Behind the times? Associations of working-time autonomy with health-related and occupational outcomes in health care personnel- a latent profile analysis.

BACKGROUND: In the light of personnel shortage, the health care sector is facing the challenge to combine increasing employees' as well as patients' needs. The aim of this study was to investigate the association between working-time autonomy and health-related (fatigue, psychosomatic complaints and work ability), as well as occupational outcomes (job satisfaction and turnover intention) in a large sample of health care employees. METHOD: Based on data of the BauA-Working Time survey, a sample of n = 1,093 employees working in the health care sector was analysed. Outcomes were assessed by the German Fatigue Scale, the Work Ability-Index and single-item measurements. Besides descriptive analyses, latent profile analysis (LPA) was used to determine clusters of employees based on working-time autonomy. Subsequently, regression analyses have been conducted to examine the association between autonomy clusters with health-related and occupational outcomes, controlling for sociodemographic characteristics and employment status. RESULTS: LPA revealed that a three-cluster model was most suitable: high autonomy (cluster 1), medium autonomy (cluster 2) and low autonomy (cluster 3). The extracted profiles of working-time autonomy differed significantly in terms of sociodemographic and occupational characteristics, but not in terms of average working hours per week or monthly household income. The multivariate regression analysis revealed that being in the low-autonomy cluster was associated with more psychosomatic health complaints (IRR: 1.427, p = 0.008), lower work ability (OR 0.339, p < 0.001), as well as less job satisfaction (OR 0.216, p < 0.001). DISCUSSION: Overall, the analyses indicate that it is crucial to prospectively consider working-time autonomy as an important factor of satisfaction, well-being and turnover intention in health care employees.

Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial.

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

Social isolation in the oldest-old: determinants and the differential role of family and friends.

PURPOSE: To examine the association of sociodemographic and health-related determinants with social isolation in relation to family and friends in the oldest-old. METHODS: Database was the multi-center prospective AgeCoDe/AgeQualiDe cohort study assessed at follow-up wave 5 (N = 1148; mean age 86.6 years (SD 3.0); 67% female). Social isolation was assessed using the short form of the Lubben Social Network Scale (LSNS-6). The LSNS-6 contains two sets of items establishing psychometrically separable subscales for isolation from family and friends (ranges 0-15 points), with lower scores indicating higher isolation. Cross-sectional linear (OLS) regression analyses were used to examine multivariate associations of sociodemographic and health-related determinants with social isolation from family and friends. RESULTS: Overall, n = 395 participants (34.6%) were considered socially isolated. On average, isolation was higher from friends (mean 6.0, SD 3.8) than from family (mean 8.0, SD 3.5). Regression results revealed that in relation to family, males were more socially isolated than females (ß = - 0.68, 95% CI - 1.08, - 0.28). Concerning friends, increased age led to more isolation (ß = - 0.12, 95% CI - 0.19, - 0.05) and functional activities of daily living to less isolation (ß = 0.36, 95% CI 0.09, 0.64). Independent of the social context, depression severity was associated with more social isolation, whereas cognitive functioning was associated with less social isolation. CONCLUSIONS: Different determinants unequally affect social isolation in relation to family and friends. The context of the social network should be incorporated more strongly regarding the detection and prevention of social isolation to sustain mental and physical health.

[Expectations of guideline developers on living guidelines]. / Erwartungen der Leitlinienentwickler*innen an "living guidelines".

BACKGROUND: Guidelines are central pillars of high-quality care and care planning. The quality requirements for the development of guidelines and the associated effort are very high. Therefore, more efficient approaches are being forced. OBJECTIVE: The opportunities and challenges in the introduction of a dynamic updating concept within the framework of the digitalization of guidelines were explored from the perspective of guideline developers in the field of psychiatry. This perspective should be included in the implementation. MATERIAL AND METHODS: Between January and May 2022 a cross-sectional survey was conducted among guideline developers (N = 561, response 39%) based on a questionnaire developed and tested in advance. Data were analyzed descriptively. RESULTS: A total of 60% were familiar with the concept of living guidelines. A large proportion endorsed a dynamic updating (83%) and digitalization (88%) of guidelines; however, various challenges are associated with the concept of living guidelines: the risk of inflationary changes (34%), the need for continuity of all actors (53%), involvement of patient and family representatives (37%) and definition of criteria regarding the decision what to change (38%). The vast majority (85%) thought it necessary that guideline development should be followed by implementation projects. CONCLUSION: German guideline developers are very receptive regarding the implementation of living guidelines; however, they named numerous challenges, which need to be addressed in this approach.

[Sociodemographic and social correlates of self-reported resilience in old age-results from the population-based LIFE-Adult-Study]. / Soziodemografische und soziale Korrelate selbstberichteter Resilienz im Alter ­ Ergebnisse der populationsbasierten LIFE-Adult-Studie.

INTRODUCTION: Resilience describes good adaptation to adversity and is a significant factor for well-being in old age. Initial studies indicate a high relevance of social resources. So far, only few studies have investigated resilience patterns in the elderly population. Therefore, the present study aims to investigate sociodemographic and social correlates of resilience in a large population-based sample aged 65 years and older. METHODS: Analyses were conducted on n = 2410 people aged 65 years and older from the follow-up survey of the LIFE-Adult-Study. The survey included the variables resilience (Resilience Scale - RS-11), social support (ENRICHD Social Support Inventory - ESSI), and social network (Lubben Social Network Scale - LSNS-6). The association of sociodemographic and social variables with resilience was analyzed using multiple linear regression analysis. RESULTS: The age of 75 years and older was associated with lower resilience compared with the age of 65-74 years. Further, widowed marital status was related to higher resilience. Better social support and a larger social network were significantly associated with higher resilience. No association was found for gender and education. DISCUSSION: The results reveal sociodemographic correlates of resilience in the elderly population that can help identify at-risk groups with lower resilience. Social resources are significant in older age for resilient adaptation and represent a starting point for deriving preventive measures. Social inclusion of older people should be promoted to strengthen resilience in this population and provide favorable conditions for successful aging.

Do oldest old individuals perceive receipt of informal care as a restriction or support of their autonomy?

OBJECTIVES: Autonomy (defined as self-governance; not equivalent to independence) is relevant to well-being and psychological functioning. However, there is a lack of research on individuals aged >85 years and their perception of autonomy when receiving informal care. This study aims to answer the question if and how the receipt of informal care is associated with perceived autonomy of individuals aged over 85 years. METHOD: A cross-sectional study was conducted with data from follow-up 9 of the AgeQualiDe study (2015/2016), which is a multi-centric prospective cohort study in Germany. The analytical sample included 570 participants aged >85 years and with a score of ≥ 19 on the Mini-Mental-State-Examination. Perceived autonomy was assessed with the Perceived Autonomy in Old Age Scale. Receipt of care was assessed as performance of at least one care task (help with basic and instrumental activities of daily living, and supervision) by relatives or friends. Sociodemographic information, mental health, functional level and receipt of professional ambulatory care were controlled for. RESULTS: Unadjusted and adjusted linear regression analyses indicated a significant negative association between receipt of informal care and perceived autonomy. The results remained stable in sensitivity analyses; no significant interaction effect was found for gender or education. CONCLUSION: Findings indicate that informal care recipients aged >85 years perceive lower autonomy compared to those not receiving care. Additional or other forms of support, and improving the care relationship and communication might be considered to support autonomy of care recipients aged >85 years.

Correlates of institutionalization among the oldest old-Evidence from the multicenter AgeCoDe-AgeQualiDe study.

OBJECTIVES: There is a lack of studies identifying the correlates of institutionalization specifically among the oldest old. Therefore, our aim was to fill this gap in knowledge. METHODS: Cross-sectional data (Follow up wave 9; n = 633 observations in the analytical sample) were used from the multicenter prospective cohort study "Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" Correlates of institutionalization among the oldest old-Evidence from a multicenter cohort study. The sample consists of primary care patients aged 86 years and over (mean 90.5 years, SD: 2.9 years). Sociodemographic and health-related independent variables were included in our regression model. Institutionalization was defined as living in a nursing home or an old-age home (not including assisted living facilities). RESULTS: Out of the 633 participants, 502 individuals (79.3%) did not live in an institutionalized setting, whereas 73 individuals (20.7%) lived in an institutionalized setting. Multiple logistic regressions showed that the likelihood of institutionalization increased with being divorced/widowed/single (compared to being married; OR: 5.35 [95% CI: 1.75-16.36]), the presence of social isolation (OR: 2.07 [1.20-3.59]), more depressive symptoms (OR: 1.11 [1.01-1.23]), increased cognitive impairment (OR: 1.67 [1.31-2.15]) and higher levels of frailty (OR: 1.48 [1.07-2.06]). CONCLUSION: The study findings identified various sociodemographic and health-related factors associated with institutionalization among the oldest old. Longitudinal studies are required to gain further insights into these associations.

Employment status and desire for work in severe mental illness: results from an observational, cross-sectional study.

PURPOSE: People with a severe mental illness (SMI) are at particular risk of occupational exclusion. Among the approaches to occupational rehabilitation, supported employment (SE) has been proven to be the most effective. A requirement to enter SE-programs is that individuals must want to seek competitive employment. The aim of this work is to investigate the relationship between serious mental illness and the desire to work including potential predictors. METHODS: This is a cross-sectional observational study of patients with SMI aged 18-65 years (n = 397). Patients were interviewed by trained staff using standardised instruments. The relationship between potential predictors and a strong preference for employment were analysed using a hierarchic binary logistic regression model. RESULTS: Only about one-quarter (27.9%) of SMI patients is in competitive employment. Another quarter is unemployed (25.9%). Results show that the desire for competitive employment is strong among more than half of the SMI patients. Among the unemployed, two-thirds express a strong desire for work. These individuals are an ideal target group for SE interventions. Comorbid chronic physical illness, diagnosis, and the subjectively judged ability to work are associated with the desire for work. CONCLUSION: Our data confirm a substantial exclusion of individuals with SMI from the workforce. In general, care needs for workplace interventions are not being met and leave much room for improvement. In addition to employment status, the desire for work should be routinely assessed. STUDY REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS) ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015801 ) and under the WHO-Platform "International Clinical Trials Registry Platform" (ICTRP) ( https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015801 ) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019).

Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial.

BACKGROUND: The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network. METHODS: In a cluster-randomized controlled trial, 50 primary care practices included 160 patients aged 18 to 60 years with obesity (BMI ≥ 30). The intervention practices had continuous access to the 5A online tutorial for the general practitioner. Patients of control practices were treated as usual. Primary outcome was the patients' perspective of the doctor-patient-interaction regarding obesity management, assessed with the Patient Assessment of Chronic Illness Care before and after (6/12 months) the training. Treatment effects over time (intention-to-treat) were evaluated using mixed-effects linear regression models. RESULTS: More than half of the physicians (57%) wished for more training offers on obesity counseling. The 5A online tutorial was completed by 76% of the physicians in the intervention practices. Results of the mixed-effects regression analysis showed no treatment effect at 6 months and 12 months' follow-up for the PACIC 5A sum score. Patients with obesity in the intervention group scored lower on self-stigma and readiness for weight management compared to participants in the control group at 6 months' follow-up. However, there were no significant group differences for weight, quality of life, readiness to engage in weight management, self-stigma and depression at 12 months' follow-up. CONCLUSION: To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results. TRIAL REGISTRATION: The study has been registered at the German Clinical Trials Register (Identifier: DRKS00009241 , Registered 3 February 2016).

Valuing end-of-life care: translation and content validation of the ICECAP-SCM measure.

BACKGROUND: The evaluation of care strategies at the end of life is particularly important due to the globally increasing proportion of very old people in need of care. The ICECAP-Supportive Care Measure is a self-complete questionnaire developed in the UK to evaluate palliative and supportive care by measuring patient's wellbeing in terms of 'capability'. It is a new measure with high potential for broad and international use. The aims of this study were the translation of the ICECAP-Supportive Care Measure from English into German and the content validation of this version. METHODS: A multi-step and team-based translation process based on the TRAPD model was performed. An expert survey was carried out to assess content validity. The expert panel (n = 20) consisted of four expert groups: representative seniors aged 65+, patients aged 65+ living in residential care, patients aged 65+ receiving end-of-life care, and professionals in end-of-life care. RESULTS: The German version of the ICECAP-Supportive Care Measure showed an excellent content validity on both item- and scale-level. In addition, a high agreement regarding the length of the single items and the total length of the questionnaire as well as the number of answer categories was reached. CONCLUSIONS: The German ICECAP-SCM is a valid tool to assess the quality of life at the end of life that is suitable for use in different settings. The questionnaire may be utilized in multinational clinical and economic evaluations of end-of-life care.

[E-Mental Health and healthcare apps in Germany]. / E-Mental-Health und digitale Gesundheitsanwendungen in Deutschland.

Digitalization trends are having an impact on mental healthcare. Online interventions can promote mental health and complement existing mental healthcare services. Effective online interventions have been developed for a variety of mental health disorders and, overall, patient and practitioner acceptance of such programs is high. The Digital Healthcare Act provides the legal framework for the use of healthcare apps in German routine care. After approval by the Federal Institute for Drugs and Medical Devices, the costs of certain healthcare apps are now covered by statutory health insurers. However, digital technologies have rarely been used in mental healthcare to date. Reasons include a low level of awareness of such programs as well as a large number of untested applications. Specified quality criteria can provide better orientation for patients and healthcare providers. Further implementation efforts are necessary in order to fully use the potential of digital support options in psychiatric and psychotherapeutic care for the benefit of patients.

[Health-related consequences of social isolation: a qualitative study on psychosocial stress and resources among older adults in the COVID-19 pandemic]. / Gesundheitliche Folgen sozialer Isolation: Qualitative Studie zu psychosozialen Belastungen und Ressourcen älterer Menschen im Zusammenhang mit der COVID-19-Pandemie.

BACKGROUND: The SARS-CoV-2 pandemic led to a general uncertainty about risk and consequences of the disease. Older adults are specifically vulnerable with regard to severe courses of the disease and have been particularly encouraged to self-isolate during the pandemic. Subsequently, expressions of concern have been raised regarding the negative impact of disease risk and quarantine on the mental health of older people. OBJECTIVES: Assessment of psychosocial stress, coping strategies, need for support, and sense of coherence of older people during the COVID-19 pandemic. MATERIALS AND METHODS: The study follows a qualitative research design. Between May and June 2020 N = 11 guided telephone interviews were conducted with older adults (70+ years). Telephone interviews were recorded by audio tape and fully transcribed. A qualitative content analysis was performed according to Mayring and Fenzl (2019) using MAXQDA. RESULTS: Participants were 74.8 years old on average. Participants showed predominantly good psychosocial health and functional coping strategies. Life experience, an optimistic attitude, understanding of the necessity of restrictions, and previous crises that have been mastered were the most important resources during the COVID-19 pandemic for older adults. Offers of support were rarely used. Participants were critical of the closing of centers or meeting points for older people. CONCLUSION: Older adults appear to be able to preserve their mental wellbeing during the COVID-19 pandemic. The relevance of mental resources of older adults for supporting younger generations seems to be unrecognized.

Unmet care needs in the oldest old with social loss experiences: results of a representative survey.

BACKGROUND: Loss experiences such as the loss of a spouse, a close relative or significant others become more likely in old age and may be strongly related to specific unmet health care needs. These unmet needs may often remain undetected and undertreated followed by a negative impact on well-being and social role functioning. The present study aims at exploring the relationship between loss experiences and specific unmet care needs in old age. METHODS: As part of the study "Need assessment in the oldest old: application, psychometric examination and establishment of the German version of the Camberwell Assessment of Need for the Elderly (CANE)", the adapted German version of the CANE was used in a population-representative telephone survey in a sample of 988 individuals aged 75+ years. Loss experiences within the last 12 months were assessed within the structured telephone survey. Descriptive and interferential statistical analyses were run in order to examine the association between loss experiences and occurring unmet care needs. RESULTS: Overall, 29.7% of the oldest old reported at least one social loss with other relatives losses being the most frequent (12.5%), followed by non-family losses (10.7%). A significant relationship between loss experiences and a higher number of unmet care needs was observed, especially for close family losses. Other risk factors for unmet care needs were age, marital status, depression, social support and morbidity. CONCLUSIONS: This study provides, for the first time in Germany, data on the association between loss experiences and unmet needs. These findings may substantially contribute to the development of loss-specific interventions, effective treatment and health care planning for the bereaved elderly.

Attitudes and treatment practice of general practitioners towards patients with obesity in primary care.

BACKGROUND: Obesity is one of the most common and relevant health problems in need of urgent action in Germany. General practitioners (GPs) are the initial contact and thus one of the most important starting points for the successful treatment of overweight and obesity. The aim of the study was to assess the treatment practice and attitudes towards patients with obesity in primary health care in Germany. METHODS: Analyses were based on baseline data of the INTERACT trial of 47 GPs in central Germany. Stigmatizing attitudes were identified using the Fat Phobia Scale (FPS). In addition, questionnaires including sociodemographic information, attribution of causes of obesity, referral behavior and clinical activities were completed. Statistical investigations include descriptive analysis, principal component analysis, inference statistics and linear regression models. RESULTS: GPs rated the quality of medical care for patients with obesity in Germany as below average. The FPS score revealed a value of 3.70, showing that GPs' attitudes towards patients with obesity are stigmatizing. Younger GP age, male gender and a lower number of referrals to specialists were associated with higher levels of stigmatizing attitudes. CONCLUSION: Weight-related stigmatization has an impact on medical treatment. Obesity management guides would help to increase knowledge and reduce weight-related stigmatization in primary care, thereby improving medical care for obese and overweight patients.

Internet Use in Old Age: Results of a German Population-Representative Survey.

BACKGROUND: The internet has the potential to foster healthy lifestyles and to support chronic disease management. Older adults could benefit from using the internet and other information and communication technology to access health-related information and interventions available online. OBJECTIVE: The aim of this study was to investigate factors influencing internet use in older and oldest age groups and to determine the frequency of internet use for health-related purposes. METHODS: Using data from a nationally representative telephone survey of older adults aged 75 years and over, a sample of 999 people was assessed using structured clinical interviews. Descriptive and binary logistic regression analyses were performed. RESULTS: Overall, 42.6% (418/999) of participants used the internet. Among those, 55.7% (233/417) searched the internet for health-related information. Regression analyses revealed that internet use was significantly associated with younger age (odds ratio [OR] 0.89, 95% CI 0.85-0.92; P<.001), male gender (OR 2.84, 95% CI 2.02-4.00; P<.001), higher education levels (OR 6.69, 95% CI 4.48-9.99; P<.001), a wider social network (OR 1.04, 95% CI 1.01-1.07; P=.01), higher health-related quality of life (OR 1.02, 95% CI 1.00-1.03; P=.006), lower levels of depressive symptoms (OR 0.89, 95% CI 0.80-0.99; P=.04), and higher rates of chronic illness (OR 1.12, 95% CI 1.04-1.21; P<.004). CONCLUSIONS: This study provides population-representative data on internet use in old age in Germany. People in the older and oldest age groups participate in online activities. Understanding the factors that are associated with older adults internet use can contribute to developing tailored interventions and eHealth (electronic health) services to improve well-being in older adults.

Needs and health care costs in old age: a longitudinal perspective: results from the AgeMooDe study.

Background: The current study aimed to identify whether needs are associated with health care costs in late life longitudinally.Methods: Data were gathered from two waves (at baseline, n = 1199; at follow-up, n = 958) of a multicenter prospective cohort study ('Late-life depression in primary care: needs, health care utilization and costs', AgeMooDe) in Germany. Individuals aged 75 years and above were recruited via general practitioners. The 'Camberwell Assessment of Need for the Elderly' (CANE) was used to assess needs. Based on a questionnaire, the health-related resource use was assessed retrospectively from a societal perspective. The assessment covered outpatient services, inpatient treatment, pharmaceuticals, as well as formal and informal nursing care. Random effects regressions were used.Results: Regressions showed that the number of 'no needs' is inversely associated with total health care costs from a societal perspective (ß = -584.0, p < .001). When a health care perspective was adopted, this association was also significant (ß = -298.8, p < .001). The association between needs and health care costs persisted in all health care sectors considered in this study.Limitations: It might be difficult to generalize our findings to individuals residing in institutional settings.Conclusion: Adjusting for several potential confounders (e.g. sociodemographic and health-related factors), our study showed that needs - quantified using the CANE - are important for health care costs. Interventions should be developed to reduce needs in late life. These interventions may be beneficial for the health care system.

Out-of-pocket-payments and the financial burden of 502 cancer patients of working age in Germany: results from a longitudinal study.

PURPOSE: Cancer patients in Germany often face payments related to their disease or treatment which are not covered by their health insurance. The aim of this study was to analyze the amount of out-of-pocket payments (OOPPs) among cancer patients in Germany, to explore potential socioeconomic determinants of OOPPs, and to identify how cancer patients are burdened by these payments. METHODS: Cancer ptients were consecutively enrolled in 16 clinics in Leipzig, Germany. Data on OOPPs for the past 3 months and on socioeconomic status were obtained at the end of their hospital stay (t0) and 3 (t1) and 15 months (t2) after t0. Financial burden was calculated by dividing the monthly OOPPs by the midpoint of the income category, and the perceived burden was assessed by using the financial difficulties scale of the EORTC QLQ-C30. A two-part regression model was used to estimate the determinants of OOPPs. RESULTS: At baseline (t0), 502 cancer patients participated in the study and provided data on OOPPs and socioeconomic status. The mean 3-month OOPPs were the following: €205.8 at baseline, €179.2 at t1, and €148.1 at t2. Compared to the lowest income group (< €500 monthly), all other income groups (€500-999, €1000-1499, and ≥ €1500) had higher 3-month OOPPs of €52.3 (p = 0.241), €90.2 (p = 0.059), or €62.2 (p = 0.176). Financial burden at t0 was 6.4% (SD 9.2%) on average, 5.4% (SD 9.9%) at t1, and to 3.9% (SD 7.0%) of monthly income at t2. CONCLUSION: German cancer patients face relatively high OOPPs during their cancer journey. These payments may burden cancer patients, especially certain subgroups like low-income groups.

[Finding the needles in the haystack: quality criteria for the use of internet-based self-management interventions in the prevention and treatment of mental disorders]. / Die Nadeln im Heuhaufen finden: Qualitätskriterien für den Einsatz von internetbasierten Selbstmanagement-Interventionen in Prävention und Behandlung psychischer Störungen.

Numerous self-management interventions have proven to be efficacious in the treatment of a number of mental disorders in randomized trials. However, these interventions have not yet reached clinical routine everywhere. Among other things, this is due to the fact that, in addition to the evidence-based interventions, other interventions are offered that have never been scientifically investigated, and in some cases, do not even rely on evidence-based methods of psychotherapy. The present quality criteria, developed by the two professional associations DGPs and DGPPN, are intended to help patients, practitioners and decision-makers in the health care sector to identify safe and efficacious interventions. The core quality criteria cover the following aspects: safety of patients and their data; ensuring therapeutic quality by using evidence-based psychotherapeutic methods and developing the intervention in liaison with licensed psychotherapists or medical specialists; the presence of proof of efficacy from at least one randomized trial; and transparency regarding key information, e. g., the cost of the intervention. We hope that these criteria can contribute to the inclusion of self-management interventions in the range of services covered by statutory health insurance companies.

User Acceptance of Computerized Cognitive Behavioral Therapy for Depression: Systematic Review.

BACKGROUND: Computerized cognitive behavioral therapy (cCBT) has been proven to be effective in depression care. Moreover, cCBT packages are becoming increasingly popular. A central aspect concerning the take-up and success of any treatment is its user acceptance. OBJECTIVE: The aim of this study was to update and expand on earlier work on user acceptance of cCBT for depression. METHODS: This paper systematically reviewed quantitative and qualitative studies regarding the user acceptance of cCBT for depression. The initial search was conducted in January 2016 and involved the following databases: Web of Science, PubMed, the Cochrane Library, and PsycINFO. Studies were retained if they described the explicit examination of the user acceptance, experiences, or satisfaction related to a cCBT intervention, if they reported depression as a primary outcome, and if they were published in German or English from July 2007 onward. RESULTS: A total of 1736 studies were identified, of which 29 studies were eligible for review. User acceptance was operationalized and analyzed very heterogeneously. Eight studies reported a very high level of acceptance, 17 indicated a high level of acceptance, and one study showed a moderate level of acceptance. Two qualitative studies considered the positive and negative aspects concerning the user acceptance of cCBT. However, a substantial proportion of reviewed studies revealed several methodical shortcomings. CONCLUSIONS: In general, people experience cCBT for depression as predominantly positive, which supports the potential role of these innovative treatments. However, methodological challenges do exist in terms of defining user acceptance, clear operationalization of concepts, and measurement.

Early retirement in cancer patients with or without comorbid mental health conditions: a prospective cohort study.

BACKGROUND: The authors investigated whether cancer patients who have comorbid mental health disorders (MD) are at greater risk of early retirement compared with those who do not have MD. METHODS: Individuals ages 18 to 55 years from a consecutive sample of patients who were admitted for inpatient oncologic treatment were interviewed using structured clinical interviews to ascertain MD. The patients were followed for 15 months, and the date of early retirement was documented. Rates of early retirement per 100 person-years (py) in patients with and without MD were compared using multivariate Poisson regression models. RESULTS: At baseline, 491 patients were interviewed, and 150 of those patients (30.6%) were diagnosed with MD. Forty-one patients began full early retirement during follow-up. In patients with MD, the incidence of early retirement was 9.3 per 100 py compared with 6.1 per 100 py in mentally healthy patients. The crude rate ratio (RR) was 1.5 (95% confidence interval [CI], 0.8-2.8). The effect of MD on early retirement was modified in part by income: in patients with low income, the adjusted RR was 11.7, whereas no effect was observed in higher income groups. Patients with depression were at greater risk of retirement when they had higher income (RR, 3.4; P = .05). The effects of anxiety (RR, 2.4; P = .05), adjustment disorders (RR, 1.7; P = .21), and alcohol dependence (RR, 1.8; P = .40) on early retirement were equal across income groups. CONCLUSIONS: Mental health conditions are risk factors for early retirement in cancer patients, although this effect differs according to the type of disorder and the patient's income level.