What do the teachers want? A targeted needs assessment survey for prospective didactic training of psychiatry medical educators.

Objectives: Physicians and psychologists at psychiatric university hospitals are assigned teaching tasks from the first day of work without necessarily having the prerequisite training in teaching methods. This exploratory survey provides a needs-based analysis for the prospective didactic training of physicians and psychologists at psychiatric hospitals in Germany, Austria and Switzerland. Methods: An online questionnaire was distributed at medical schools via email in German-speaking countries in Europe. All physicians involved in teaching medical students at psychiatry faculties were eligible to participate in the survey. Participants were further requested to recruit eligible participants (snowball sampling). Responses were analyzed descriptively, and differences between groups were calculated using nonparametric Mann-Whitney U tests (p<.05). Results: Overall, 97 respondents (male=55, female=42; mean age= 40.6) from 19 medical schools completed the survey. The respondents consisted of 43 residents, 39 specialists, 6 chief physicians and 9 psychologists. Of the respondents, 97.6% rated didactic competence as either highly relevant or rather relevant for teaching medical students. The highest overall interest was shown for bedside teaching (mode=4; IQR: 2-4) and error culture (mode=3; IQR: 2-4). Respondents expressed the highest training needs for topics regarding presentation and communication (mode=3; IQR: 2-3). Resident physicians were significantly more interested in bedside teaching (U=362.0, p=0.004) and roleplay (U=425.0; p=0.036) than specialist physicians, who were more interested in examination didactics (U=415.0; p=0.022). Chief physicians displayed significantly deeper interest in group dynamics (U=51; p=0.023) than specialist physicians. In-person training was preferred by a majority of respondents, and 27.4% preferred online/web-based training. Conclusions: The majority of physicians and psychologists at psychiatric university hospitals considered professional development for faculty to be helpful for teaching medical students. Bedside teaching and error culture management were the most desired teaching topics for training medical teachers. Tailored educational interventions are recommended, with target-oriented priorities for different hierarchical levels.

Value-related attitudes towards mental health problems and help-seeking barriers: a sequential mixed-methods design investigating participants with reported depressive episodes in rural Northern Germany with and without treatment experience.

BACKGROUND: Seeking help for severe depressive symptoms remains a major obstacle for particular groups within the general population. Value-related attitudes might contribute to this treatment gap, particularly in rural regions with a low density of psychiatric-psychotherapeutic services. We aimed to investigate narratives of socialization, value systems, and barriers of help-seeking to better understand social milieus at increased risk for underuse of psychiatric-psychotherapeutic services in a rural area in East Germany. This could complement the explanatory power of classical socio-demographic determinants and provide guidance for possible interventions. METHOD: Based on results of an analysis of a population-based German cohort study (SHIP-TREND-1), 20 individual semi-structured interviews were conducted with participants who met criteria for having been moderately or severely depressed at least once in their life. Qualitative analyses of interview data were guided by grounded theory methodology. RESULTS: Participants with severe symptoms of depression were more frequent among non-responders of this study. We identified key aspects that influence help-seeking for mental health problems and seem to be characteristic for rural regions: family doctors serve as initial contact points for mental health problems and are considered as alternatives for mental health professionals; norms of traditional masculinity such as being more rational than emotional, needing to endure hardships, embodying strength, and being independent were frequently mentioned as inhibiting help-seeking by middle-aged men; anticipated adverse side-effects of therapy such as worsening of symptoms; a frequently expressed desire for less pathologically perceived treatment options. CONCLUSIONS: Our results suggest that barriers regarding help-seeking in rural regions are multifaceted and seem to be influenced by traditional norms of masculinity. We believe it is critical to strengthen existing and already utilized services such as family doctors and to implement and evaluate tailored interventions targeting the needs of the rural milieu.

Mental resources, mental health and sociodemography: a cluster analysis based on a representative population survey in a large German city.

BACKGROUND: Mental resources such as optimism and social support are important to face different stressors. The aim of this study is to identify groups in the population that are similar in terms of their mental resources. METHODS: For this purpose, a randomly selected general population community sample was used, representative for the city of Leipzig, Germany. In a two-stage process, three clusters were identified using hierarchical cluster analysis and the K-means method and then tested with a multinomial logistic regression analysis for differences in sociodemographic characteristics. RESULTS: Three clusters were identified which vary in their extent of social support and optimism. In distinguishing between those with higher and lower (medium or poor) mental resources, male gender, unemployment, being born abroad and low household income are risk factors for having fewer mental resources. Internal migrants from West Germany and persons with children at home have a higher chance of being in the type with good mental resources. The groups with medium and lower mental resources differ significantly only by variables living with a partner and employment. CONCLUSION: Our results indicate that good mental resources are associated with good mental health. Special mental health care programs, focusing in particular on the needs of vulnerable groups with poor mental resources within a society, should be implemented.

Trauma assessment in outpatient psychotherapy and associations with psychotherapist's gender, own traumatic events, length of work experience, and theoretical orientation.

BACKGROUND: Traumatic events are strongly associated with mental health problems. At present, traumatic events and trauma-specific needs are commonly underdetected in therapeutic settings. Many mental health professionals lack key competencies for trauma inquiry and treatment. OBJECTIVE: In this study, we aimed to investigate the everyday practices of dealing with traumatic events in outpatient psychotherapy in Germany as well as the influence of the therapist's gender, own traumatic events, length of professional experience, and theoretical orientation. METHOD: A total of 148 outpatient psychotherapists completed a purpose-designed online questionnaire. Therapists rated barriers and attitudes towards trauma assessment, possible requirements for enquiring about trauma, and practical aspects of trauma assessment. RESULTS: Barriers reported in previous studies, e.g. fear of offending the patient or exacerbating their psychological state, could not be confirmed in our sample. Overall, participating therapists felt confident in engaging with traumatic events and considered enquiring about trauma important in all patients. Group differences were found for therapist's gender, own traumatic events, length of work experience, and theoretical orientation. CONCLUSIONS: Our results suggest that trauma training lowers barriers and raises therapists' self-confidence in dealing with patients´ traumatic experiences. Therapists' characteristics effecting trauma assessment should be considered during training. Due to the increasing demand for psychotherapy, especially considering people with severe mental illness affected by traumatic events, trauma training should be obligatory for all mental health professionals.

Antecedentes: Los eventos traumáticos están fuertemente asociados a problemas de salud mental. En la actualidad, los eventos traumáticos y las necesidades específicas asociadas al trauma no suelen ser detectadas en entornos terapéuticos. Muchos profesionales de salud mental carecen de las competencias para indagar sobre el trauma y tratarlo.Objetivo: En este estudio, el objetivo fue el investigar las prácticas cotidianas del abordaje de los eventos traumáticos en la psicoterapia ambulatoria de Alemania, así como investigar la influencia que el género del terapeuta, sus propios eventos traumáticos, el tiempo de su experiencia laboral y su orientación teórica tiene sobre esto.Métodos: Ciento cuarenta y ocho (148) psicoterapeutas de atención ambulatoria completaron un cuestionario en línea diseñado para el propósito del estudio. Los psicoterapeutas calificaron las barreras y actitudes respecto a la evaluación del trauma, los posibles requisitos para preguntar sobre el trauma y los aspectos prácticos de la evaluación del trauma.Resultados: No se pudieron confirmar las barreras reportadas en estudios previos como, por ejemplo, el temor a ofender al paciente o el empeorar su estado psicológico. En general, los psicoterapeutas participantes sentían confianza al momento de abordar los eventos traumáticos y consideraron que el preguntar sobre el trauma era importante en todos los pacientes. Se encontraron diferencias según el género del psicoterapeuta, sus propios eventos traumáticos, el tiempo de su experiencia laboral y su orientación teórica.Conclusiones: Nuestros resultados sugieren que el entrenamiento en trauma disminuye las barreras e incrementa la confianza de los psicoterapeutas consigo mismos para abordar las experiencias traumáticas de los pacientes. Las características de los psicoterapeutas que afectan la evaluación del trauma deben ser consideradas durante el entrenamiento. Debido a que existe un incremento en la demanda de psicoterapia, considerando especialmente a las personas con enfermedad mental severa afectadas por eventos traumáticos, el entrenamiento en trauma debería ser obligatorio para todos los profesionales de salud mental.

Development and validity of the Value-based Stigma Inventory (VASI): a value-sensitive questionnaire for the assessment of mental health stigma.

BACKGROUND: It has been hypothesized that mental illness stigma differs according to what matters most to people, and that this results in value-based differences in stigma within societies. However, there is a lack of stigma measures that account for a broad range of values, including modern and liberal values. METHODS: For the development of the Value-based Stigma Inventory (VASI) a preliminary item-pool of 68 VASI-items was assembled by mental health and stigma experts. For psychometric evaluation, we tested the VASI in an online sample of the general population (n = 4983). RESULTS: Based on item-characteristics as well as explorative and confirmatory factor analyses, a final version of the VASI was developed, comprising 15 items and 5 subscales. The VASI shows good psychometric properties (item difficulty = 0.34 to 0.67; mean inter-item correlation r = 0.326; Cronbach's α = 0.879). Medium to high correlations with established stigma scales (SDS, SSMI), medium associations with instruments assessing personal values (PVQ, KSA-3) and small to no associations with a social desirability scale (KSE-G) attest to good convergent and discriminatory validity of the new instrument. Normative values for the VASI subscales are presented. CONCLUSIONS: The developed VASI can be used to assess public stigma of mental illness including personal stigma-relevant value orientations.

Homelessness: care for the most vulnerable - a narrative review of risk factors, health needs, stigma, and intervention strategies.

PURPOSE OF REVIEW: To summarize the most recent literature on risk factors of homelessness, mental, and somatic health needs, healthcare use, stigma as well as intervention strategies for people experiencing homelessness. RECENT FINDINGS: Studies identified adverse life events as well as mental health problems like drug use or suicidality as significant predictors of becoming homeless. Prevalence rates of mental disorders, especially substance use disorders, psychotic disorders, and depression are high. Barriers of healthcare use are financial resources and insurance status as well as experiences of discrimination. Aspects of trust and safety as well as age and gender were identified of high importance in the design of interventions. Strategies of permanent supportive housing like Housing First have shown a stable positive effect on housing stability, but not mental health outcomes. Peer support, forms of intensive case management, and harm reduction strategies are the most promising approaches to address these further needs. SUMMARY: Exploration into the relationship of homelessness and mental health as well as adequate intervention strategies is far from being conclusive. Especially, the development of effective interventions addressing issues of trauma, stigma and discrimination, community integration, and mental health needs is still in its infancy.