Experiences of Domestic and School Violence Among Child and Adolescent Psychiatric Outpatients.

The experience of cumulative childhood adversities, such as exposure to domestic violence or abuse by caregivers, has been described as risk factor for poor mental health outcomes in adolescence and adulthood. We performed an investigation of experience of violence in all patients aged 6 to 20 years who had consulted the Department of Child and Adolescent Psychiatry, Medical University of Vienna, as outpatients during the period of one year. We were using the Childhood Trauma Interview (CTI) in order to obtain information on the kind of violence. Seventy-five percent of all patients had reported experiences of violence. These youth were significantly more often involved in acts of school violence, thus a significant correlation between experience of domestic violence and violence at school could be revealed. The results of our study emphasize the need for interventions preventing violence both in domestic and in school environments.

Awareness and knowledge of child abuse amongst physicians - a descriptive study by a sample of rural Austria.

This study with a selected sample of physicians was conducted to assess their awareness and knowledge of child abuse. Two thirds (66.7%) of all participants confirmed contact with obviously abused children in the course of their professional life, whereas 87.3% did not report any prior education or training in that field. In relation to general practitioners, pediatricians had significantly more contacts with abused children (p = 0.021) and more prior education (p = 0.012). Results indicate that physicians in rural regions of Austria possess basic knowledge. Better training and further specialization is needed to facilitate diagnosing, enhance reporting, strengthen cooperation with experts and reduce fears when handling abuse victims. Austria is a rich country with excellent health care and competitive research structures. However, child abuse research in Austria still has to fill gaps in order to keep up with international developments.

[Referral success to psychotherapy of patients with personality disorders - therapeutic consequences]. / Uberweisungserfolg in Psychotherapie bei Patienten mit Persönlichkeitsstörungen - Therapeutische Konsequenzen.

BACKGROUND: Psychotherapy plays an important role in the treatment of patients suffering from a personality disorder. It is known that many patients with personality disorders do not take up psychotherapy or drop out of treatment prematurely. The aim of the present study was the detection of factors in patients with personality disorders which influence the referral to psychotherapy. METHODS: Personality characteristics (socio-demographic parameters, affect experience and regulation, quality of object relations, character traits, level of interpersonal problems) of 297 patients of a psychoanalytic-psychotherapeutic outpatient clinic were assessed. Their influence on therapy engagement were analysed by means of logistic regressions. RESULTS: Within univariate analysis certain personality traits (mature psychological functioning vs. negativistic personality features) showed predictive power. The multivariate analysis identified the patients' educational level as the principal indicator for psychotherapy utilization. CONCLUSIONS: Consequences for diagnostic initial interviews in connection with the role of the educational level for the therapeutic alliance are discussed. Further, the impact of economic aspects on therapy engagement is discussed.

[Predictive power on therapy engagement in personality disorders: SWAP- 200 versus SCID-II]. / Voraussagekraft für die Therapie-Inanspruchnahme bei Persönlichkeitsstörungen: SWAP-200 und SKID-II im Vergleich.

The study compares the predictive power of the Shedler-Westen-Assessment Procedure-200 with the Structured Clinical Interview for DSM-IV on engagement in (psychoanalytic) psychotherapy within 297 patients with personality disorders in a 4-year-follow-up. Multinomial logistic regression showed small differences between the prediction rates in the cross-validated data. Both instruments showed clinically useful prediction rates for treatment rejecters: SWAP scales led to correct predictions with dysphoric traits as semi-stable predictors for rejecters, while SCID scales led to correct predictions with Negativistic, Depressive and Schizotypal PD as stable predictors. Results are discussed under the aspect of advantages and disadvantages of the SWAP-200 diagnostic procedure, which includes the assessment of affect-experience, defence-organisation, and object-relation-style.

[Students' attitudes towards psychotherapy: changes after a course on psychic functions in health and illness]. / Einstellungen von Medizinstudenten zu Psychotherapie: Veränderungen nach Unterricht über Psychische Funktionen in Gesundheit und Krankheit.

OBJECTIVES: Little is known about the attitude of medical students towards psychotherapy and the influence of lectures on psychotherapy during the medical curriculum on these attitudes. METHODS: 2 years in a row, medical students of the Medical University of Vienna in their fourth academic year were asked regarding their attitudes, connotations and associations towards psychotherapy before and after a 5-week psychotherapeutic course. RESULTS: The attitudes of the medical students were predominantly positive, while some prejudices could be found. The students' sex and prior experience with psychotherapy influenced their attitudes. The attitudes turned out to be relatively resistant to change through teaching. CONCLUSIONS: Reasons for the small influence of the training program on the students' attitudes and possible improvements of the course (small lecture groups) are discussed.

Psychosomatic medicine in primary care: influence of training.

BACKGROUND: General practitioners (GPs) are often confronted with patients presenting somatic symptoms presumed to be decisively modulated by psychosocial factors. OBJECTIVES: We aimed to explore GPs' reported clinical routine in dealing with these patients according to the GPs' level of training in psychosomatic medicine. METHODS: A structured postal questionnaire survey was conducted among all Austrian GPs with a standardized training background in psychosomatic medicine (three levels of training; duration between one and six years) as well as in a random national sample of Austrian GPs without such training, resulting in four study subgroups. RESULTS: Respondents estimated that between 20% and 40% of their patients presenting somatic symptoms need psychosocial factors to be addressed. Study subgroups differed significantly concerning their reported diagnostic and therapeutic routine behavior patterns. Some diagnostic approaches such as clarification of lay etiology increased linearly with the level of training. The proportion of patients receiving corresponding treatment in the GP's own practice was also reported to increase with the level of training (no training: 35%, levels one and two: 46%, level three: 54%), although all subgroups estimated that over 20% of patients do not receive any corresponding treatment. CONCLUSIONS: Results point at the clinical relevance of a general training in psychosomatic medicine in primary care. They also suggest specific training effects that need to be substantiated in observational studies.

[The image of psychotherapies - a comparison between prospective therapists and laypersons]. / Das Bild der Psychotherapie(n) - ein Vergleich zwischen angehenden Psychotherapeuten und Laien.

OBJECTIVES: Considering the specific situation of psychotherapy in Austria with its wide range of different therapeutic methods which are accredited by law, we investigated their respective level of familiarity and the connotative associations of future therapists and of a sample group of the lay public regarding the different schools. METHODS: 175 persons (students of economics, students at the university clinic for psychoanalysis, and prospective psychotherapists) were interviewed concerning terms of familiarity and popularity of the therapeutic methods. Using the semantic differential we tried to operationalize the resonant connotative associations. RESULTS: There is insufficient information with regards to the existence of the various different schools on the side of the lay public. The connotations of the different groups are similar: independent of the level of familiarity, 4 different types of therapy can cluster-analytically be identified in relation to the 3 factors of the polarity profile (activity-potency-valence). CONCLUSIONS: More extensive information of the public concerning the different therapeutic possibilities is needed. Further the importance of considering subjective connotations in situations of referral and indication is discussed. Specific attention has been given to the situation of prospective psychotherapists.

Rural-urban differences in Austrian suicides.

OBJECTIVES: The answer to the question whether suicide rates are higher in urban than in rural areas may have changed over the years. This study analyzes the longitudinal trends of rural and urban suicides in Austria from 1970 to 2005. The most recent decade, 1995-2005 was also investigated cross-sectionally in terms of age groups, gender, suicide methods and family status. METHODS: Official suicide statistics were calculated in a Poisson regression model to determine trends in suicide rates according to gender in rural and urban regions as well as the ratios of rural- to urban-suicide rates. Population density levels were used as a measure of urbanization. Differences in suicide rates across the rural-urban categories were investigated in terms of genders, age groups, suicide methods and family status using Spearman correlations. RESULTS: The ratio of rural to urban suicide rates has continuously increased in both genders over the past 35 years, indicating a growing risk in rural areas. Suicide methods used in rural and urban areas vary significantly and suicide rates among men, but not women, were found to decrease with increasing urbanicity. CONCLUSION: In line with recent findings from other western countries, we showed a growing gap between rural and urban suicide rates. This suggests a need for rural-specific suicide prevention efforts, especially aimed at the male rural population.

The influence of protocol pain and risk on patients' willingness to consent for clinical studies: a randomized trial.

We tested the hypothesis that the risk or discomfort associated with a clinical trial influence patients' decisions to participate. Simultaneously, we evaluated factors likely to influence patients' decisions such as understanding of the risk and discomfort associated with the study, patient age, educational level, and psychological status. With IRB approval, participants, who believed they were being asked to participate in a real trial, were presented one of three sham protocols: no risk or pain (Control, n = 48), pain but no risk (Pain, n = 51), or risk but no pain (Risk, n = 51). Patients were debriefed at the end of the interview. Our major outcome measures were (a) understanding risk or pain associated with the proposed studies, (b) the extent to which patients felt pressured to participate, and (c) willingness to participate. Whereas understanding was similar in all groups (Control, 68%; Pain, 67%; and Risk, 72%), willingness to participate differed significantly (Control, 64%; Pain, 35%; Risk, 26%; P < 0.001). Patients who understood the level of risk or pain associated with the protocols were twice as likely to participate than those who did not (49% versus 24%; P = 0.003). Nine percent agreed to participate in the risky or painful protocols without understanding the risks involved. Patients who felt pressured did not agree to participate. Thus, the consent process protected patients, although for unexpected reasons. Understanding was poor, but patients who did not understand the risks or pain involved or who felt pressured rarely consented. Consequently, relatively few patients unknowingly agreed to participate in risky or painful studies.

[Epidemiology and management of psychosomatic patients in Austria]. / Zur Epidemiologie und Versorgung psychosomatisch Kranker in Osterreich.

The problem of epidemiological surveys of psychosomatic patients particularly in view of their requirements and willingness for treatment is discussed. Since there are no data available for Austria data from FRG are presented. These data are compared with the provision of psychotherapeutic and psychosomatic care in Austria. In addition the provision of in-patient treatment for psychosomatic patients is presented. Whereas the outpatient provision of care for psychosomatic patients can be considered acceptable in the big cities, there is a big gap in the rural areas and smaller towns. The provision of in-patient treatment is at present well below of what is considered necessary by the ministry of social affairs. From these data a serious lack of provision of care for psychosomatic patients in Austria can be deduced.

Can legislation provide a better match between demand and supply in psychotherapy?

BACKGROUND: There is evidence showing that psychotherapy very often does not reach the persons most in need of it. A change in patterns of "consumer behaviour" is difficult to achieve on the basis of individual behavioural change. Can it be achieved by changes in legislation? METHODS: By comparing socio-demographic criteria of patients seen at the University Clinic of Psychoanalysis and Psychotherapy between 1990 and 1996, we are able to give some evidence that changes in legislation, concerning psychotherapy, which took place in the years 1991, 1994 and 1995, had a significant effect on the socio-demographic composition of our patient population, showing a convergence of patient population towards the socio-demographic criteria of the population of Vienna. CONCLUSION: We argue that the changes in legislation in Austria, concerning funding of psychotherapy, and introducing a new profession "psychotherapist", have a measurable effect which works in two ways: 1) direct effect: decreased financial charge of patients; 2) indirect effect: increased motivation of patients, resulting from a reduction in stigmas attached to the role of "psychiatric patient".