[Development and Psychometric Evaluation of a Short Questionnaire on Self-Efficacy Expectations in Dealing with Psychologically Difficult Situations (SWEP)]. / Entwicklung und psychometrische Überprüfung eines Kurzfragebogens zur Selbstwirksamkeitserwartung im Umgang mit psychisch belastenden Situationen (SWEP).

OBJECTIVE: Development and psychometric evaluation of a German 6-item instrument to assess self-efficacy expectations to seek support in psychologically difficult situations (SWEP). METHODS: Development of items, determination of distribution characteristics, factor structure, and internal consistency of the scale based on a paper-pencil survey (N=269) and a survey of an online intervention on suicide prevention (N=802). RESULTS: Principal component analysis revealed the SWEP scale to be a one-dimensional construct with high internal consistency (Cronbach's α=.83 and α=.89). We found content-plausible correlations to other constructs and initial evidence of a high retest reliability. CONCLUSION: The SWEP provides a reliable, valid, brief instrument for assessing self-efficacy expectations of being able to seek support.

[Medical Psychology and Medical Sociology in Transition - Review and Perspectives of the two Disciplines in Germany]. / Medizinische Psychologie und Medizinische Soziologie im Wandel ­ Bestandsaufnahme und Perspektiven der beiden Fächer in Deutschland.

AIM OF THE STUDY: Through the Master Plan for Medical Studies 2020 and the development of the National Competence-Based Learning Target Catalogue Medicine (NKLM), significant changes in university medicine were started. The aim of the study was a systematic analysis of the state and perspectives of the disciplines of medical psychology and sociology at the medical faculties in Germany. METHODOLOGY: An online survey was conducted on 5 topics (structure, teaching, research, care, perspectives). 46 departments and institutes of medical psychology and sociology were invited to the survey. RESULTS: 40 of the 46 contacted institutions have called up the online questionnaire, 35 have answered in full (return: 76.1%). 77% of the institutions are autonomous. In the median, the institutions have 15 employees (range: 1 to 149). 9 universities have established a model curriculum. More than half of the institutions use and train simulation patients. The main research priorities are clinical research, health care research, neuroscience and classical medical psychology or sociological research topics. The institutions receive primarily public funding and publish 19 publications (80% international, median) each year. Publication opportunities are considered "satisfactory" by 54% of institutions (2003: 44%), and by 29% as "very satisfactory" (2003: 21%). 9 out of 27 medical psychology institutes provide clinical services to patients and relatives with mental or chronic physical illness. Almost half of the institutions expect the Master Plan 2020 to further increase the relevance of the subjects. DISCUSSION: Since 2003 there has been a substantial increase in scientific staff, third-party funding and publications. The sites show a pronounced heterogeneity in terms of size and equipment, which leads to an imbalance in terms of teaching and research as well as clinical services. CONCLUSION: The subjects of medical psychology and medical sociology have developed very heterogeneously in terms of independence, size, equipment and possibilities at the various faculties in Germany. Therefore, it is very important in the future that the 2 disciplines intensify the dialogue with each other and also with other psychosocial disciplines in order to influence the current development regarding NKLM and Master Plan 2020 constructively. On the one hand, this calls for an expansion of disadvantaged institutions and a consolidation of the existing autonomous institutions.

Differences in depression stigma towards ethnic and socio-economic groups in Germany - Exploring the hypothesis of double stigma.

BACKGROUND: Ethnic minorities and people with a low socio-economic status (SES) are often mentioned groups potentially affected by double stigma when faced with the burden of mental illness. Against this background we examine differences in public attitudes towards a) migrant vs. non-migrant persons with depression and b) low vs. high SES persons with depression. METHOD: Analyses are based on data of a representative cross-sectional telephone survey among the adult population in Germany (N=2013). To compare the four groups, different depression vignettes were presented to the respondents. Three components of stigma were assessed in the survey: (1) characteristics ascribed to persons with a depression, (2) emotional reactions to people afflicted by depression, and (3) desire for social distance. RESULTS: Respondents less often felt annoyed when the person in the depression vignette was a migrant coming from Turkey. However, differences are not statistically significant in the vast majority of the analyzed items. In terms of the comparison between high and low SES persons, analyses reveal small and inconsistent differences in public depression stigma. LIMITATIONS: The study focusses on two deprived groups (ethnic minorities and people with a low SES) and is restricted to Germany. CONCLUSIONS: Individuals with a low SES (compared to those with a high SES) and migrants (compared to non-migrants) with depression do not seem to be confronted with double public stigma in terms of stereotypes, emotional reactions, and desire for social distance.

Self-help friendliness: A German approach for strengthening the cooperation between self-help groups and health care professionals.

Public and patient involvement in social and health care has proceeded in many civil societies. Depending on the legislations on national and community levels, citizens and patients have a greater say in shaping social and health care. In Germany, the patient involvement by self-help organizations at the macro level (national level and level of federal states) has significantly developed over the last ten years. At the meso level, however, the patient involvement is neither such far nor such systematically developed. The concept of self-help friendliness (SHF) in health care is a patient centred model that allows the development and implementation of patient participation in different health care institutions: hospitals, ambulatory medical care, public health institutions, rehabilitation facilities etc. In a series of projects on SHF we have (1) analysed the needs and wishes of self-help groups for cooperation with health care professionals as well as their experience, (2) gathered facilitators and barriers concerning the cooperation between self-help groups and hospitals, (3) developed a framework concept for SHF in hospitals including eight quality criteria for measuring SHF, and (4) implemented the framework of SHF in about 40 health care institutions (www.selbsthilfefreundlichkeit.de). Further projects followed: development of an instrument for measuring SHF in hospitals, integration of SHF-criteria in quality management systems in inpatient care as well as in out-patient care, and transferring SHF to a) medical ambulatory care, b) public health departments, and c) rehabilitation facilities. Considering advantages and shortcomings of the approach, we can summarize that implementing SHF is feasible, transferable and a helpful measure for promoting patient centeredness in health care.

Beliefs about depression--do affliction and treatment experience matter? Results of a population survey from Germany.

BACKGROUND: There is not much known about the associations of beliefs about depression (depression literacy) with a history of depression and treatment experience. METHODS: Analyses were based on a telephone survey in two large German cities (Hamburg and Munich). Written vignettes with typical signs and symptoms suggestive of a depression were presented to 1293 respondents. Respondents were then asked about beliefs about causes, symptoms, prevalence, and treatment using a standardized questionnaire. For the analysis respondents were divided into three groups: (1) people who never had a depression, (2) people who had a depression but were not treated and (3) people with treatment experience. RESULTS: Respondents with experience in treatment for depression were more likely to correctly recognize the disorder, to positively evaluate treatability and to favor external factors (adverse conditions in childhood and psychosocial stress) as potential causes of depression compared to those who never were afflicted. There were no significant differences between these two groups regarding beliefs about the effectiveness of treatment options. There were only few significant differences in depression literacy between respondents who have a history of depression but have not sought help and those who never were afflicted. LIMITATIONS: The three groups were constituted on the basis of respondents׳ self-reports, not medical diagnoses. CONCLUSIONS: Our findings only partly support the general assumption that being afflicted and having sought help is associated with beliefs closer to those of professionals.

[Diagnosis and therapy of depression in the elderly--influence of patient and physician characteristics]. / Diagnose und Therapie einer Depression im höheren Lebensalter--Einflüsse von Patienten- und Arztmerkmalen.

Studies from the United States and the United Kingdom show variations in medical decision making concerning the primary care of depression. Patient and physicians attributes independently influence doctors' decisions regardless of the patients' condition. In this paper results are presented on how these factors influence primary care doctors' diagnostic and management decisions regarding a depression in Germany. A factorial experiment with a videotaped patient consultation was conducted. Professional actors played the role of patients with symptoms of a depression. A videotape with typical symptoms of the disease under study was produced where actors differ according to age (55 vs. 75 years), gender, and social status (teacher vs. janitor) in order to mirror respective patient characteristics. The videotape was presented to a total of 128 randomly selected primary care physicians in Germany, taking gender and duration of professional experience (<5 vs. >15 years) into account. Physicians confronted with the videotape were asked to judge the clinical condition and to give recommendations for diagnosis and therapy. In particular, the physicians were asked what questions they would ask, to name the most likely diagnoses, what their certainty levels were, which test(s) they would order, which medication(s) they would prescribe, and what lifestyle recommendation(s) they would make if they saw the patient from the video in their everyday clinical practice. Contrary to international studies results show only minor variation in the primary care of depression. Thus, in most aspects care of depression in Germany seems to be independent from patients' and physicians' characteristics under study.