[On the Way to Culture-Sensitive Patient Information Materials: Results of a Focus Group Study]. / Auf dem Weg zu kultursensitiven Patienteninformationsmaterialien: Ergebnisse einer Fokusgruppenuntersuchung.

AIM: This study was part of a double-blind randomised controlled trial aimed to evaluate the effects of culture-sensitive patient information materials (PIM) compared with standard translated material. The study aimed to obtain the data for the development of culture sensitive PIM about unipolar depression for the 4 largest migrant groups in Germany (Turkish, Polish, Russian and Italian migration background). METHOD: A qualitative study using 4 manual-based focus groups (FG), one for each migrant group, with 29 participants (9 with a Turkish (TüG), 8 with a Polish (PoG), 5 with a Russian (RuG) and 7 with an Italian (ItG) migration background) was conducted. The discussions were recorded, transcribed and analyzed using qualitative content analysis. RESULTS: 7 categories were identified. For the (1.) development of a good culture-sensitive PIM an easy language, a clear structure, an assessable extent of information and the avoidance of stereotypes were highlighted cross-culturally in all four FG. RuG and PoG had the largest (2.) lack of information about the German health care system. Concerning the (3.) illness perception RuG named problems with recognizing and understanding depression. PoG, RuG and TüG thematized (4.) feared consequences of the illness and of professional helpseeking. ItG, PoG, RuG had fears concerning (5.) psychotropic drugs as a result from insufficient knowledge about medication. For (6.) doctor-patient relationship cultural specifics were identified in RuG and TüG and for (7.) migration or culture specific reasons for depression in RuG, ItG and TüG. CONCLUSION: Although the identified categories were relevant for all or for the majority of migrant groups, for most categories specific cultural aspects were discovered. These findings show the importance of a culture sensitive adaptation of PIM.

Effects of culture-sensitive adaptation of patient information material on usefulness in migrants: a multicentre, blinded randomised controlled trial.

OBJECTIVES: To evaluate the usefulness of culture-sensitive patient information material compared with standard translated material. DESIGN: Multicentre, double-blind randomised controlled trial. SETTING: 37 primary care practices. PARTICIPANTS: 435 adult primary care patients with a migration background with unipolar depressive disorder or non-specific chronic low back pain were randomised. Patients who were unable to read in the language of their respective migration background were excluded. Sufficient data were obtained from 203 women and 106 men. The largest group was of Russian origin (202 patients), followed by those of Turkish (52), Polish (30) and Italian (25) origin. INTERVENTIONS: Intervention group: provision of culture-sensitive adapted material. CONTROL GROUP: provision of standard translated material. MAIN OUTCOME MEASURES: Primary outcome: patient-rated usefulness (USE) assessed immediately after patients received the material. SECONDARY OUTCOMES: patient-rated usefulness after 8 weeks and 6 months, symptoms of depression (PHQ-9), back pain (Back Pain Core Set) and quality of life (WHO-5) assessed at all time points. RESULTS: Usefulness was found to be significantly higher (t=1.708, one-sided p=0.04) in the intervention group (USE-score=65.08, SE=1.43), compared with the control group (61.43, SE=1.63), immediately after patients received the material, in the intention-to-treat analysis, with a mean difference of 3.65 (one-sided 95% lower confidence limit=0.13). No significant differences were found for usefulness at follow-up (p=0.16, p=0.71). No significant effect was found for symptom severity in depression (p=0.95, p=0.66, p=0.58), back pain (p=0.40, p=0.45, p=0.32) or quality of life (p=0.76, p=0.86, p=0.21), either immediately after receiving the material, or at follow-up (8 weeks; 6 months). Patients with a lower level of dominant society immersion benefited substantially and significantly more from the intervention than patients with a high level of immersion (p=0.005). CONCLUSION: Cultural adaptation of patient information material provides benefits over high quality translations. Clinicians are encouraged to use culture-sensitive material in their consultations, particularly with low-acculturated patients. TRIAL REGISTRATION NUMBER: German Register for Clinical Trials: DRKS00004241, Universal Trial Number: U1111-1135-8043, Results.

Effectiveness of Telephone-Based Health Coaching for Patients with Chronic Conditions: A Randomised Controlled Trial.

BACKGROUND: Chronic diseases, like diabetes mellitus, heart disease and cancer are leading causes of death and disability. These conditions are at least partially preventable or modifiable, e.g. by enhancing patients' self-management. We aimed to examine the effectiveness of telephone-based health coaching (TBHC) in chronically ill patients. METHODS AND FINDINGS: This prospective, pragmatic randomized controlled trial compares an intervention group (IG) of participants in TBHC to a control group (CG) without TBHC. Endpoints were assessed two years after enrolment. Three different groups of insurees with 1) multiple conditions (chronic campaign), 2) heart failure (heart failure campaign), or 3) chronic mental illness conditions (mental health campaign) were targeted. The telephone coaching included evidence-based information and was based on the concepts of motivational interviewing, shared decision-making, and collaborative goal setting. Patients received an average of 12.9 calls. Primary outcome was time from enrolment until hospital readmission within a two-year follow-up period. Secondary outcomes comprised the probability of hospital readmission, number of daily defined medication doses (DDD), frequency and duration of inability to work, and mortality within two years. All outcomes were collected from routine data provided by the statutory health insurance. As informed consent was obtained after randomization, propensity score matching (PSM) was used to minimize selection bias introduced by decliners. For the analysis of hospital readmission and mortality, we calculated Kaplan-Meier curves and estimated hazard ratios (HR). Probability of hospital readmission and probability of death were analysed by calculating odds ratios (OR). Quantity of health service use and inability to work were analysed by linear random effects regression models. PSM resulted in patient samples of 5,309 (IG: 2,713; CG: 2,596) in the chronic campaign, of 660 (IG: 338; CG: 322) in the heart failure campaign, and of 239 (IG: 101; KG: 138) in the mental health campaign. In none of the three campaigns, there were significant differences between IG and CG in time until hospital readmission. In the chronic campaign, the probability of hospital readmission was higher in the IG than in the CG (OR = 1.13; p = 0.045); no significant differences could be found for the other two campaigns. In the heart failure campaign, the IG showed a significantly reduced number of hospital admissions (-0.41; p = 0.012), although the corresponding reduction in the number of hospital days was not significant. In the chronic campaign, the IG showed significantly increased number of DDDs. Most striking, there were significant differences in mortality between IG and CG in the chronic campaign (OR = 0.64; p = 0.005) as well as in the heart failure campaign (OR = 0.44; p = 0.001). CONCLUSIONS: While TBHC seems to reduce hospitalization only in specific patient groups, it may reduce mortality in patients with chronic somatic conditions. Further research should examine intervention effects in various subgroups of patients, for example for different diagnostic groups within the chronic campaign, or duration of coaching. TRIAL REGISTRATION: German Clinical Trials Register DRKS00000584.

[Transcultural prevention of alcohol-related disorders : effects of a culture- and migration-sensitive approach in elderly migrants with respect to attitudes and behavior: a cluster randomized controlled trial]. / Transkulturelle Prävention von Alkoholerkrankungen : Effekte eines kultur- und migrationssensitiven Ansatzes auf Einstellungen und Verhalten älterer Personen mit Migrationshintergrund - Eine Cluster-randomisierte kontrollierte Studie.

BACKGROUND: For migrants who are older than 50, alcohol frequently becomes a problem. Simultaneously alcohol-related prevention measures only reach this group insufficiently. Therefore, a transcultural concept for preventing alcohol-related disorders in elderly (≥ 45 years) migrants has been developed. METHOD: The transcultural concept, which consisted of a prevention event as well as a cultural and language-sensitive information booklet, was evaluated in a cluster-randomized controlled trial (n = 310 immigrants). As a control condition there was a prevention event with materials from Deutsche Hauptstelle für Suchtfragen (German Centre for Addiction Issues). Data were obtained before and after the event, as well as after 6 months. All materials were available both in German and in Russian, Italian, Spanish and Turkish. RESULTS: Directly after the event, as well as 6 months thereafter, the transcultural approach was rated significantly better than the general prevention event. 73.4 % of the participants read the cultural and migration-sensitive booklet, whereas only 21.2 % in the control condition (p = 0.0001). Furthermore, significantly more participants of the transcultural approach reported a reduced alcohol consumption (49.4 vs. 16.7 %; p = 0.004) after 6 months. CONCLUSION: The consideration of diversity with respect to cultural, migration-related, socio demographic und linguistic aspects improves the effectiveness of prevention measures.

Usefulness scale for patient information material (USE) - development and psychometric properties.

BACKGROUND: One economical way to inform patients about their illness and medical procedures is to provide written health information material. So far, a generic and psychometrically sound scale to evaluate cognitive, emotional, and behavioral aspects of the subjectively experienced usefulness of patient information material from the patient's perspective is lacking. The aim of our study was to develop and psychometrically test such a scale. METHODS: The Usefulness Scale for Patient Information Material (USE) was developed using a multistep approach. Ultimately, three items for each subscale (cognitive, emotional, and behavioral) were selected under consideration of face validity, discrimination, difficulty, and item content. The final version of the USE was subjected to reliability analysis. Structural validity was tested using confirmatory factor analysis, and convergent and divergent validity were tested using correlation analysis. The criterion validity of the USE was tested in an experimental design. To this aim, patients were randomly allocated to one of two groups. One group received a full version of an information brochure on depression or chronic low back pain depending on the respective primary diagnosis. Patients in the second group received a reduced version with a lower design quality, smaller font size and less information. Patients were recruited in six hospitals in Germany. After reading the brochure, they were asked to fill in a questionnaire. RESULTS: Analyzable data were obtained from 120 questionnaires. The confirmatory factor analysis supported the structural validity of the scale. Reliability analysis of the total scale and its subscales showed Cronbach's α values between .84 and .94. Convergent and divergent validity were supported. Criterion validity was confirmed in the experimental condition. Significant differences between the groups receiving full and reduced information were found for the total score (p<.001) and its three subscales (cognitive p<.001, emotional p=.001, and behavioral p<.001), supporting criterion validity. CONCLUSIONS: We developed a generic scale to measure the subjective usefulness of written patient information material from a patient perspective. Our construct is defined in line with current theoretical models for the evaluation of written patient information material. The USE was shown to be a short, reliable and valid psychometric scale.

Development and testing of culturally sensitive patient information material for Turkish, Polish, Russian and Italian migrants with depression or chronic low back pain (KULTINFO): study protocol for a double-blind randomized controlled trial.

BACKGROUND: Many of the approximately 15 million people with a migration background living in Germany (19% of the population) are inadequately reached by existing healthcare provision. In the literature, the necessity for cultural adaptation of information material for patients with a migration background is often cited as a measure for improving healthcare.In this study, culturally sensitive information material will be developed and evaluated for patients with a migration background and depression or chronic low back pain. In this respect, it will be examined whether culturally sensitive information material is judged as more useful by the patients than standard translated patient information without cultural adaptation. METHODS/DESIGN: The implementation and evaluation of culturally sensitive patient information material will occur in the framework of a double-blind randomized controlled parallel-group study in four study centres in Germany. Primary care patients with a Turkish, Polish, Russian or Italian migration background with a diagnosis of depressive disorder or chronic low back pain will be included and randomly allocated to the intervention group or the control group. In the intervention group, culturally sensitive patient information will be handed to the patient at the end of the physician consultation, while in the control group, standard translated patient information material will be provided. The patients will be surveyed by means of questionnaires following the consultation as well as after 8 weeks and 6 months. In addition to the primary outcome (subjective usefulness), several patient- and physician-rated secondary outcomes will be considered. DISCUSSION: The study will provide an empirical answer to the question of whether persons with a migration background perceive culturally sensitive patient information material as more useful than translated information material without cultural adaptation. TRIAL REGISTRATION: Deutsches Register Klinischer Studien (DRKS-ID) DRKS00004241 and Universal Trial Number (UTN) U1111-1135-8043.

Telephone-based health coaching for chronically ill patients: study protocol for a randomized controlled trial.

BACKGROUND: The rising prevalence of chronic conditions constitutes a major burden for patients and healthcare systems and is predicted to increase in the upcoming decades. Improving the self-management skills of patients is a strategy to steer against this burden. This could lead to better outcomes and lower healthcare costs. Health coaching is one method for enhancing the self-management of patients and can be delivered by phone. The effects of telephone-based health coaching are promising, but still inconclusive. Economic evaluations and studies examining the transferability of effects to different healthcare systems are still rare. Aim of this study is to evaluate telephone-based health coaching for chronically ill patients in Germany. METHODS/DESIGN: The study is a prospective randomized controlled trial comparing the effects of telephone-based health coaching with usual care during a 4-year time period. Data are collected at baseline and after 12, 24 and 36 months. Patients are selected based on one of the following chronic conditions: diabetes, coronary artery disease, asthma, hypertension, heart failure, COPD, chronic depression or schizophrenia. The health coaching intervention is carried out by trained nurses employed by a German statutory health insurance. The frequency and the topics of the health coaching are manual-based but tailored to the patients' needs and medical condition, following the concepts of motivational interviewing, shared decision-making and evidence-based-medicine. Approximately 12,000 insurants will be enrolled and randomized into intervention and control groups. Primary outcome is the time until hospital readmission within two years after enrolling in the health coaching, assessed by routine data. Secondary outcomes are patient-reported outcomes like changes in quality of life, depression and anxiety and clinical values assessed with questionnaires. Additional secondary outcomes are further economic evaluations like health service use as well as costs and hospital readmission rates. The statistical analyses includes intention-to-treat and as-treated principles. The recruitment will be completed in September 2014. DISCUSSION: This study will provide evidence regarding economic and clinical effects of telephone-delivered health coaching. Additionally, this study will show whether health coaching is an adequate option for the German healthcare system to address the growing burden of chronic diseases. TRIAL REGISTRATION: German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS) DRKS00000584.

['Optimal care for depression': Freiburg model of integrated care for depressive disorders]. / "Optimal versorgt bei Depression" - Freiburger Modell zur Integrierten Versorgung depressiver Erkrankungen.

BACKGROUND: Health care for persons with depressive disorders is not networked to an optimal degree in Germany. In order to improve outpatient care, an integrated care model for patients with depressive disorders was initiated in Freiburg in December 2008. The model aims at implementation of central recommendations of the "Conceptual Framework Integrated Care: Depression" of the German Association for Psychiatry and Psychotherapy. METHODS: Usage of health services and effects of the model were analyzed by means of patient and physician data as part of a continuous project evaluation. RESULTS: Since the launch of the project in December 2008, 40 physicians have been participating, and have included a total of 234 patients. Unipolar depressions constitute by far the most frequent disorders (91%). Most patients showed moderate (58%) or severe (36%) depressive symptoms. Most disorders were recurrent (61%). About three quarters of patients (75%) are treated exclusively by general practitioners. According to the physicians' ratings, 58% of the patients were remitted or showed subsyndromal symptoms in the eighth treatment week following their inclusion in the Freiburg model. After 16 weeks this number rose to 70% of patients. According to the information provided by the patients, in the PHQ-D, 59% of the patients were remitted or showed minimal symptoms. CONCLUSIONS: In the Freiburg model the "Conceptual Framework Integrated Care: Depression" could be implemented under current routine conditions. The first evaluation results indicate the success of this model. The results are indicative of a high quality of health care of the Freiburg model.

[Health care utilisation of migrants with mental disorders compared with Germans]. / Gesundheitsbezogenes Inanspruchnahmeverhalten von Personen mit Migrationshintergrund und einer psychischen Störung im Vergleich zu Deutschen.

OBJECTIVE: Analysis of the health care utilisation of migrants with mental disorders compared to Germans with mental disorders under consideration of migration-related and socio-economic factors. METHODS: Reanalysis of the supplement survey "Mental Disorders" of the "German Health Survey" 1998 with a matched sample of migrants (n = 151) and Germans (n = 151) with a positive 12-month prevalence of mental disorders. RESULTS: Regarding the prevalence rates for mental disorders and health care utilisation no differences in the sample between Germans and migrants could be found. CONCLUSIONS: The migration background alone does not explain the differences in health care utilisation which are found in many studies. It is assumed, that differences arise multifactorial, and can be explained through migration-related factors but especially through socio-economic factors. To provide a better understanding of health care utilisation of migrants it might be necessary to set the focus on socio-economic factors. In addition a differentiated measurement of cultural and migration-related factors is needed in future studies.

[Culture sensitive analysis of psychosomatic complaints in migrants in Germany]. / Vergleichende Analyse psychosomatischer Beschwerden bei Personen mit spanischem, italienischem, türkischem und russischem Migrationshintergrund.

BACKGROUND: To ensure an adequate health care of migrants, differentiated information on the association of cultural background and migration related factors and psychosomatic complaints are necessary. METHOD: Cross-sectional questionnaire based survey regarding psychosomatic complaints of migrants from Turkey (n = 77), Italy (n = 95), and Spain (n = 67) and ethnic German resettled from the states of the former Soviet Union (n = 196). Questionnaires distributed by non-health specific counselling agencies of welfare associations. RESULTS: The cultural background was a relevant factor for psychosomatic complaints, showing higher complaints in Turkish and ethnic German resettled migrants, also compared to a sample of age corresponding Germans. In contrast, Spanish and Italian migrants showed a lower risk for psychosomatic complaints. Also gender, feeling unwell in Germany and fatalism showed a significant association with psychosomatic complaints. CONCLUSION: Migrants in Germany do not have per se a higher risk for psychosomatic complaints. A distinct differentiation by cultural background is necessary.

Lay theories toward cancer and myocardial infarction: a trans-cultural comparison of Germans and Spaniards.

The objective of this study was a transcultural comparison regarding illness-related causal and control attributes using a survey of healthy Germans in Germany, Spaniards in Spain and Spaniards in Germany. Each group contained 100 persons, matched according to sex, age and education. Germans showed more pronounced internal causal as well as control beliefs while Spaniards in Germany showed fatalistic attribution and Spaniards in Spain placed more emphasis on social aspects. It was possible to correctly assign over 75 percent of persons to a group depending on their characteristics in terms of causal and control attributions. Considerations of cultural and migration-related factors regarding public health appear especially promising.

Unipolar depression: diagnostic and therapeutic recommendations from the current S3/National Clinical Practice Guideline.

BACKGROUND: Depressive disorders are among the most common illnesses and reasons for obtaining health care. Their diagnosis and treatment are still in need of improvement. In Germany, a new S3/National Clinical Practice Guideline has been developed for this purpose. METHODS: The existing guidelines on unipolar depression from Germany and other countries were synoptically compared and supplemented with systematic literature searches. After 14 consensus conferences, a total of 107 evidence-based recommendations were issued. RESULTS: Unipolar depression should be diagnosed in accordance with ICD-10 criteria. Screening questionnaires are useful aids to diagnostic classification. When a treatment is chosen, shared decision-making with the patient is essential. Mild depressive episodes can be treated initially by watchful waiting for 14 days. For moderate depressive episodes, pharmacotherapy and psychotherapy are equally effective treatment options. For severe depression, a combination of pharmacotherapy and psychotherapy is recommended. If 4 to 6 weeks of acute therapy are insufficiently effective, lithium augmentation is recommended, rather than combination antidepressant therapy or a switch to another antidepressant. After remission, maintenance therapy should be continued for 4 to 9 months. In recurrent depression, pharmacotherapy and/or psychotherapy, where appropriate, should be continued for at least two years. Specific recommendations are given for patients who have somatic or mental comorbidities or are acutely suicidal, and recommendations are also given for coordination of care. CONCLUSION: This guideline is a comprehensive set of evidence- and consensus-based recommendations for the diagnosis and treatment of unipolar depression. An improvement in the care of patients with unipolar depression will require broad implementation of the guideline, both in the inpatient and outpatient setting.

Sick leave and depression - determining factors and clinical effect in outpatient care.

Sickness leave is a major source of societal costs in depression treatment. However, very little is known about the rationale behind sick leave and their effects on depressive symptoms. Aim of the paper is to evaluate the effect of sick leave on treatment outcome and the association of sick leave with patient, depression and treatment-related factors. For this we compared patients with sick leave and non-sick leave regarding symptom reduction following 6 weeks of treatment. A total of 118 patients of 41 physicians in a controlled clinical trial with a naturalistic prospective design were analysed. After 8 weeks of treatment no significant differences were found between patients who had or did not have sick leave, in terms of improvement of depressive symptoms. The analyses of physician, patient and illness-related variables regarding their predictive value showed no significant effect. No systematic effect of sick leave and no clear criteria were found that were related to receiving a sick leave certificate. It can be assumed that physicians do not only base the decision of whether to sign a depressive patient off sick on illness-specific factors. For a targeted implementation of sick leave as therapeutic measure predictors for effectiveness should be defined.

[Outpatient depression treatment--comparative analysis of general practitioners', psychiatrists' and psychotherapists' treatment strategies]. / Ambulante Depressionsbehandlung--eine vergleichende Analyse des fachärztlichen, hausärztlichen und psychotherapeutischen Versorgungssektors.

OBJECTIVE: To analyse the status quo of outpatient treatment of depression from general practitioners', psychiatrists' and psychotherapists' point of view. METHOD: Pooled analysis of the outpatient treatment of depression of general practitioners (n=180), psychiatrists (n=71), and psychotherapists (n=160). Survey performed to uncover the clinical process the clinical process, the perceived obstacles, and subjective responsibilities. RESULTS: The diagnosis of all three groups was based primarily on their clinical impression, rather than on formal diagnosis criteria. The cooperation with the medical-psychotherapeutic sector was assessed more favourably than cooperation with the psycho-social sector. CONCLUSIONS: Needs for improvements particularly regarding diagnoses and an interdisciplinary cooperation.

[Mental disorders in people with migration background compared with German general population]. / Psychische Störungen bei Menschen mit Migrationshintergrund im Vergleich zur deutschen Allgemeinbevölkerung.

OBJECTIVE: Comparison of 4-week, 12-month and lifetime prevalence rates of mental disorders between the German general population and persons without German nationality who were not born in Germany (migrants). METHODS: A migration-sensitive reanalysis of the supplement survey "mental disorders" of the German Health Survey 1998/1999 was conducted. 143 migrants were compared with 3740 Germans. RESULTS: Results demonstrate significantly higher 4-week, 12-month and lifetime prevalence rates of mental disorders for migrants in comparison to Germans. These differences are highest regarding affective disorders (4-week prevalence: 11.7 vs. 5.8 %; 12-month prevalence: 17.9 vs. 11.3 %; lifetime prevalence: 24.9 vs. 18.2 %) and somatoform disorders (4-week prevalence: 15.5 vs. 6.9 %; 12-month prevalence: 19.9 vs. 10.3 %; lifetime prevalence: 24.1 vs. 15.4 %). CONCLUSIONS: The results highlight the importance of a differentiating examination of prevalence rates for migrants. They also serve as a basis for further investigation of the relation between migration and mental health as well as for developing a cultural sensitive health care.

[Evidence-based treatment of depression: what does the new S3- and national healthcare guideline Unipolar Depression really recommend?]. / Evidenzbasierte Behandlung bei depressiven Erkrankungen--was empfiehlt die neue S3-/Nationale Versorgungsleitlinie "Unipolare Depression" wirklich?

The paper reflects central recommendations and methodological issues of the new German guidelines for the treatment of depression, as discussed in the article New German Guidelines for the Treatment of Depression - The Central Role of Psychotherapy (Schauenburg et al. 2009). Members of the steering group for these guidelines disagree with the authors' description in several points, especially with reference to the efficacy of pharmacotherapy with antidepressants and psychotherapy, as well as the relationship between both strategies of therapy and their combination in diverse phases of treatment (acute/maintenance). Furthermore, we try to clarify some misunderstandings in matters of the guideline's methodology which arose in the paper cited.

[Is patient's satisfaction with inpatient depression treatment related to their German language proficiency?]. / Ist Patientenzufriedenheit in der stationären Depressionsbehandlung von der Qualität sprachlicher Deutschkenntnisse abhängig?

OBJECTIVE: To analyze patient satisfaction in inpatient depression treatment depending on German language proficiency. METHODS: Documentation of patients in 24 psychiatric hospitals in Baden-Württemberg (South Germany). The following three groups were matched according to age, gender, and education: native German speakers, non-native speakers with good German proficiency, and non-native speakers with limited German proficiency (67 in each group). RESULTS: The number of unsatisfied patients was four times higher in the group of non-native speakers with limited German proficiency (24 %) than in the native German speakers group (6,5 %) and more then twice as high as in the group of non-native speakers with good German proficiency (10.2 %). Patient satisfaction was lower in the group of non-native speakers with limited German proficiency independent of treatment outcome than in both other groups, whereas in both groups with good German proficiency, satisfaction was associated with treatment outcome. CONCLUSIONS: Good linguistic understanding is more important for patient satisfaction in inpatient depression treatment than treatment outcome.

Patients' language proficiency and inpatient depression treatment in Baden-Württemberg (South Germany).

OBJECTIVE: This study analyzed whether quality of inpatient depression treatment was dependent on German language proficiency. METHODS: Native German speakers and nonnative speakers with good or limited German proficiency (67 per group) hospitalized for depression in 24 psychiatric hospitals in Baden-Württemberg were matched by age, gender, and education. RESULTS: Germans received more group psychotherapy than the other two groups (p=.003). No differences were found in regard to pharmacotherapy. Those with limited German proficiency were discharged an average of 18 days earlier than native German speakers and six days earlier than those with good proficiency (p=.02). Twice as many nonnative patients with good proficiency and nearly four times as many patients with limited proficiency were discharged with lingering depressive symptoms (p=.006). CONCLUSIONS: Results confirmed the significance of linguistic factors for the effectiveness of treatment of patients with depression and showed a direct impact of linguistic factors on length of hospitalization.

Improving outpatient care of depression by implementing practice guidelines: a controlled clinical trial.

OBJECTIVE: Depressive disorders are of great medical and political significance. Although evidence-based guidelines have been published and educational initiatives have been launched to implement them, they are rarely actually used. The aim of the study was to implement clinical practice guidelines for outpatient care of depression using a practice-oriented and interdisciplinary approach. DESIGN: Controlled clinical trial with a naturalistic design (data collection within routine practice) designed as a prospective pre-post study. SETTING: Outpatient care. PARTICIPANTS: 29 general practitioners (intervention: 18; control: 11) and 15 psychiatrists (intervention: 11; control: 4). Overall, the treatment of 698 patients (two samples: pre: 361; post: 337) was documented. INTERVENTION: s) Multifaceted intervention combining benchmarking, continuous medical education and interdisciplinary quality circles for the diagnosis and treatment of depressive disorders. MAIN OUTCOME MEASURES: Mixed-effects regression models for cluster-adjusted analysis of patients' symptom reduction. RESULTS: Although physicians in the intervention group improved their clinical effectiveness (proportion of patients with response/remission) to a greater extent than physicians in the control group (intervention: 48.6% to 66.9%; control: 54.9% to 61.5%), cluster-adjusted analysis failed to prove a statistically significant effect of the intervention on the treatment outcome. CONCLUSIONS: Although no statistically significant improvements were found regarding the outcomes, the action programme provides important work, materials and results for an integrated treatment model for depression.

[Depression treatment by psychiatrists - treatment strategies and experienced barriers from psychiatrists' point of view]. / Fachärztliche Depressionsbehandlung - subjektive Wahrnehmung der Versorgungssituation und erlebte Barrieren.

OBJECTIVE: To analyse the status quo of depression treatment (procedure, responsibilities, and treatment barriers) from psychiatrists' point of view. METHODS: Cross-sectional survey (n = 71 psychiatrists; return rate: 45.5 %). RESULTS: Diagnostic and therapeutic knowledge were validated as good. Psychiatrists view their responsibility mainly in identifying depressed patients, in differential diagnosis and medical treatment. The clinical diagnosis corresponded only in 52.7 % to ICD-10 criteria. Pharmacotherapy and referral were according to guidelines. Psychiatrists were less satisfied with cooperation with the psychosocial sector (social service, counselling centres) than with family physicians, psychotherapists and hospitals. The need for continuous medical education was seen specifically regarding therapeutic procedures (prophylaxis of relapse and combined therapy) and less concerning the diagnoses. CONCLUSIONS: The results affirm the quality outpatient psychiatric care of depressive patients. Improvement potentials regard evidence-based diagnostic and networking with the psychosocial sector.