsmarktsituation für die psychische Gesundheit Erwerbstätiger geleistet. In einem zweiten Schritt werden empirisch bewährte Merkmale der Arbeitssituation in die Analysen einbezogen. Den theoretischen Rahmen der Arbeit bilden das Belastungs-Beanspruchungs-Konzept (BBK) und ein spezifiziertes Zwei-Ebenen-Modell. Sekundäranalytisch werden zweier branchenspezifische Gelegenheitsstichproben (N1 = 183; N2 = 314) und die repräsentative BIBB/IAB-Strukturerhebung von 1998/1999 (N3 = 34.343) ausgewertet. Es liegt ein ex-post-facto-Design vor. Das Merkmal der Arbeitsmarktsituation wird als Risiko langzeitarbeitslos zu werden operationalisiert und dokumentenanalytisch generiert. Diese Operationalisierung erweist sich als valide. Die anderen Merkmale werden mittels schriftlicher Befragungen erhoben. Die Datenauswertung erfolgt mit Methoden des ALM. Die globalen Zusammenhänge zwischen der Arbeitsmarktsituation und der psychischen Gesundheit Erwerbstätiger sind marginal. Bei Betrachtung der mit Hilfe des BBK gebildeten Subgruppen zeigen sich jedoch hypothesenkonform veränderte Zusammenhänge. Dieses Ergebnismuster kann im Sinne des sozialepidemiologischen Risikofaktorenmodells als Beleg für das Belastungspotenzial einer schlechten Arbeitsmarktsituation angesehen werden. Zentral für die Vorhersage der psychischen Gesundheit Erwerbstätiger sind jedoch die Merkmale der Arbeitssituation: Auch in Zeiten mit einer problematischen Arbeitsmarktsituation reicht es nicht aus, einfach nur Arbeit zu haben. Die konkrete Arbeitssituation bleibt zentral.
Within the field of occupational psychology there is very little empirical research on the socially highly relevant topic of the labor market. Studies on voluntariness within gainful occupation and on job insecurity have provided initial evidence that a poor labor market situation poses a potential risk to employees’ health. However, all of these studies can be criticized for having the method-immanent interpretation problem of shared method variance. Excluding this methodological problem, the present study, first, contributes to clarifying the role of the labor market situation for employees’ mental health. In a second step, empirically established characteristics of the personal job situation are included in the analyses. The theoretical framework for this research is the stress-strain concept (SSC) and a more specific two-level model. Secondary analyses are conducted with two sectoral convenience samples (N1 = 183; N2 = 314) and the representative BIBB/IAB data set of 1998/1999 (N3 = 34.343). An ex-post-facto design is used. The characteristic of the labor market situation was operationalized as the risk for long-term unemployment, which was generated through document analyses. This operationalization proves to be valid. Other characteristics were assessed with questionnaires. Data analyses were conducted with methods of the GLM. The overall relations between the labor market situation and mental health are marginal. However, when studying subgroups that were formed utilizing the SSC the observed relations vary as hypothesized. These findings can be interpreted within the social-epidemiological risk-factor model as a demonstration of the stress potential of poor labor market conditions. Nevertheless, the central predictors of employees’ mental health are characteristics of the personal job situation: Even in times of a problematic labor market situation just being employed it is not sufficient to ensure good mental health. The person’s specific job situation remains central.

Background Close, continuous and efficient collaboration between different professions and sectors of care is necessary to provide patient-centered care for individuals with mental disorders. The lack of structured collaboration between in- and outpatient care constitutes a limitation of the German health care system. Since 2012, a new law in Germany (§64b Social code book (SGB) V) has enabled the establishment of cross-sectoral and patient-centered treatment models in psychiatry. Such model projects follow a capitation budget, i.e. a total per patient budget of inpatient and outpatient care in psychiatric clinics. Providers are able to choose the treatment form and adapt the treatment to the needs of the patients. The present study (EVA64) will investigate the effectiveness, costs and efficiency of almost all model projects established in Germany between 2013 and 2016. Methods/design A health insurance data-based controlled cohort study is used. Data from up to 89 statutory health insurance (SHI) funds, i.e. 79% of all SHI funds in Germany (May 2017), on inpatient and outpatient care, pharmaceutical and non-pharmaceutical treatments and sick leave for a period of 7 years will be analyzed. All patients insured by any of the participating SHI funds and treated in one of the model hospitals for any of 16 pre-defined mental disorders will be compared with patients in routine care. Sick leave (primary outcome), utilization of inpatient care (primary outcome), utilization of outpatient care, continuity of contacts in (psychiatric) care, physician and hospital hopping, re-admission rate, comorbidity, mortality, disease progression, and guideline adherence will be analyzed. Cost and effectivity of model and routine care will be estimated using cost-effectiveness analyses. Up to 10 control hospitals for each of the 18 model hospitals will be selected according to a pre-defined algorithm. Discussion The evaluation of complex interventions is an important main task of health services research and constitutes the basis of evidence-guided advancement in health care. The study will yield important new evidence to guide the future provision of routine care for mentally ill patients in Germany and possibly beyond. Trial registration This study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713).

This dissertation develops several new statistical methods for disease classification that directly account for the unique logic structure of criteria sets found in the Diagnostic and Statistical Manual of Mental Disorders. For psychiatric disorders, a clinically significant anatomical or physiological deviation cannot be used to determine disease status. Instead, clinicians rely on criteria sets from the Diagnostic and Statistical Manual of Mental Disorders to make diagnoses. Each criteria set is comprised of several symptom domains, with the domains determined by expert opinion or psychometric analyses. In order to be diagnosed, an individual must meet the minimum number of symptoms, or threshold, required for each domain. If both the overall number of domains and the number of symptoms within each domain are small, an exhaustive search to determine these thresholds is feasible, with the thresholds chosen to minimize the overall misclassification rate. However, for more complicated scenarios, such as incorporating a continuous biomarker into the diagnostic criteria, a novel technique is necessary. In this dissertation, we propose several novel approaches to empirically determine these thresholds. Within each domain, we start by fitting a linear discriminant function based upon a sample of individuals in which disease status and the number of symptoms present in that domain are both known. Since one must meet the criteria for all domains, an overall positive diagnosis is only issued if the prediction in each domain is positive. Therefore, the overall decision rule is the intersection of all the domain specific rules. We fit this model using several approaches. In the first approach, we directly apply the framework of the support vector machine (SVM). This results in a non-convex minimization problem, which we can approximate by an iterative algorithm based on the Difference of Convex functions algorithm. In the second approach, we recognize that the expected population loss function can be re-expressed in an alternative form. Based on this alternative form, we propose two more iterative algorithms, SVM Iterative and Logistic Iterative. Although the number of symptoms per domain for the current clinical application is small, the proposed iterative methods are general and flexible enough to be adapted to complicated settings such as using continuous biomarker data, high-dimensional data (for example, imaging markers or genetic markers), other logic structures, or non-linear discriminant functions to assist in disease diagnosis. Under varying simulation scenarios, the Exhaustive Search and both proposed methods, SVM Iterative and Logistic Iterative, have good performance characteristics when compared with the oracle decision rule. We also examine one simulation in which the Exhaustive Search is not feasible and find that SVM Iterative and Logistic Iterative perform quite well. Each of these methods is then applied to a real data set in order to construct a criteria set for Complicated Grief, a new psychiatric disorder of interest. As the domain structure is currently unknown, both a two domain and three domain structure is considered. For both domain structures, all three methods choose the same thresholds. The resulting criteria sets are then evaluated on an independent data set of cases and shown to have high sensitivities. Using this same data, we also evaluate the sensitivity of three previously published criteria sets for Complicated Grief. Two of the three published criteria sets show poor sensitivity, while the sensitivity of the third is quite good. To fully evaluate our proposed criteria sets, as well as the previously published sets, a sample of controls is necessary so that specificity can also be assessed. The collection of this data is currently ongoing. We conclude the dissertation by considering the influence of study design on criteria set development and its evaluation. We also discuss future extensions of this work such as handling complex logic structures and simultaneously discovering both the domain structure and domain thresholds.

碩士
高雄師範大學
復建諮商研究所
97
The purposes of the study were to develop a Chinese ICF checklist based on the International Classification of Functioning, Disability and Health (ICF) checklist in order to analyze the contents of vocational evaluation reports for individuals with mental retardation and to investigate the relationship between the characteristics of individuals with mental retardation and their work status. Participants of the study were 89 individuals with mental retardation, who once obtained vocational evaluation services during the study period. The methods of descriptive statistics, t -tests and logistic regression were used to analyze the data. Major findings of this study were as follows: 1. The vocational evaluation reports provided more information for answering the items under the Activity and Participation domains than those under the domains of Body Structures and Environmental Factors. 2. Individuals with mental retardation who had stable histories (ever maintained their jobs more than six months in their work histories) were found significantly better than those with mental retardation who had not in their functional levels of mental function(b1) and attitudes(e4). 3. No differences were found in functional levels of Body Structures and Activity Participation domains between individuals with mental retardation who had stable work histories and those with mental retardation who had not. 4. Factors such as body function and mental function were found be able to predict and explain whether the individuals with mental retardation will have stable work histories or not. Implications and suggestions for information provided in vocational evaluation reports and future studies are provided accordingly.

Das Internet beeinflusst unser tägliches Leben; so erweitert es auch seit Jahren das therapeutische Spektrum in der Behandlung von Patienten mit einer psychischen Erkrankung. Dennoch gilt es aufgrund von vielen unübersichtlichen Angeboten, unzureichenden rechtlichen Rahmenbedingungen sowie keiner einheitlichen Behandlungsleitlinie weiterhin einige Hürden in der Implementierung in den therapeutischen Versorgungsalltag zu überwinden. Ziel unserer Untersuchung war es, das aktuelle Internetnutzungsverhalten bezüglich der eigenen Erkrankung sowie den allgemeinen Zugang zum Internet und den aktuellen Einsatz von Selbstmanagement-Interventionen zu untersuchen, um Angebote gezielter auf die Patientengruppen anzupassen. Dabei wurden im Rahmen einer einmaligen Untersuchung zwischen Januar 2018 und Januar 2019 mittels Fragebogen, Patienten (n=301) während ihrer stationären, teilstationären oder ambulanten Behandlung in der Klinik für Psychiatrie und Psychotherapie des Universitätsklinikums Leipzig befragt. Die Mehrheit der Patienten (98 %) nutzt das Internet, wobei die meisten Patienten über ein Smartphone (90 %) und/oder ein Tablet (37 %) mit mobilem Internetzugang verfügen. Während bisher nur ein kleiner Teil (10 %) der Stichprobe bereits Erfahrungen mit internetbasierten Selbsthilfeinterventionen in der Behandlung gesammelt hat, gibt es eine weit größere Gruppe (46 %), die daran Interesse zeigt. Dieses Interesse war bei Patienten größer, die jünger waren (p=.001), ein höheres Bildungsniveau haben (p=.003) oder die das Internet zuvor als hilfreich für den Umgang mit ihrer psychischen Erkrankung empfunden haben (p=.033). Es zeigte sich zudem, dass jüngere Patienten signifikant häufiger nach Informationen über Krankheiten (p<.001), Psychiatern und Kliniken (p<.001) und den Austausch mit anderen Patienten (p=.001) im Internet suchten als ältere Patienten. Während nur ein kleiner Prozentsatz der Patienten Online-Selbstmanagement-Interventionen bereits verwendet, besteht bei einem weitaus größeren Teil das Interesse sie in die Behandlung einzubeziehen. Dieses Interesse zeigt noch einmal das große Potential, diese Angebote verstärkt in die Prävention (z.B. digitale Informations- und Austauschmöglichkeiten) aber auch Intervention (z.B. durch Psychotherapie- und Selbstmonitoringprogramme) in der Behandlung von psychischen Erkrankungen einzubinden. Hintergründe warum dieses Potential bisher noch nicht ausgeschöpft werden konnte, sollte fernerhin untersucht werden um die Versorgungsangebote mittels E- Mental- Health für die Patienten weiter zu verbessern.

Between 1918 and 1933, the eugenic notion of “defective heredity” was central to psychiatric practice in British Columbia. Public and medical professionals’ concerns were heightened by an apparent increase in “insane” and “mentally deficient” individuals in the province. Using the annual reports for the asylums and the case files of women who were admitted to the Public Hospital for the Insane and to Essondale between 1918 and 1933, this thesis examines the relationship between psychiatric practice and eugenics, specifically how eugenically-minded asylum physicians classified and diagnosed female patients. Asylum physicians used admissions forms, patient interviews, observation, and inference to make diagnoses. Often, despite a lack of evidence, they concluded that patients had inherited a predisposition to mental disease. Women admitted to B.C.’s Public Hospital for the Insane and to Essondale were more likely than their male counterparts to have their mental condition linked to heredity. Any “eccentric” or “abnormal” behaviour or personality in the patient or their family was considered by asylum physicians to be evidence of a predisposition to mental disorder. Within the population of female asylum patients, racialized women were the most likely to be labeled as having “defective heredity.” Widespread racial discrimination in the province, combined with the fact that eugenic discourse targeted non-white citizens as being biologically and culturally inferior, shaped and influenced the asylum physicians’ classification and diagnoses of mental illness among racialized women. The experiences of these women during their incarceration were also shaped by racialized discourse and their behaviour was negatively stereotyped by asylum staff.
Graduate
2018-08-17

The present thesis provides insight into health psychology aspects of overweight and obesity prevention and therapy. Participation behavior, psychosocial well-being and mental health have been examined closely. Continuous adherence to physical activity programs designed to avoid development or progression of juvenile overweight and obesity is difficult to maintain in everyday-life of participants. Motivation for participation and a personal schedule, that complements intervention time requirements, is essential for success and sustainability of physical activity interventions. Media support in promoting adherence is a topic of controversial discussion, but might help to promote motivation for health behavior change if used appropriately for the right target group. Therefore, means of communicating with young people need to be analyzed and integrated into health messages in order to make them convincing and interesting. Further media devices and channels need to be investigated to achieve an up-to-date understanding of health promotion technology. Telephone counseling is as effective as face-to-face counseling regarding BMI reduction. However, its effect on psychosocial well-being and body image seems to be minor. The effect of parental delivery of health messages and information on psychosocial well-being and stress to their children regarding body image and related constructs needs to be further elucidated. Mediators and moderators should be investigated in order to be able to control health promotion content. Mental health plays a crucial role in the development and progression of extreme obesity in adolescence. Early mental health impairments such as internalizing and externalizing behavior may lead to pathological eating and pathological health behavior habits and consequent weight gain. During the course of a treatment program it is of great importance to focus on psychiatric comorbidities in order to achieve stable and long-lasting effects on weight loss and lifestyle behavior. Adolescents undergoing bariatric surgery often suffer from moderate to severe depressive symptoms or clinically diagnosed depression. The interdependency between depression and obesity impedes predictability of bariatric surgery on weight loss outcomes and compliance with lifestyle requirements after surgery. In any case, mental health needs to be closely examined before a patient undergoes surgery. Monitoring and stabilization of psychological well-being after invasive treatment could lead to the practice of beneficial health behavior, enduring weight stabilization and improved quality of life.

The objective of this dissertation thesis is the application of the International Classification of Functioning, Disability and Health (ICF) with mentally retarded persons, or the examination of ways of application of its data for a possible inclusion of mentally retarded persons into society. The thesis deals with the system of the ICF classification, its application within the framework of research as well as the subsequent possible application in practice when reviewing the situation of disabled persons.The results of the thesis bring a recommendation how it is possible to proceed when reviewing the situation of a mentally retarded client in practice and how to use the ICF classification as a tool of support of psychosocial inclusion of these persons.

Die vorliegende Arbeit befasst sich mit der Prävention psychischer Erkrankungen bei Kindern und Jugendlichen. Sie verbindet fünf Publikationen. Wird zunächst die besondere Eignung von Schule als Setting zur Förderung psychischer Gesundheit erörtert, verdeutlicht eine systematische Übersichtsarbeit den Bedarf in diesem Bereich, und stellt die Bedeutung einer Kombination von Informationsvermittlung und direktem Kontakt mit Betroffenen heraus. Im zweiten Teil der Arbeit werden sowohl qualitative wie auch quantitative Evaluationen von Interventionen des Leipziger Vereins \"Irrsinnig Menschlich e.V.\" vorgestellt. Zum einen wurden Schüler, Lehrer und Eltern der Projektschulen des \"Schulcoach\"-Projekts in Fokusgruppen und mittels Fragebögen befragt, welche Entwicklungen diese spezielle Form der systemischen Betreuung angestoßen hat und welchen Einfluss die Schulcoaches auf die Rolle der psychischen Gesundheit im Schulalltag nahmen. Des Weiteren werden Schüler mittels einer qualitativen Fokusgruppen-Erhebung gezielt nach der äußeren Gestaltung, der thematischen Ausrichtung und dem Nutzungsverhalten von eigens gestalteten Informationsmaterialien, den \"Info-Pocket-Guides\", befragt. Die Ergebnisse dieser Evaluationen werden schließlich vor dem Hintergrund des Eingangs dargestellten Bedarfs diskutiert.:1. Bibliographische Beschreibung 2. Einführung 2.1. Die Prävalenz psychischer Störungen und ihre Auswirkungen 2.2. Psychische Gesundheit bei Kindern und Jugendlichen 2.3. Die Rolle der Schule als Setting für präventive Maßnahmen 2.4. Ziele dieser Arbeit 3. Schule als Setting zur Prävention psychischer Störungen: Chancen, Perspektiven und Beispiele guter Praxis 4. School-based prevention programs for depression and anxiety in adolescence: a systematic review 5. Übergang 6. Die Förderung psychischer Gesundheit in der Schule durch Schulcoaches: Evaluation eines Modellprojekts in Sachsen 7. Do \"School Coaches\" make a difference in school-based mental health promotion? – Results from a large focus group study 8. Info-Pocket-Guides als Beitrag zur Prävention psychischer Erkrankungen: Wie bewerten SchülerInnen Inhalt, Design und Nutzen? 9. Diskussion 10. Zusammenfassung 11. Literaturverzeichnis I. Danksagung II. Erklärung über die eigenständige Abfassung der Arbeit III. Curriculum Vitae IV. Publikationen

With yearly rates ranking clearly above world average in Europe, suicide constitutes a substantial public health problem. Because of that, prevention has become a major concern for German mental health institutions. A requirement for successful prevention strategies is to address all key factors that contribute to suicidality. It is highly relevant in this respect that suicidal behaviour itself exhibits a social gradient: drawing on the relevant literature, low socioeconomic status (SES) and a high extent of social isolation (SI) are related to increased suicide risks (Lorant et al. 2005; Li et al. 2011; Qin et al. 2003; Agerbo et al. 2007). The purpose of this study was therefore to add to these findings and to further investigate associations of SES and SI with suicide in order to define starting points for public health interventions. It was consequently hypothesized that lower individual levels of SES and higher individual levels of SI are correlated with increased suicide rates. SI potentially compromises the perception of social support in stressful live events associated with low SES (Cohen et al. 2006; Kumari et al. 2010). Since such life events correlate with suicidal behavior (Beautrais et al. 1997; Cohen et al. 2019), the effects of low SES were further hypothesized to be aggravated in individuals with high SI levels (SES x SI interaction). In order to test the hypotheses, all 149.033 suicide deaths between 1997 and 2010 (T = 14 years) were extracted from the official German death record as coded by ICD categories E950 - E959 for 1997 and X60 - X84 for the years from 1998 onwards, respectively. Information on SES and SI was gained by merging the dataset with Germany’s main household survey, i.e. the Microcensus. In accordance with the existing literature, established indexes on occupational status (ISEI, Ganzeboom & Treiman 1996) and educational achievements (CASMIN, König et al. 1988) were applied as well as items on income, minor employment, unemployment, the number of received public transfers and the reception of social bene fits due to unemployment (ALG I/II) in order to capture SES. SI was proxied with variables measuring single marital status, living in a one-person-household and relocations throughout the year before the survey was conducted. Due to German data protection regulations that do not permit the analysis of death record data based on individual level information, suicide deaths were examined as aggregated rates at the level of N = 390 administrative districts. In order to deal with two problems associated with this kind of statistical analysis, Prentice and Sheppard’s model for aggregate data (1995) was applied accounting for potential estimation biases due to differences in baseline suicide rates between districts and between time periods. The model specification further corrected for spatial effect correlations. An important limitation to this procedure is that the estimates represent a blend of effects at the individual and district levels. However, an adequate solution is only available through the application of individual level data. The statistical analysis turned out the following results: The positive effect on suicide rates of unemployment and the negative effect of income as two out of seven SES proxies and the positive effect of living in a one-person-household as one out of three SI proxies validate the proposed hypotheses on the relations of SES and SI with suicide rates. Confirming the hypothesis on SI mediating SES effects, the model revealed positive effects on suicide rates of income decreases in single individuals. Likewise, we observed positive effects on district suicide rates for decreasing levels of CASMIN in district population shares who had relocated throughout the past year. In contradiction to the theoretical claims, however, increases in CASMIN scores were found to result in positive effects on suicide rates just as a history of relocation prior to suicide was related to decreasing suicide rates. Furthermore, decreases in income were found to result in negative effects on suicide rates in the district population of persons living in a one-person-household. The results indicating associations of SES and SI with increases in district suicide rates represent appropriate starting points for the definition of suicide prevention strategies. Thus, particularly the unemployed, individuals with low incomes, persons living in one-person-households and relocated individuals with lower educational levels should be targeted by public health interventions. Moreover, the observations of the present study clearly demonstrate the significance of longitudinal individual level data for public health policies. Respective research incorporating such data would permit a better understanding of the causal mechanisms resulting in suicidality and help to further investigate the robustness of the shown results. By this means, prevention strategies could be better adapted to the specfic needs of the individuals under concern. Regarding the findings contradicting the theoretical claims, it needs to be mentioned that associations of low SES and high SI levels with increases in suicide risks can not be ruled out at the individual level. Rather, the observed inconsistent effects might be attributable to differences in district compositions than to differences in characteristics of the respective subjects. Also a statistical separation of compositional effects from effects of individual traits would be made possible by including individual level data in future work.:Abbrevations II Tables II 1 Introduction 1 1.1 Suicide - A Global Health Burden 1 1.2 Risk Factors and Etiology of Suicide 1 1.3 Suicide Prevention 2 1.4 Social Disparities in Suicide 2 1.4.1 Socioeconomic Status 2 1.4.2 Social Isolation 3 1.4.3 Health Inequalities and Health Inequities 4 1.4.4 Causation and Selection 5 1.4.5 Individual Life Courses 7 1.5 Stress and Diathesis 8 1.5.1 Critical Life Events 9 1.6 Neurobiological Correlates of Suicidality 9 1.6.1 Neurobiological Correlates of SES and SI 10 1.7 SES, SI and Social Support 11 1.8 Aims of the Thesis 11 1.9 Methods 12 2 Original Publication 14 Summary 23 References 26 Supplementary Materials - Further Statistical Tests & Models 41 Structural Breaks in Suicide Numbers 41 Age- and Gender-Adjustment of District Suicide Rates 42 Alternate Model Specifications Anlagen i Erklärung über die eigenständige Abfassung der Arbeit i Spezifizierung des eigenen wissenschaftlichen Beitrags iii Danksagung iii

Adverse birth outcomes can have an overwhelmingly negative impact on many aspects of society – the infant, mother and family are intimately affected, but there are also major consequences on the overall health system. For the purpose of this study, adverse birth outcomes were defined as: premature birth, low birth weight, congenital conditions, stillbirth and neonatal death. The few studies, based overseas, that have investigated the health system costs of women following adverse birth outcomes showed these costs were significant and needed to be addressed. To date, no such studies have been conducted with Australian data. This thesis contributes to this area by quantifying the difference in maternal health system costs of women who experienced adverse birth outcomes and those that did not, using Australian data. The cost differentials were assessed across both hospital and out-of-hospital systems. In addition, statistical and actuarial techniques were employed on a comprehensive dataset – with linkages between various administrative data and longitudinal data collected on a large, broadly representative, sample of women. The techniques adopted in this study enabled an in-depth analysis of the complexities in the area, in particular the associations between risk factors and their impact on health system costs. These results were used to develop cost-effective health policy recommendations. The results showed that the mean maternal health system cost differentials for adverse births were substantial at 23% and 27% for hospital and out-of-hospital costs, respectively. These amounts are broadly in line with the existing literature. The key cost risk factors were mode of delivery, use of In Vitro Fertilisation treatments, specialist and general practitioner use for perinatal services, private health insurance status, adverse births, area of residence, diabetes, smoking status and mental health factors. The findings of this project showed that there were a number of key areas where health resources may be directed and smoking and mental health policy were considered further. With regard to smoking, programs providing incentives for smokers to quit during pregnancy have been found to produce successful outcomes and recommended for further consideration. For mental health, numerous mental health initiatives were recommended as a priority for attention. These included a national universal mental health screening protocol for antenatal and postnatal periods in conjunction with improved screening methods and health services that focus on holistic, proactive early intervention so that mental health problems are detected and treated early. While these recommendations are likely to require increased funding in some areas, the results of this study suggest they are worth exploring further as investing in preventative strategies are likely to reduce costs in the future when these women experience major life events such as the birth of a baby. Not only are the initiatives likely to be cost-effective, but more importantly, they are likely to improve the health outcomes for those women who are most at risk of experiencing these adverse conditions.

The present study compared the suicidal behaviour and related measures of adolescents in high school in Germany (N=318) and South Africa (N=299). Participants completed a series of self-report measures of the SPS (Suicide Probability Scale), PSS-Fa (Perceived Social Support From Family Scale), PSS-Fr (Perceived Social Support From Friends Scale), SIB (Scale Of Interpersonal Behaviour) and a number of demographic questions. Analyses were conducted using content analysis, correlation coefficients and logistic regression to determine variables related to previous suicide attempts, stepwise multiple regression to account for variables predicting currents suicidal risk; and multivariate analysis of variance (MANOVA) to examine differences among the groups and among suicide attempters and non-attempters. 36 German (11.3%) and 48 South African (16.1%) adolescents reported that they had made previous suicide attempts. German adolescents reported 45 (14.2%) suicide attempts in the family and 82 (25.8%) suicide attempts by friends. South African adolescents reported 43 (14.4%) suicide attempts in the family and 92 (30.7%) suicide attempts by friends. The following variables were associated with previous suicide attempts in the German sample: attempted suicide by friends, a life-threatening event, previous psychiatric contact, the death of a friend, low perceived family support, female gender, attempted suicide in the family, suicide of a friend, and low perceived friend support. The following variables were associated with previous suicide attempts in the South African sample: low perceived family support, death of a friend, attempted suicide by friends, female gender, a life-threatening event, previous psychiatric contact, suicide of friends, and attempted suicide in the family. The following variables for the German sample were found to be significant predictors of current suicidal risk: low perceived family and friend support, previous suicide attempts, suicide attempts in the family, a life-threatening event, suicide attempts of friends, suicide of friends, female gender, and previous psychiatric contact. The following variables for the South African sample were found to be significant predictors of current suicidal risk: previous suicide attempts, low perceived family and friend support, death of a friend, a life-threatening event, previous psychiatric contact, suicide attempts in the family, suicide of friends, and suicide attempts of friends. These findings show that suicidal behaviour is frequent in both countries. Suicidal deaths of friends and family is more prevalent in Germany, whereas religion or belief in god does not protect against suicide attempts in both countries. Results indicate that perceived support from family is a strong protective factor against suicide attempts.
Psychology
M.A. (Psychology)

Indiana University-Purdue University Indianapolis (IUPUI)
Consistent under-reporting of autism cases by Indiana physicians to the Indiana Birth Defects and Problems Registry (IBDPR) has made quality autism-related data very difficult to obtain (Indiana Birth Defects and Problems Registry [IBDPR], 2011). As a result, the Indiana State Department of Health (ISDH) currently also utilizes data from billing information that it receives from hospital discharges. However, such cases must be investigated further because autism is often merely suspected as a possibility in the discharge data. A chart auditor must therefore review the child’s chart to determine if the condition is confirmed. Meanwhile, the Indiana Department of Education (IDOE) has a different diagnostic procedure from physicians for determining whether a student has an Autism Spectrum Disorder (ASD), which qualifies him or her for special education. A physician diagnosis of autism does not guarantee that a child will receive special education from public schools. With all of these current complications surrounding autism, announced changes in the definition of autism by the American Psychiatric Association (APA) will likely have effects on both the special education field and the public health field. There is a possibility that children who had previously received special education could cease to maintain their eligibility and may find it difficult to obtain benefits. The IDOE may find it necessary to reevaluate their criteria for determining special education eligibility. Additionally, public health officials may see the definition changes affect the number of autism cases they perceive their populations to have, thus impacting community and policy decisions. This study was performed as an attempt to investigate and compare the sources used by the IBDPR to obtain autism data, and determine whether or not the resulting data creates an accurate depiction of the autistic population of Indiana. It was also performed to speculate whether a stricter definition of autism will result in a higher quality of data for the IBDPR and a more consistent view on the disorder between the ISDH and the IDOE. Perhaps from such consistency and simpler definitions, future recorded data will more closely resemble that of reality, enabling the ISDH to utilize the IBDPR to its full extent. Using current definitions for an exploratory analysis of data from the past five years, a discrepancy clearly exists between the IBDPR and the reality of the population of Indiana.

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.