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BACKGROUND: Risk factors for mental health can be found in socio-economic-, gender- and migration-specific inequalities. These factors and the extent of depression, anxiety, and somatization among employees were examined in the present study. METHODS: As part of the Early Intervention in the Workplace Study (friaa), mentally burdened employees at five locations in Germany were surveyed on socio-demographic-, work-, migration-, and health-related content. Regression analyses were used to examine the relationship between these factors and depression (Patient-Health-Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder-2, GAD-2), and somatization (Somatic Symptom Scale-8, SSS-8) in the entire sample and in people with migration background (MB). For the latter, acculturation (Frankfurt Acculturation Scale, FRACC) and the perception of burden in terms of demands of immigration (Demands of Immigration Scale, DIS) were also taken into account. RESULTS: On average, the 550 employees (12% with MB) showed clinically relevant depression (Mâ¯= 13.0, SDâ¯= 5.1) (PHQ-9â¯≥ 10), anxiety (Mâ¯= 3.5, SDâ¯= 1.7) (GADâ¯≥ 3) and somatization (Mâ¯= 13.0, SDâ¯= 5.8) (SSS-8â¯≥ 12). Female gender was associated with higher anxiety and somatization. Older age and night shift work were associated with higher somatization. DISCUSSION: The results confirm the high level of mental burden among this sample of employees in Germany. In order to maintain their mental health, support measures should be offered, especially for vulnerable groups such as women, older employees, and night shift workers.
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Lugar de Trabajo , Humanos , Alemania/epidemiología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Lugar de Trabajo/psicología , Factores Socioeconómicos , Distribución por Sexo , Trastornos Somatomorfos/epidemiología , Trastornos Somatomorfos/psicología , Adulto Joven , Disparidades en el Estado de Salud , Factores de Riesgo , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/psicología , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicologíaRESUMEN
BACKGROUND: Service use among employees with mental health problems and the associated costs for the health and social system have not yet been systematically analysed in studies or have only been recorded indirectly. The aim of this article is to report the service use in this target group, to estimate the costs for the health and social system and to identify possible influencing factors on the cost variance. METHODS: As part of a multicentre study, use and costs of health and social services were examined for a sample of 550 employees with mental health problems. Service use was recorded using the German version of the Client Sociodemographic Service Receipt Inventory (CSSRI). Costs were calculated for six months. A generalized linear regression model was used to examine influencing cost factors. RESULTS: At the start of the study, the average total costs for the past six months in the sample were â¯5227.12 per person (standard deviation â¯7704.21). The regression model indicates significant associations between increasing costs with increasing age and for people with depression, behavioural syndromes with physiological symptoms, and other diagnoses. DISCUSSION: The calculated costs were similar in comparison to clinical samples. It should be further examined in longitudinal studies whether this result changes through specific interventions.
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Costos de la Atención en Salud , Trastornos Mentales , Humanos , Alemania/epidemiología , Trastornos Mentales/economía , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Femenino , Masculino , Adulto , Persona de Mediana Edad , Costos de la Atención en Salud/estadística & datos numéricos , Adulto Joven , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Revisión de Utilización de RecursosRESUMEN
BACKGROUND: Unemployment is associated with a high risk of experiencing mental illness. This can lead to stigmatisation, reduced quality of life, and long-term costs like increased healthcare expenditure and productivity losses for society as a whole. Previous research indicates evidence for an association between unemployment and higher mental health service costs, but there is insufficient information available for the German healthcare system. AIM OF THE STUDY: This study aims to identify costs and cost drivers for health and social service use among unemployed people with mental health problems in Germany. METHODS: A sample of 270 persons participated at baseline and six-month-follow-up. Healthcare and social service use was assessed using the Client Socio-Demographic and Service Receipt Inventory. Descriptive cost analysis was performed. Associations between costs and potential cost drivers were tested using structural equation modelling. RESULTS: Direct mean costs for 12 months range from EUR 1265.13 (somatic costs) to EUR 2206.38 (psychiatric costs) to EUR 3020.70 (total costs) per person. Path coefficients indicate direct positive effects from the latent variable mental health burden (MHB) on stigma stress, somatic symptoms, and sick leave. DISCUSSION: The hypothesis that unemployed people with mental health problems seek help for somatic symptoms rather than psychiatric symptoms was not supported. Associations between MHB and costs strongly mediated by sick leave indicate a central function of healthcare provision as being confirmation of the inability to work. IMPLICATIONS FOR HEALTH POLICIES: Targeted interventions to ensure early help-seeking and reduce stigma remain of key importance in reducing long-term societal costs. IMPLICATIONS FOR FURTHER RESEARCH: Future research should explore attitudes regarding effective treatment for the target group.
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Costos de la Atención en Salud/estadística & datos numéricos , Trastornos Mentales/economía , Trastornos Mentales/terapia , Servicios de Salud Mental/economía , Ausencia por Enfermedad/economía , Desempleo/estadística & datos numéricos , Adulto , Femenino , Alemania/epidemiología , Humanos , Masculino , Trastornos Mentales/epidemiología , Salud Mental , Servicios de Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Calidad de Vida , Estigma Social , Desempleo/psicología , Adulto JovenRESUMEN
Background: Unemployed people with mental health problems often do not use available mental health services. Help-seeking may depend on knowledge, recognition and attitudes associated with mental health - a concept referred to as mental health literacy (MHL).Aim: To investigate the influence of MHL on help-seeking intentions and behaviors among unemployed individuals with mental health problems.Methods: A total of 301 unemployed individuals with mental health problems were recruited mainly from employment agencies in Southern Germany. MHL was assessed by the Mental Health Knowledge Schedule (MAKS), the Depression Literacy Scale (DLS), and the Depression with Suicidal Thoughts Vignette. Help-seeking intentions and behaviors were measured using the General Help-Seeking Questionnaire (GHSQ). Associations between MHL and help-seeking intentions and behaviors were tested using regression analyses and structural equation modeling (SEM).Results: All three MHL scales were significantly positively associated with help-seeking intentions and behaviors. In our SEM model, greater MHL was significantly associated with increased intentions and behaviors to seek help from health professionals (formal help) and from family and friends (informal help).Conclusions: Among unemployed persons with mental health problems, programs to improve MHL could facilitate formal as well as informal help-seeking. Future research should examine the efficacy of MHL-interventions to increase help-seeking.
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Alfabetización en Salud , Conducta de Búsqueda de Ayuda , Trastornos Mentales/psicología , Salud Mental , Aceptación de la Atención de Salud , Desempleo/psicología , Adulto , Femenino , Alemania/epidemiología , Humanos , Análisis de Clases Latentes , Masculino , Persona de Mediana Edad , Análisis de RegresiónRESUMEN
Unemployment and mental disorders are associated with impaired quality of life. Because of the stigma associated with mental illness, unemployed individuals with mental health problems face the difficult decision whether to disclose their condition to others. Disclosure has both risks and benefits, and it is unclear how it affects quality of life. We therefore examined disclosure attitudes at baseline as predictors of quality of life after 6 months and also assessed social support, depressive symptoms, self-stigma, and perceived discrimination among 301 unemployed individuals with mental health problems. Better quality of life at follow-up was predicted by better attitudes toward disclosure among family and friends, shorter length of unemployment, less symptoms, and, at a trend level, less self-stigma at baseline. Thus disclosure in one's private environment may improve quality of life among unemployed individuals with mental health problems.
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Trastornos Mentales/psicología , Calidad de Vida/psicología , Autorrevelación , Apoyo Social , Desempleo/psicología , Adolescente , Adulto , Familia , Femenino , Estudios de Seguimiento , Amigos , Humanos , Masculino , Persona de Mediana Edad , Discriminación Social , Estigma Social , Trastornos Relacionados con Sustancias/psicología , Adulto JovenRESUMEN
Despite low unemployment rates, individuals with mental health problems often struggle to gain reemployment. Many face the decision whether to disclose their mental illness to employers. This study therefore examined the role of disclosure attitudes for reemployment over time. Clinical and job search variables as well as attitudes toward disclosing a mental health issue to an employer were assessed among 301 unemployed individuals with mental health problems. Predictors of reemployment at 6-month follow-up were assessed using multiple regression, adjusted for sociodemographic variables, unemployment length, and depressive symptoms. Greater reluctance to disclose mental health problems at baseline predicted reemployment after 6 months. Reemployment was also associated with male sex, better education, lower disability levels, and more job offers at baseline. Therefore, a cautious approach toward disclosing a mental health problem may facilitate short-term reemployment. It is unclear whether this is a successful long-term strategy in employment settings.
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Actitud Frente a la Salud , Empleo/psicología , Trastornos Mentales/psicología , Autorrevelación , Depresión/psicología , Femenino , Humanos , Estudios Longitudinales , Masculino , Trastornos Mentales/rehabilitación , Persona de Mediana EdadRESUMEN
PURPOSE: The everyday lives of unemployed people with mental health problems can be affected by multiple discrimination, but studies about double stigma-an overlap of identities and experiences of discrimination-in this group are lacking. We therefore studied multiple discrimination among unemployed people with mental health problems and its consequences for job- and help-seeking behaviors. METHODS: Everyday discrimination and attributions of discrimination to unemployment and/or to mental health problems were examined among 301 unemployed individuals with mental health problems. Job search self-efficacy, barriers to care, and perceived need for treatment were compared among four subgroups, depending on attributions of experienced discrimination to unemployment and to mental health problems (group i); neither to unemployment nor to mental health problems (group ii); mainly to unemployment (group iii); or mainly to mental health problems (group iv). RESULTS: In multiple regressions among all participants, higher levels of discrimination predicted reduced job search self-efficacy and higher barriers to care; and attributions of discrimination to unemployment were associated with increased barriers to care. In ANOVAs for subgroup comparisons, group i participants, who attributed discrimination to both unemployment and mental health problems, reported lower job search self-efficacy, more perceived stigma-related barriers to care and more need for treatment than group iii participants, as well as more stigma-related barriers to care than group iv. CONCLUSIONS: Multiple discrimination may affect job search and help-seeking among unemployed individuals with mental health problems. Interventions to reduce public stigma and to improve coping with multiple discrimination for this group should be developed.
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Conducta de Búsqueda de Ayuda , Trastornos Mentales/psicología , Discriminación Social/psicología , Estigma Social , Desempleo/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , AutoeficaciaRESUMEN
BACKGROUND: Unemployed people with mental health problems often do not use mental health services and therefore do not benefit from available therapies. As unemployed individuals outside the healthcare system are a hard-to-reach group, barriers to and facilitators of mental health service use are poorly understood. The purpose of this study was to identify barriers to and facilitators of help-seeking and service use based on experiences of unemployed people with mental health problems. METHODS: Fifteen qualitative semi-structured individual interviews were conducted with unemployed persons who reported mental health problems. Interview topics included individual experience with help-seeking and mental health service use with a focus on barriers and facilitators. Transcripts were analysed using qualitative content analysis and major themes were identified. RESULTS: Participants reported being treated as "different" within their social environment as well as by health care professionals because of their mental health problems, which resulted in a lack of self-esteem and avoidance of help-seeking. Interviewees associated negative attributes with help-seeking such as helplessness and weakness. They equated psychiatric medication with illegal drugs and worried about the risk of addiction. However, social support and a desire for change on the other hand increased the motivation to search for help. Employment agency staff were mostly perceived as supportive by individuals seeking mental health services. CONCLUSIONS: Unemployed individuals with mental health problems faced barriers and facilitators when seeking help on three different levels: (1) mental health literacy; (2) stigma and discrimination; and (3) structures and conditions of health care. Awareness and attitudes of health care professionals concerning mental health issues should be improved. Stigmatisation of people with mental illnesses should be reduced in health care settings. Training for employment agency staff concerning mental health problems and services is recommended.
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Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Adulto , Concienciación , Empleo , Femenino , Personal de Salud , Humanos , Drogas Ilícitas , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Estigma Social , Apoyo Social , Estereotipo , Desempleo , Adulto JovenRESUMEN
BACKGROUND: Only two-thirds of patients admitted to psychiatric wards return to their previous jobs. Return-to-work interventions in Germany are investigated for their effectiveness, but information regarding cost-effectiveness is lacking. This study investigates the cost-utility of a return-to-work intervention for patients with mental disorders compared to treatment as usual (TAU). METHODS: We used data from a cluster-randomised controlled trial including 166 patients from 28 inpatient psychiatric wards providing data at 6- and 12-month follow-ups. Health and social care service use was measured with the Client Sociodemographic and Service Receipt Inventory. Quality of life was measured with the EQ-5D-3L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional QALY (Quality-Adjusted Life Years) gained by receiving the support of return-to-work experts, in comparison to TAU. RESULTS: No significant cost or QALY difference between the intervention and control groups has been detected. The return-to-work intervention cannot be identified as cost-effective in comparison to TAU. CONCLUSIONS: The employment of return-to-work experts could not reach the threshold of providing good value for money. TAU, therefore, seems to be sufficient support for the target group.
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Costos de la Atención en Salud , Trastornos Mentales , Reinserción al Trabajo , Humanos , Reinserción al Trabajo/economía , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Alemania , Calidad de Vida , Encuestas y Cuestionarios , Análisis Costo-Beneficio , Masculino , Femenino , Adulto , Persona de Mediana Edad , Ausencia por EnfermedadRESUMEN
BACKGROUND: Children of families with a parent with a mental illness have an increased risk of developing social and mental health problems resulting in decreased quality of life. Therefore, children and adolescents living in families with a parent with mental illness are regarded as a target group for preventive interventions. To date, only a few economic evaluation studies for interventions directed at preventing the intergenerational transmission of mental health problems exist. In this investigation we estimated the cost utility of an intervention for the support of children and adolescents with a parent having a mental illness from the perspective of the German health and social care system. METHODS: We randomly assigned a total of 214 families with 337 children and adolescents to the intervention (INT) group (108/170) or the control (TAU) group (106/167). Families in the intervention group received on average eight intervention sessions (50-90 min) over 6 months. We estimated total cost of illness by means of the Children and Adolescent Mental Health Service Receipt Inventory (CAMHSRI) over 24 months. For the estimation of Quality-Adjusted Live Years (QALYs) we applied the KIDSCREEN-10. For estimating the incremental cost-utility of the intervention compared to treatment as usual we used the net-benefit approach. RESULTS: We estimated the annual cost of illness amounting to 3784.59 (SD 8581.11) in the TAU group and 3264.44 (SD 9431.89) in the INT group. The annual cost difference between INT and TAU was - 516.14 (SE 1124.95) which was not significant (p ≤ 0.05). We estimated the average QALY to be 0.759 (SD 0.073) in the TAU group and 0.763 (SD 0.072). The QALY difference between INT and TAU was 0.0037 (SE 0.0092) which was not significant (p ≤ 0.05). The incremental cost utility ratio (ICUR) indicated that the gain of one additional year in full health by means of the intervention was associated with the saving of 139.49. However, the stochastic insecurity of the ICUR did not allow a unique decision about the cost-utility of the intervention. CONCLUSIONS: More information on the economic value of the intervention for families with a parent with mental illness in comparison to treatment as usual in Germany is needed. TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.
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BACKGROUND: If people with episodic mental-health conditions lose their job due to an episode of their mental illness, they often experience personal negative consequences. Therefore, reintegration after sick leave is critical to avoid unfavorable courses of disease, longer inability to work, long payment of sickness benefits, and unemployment. Existing return-to-work (RTW) programs have mainly focused on "common mental disorders" and often used very elaborate and costly interventions without yielding convincing effects. It was the aim of the RETURN study to evaluate an easy-to-implement RTW intervention specifically addressing persons with mental illnesses being so severe that they require inpatient treatment. METHODS: The RETURN study was a multi-center, cluster-randomized controlled trial in acute psychiatric wards addressing inpatients suffering from a psychiatric disorder. In intervention wards, case managers (RTW experts) were introduced who supported patients in their RTW process, while in control wards treatment, as usual, was continued. RESULTS: A total of 268 patients were recruited for the trial. Patients in the intervention group had more often returned to their workplace at 6 and 12 months, which was also mirrored in more days at work. These group differences were statistically significant at 6 months. However, for the main outcome (days at work at 12 months), differences were no longer statistically significant (p = 0.14). Intervention patients returned to their workplace earlier than patients in the control group (p = 0.040). CONCLUSIONS: The RETURN intervention has shown the potential of case-management interventions when addressing RTW. Further analyses, especially the qualitative ones, may help to better understand limitations and potential areas for improvement.
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Trastornos Mentales , Reinserción al Trabajo , Humanos , Reinserción al Trabajo/psicología , Empleo , Trastornos Mentales/terapia , Trastornos Mentales/psicología , Lugar de Trabajo , Ausencia por Enfermedad , HospitalizaciónRESUMEN
AIM: The quasi-experimental AKtiV study investigates the effects inpatient-equivalent home treatment (IEHT). This paper describes the study population based on demographic and clinical parameters at baseline and compares the index treatment. METHODS: Over a period of 12 months 200 IEHT users were included in the intervention group (IG) and 200 inpatients were included in the control group (CG). The comparability of the two groups was ensured by propensity score matching (PSM). RESULTS: In addition to the PSM variables, IG and CG did not differ significantly from each other variables at study inclusion. The duration of the index treatment was significantly longer in the IG (M=37.2 days) compared to the CG (M=27.9 days; p<0.001). CONCLUSION: The similarity of the two groups enables comparisons over 12 months, investigating IEHT effects on long-term outcomes.
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Hospitalización , Pacientes Internos , Humanos , Resultado del Tratamiento , AlemaniaRESUMEN
This part of the AKtiV Study focuses on treatment satisfaction of patients and their relatives within Inpatient Equivalent Home Treatment (IEHT) and regular treatment. Stress of relatives and job satisfaction and workload of employees in IEHT is also considered. Relevant Parameters were collected via established as well as newly adapted questionnaires at the end of treatment. Patients and relatives in IEHT are significantly more satisfied. The stress experienced by relatives is reduced in both forms of treatment. Employees in IEHT are generally very satisfied, although there is no correlation with the satisfaction of relatives and patients. Known limitations of satisfaction surveys must be taken into account. In general these results encourage the expansion and continuous development of this new form of treatment in Germany.
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INTRODUCTION: The integration of a web-based computer-adaptive patient-reported outcome test (CAT) platform with persuasive design optimised features including recommendations for action into routine healthcare could provide a promising way to translate reliable diagnostic results into action. This study aims to evaluate the effectiveness and cost-effectiveness of such a platform for depression and anxiety (RehaCAT+) compared with the standard diagnostic system (RehaCAT) in cardiological and orthopaedic health clinics in routine care. METHODS AND ANALYSIS: A two-arm, pragmatic, cluster-randomised controlled trial will be conducted. Twelve participating rehabilitation clinics in Germany will be randomly assigned to a control (RehaCAT) or experimental group (RehaCAT+) in a 1:1 design. A total sample of 1848 participants will be recruited across all clinics. The primary outcome, depression severity at 12 months follow-up (T3), will be assessed using the CAT Patient-Reported Outcome Measurement Information System Emotional Distress-Depression Item set. Secondary outcomes are depression at discharge (T1) and 6 months follow-up (T2) as well as anxiety, satisfaction with participation in social roles and activities, pain impairment, fatigue, sleep, health-related quality of life, self-efficacy, physical functioning, alcohol, personality and health economic-specific general quality of life and socioeconomic cost and benefits at T1-3. User behaviour, acceptance, facilitating and hindering factors will be assessed with semistructured qualitative interviews. Additionally, a smart sensing substudy will be conducted, with daily ecological momentary assessments and passive collection of smartphone usage variables. Data analysis will follow the intention-to-treat principle with additional per-protocol analyses. Cost-effectiveness analyses will be conducted from a societal perspective and the perspective of the statutory pension insurance. ETHICS AND DISSEMINATION: The study will be conducted according to the Declaration of Helsinki. The Ethics Committee of Ulm University, has approved the study (on 24 February 2021 ref. 509/20). Written informed consent will be obtained for all participants. Results will be published via peer-reviewed journals. TRIAL REGISTRATION NUMBER: DRKS00027447.
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Depresión , Calidad de Vida , Ansiedad/terapia , Análisis Costo-Beneficio , Depresión/psicología , Humanos , Internet , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Importance: The cost-effectiveness of the Self-Help Plus (SH+) program, a group-based, guided, self-help psychological intervention developed by the World Health Organization for people affected by adversity, is unclear. Objective: To investigate the cost-utility of providing the SH+ intervention combined with enhanced usual care vs enhanced usual care alone for Syrian refugees or asylum seekers hosted in Turkey. Design, Setting, and Participants: This economic evaluation was performed as a prespecified part of an assessor-blinded randomized clinical trial conducted between October 1, 2018, and November 30, 2019, with 6-month follow-up. A total of 627 adults with psychological distress but no diagnosed psychiatric disorder were randomly assigned to the intervention group or the enhanced usual care group. Interventions: The SH+ program was a 5-session (2 hours each), group-based, stress management course in which participants learned self-help skills for managing stress by listening to audio sessions. The SH+ sessions were facilitated by briefly trained, nonspecialist individuals, and an illustrated book was provided to group members. Th intervention group received the SH+ intervention plus enhanced usual care; the control group received only enhanced usual care from the local health care system. Enhanced usual care included access to free health care services provided by primary and secondary institutions plus details on nongovernmental organizations and freely available mental health services, social services, and community networks for people under temporary protection of Turkey and refugees. Main Outcomes and Measures: The primary outcome measure was incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the Turkish health care system. An intention-to-treat analysis was used including all participants who were randomized and for whom baseline data on costs and QALYs were available. Data were analyzed September 30, 2020, to July 30, 2021. Results: Of 627 participants (mean [SD] age, 31.3 [9.0] years; 393 [62.9%] women), 313 were included in the analysis for the SH+ group and 314 in the analysis for the enhanced usual care group. An incremental cost-utility ratio estimate of T£6068 ($1147) per QALY gained was found when the SH+ intervention was provided to groups of 10 Syrian refugees. At a willingness to pay per QALY gained of T£14â¯831 ($2802), the SH+ intervention had a 97.5% chance of being cost-effective compared with enhanced usual care alone. Conclusions and Relevance: This economic evaluation suggests that implementation of the SH+ intervention compared with enhanced usual care alone for adult Syrian refugees or asylum seekers hosted in Turkey is cost-effective from the perspective of the Turkish health care system when both international and country-specific willingness-to-pay thresholds were applied.
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Refugiados , Adulto , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Años de Vida Ajustados por Calidad de Vida , Refugiados/psicología , Siria , TurquíaRESUMEN
BACKGROUND: Children of parents with mental illness have a higher risk of developing mental health problems when compared with the general population. Therefore, families with parents with mental illness are a suitable target group for selective prevention. In order to plan and evaluate the health economic consequences of preventive interventions for this target group, data on the societal costs related to parenthood under the condition of mental disorders are needed. To date, within Germany there has been a lack of research evaluating the costs of mental health treatment and use of social services by children and adolescents with parents with mental illness. METHODS: As part of a multicentre randomised controlled trial, use and costs of health and social services were assessed for a sample of 332 children and adolescents with parents with mental illness in six regions of Germany. Service use at baseline was assessed by the German version of the Children and Adolescent Mental Health Service Receipt Inventory. Costs were calculated for 12 months based on diagnosis and service user status and described separately. Cost drivers were identified by means of a two-part regression model. RESULTS: Total mean costs for 12 months for the total sample amount of 3736.35 (95% CI: 2816.84-4813.83) per person. Children with a psychiatric diagnosis generated a total of 5691.93 (95% CI: 4146.27-7451.38) of costs per person, compared to 1245.01 (95% CI: 657.44-1871.49) for children without a psychiatric diagnosis. The logit part indicates significant odds ratios for individual functioning and diagnosis of the child as well as for family functioning. The linear part reveals that increasing individual functioning in the child is related to decreasing costs. CONCLUSIONS: Children of families with parents with mental illness use a broad spectrum of mental health care, school-based support and youth welfare services even if they are not yet diagnosed as having a mental disorder. Further research should examine whether these institutions are sufficiently qualified and interlinked to meet the support needs of this vulnerable group. Trial registration The study was registered at the 07/10/2014 before the start of data collection (04/11/2014) at the German clinical trials register (Deutsches Register Klinischer Studien, DRKS, nr: DRKS00006806, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006806 ).
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BACKGROUND: More than half of the unaccompanied young refugees (UYRs) resettled in Europe report elevated levels of posttraumatic stress symptoms (PTSS) and comorbid symptoms. Earlier studies have highlighted the effectiveness of the trauma-focused preventive group intervention "Mein Weg" (English "My Way"), and the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for UYRs. Both interventions are deemed to be empirically supported treatments (ESTs). However, UYRs seldom receive ESTs or, in fact, any treatment at all. In view of the high need and the limited treatment resources available, a stepped-care approach is indicated but has not been evaluated so far. The purpose of this trial is to compare the stepped-care approach BETTER CARE with usual care enhanced with screening and indication (usual care+). METHODS: In a cluster randomized controlled trial involving N = 540 UYRs living in up to N = 54 child and youth welfare service (CYWS) facilities, BETTER CARE will be compared with usual care+. We will randomize clusters comprising a CYWS facility with at least one eligible psychotherapist. BETTER CARE consists of step (1) screening and indication and either step (2) preventive trauma-focused group intervention "Mein Weg" delivered by trained CYWS staff or step (3) TF-CBT delivered by trained community therapists and supported by trained translators if necessary. Participants will be assessed 6 and 12 months after randomization. The primary outcome is the severity of PTSS after 12 months. Secondary outcomes are depressive and anxiety symptoms, quality of life, and proxy reported PTSS. Furthermore, drug use, health costs, benefits, and long-term effects on integration/acculturation will be assessed. DISCUSSION: The trial will directly integrate a stepped-care approach into existing structures of the German child welfare and (mental) health system. It could, therefore, serve as a blueprint for how to implement ESTs for UYRs. If successful, screening, prevention, and intervention will be sustainably implemented in CYWS in southern Germany. TRIAL REGISTRATION: German Clinical Trials Register DRKS00017453 . Registered on 11 December 2019.
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Refugiados , Adolescente , Niño , Europa (Continente) , Alemania , Humanos , Salud Mental , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
BACKGROUND: Unemployment and mental ill health often contribute to each other and lead to social exclusion with negative consequences for individuals and society. Yet, unemployed people with mental health problems often do not seek care. AIMS: The aim of this study was to assess predictors of help-seeking among unemployed people with mental health problems. METHODS: At baseline, 301 unemployed participants with mental health problems reported potential predictors of help-seeking in terms of mental health literacy, perceived barriers to care, self-concept as having a mental illness and current mental health service use. At 6-month follow-up, 240 participants reported whether or not they had started new mental health treatment since baseline. RESULTS: Adjusted for symptoms, sociodemographic and work-related variables, help-seeking was predicted by previous mental health service use and by fewer non-stigma-related barriers, not by stigma-related barriers. CONCLUSION: Implications for interventions to increase help-seeking among this vulnerable group are discussed.
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Conducta de Búsqueda de Ayuda , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Estigma Social , Desempleo/psicología , Adulto , Femenino , Alfabetización en Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , AutoeficaciaRESUMEN
Many people with mental illness struggle with stigma. Secrecy is one coping mechanism to deal with mental illness stigma but has some major pitfalls. In this study with 301 unemployed persons with mental health problems, we assessed whether disease concepts are associated with secrecy. We found that genetic and neurobiological disease models are significantly associated with more secrecy. This might be due to a cognitive bias called genetic essentialism. Critical awareness of biogenetic disease models and programmes helping with disclosure decisions might be helpful.
Asunto(s)
Confidencialidad/psicología , Trastornos Mentales/psicología , Salud Mental , Estigma Social , Desempleo/psicología , Adaptación Psicológica/fisiología , Adulto , Concienciación/fisiología , Estudios Transversales , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Análisis de Regresión , Percepción SocialRESUMEN
BACKGROUND: People with long-term unemployment and mental health problems often find it difficult to take active steps toward help-seeking and job search and to navigate the complex system of available services. Likewise, job center staff would welcome interventions to improve the reintegration of long-term unemployed individuals with mental health problems into the labor market. AIM: To examine the efficacy of a peer-led group program that supports unemployed people with mental health problems in terms of help-seeking, job search and recovery. METHODS: Based on participatory research, a four-session group program was designed and evaluated in a pilot randomized controlled trial (RCT) with 42 participants, randomized to the program ( n = 23) or treatment as usual ( n = 19). Outcomes were assessed at baseline (T0), 3 weeks (T1), 6 weeks (T2) and 6 months later (T3). RESULTS: There were no significant intervention effects on primary outcomes (job search self-efficacy and help-seeking). But compared to the control group, intervention participants showed significant improvements in depressive symptoms ( p = .02) and recovery ( p = .04) at T2 with medium effect sizes. There were trend-level positive program effects on self-stigma, hopelessness and secrecy. CONCLUSION: This pilot RCT provides initial evidence for the efficacy of a peer-led group program to improve symptoms and recovery among unemployed participants with mental health problems.