[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.

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.

[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.

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.

[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.

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.

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.

Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care.

Somatic symptoms and anxiety symptoms are often disregarded in the detection of depression in primary care. The present investigation examined to what extent somatic and anxiety symptoms recorded with the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC) can improve the detection of depression as compared to the General Health Questionnaire-12-item version alone. Data from the World Health Organization study on Psychological Problems in General Health Care were used. The study sample consisted of primary care attenders from 15 centres from all over the world who underwent a psychiatric examination with the CIDI-PHC. Medically unexplained somatic symptoms (back pain, feelings of heaviness/lightness in parts of the body, periods of bodily weakness, seizures/convulsions, permanent tiredness, exhaustion after a minimum of effort) and-to a smaller extent-diverse anxiety symptoms (e.g. feelings of anxiousness/nervousness, feelings of tension, difficulties relaxing) significantly contributed to the detection of depression in a logistic regression analysis. The results confirm the observation that in primary care somatic symptoms play an important role in the manifestation of depressive disorders. The items investigated herein could prove beneficial for future depression screening instruments to improve the detection of depressive disorders in primary care.

[Barriers and need for support in the primary care of depressive patients]. / Barrieren und Unterstützungsbedarf in der hausärztlichen Versorgung depressiver Patienten.

The aim of the study was to record the difficulties and barriers in the management of depressive patients faced by primary care physicians, their self-reported competence and need for support. In this study a questionnaire was sent out to 960 physicians, of whom 180 replied (response rate: 19%). This sample matches the total sample in essential dimensions such as age, sex and special field. From the results retrieved it can be concluded that apart from organisational structural factors the greatest barriers in the treatment of depressive patients are created by the patients' behaviour, i.e. mainly scepticism and reluctance towards treatment. The physicians rated their own competence in treating depression highly, especially concerning diagnostics and primary care. Accordingly, physicians reported they required support in more specific areas (mainly in the management of suicidality). The results are discussed with respect to their implications for professional development programs. Two central aspects were identified: a) the development of practice-oriented measures that can be used to improve guideline-based health care and b) the explicit involvement of patients into treatment processes.

[Development and evaluation of a basic documentation tool for guideline-oriented ambulatory care of depressive patients]. / Entwicklung und Evaluation einer Basisdokumentation zur leitlinienorientierten ambulanten Versorgung depressiver Patienten.

Quality assurance in the treatment of mental disorders is becoming increasingly significant. In this context, documentation systems are important in order to control the implementation of guidelines, to analyse shortcomings and to reveal improvement possibilities. Up till now there is no specific documentation tool for the outpatient care of depressive disorders. Within the project "Comprehensive Quality Management in Out-patient Care" a documentation tool for primary care as well as for psychiatric care of depressive patients has been developed, which embraces the principal diagnostic and therapeutic measures. This documentation tool consisting of an instrument for the physician to record the first consultation, a second instrument to record the following consultations as well as a patient questionnaire has been implemented and evaluated in primary care and psychiatric practices. The evaluation results demonstrate that the documentation tool is able to assess guideline-oriented treatment measures. Physicians evaluated the usefulness and practicability of the documentation tool positively. And although the documentation efforts required are quite extensive, this documentation tool provides a suitable basis for external or internal quality assurance as well as patient-oriented case-monitoring.

[Continuing education and quality management measures for the implementation of clinical practice guidelines]. / Fortbildungs- und Qualitätsmanagement-Massnahmen zur Implementierung von Versorgungsleitlinien.

In the past years it could be shown that evidence-based guideline-oriented treatment of depressive patients leads to better diagnosis, to more adequate therapy and to better networking of the different levels of care. And yet, guidelines have been rarely used. On the other hand, better short-dated support of depressive patients is achievable by medical education. But to ensure the application of guidelines in the long term, it is necessary to consider individual practice and local/regional conditions. There is a need for interactive and experience-oriented educational concepts. The present educational concept of "Out-patient Depression Management" has been developed as part of the "Comprehensive Quality Management in Out-patient Care" project and implemented in two study regions of Southern Baden and North Rhine. The depression management concept was designed as a combination of interactive, guideline-oriented continuous medical education with interdisciplinary quality circles. The evaluation of the depression management concept shows very positive ratings from both primary care physicians and psychiatrists: 70% of the primary care physicians and 83% of the psychiatrists were satisfied or much satisfied with the program. 70% of the primary care physicians and 50% of the psychiatrists evaluated the usefulness for practice as good or very good.

[Information and participation interests of patients with depression in clinical decision making in primary care]. / Informations- und Partizipationsinteressen depressiver Patienten bei der medizinischen Entscheidungsfindung in der hausärztlichen Versorgung.

A main flaw in the primary care of depression is the patients' skepticism about adequate treatment. Despite effective treatment options patients' medical demand is poor and their information insufficient. The present study aims to improve patients' information and their participation in decision making to enhance treatment motivation and satisfaction with treatment and clinical outcome. It is unclear, though, if patients are able to show interest in information and participation because of depression-specific deficits (e.g. an impairment of cognition and concentration). In a controlled study 232 patients with depression from 30 GP practices completed questionnaires assessing information and participation needs. Patients with all severity grades of depression are highly interested in information (mean = 85.2; range 0-100) and moderately interested in participating in decision making (mean = 46.8; range 0-100). Perceived involvement in care achieved a mean of 68.4 (range 0-100). The implementation of shared decision making in the primary care of depressive patients is reasonable and will be realised and evaluated within the scope of a targeted continuing education program for general practitioners.

[Comprehensive ambulatory care quality management for patients with depressive disorders]. / Umfassendes ambulantes Qualitätsmanagment in der Versorgung depressiver Patienten.

Depressive disorders are of great medical and political significance. Despite improvements in the treatment of depressive patients, the potential for guideline-oriented diagnosis and therapy as well as better co-operation between different levels of care is evident. This study is part of the German Research Network on Depression and Suicidality. The study is conducted in Southern Baden, North Rhine and Munich. The objective is to develop a quality management program for primary care physicians and psychiatrists. A comprehensive continuous medical education concept as well as quality management measures were developed, implemented and evaluated. A total of 66 physicians (43 primary care physicians and 23 psychiatrists) participated. They documented the diagnostic and treatment measures provided to depressive patients before and after the intervention that had been implemented in the intervention regions of Southern Baden and North Rhine. Effects regarding guideline orientation and implementation of stepped-care treatment are analysed with an intervention/control group design and prepost data measurement.

[Clinical practice guidelines for the diagnosis and therapy of depressive disorders in primary care]. / Versorgungsleitlinien zur Diagnostik und Therapie depressiver Störungen in der hausärztlichen Praxis.

The guidelines for diagnosis and treatment of depressive disorders are practice-oriented and evidence-based recommendations for primary care of depressive patients. They were developed in the context of subproject 3.1 "Comprehensive Quality Management in Outpatient Care" within the German Research Network on Depression and Suicidality. The guidelines were developed by research groups from study centres in Freiburg, Duesseldorf and Munich and an external expert group. In addition, a close co-operation was established with the Guideline Clearing Commission of the Agency for Quality in Medicine (AQuMed) and the Drug Commission of the German Medical Profession (AkdA) and are intended as an orientational aid in terms of a "pathway of care". The guidelines particularly address physicians in primary care. The development process followed the methodological recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) and the requirements of evidence-based medicine. National and international guidelines for depressive disorders as well as Cochrane reviews (CR) and quality-assessed reviews (CRD) were taken into account. The present formulation of the treatment guidelines and the evidence was agreed upon in a consensus process that included all participants.

[Agreement in physicians' and patients' assessment of depressive disorders]. / Konkordanz von Arzt- und Patienten-Einschätzung bei depressiven Störungen.

Depression is one of the most frequently encountered mental health disorders in primary care. The health and financial burden caused by this disorder emphasise the clinical importance of depressive disorders. Research shows that these conditions often remain unrecognised and untreated. The aim of this study is to analyse if and how primary care physicians identify this condition in comparison to the patients' self-evaluation. A total of 1,233 cases in 32 primary care physicians' offices were examined to see if symptoms of depression were recognised. The assessment procedures were evaluated, too. In this study, the prevalence of depressive disorders was 10%, and the recognition rate of primary care physicians 45%. These results underscore the importance of improving physicians' recognition of depression and use of ICD-10 criteria for differential diagnosis. Conclusions must be drawn for a specific training of primary care physicians that focuses on the improvement of diagnosis and treatment of depressed patients.

[Reason for encounter and diagnosis of depression in patients in general practice]. / Beratungsanlass und Diagnosestellung bei depressiven Patienten in der hausärztlichen Praxis.

The present study investigates the extent to which the physicians' diagnosis of depression was influenced by the reason that patients gave for seeking help, i.e. the reason for encounter. The level of correspondence between the somatic diagnoses of 20 GPs and the self-ratings of 862 patients from the regions of North Rhine and Southern Baden in regard to the presence of a depressive syndrome was recorded. In addition to the somatic diagnosis of depression (yes/no), the reason for encounter as well as primary and secondary diagnoses of the participating GPs were also documented. The results show that approximately 10% of the GPs' patients judged themselves to be depressed and that in these patients, the GPs diagnosed depression in only 39% of cases. This low level of correspondence between physician and patient in regard to depression can be accounted for by the finding that first, there is little difference between depressed and non-depressed patients in the manner in which they distinguish themselves in regard to their reason for encounter and that second, depressed patients expressed more somatic (57%) than mental symptoms (20%). A depressive disorder was only reported for 5% of the patients who had judged themselves to be depressed. On the whole, the results have shown that the reasons for seeking treatment expressed by patients had a significant influence on correspondence between the physician and patient: for patients who had been judged by a physician and themselves to be depressed, mental complaints (34%) were more likely to be reported than for patients who had not been diagnosed with depression by their GPs (10%). Additional questions addressed to the physicians revealed that they were more likely to diagnose depression on the basis of the patients' self-ratings and behaviour than to routinely question the patients for symptoms of depression. Hence, the study underlines the need for training in criteria-orientated diagnosis and the application of suitable screening instruments for depressive disorders in general practice.

[Subjectively-perceived inappropriate treatment of depressed patients in general and psychiatric practice]. / Unzureichender subjektiver Behandlungsverlauf bei depressiven Patienten in der haus- und nervenärztlichen Praxis.

In the present study, process quality in outpatient depression care was documented by general practitioners and specialists in psychiatry. Opportunities to improve inpatient treatment were identified by comparing current physicians' treatment procedures with guideline recommendations and, furthermore, by evaluating treatment outcomes from the patients' perspective. Data of 350 depressed outpatients were collected by 43 GPs and 23 specialists in psychiatry in three study regions (Rhineland, South Baden and Munich). Data reflected psychopathology, diagnostic assessment, investigation of suicidal intentions as well as somatic and psychotherapeutic measures at the first visit. Additionally, change in depression symptoms after six to eight weeks by means of self-rating (n = 165) and expert rating (n = 70) was measured. The study shows that the GPs and, to a lesser extent, the specialists, still fail to orient themselves towards guideline recommendations regarding assessment, therapy and referral in depression care. These findings seem to be reflected in insufficient self rated treatment outcome: one half of the patients reported a reduction in depression symptoms, the other half of patients reported stagnation or even progression. Expert ratings of treatment courses were more positive. The results indicate a considerable need for guideline training and improvement of networking and co-operation between GPs and specialists as well as between inpatient and outpatient settings.

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.