Validation of the Warwick-Edinburgh Mental Well-Being Scale for the Mental Health Surveillance (MHS) of German adults.

BACKGROUND: Mental health encompasses more than just the absence of mental disorders. Thus, a Mental Health Surveillance (MHS) and reporting system for Germany should monitor mental well-being in addition to psychopathology to capture a more complete picture of population mental health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is an internationally established inventory for the integrated assessment of different aspects of mental well-being (i.e., hedonic and eudaimonic) in population samples that has not yet been validated for Germany. METHODS: Using data from a cross-sectional online survey of a convenience sample of N = 1.048 adults aged 18-79 years (51% female) living in Germany, the factorial structure, measurement invariance (age, sex) and psychometric properties of the WEMWBS in its long (14 items) and short (7 items) versions were analyzed. Additionally, correlations to relevant factors (e.g., health-related quality of life, psychological distress) were investigated as indicators of criterion validity. RESULTS: Means of model fit indices did not confirm a unidimensional factor structure for either version. The three-factor-correlative models showed moderate to good fit while the bifactor model with one general mental well-being factor and three grouping factors fitted the data best. The full range of possible responses was used for all items, and the distribution of both scales was approximately normal. Moreover, the results revealed measurement invariance across sex and age groups. Initial evidence of criterion validity was obtained. Internal consistencies were α = 0.95 and α = 0.89, respectively. Average mental well-being was comparable to that of other European countries at 3.74 for the long version and 3.84 for the short version. While there were no differences by sex, comparisons between age groups revealed higher mental well-being among the older age groups. CONCLUSIONS: Both versions of the WEMWBS showed sound psychometric characteristics in the present German sample. The findings indicate that the instrument is suitable for measuring mental well-being at the population level due to its distributional properties. These results are promising, suggesting that the scale is suitable for use in a national MHS that aims to capture positive mental health in the population as a foundation for prevention and promotion efforts within public mental health.

German adult population norm values of the short Warwick Edinburgh mental well-being scale (SWEMWBS).

PURPOSE: The Warwick-Edinburgh Mental Well-Being Scale represents an internationally established inventory to assess population mental well-being. Particularly the short form (SWEMWBS) is recommended for use in Mental Health Surveillance. In the present study, we present normative data of the SWEMWBS for the German adult population. METHODS: Data from the telephone survey German Health Update (GEDA) in 2022 representative of the German adult population (48.9% women, 18-98 years) was processed to estimate SWEMWBS percentile norm values, T-values, z-values and internationally comparable logit-transformed raw scores for the total sample (N = 5,606) as well as stratified by sex, age group and sex with age group combinations. RESULTS: The average mental well-being was comparable to that of other European countries at M = 27.3 (SD = 4.0; logit-transformed: M = 24.79, SD = 3.73). To provide a benchmark, the cut off for low well-being was set at the 15th percentile (raw score: 23; logit-transformed: 20.73), for high well-being at the 85th percentile (raw score: 32; logit-transformed: 29.31). CONCLUSION: The present study provides SWEMWBS norm values for the German adult population. The normative data can be used for national and international comparisons on a population level to initiate, plan and evaluate mental well-being promotion and prevention measures.

[Mental health surveillance at the Robert Koch Institute - strategies for monitoring the mental health of the population]. / Mental Health Surveillance am Robert Koch-Institut ­ Strategien zur Beobachtung der psychischen Gesundheit der Bevölkerung.

The continuous and systematic surveillance of the health of populations is fundamental for effective public health practice. In light of the growing importance of mental health within population health, a Mental Health Surveillance for Germany is being established at the Robert Koch Institute. Its aim is to continually provide reliable information on the current state and development of the mental health of the population.Three surveillance strategies are currently being pursued: 1) Regular comprehensive assessments aim to describe the mental health status of the population using a wide range of indicators and data sources and to observe long-term developments. They build on existing work in epidemiology and health services research. 2) High-frequency monitoring of a selection of indicators is used for the early detection of trends. 3) A continuous literature review collates current findings on mental health developments in the COVID-19 pandemic on a monthly basis. The latter two strategies were implemented in response to new information needs in the pandemic.This paper describes and discusses these three strategies and their functions, limitations, and potential for development. Their results are communicated through different forms of reporting and serve to identify needs for action and research in public mental health. The further development and long-term operation of the Mental Health Surveillance as a whole has the potential to facilitate the achievement of public mental health objectives and to contribute on different levels to the improvement of population health.

Taking a closer look at mindful eating: incremental validity and importance of subfacets.

PURPOSE: Mindful eating (ME) seems a promising approach to clarify the underlying mechanisms of mindfulness-based interventions for eating and weight-related issues. The current study aimed to investigate the incremental validity of this eating-specific approach beyond a generic conception of mindfulness and explore preliminary indication which subfacets of the multidimensional construct ME might be of particular importance in order to study them more precisely and tailor mindfulness-based interventions for eating and weight-related issues more properly. METHODS: Self-report data (N = 292) were collected online. Hierarchical regression analyses were used to explore the incremental validity of ME beyond generic mindfulness, predicting maladaptive eating (emotional and uncontrolled eating) and consumption of energy-dense food. Multiple regressions were used to examine the impact of the seven different ME subfacets on the very same outcomes. RESULTS: Findings demonstrated the incremental validity of ME on all outcomes. Generic mindfulness no longer predicted emotional eating, uncontrolled eating, or the consumption of energy-dense food when entering ME. The subfacet 'non-reactive stance' predicted all three outcomes significantly. For emotional and uncontrolled eating, the subfacets 'accepting and non-attached attitude toward one's own eating experience', 'eating in response to awareness of fullness', and the 'awareness of eating triggers and motives' additionally showed a significant influence. CONCLUSION: ME seems a valuable approach in clarifying how mindfulness might impact eating and weight-related issues. Beyond that, it might be beneficial for upcoming interventions to strengthen specific ME subfacets, depending on the focused outcomes. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Getting a deeper understanding of mindfulness in the context of eating behavior: Development and validation of the Mindful Eating Inventory.

PURPOSE: Current research supports the effectiveness of mindfulness-based interventions for maladaptive eating behaviors associated with obesity and eating disorders. To investigate potential underlying mechanisms at work, reliable and valid instruments that allow for an exhaustive assessment of the context-specific construct Mindful Eating (ME) are needed. Therefore, the current work aimed to develop a comprehensive inventory reflecting a wide range of ME attitudes and behaviors: The Mindful Eating Inventory (MEI). METHODS & RESULTS: Study 1 describes the item pool development for an initial version of the MEI comprising various steps (compilation of items, expert ratings, focus groups and think aloud protocols by laypersons). Within Study 2, the factor structure of this initial version was explored in an online sample of N = 828 participants and the item pool was shortened via a sequential process based on statistical and content-related considerations. Exploratory factor analyses yielded a seven-factor structure. This structure could be confirmed within Study 3 on an independent online sample of N = 612 participants using confirmatory factor analysis. Criterion validity was supported by hypotheses-confirming correlations with eating-specific and global health-relevant outcomes. CONCLUSION: Our findings demonstrate that the MEI is a valid and reliable (in terms of internal consistency and retest-reliability) tool, which allows for a comprehensive assessment of various ME attitudes and behaviors within one parsimonious inventory. It further enabled us to propose a so far missing, initial scientific operational definition of this eating-specific construct, that may help to advance future research and clinical application by clarifying mechanisms of action.

Healthcare and health situation of adults with type 2 diabetes in Germany: The study GEDA 2021/2022-Diabetes.

Background: The nationwide study German Health Update (GEDA) 2021/2022-Diabetes was conducted to assess the current healthcare and health situation of adults with diabetes in Germany. Methods: GEDA 2021/2022-Diabetes comprises a sample of adults with diagnosed diabetes from the general population. The analysis focuses on adults aged 45 years and over with type 2 diabetes (N = 1,448) and provides selected indicators on diabetes care as well as mental, social and general health. Results: 87.5 % of participants aged 45 years and over with type 2 diabetes are treated with blood glucose-lowering medication. 36.5 % receive insulin alone or in combination with other antidiabetics; 0.7 % use an insulin pump. Almost 96 % had an HbA1c measurement in the last year and about two thirds each report annual foot and eye examinations, participation in a diabetes self-management education programme and self-monitoring of their feet and of blood glucose (12.0 % with continuous glucose monitoring). On average, the quality of diabetes care is perceived as moderate. 23.8 % rate their mental health as excellent/very good. More than a tenth each have anxiety or depressive symptoms and feelings of loneliness. Half rate their general health as very good/good. Conclusions: There is a potential for improvement in the quality of diabetes care and the mental and physical health of adults with type 2 diabetes.

Time trends in mental health indicators in Germany's adult population before and during the COVID-19 pandemic.

Background: Times of crisis such as the COVID-19 pandemic are expected to compromise mental health. Despite a large number of studies, evidence on the development of mental health in general populations during the pandemic is inconclusive. One reason may be that representative data spanning the whole pandemic and allowing for comparisons to pre-pandemic data are scarce. Methods: We analyzed representative data from telephone surveys of Germany's adults. Three mental health indicators were observed in ~1,000 and later up to 3,000 randomly sampled participants monthly until June 2022: symptoms of depression (observed since April 2019, PHQ-2), symptoms of anxiety (GAD-2), and self-rated mental health (latter two observed since March 2021). We produced time series graphs including estimated three-month moving means and proportions of positive screens (PHQ/GAD-2 score ≥ 3) and reports of very good/excellent mental health, as well as smoothing curves. We also compared time periods between years. Analyses were stratified by sex, age, and level of education. Results: While mean depressive symptom scores declined from the first wave of the pandemic to summer 2020, they increased from October 2020 and remained consistently elevated throughout 2021 with another increase between 2021 and 2022. Correspondingly, the proportion of positive screens first decreased from 11.1% in spring/summer 2019 to 9.3% in the same period in 2020 and then rose to 13.1% in 2021 and to 16.9% in 2022. While depressive symptoms increased in all subgroups at different times, developments among women (earlier increase), the youngest (notable increase in 2021) and eldest adults, as well as the high level of education group (both latter groups: early, continuous increases) stand out. However, the social gradient in symptom levels between education groups remained unchanged. Symptoms of anxiety also increased while self-rated mental health decreased between 2021 and 2022. Conclusion: Elevated symptom levels and reduced self-rated mental health at the end of our observation period in June 2022 call for further continuous mental health surveillance. Mental healthcare needs of the population should be monitored closely. Findings should serve to inform policymakers and clinicians of ongoing dynamics to guide health promotion, prevention, and care.

Mental health indicators for children and adolescents in OECD countries: a scoping review.

Background: This scoping review is a further step to build up the Mental Health Surveillance System for Germany. It summarizes and analyzes indicators used or described in Organization for Economic Co-operation and Development (OECD) countries for public mental health monitoring in children and adolescents aged 0-18 years. Methods: We searched PubMed-MEDLINE, PsycINFO, Cochrane Databases, and Google Scholar from 2000 to September 2022. The search used five general keyword categories: 1) "indicators/monitoring/surveillance" at the population level, 2) "mental/psychological," 3) "health/disorders," 4) "children and adolescents," and 5) 38 OECD countries. The search was complemented with an extensive grey literature search, including OECD public health institutions and an internet search using Google. A predefined set of inclusion and exclusion criteria was applied. Results: Over 15,500 articles and documents were screened (scientific search N = 10,539, grey literature search more than 5,000). More than 700 articles and documents have been full-text assessed, with 382 being ultimately included. Out of 7,477 indicators extracted, an initial set of 6,426 indicators met our inclusion criteria for indicators. After consolidating duplicates and similar content, this initial set was categorized into 19 topics, resulting in a final set of 210 different indicators. The analysis highlighted an increasing interest in the topic since 2008, but indicators for the younger age, particularly those aged 0 to 2 years, were less readily available. Conclusion: Our research provides a comprehensive understanding of the current state of mental health indicators for children and adolescents, identifying both (1) indicators of public mental health noted in a previous scoping review on adults and (2) new indicators specific to this age group. These findings contribute to the development of effective public health surveillance strategies for children and adolescents and inform future research in this field.

[Evidence syntheses in public health: An overview]. / Evidenzsynthesen in Public Health: ein Überblick.

BACKGROUND: Since the beginning of the COVID-19 pandemic, there has been a high demand for rapid evidence syntheses to answer urgent public health questions. This article provides an overview of different types of reviews for public health questions and a synthesis of existing recommendations for the preparation of reviews. The aim is to support the planning of one's own review and the critical evaluation of published reviews. METHODS: The basis of this summary is an extensive search for guidelines and recommendations for different review types. Furthermore, internal journal clubs were held to determine knowledge needs and to critically discuss the various review types. Relating to the dissemination of results, fact sheets were developed for the individual review types including the most important information, prerequisites and work steps, as well as a decision tree for identifying the appropriate review type for the respective question. RESULTS: Of the review types identified, Systematic, Rapid, Scoping, Umbrella, and Narrative Reviews were considered in more detail because they are particularly relevant to public health issues. Together with scoping and umbrella reviews, systematic reviews have the highest resource requirements due to the demands for extensive, systematic evidence synthesis and reproducibility. Rapid methods can accelerate the review process, for example by a very narrowly formulated question, a limited literature search, or the execution of certain steps by one instead of two persons. DISCUSSION: Systematic Reviews may be considered as the gold standard, but they were developed primarily for clinical questions relating to interventions. This article, however, focusses on review types that consider the diversity of questions as well as the predominant use of quantitative methods in the field of public health. The fact sheets developed and the decision tree should enable low-threshold access to reviews while linking the perspectives of research and resource planning. They complement existing guidelines and recommendations. CONCLUSION: To answer the diverse spectrum of public health questions, various types of reviews with various requirements and approaches are available. Given this diversity, a systematic introduction can be helpful for researchers planning or assessing a review.

Indicators for Public Mental Health: A Scoping Review.

Background: To monitor population mental health, the identification of relevant indicators is pivotal. This scoping review provides a comprehensive overview of current indicators representing the various fields of public mental health core topics. It was conducted as a first step to build up a Mental Health Surveillance for Germany. Methods: We conducted a systematic MEDLINE search via PubMed. This search was supplemented by an extensive examination of the websites of relevant national as well as international institutions in the context of public mental health and an additional internet search via Google. To structure the data, an expert-based focus group identified superordinate topics most relevant to public mental health to which the identified indicators could be assigned to. Finally, the indicator set was screened for duplicates and appropriate content to arrive at a final set. Results: Within the various search strategies, we identified 13.811 records. Of these records, a total of 365 records were processed for indicator extraction. The extracted indicators were then assigned to 14 topics most relevant to public mental health as identified by the expert-based focus group. After the exclusion of duplicates and those indicators not meeting criteria of specificity and target group, the final set consisted of 192 indicators. Conclusion: The presented indicator set provides guidance in the field of current concepts in public mental health monitoring. As a comprehensive compilation, it may serve as basis for future surveillance efforts, which can be adjusted and condensed depending on the particular monitoring focus. Our work provides insights into established indicators included in former surveillance work as well as recent, not yet included indicators reflecting current developments in the field. Since our compilation mainly concludes indicators related to mental health in adults, it should be complemented with indicators specific to children and adolescents. Furthermore, our review revealed that indicators on mental health promotion and prevention are underrepresented in current literature of public mental health and should hence be focused on within future research and surveillance.

Mental health of the adult population in Germany during the COVID-19 pandemic. Rapid Review.

This rapid review examines how the mental health of adults in the general population in Germany changed during the COVID-19 pandemic. We conducted a systematic literature search and included 68 publications as of July 30 2021. The underlying studies were classified according to their suitability for representative statements for the general population and for estimating changes in mental health over time. In addition, the observation period and operationalisation of outcomes were considered. The first wave of infection and the summer plateau were mapped by 65% of the studies. Studies that were particularly suitable for representative statements due to their research design showed mixed results, which tend to indicate a largely resilient adult population with a proportion of vulnerable individuals. A predominantly negative development of mental health was described by results from more bias-prone study designs. Routine data analyses showed decreases in outpatient and especially inpatient care, increased use of a crisis service, mixed results for outpatient diagnoses, incapacity to work and mortality as well as indications of shifts in the spectrum of diagnoses. As the current evidence is ambiguous, generalised statements should be reflected in favour of a differentiated view. There is a need for research on the further course of the pandemic, specific risk groups and the prevalence of mental disorders.

Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set.

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