Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment.

BACKGROUND: Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy. METHODS: A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II. RESULTS: Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation. LIMITATION: Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II. CONCLUSION: Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

[Psychotherapy with older caregivers]. / Psychotherapie mit älteren pflegenden Angehörigen.

Nursing and caring for a relative can be regarded as an important developmental task, which mainly affects elderly people who provide care for their very old parents or their (spouse) partners. Being responsible for the care of someone can be associated with a severe caregiver burden and experienced as a crisis. Possible psychological consequences are pronounced depressive symptoms or maladaptive stress reactions. For these caregivers, psychotherapeutic counselling can be sensible and helpful in addition to other resources of caregiver support. This applies in particular to improving coping with problematic everyday situations, stressful emotions, and strengthening resources. Multimodal interventions that address methods of cognitive behavioral therapy and acceptance as well as commitment therapy could show good evidence for this target group but have so far received little attention in healthcare programs. Because it is often difficult for caregivers to organize regular visits to the psychotherapist's practice, psychotherapeutic offers would be desirable in more flexible settings (e. g. by telephone or internet-based). The extent to which such supplementary interventions can be embedded and financed in the context of chronic care models is still unclear.

Maintaining Mental Health Through Positive Writing: Effects of a Resource Diary on Depression and Emotion Regulation.

OBJECTIVE: The present study investigated the beneficial effects of the resource-oriented positive writing intervention resource diary (RD) on mental health variables among patients recently discharged from psychiatric inpatient treatment. METHOD: Eighty-nine patients were randomly assigned to either an intervention group completing RD over the course of 4 weeks (n = 45) or a control group receiving no intervention (n = 44). To measure changes in mental health, patients filled out a number of self-report questionnaires on depression, emotion regulation, and resource activation before and after the intervention.  RESULTS: Participants completing RD had significantly lower depression scores than controls and reported an increased use of the functional emotion regulation strategy "reappraisal" 5 weeks after discharge. A decreased use of the dysfunctional strategy "expressive suppression" was found in the female subsample. No differences were found for resource activation. CONCLUSION: These findings suggest that a resource-oriented positive writing intervention has potential for stabilizing mental health after psychiatric discharge and could therefore present an economical alternative or addition to established aftercare programs.

[Carer burden in dementia: origins and intervention]. / Die Belastung pflegender Angehöriger bei Demenz : Enstehungsbedingungen und Interventionsmöglichkeiten.

Caring for a demented elderly indiviudal in the home is associated with a high burden on care-providing family members. Factors contributing to this burden include invariable context conditions such as gender, type of relationship and severity of symptoms as well as role change, coping style, available support and appraisal of the caring role. Most interventions for family carers have focused on providing dementia-related information and problem solving skills but have placed less emphasis on the emotional facets of the burden. Controlled studies evaluating the efficacy of support programs for family carers suggest that the greatest benefits can be achieved by interventions which are intensive, long-term, individually tailored and targeted to the everyday context. From these findings and experiences the outline of a psychologically based behavioral intervention for family carers of dementia patients is derived.

[Gender- and age-specific aspects of assistance need in caregivers of stroke patients: results from a qualitative panel study]. / Geschlechts- und altersspezifische Aspekte des Hilfebedarfs bei Angehörigen von Schlaganfallpatienten - Ergebnisse einer qualitativen Längsschnittstudie.

AIM: The present study aimed at investigating the need for professional assistance in carers of stroke patients who do not require a therapeutic group intervention; and furthermore, how this need for assistance is changing in the course of rehabilitation. METHOD: Ten highly burdened spouses of stroke survivors were interviewed twice in the framework of a qualitative panel study. In-depth interviews concerning subjective burden and assistance requirements were carried out and analyzed using Grounded Theory coding procedures. RESULTS: The evaluation of the interview data showed that the relatives' needs for assistance change in the course of rehabilitation, and feature gender- and age-specific differences. Assistance needs persist in the medium and long term, with qualitative diversifications: During the in-patient rehabilitation period, carers request mainly illness-related information, whereas emotional assistance is rarely desired. This is different during the out-patient rehabilitation period: While the desire for further information decreases, the need for emotional assistance (e. g.disburdening counselling) increasingly comes to the fore. Women much more often desire professional assistance than men. DISCUSSION: When designing and offering professional assistance for caregivers of stroke patients, gender- and age-specific aspects should be taken into account, as well as the medium- and long-term changes in assistance need.

[Long-term life changes and stress sequelae for spouses of stroke patients]. / Langfristige Lebensveränderungen und Belastungsfolgen bei Ehepartnern von Schlaganfallpatienten.

OBJECTIVE: This study investigates the long-term effect of stroke on the quality of life and health of patients' spouses. METHOD: Twenty-six spouses of stroke patients were interviewed by means of standardized questionnaires and qualitative interviews. The study participants had been living with the consequences of stroke for 3 years on average when the interviews were carried out. RESULTS: A stroke is often followed by considerable changes in everyday life and by role shifts within the relationship. In particular, depressive and aggressive changes in the patient's behaviour are experienced as burdensome. In addition to impairments in quality of life, psychological and psychosomatic troubles can also from the burden experienced. Depressive symptoms are the main factor in these negative consequences: the more a patient is assessed as depressive, the more his/her spouse reports health problems and poor quality of life. DISCUSSION: Long-term changes in everyday life and partnership can bring about significant chronic burden for the spouses of stroke patients. Hence, offers of support and counseling are required not only in the acute and post-acute stages of stroke, but also after inpatient rehabilitation has ended.

[The emotional burden in caregiving relatives of stroke patients]. / Psychische Belastungen bei Angehörigen von Schlaganfallpatienten.

Sustained psychosocial burdens as a consequence of stroke not only affect the stroke victim but frequently their spouses and significant others as well. The present study analyses the extent of emotional burden in spouses of stroke patients (Beck Depression Inventory, BDI and Beck Anxiety Inventory, BAI), examining the relationships of emotional burden in spouses with the medical assessment regarding stroke severity (Barthel Index, BI) and with the spouses' own perceptions of the stroke patients' impairment (Patient Competency Rating, PCR) as well as determining the factors that were independently associated with emotional burden in spouses. 82 spouses of stroke patients are examined in our study. The questioning was realised on admission into inpatient or partially inpatient rehabilitation centres. Initial results indicated that relatives of stroke victims have higher scores for anxiety compared to the general population. The assessment of disability in the stroke victims by their spouses correlates directly with the psychosocial burden of the spouses. By using this methodology, a high-risk group of spouses could be identified. The predictors of emotional burden in spouses (Anxiety and Depression) are gender of spouse and the spouse's subjective perception of disability in the stroke victim. The age of spouses and medical assessment of the severity of stroke on the other hand have no predictive value for the extent of emotional burden in spouses.

[Effects of chronic stress on physical or psychological health - an analysis of family caregivers of dementia patients]. / Auswirkungen chronischer Belastungen auf die physische und psychische Befindlichkeit - eine Prozessanalyse bei Pflegenden Angehörigen von Demenzkranken.

The effects of chronical strains on physical or psychological health are subject of this paper. Stress-related symptoms of family caregivers of dementia patients have been proven in various studies. For this group of people an analysis of the health risk factors is regarded as to be especially important. Diary investigations allow to identify the individual assessment (by the caring person) of factors related to the care situation and to recognize the health and quality of sleep have been used as indicators regarding the state of health. In this study strong differences in the individual view of stress factors and their effects on psychological an physical state of the caring person are shown.

[Perception of stress by caregiving relatives of dementia patients]. / Belastungserleben pflegender Angehöriger von Demenzpatienten.

The increasing interest in research on burden and health risks of family caregivers was furthered by the increasing prevalence rate of dementias in the elderly and by the fact that 80-90% of the demented are cared for by near family members. The present paper presents some results of a study investigating stress-related symptoms of family caregivers. From a clinical perspective these results point to needed interventions for supporting the caregivers. Specific burden components, depression, and body complaints were assessed in n = 70 family caregivers of dementia patients. A substantial degree of social isolation, depressive disorders, and physical complaints could be found. The level of burden experienced was not directly related to severity of dementia and to impairment of the demented or to structural conditions of the care (degree and length of care). Differences were observed between spouse caregivers and other relatives; spouses suffer more psychosomatic complaints and depression.