[Treatment clusters and personnel assessment in psychosomatic medicine and psychotherapy - results of a feasibility study of the platform model]. / Behandlungscluster und Personalbemessung in der psychosomatischen Medizin und Psychotherapie ­ Ergebnisse einer Machbarkeitsstudie zum Plattformmodell.

Treatment clusters and personnel assessment in psychosomatic medicine and psychotherapy - results of a feasibility study of the platform model Objectives: In accordance with the legal requirements of the PsychVVG, it is necessary to develop criteria for inpatient and day-care psychosomatic psychotherapeutic care, which can be used to determine the appropriate staffing for different treatment areas and different care structures. For psychosomatic medicine and psychotherapy a model with four treatment clusters was developed, which is oriented on the one hand to the psychotherapeutic intensity and on the other hand to the medical expenditure. Method: In three consecutive rounds with up to 30 experts, representative selected from the three institution types university hospital, departmental psychosomatic medicine and specialized clinic, the minute values per patient required for a treatment according to the guidelines were determined using the Delphi method. Newly developed activity profiles for the six occupational groups were used, which allow the recording of all patient- and setting-related activities. Results: With the results of the feasibility study, an instrument has been developed for the first time to determine the requirements of staffing in psychosomatic medicine. Convergent minute values could be formulated for three of the four treatment clusters. Conclusions: The provision of care in psychosomatic medicine and psychotherapy is complex, so that a limitation to four treatment areas is only possible if significantly more generous equivalence rules are applied between the professional groups than those laid down in the PPP Directive.

Individual and Needs-Based: The Platform-Model for Personnel Allocation in Child and Adolescent Psychiatry and Psychotherapy.

Objective: An initiative by scientific societies of psychiatry, child and adolescent psychiatry, psychosomatic medicine, and further associations established the Platform-Model for the development of a needs-based system for adequate personnel allocation in psychiatric inpatient and day clinic units. We present the development of the instrument and a pilot study to identify feasibility and limitations. Methods: The basis of the study was a threefold methodological approach. Paradigmatic case vignettes adequately reflecting symptomatology and circumstances were described and validated, working profiles were generated and validated, and a matrix representing different needs-based dimensions was developed. Through reference date surveys, patients were assigned to needs-based clusters and Psych-PV categories. The required treatment effort under consideration of guidelines or expert consensus was estimated in several rounds of expert panels (Delphi method). Results: The pilot study proves the feasibility of the Platform-Model. Methodological findings as well as limitations of the model were identified in order to further develop the Platform-Model. Conclusions: The Platform-Model cannot serve as a tool to describe clinical pathways, but it appears to be an adequate and practical tool for assessment of the required staffing level based on patient needs independent of diagnosis and setting.

[Increased attention of radiotherapy patients to religiousness and spirituality - a comparison with patients in a psychosomatic outpatient clinic]. / Erhöhte Hinwendung von Strahlentherapiepatienten zu Religiosität und Spiritualität ­ ein Vergleich mit Patienten einer psychosomatischen Ambulanz.

Increased attention of radiotherapy patients to religiousness and spirituality - a comparison with patients in a psychosomatic outpatient clinic Objectives: The aim of this study is to prove both hypothesis, that patients of radiation therapy are different to patients of a psychosomatic outpatient unit in case of their spirituality and religiosity and that these attitudes have an influence of their own lives. Methods: In a cross-sectional study, a data set of the Department of Psychosomatic and Psychotherapy of the University Hospital Münster in 2013 (n = 1110) was compared to data from 2017 by the Department of Radiation Therapy - Radiation oncology of the University Münster (n = 275) in terms of their religiosity and spirituality. The survey was carried out by a questionnaire on religious attitudes (FRA-RE, Heuft 2016). An age- and gender-controlled statistical analysis has been made by means of partial correlations and mean comparisons. Results: The results are consistent with the hypothesis that patients of radiotherapy, in contrast to psychosomatic patients, are more religious, more spiritual, show more private, but also public religious/spiritual practice, have a stronger desire for more religiosity in their lives and belief that religiosity helps to overcome times of crisis. Conclusions: Thus, it is of particular importance to provide this burdened patient clientele spiritual/religious offers for coping with their disease.

[Psychometric Properties of the Shortend Version of the Scale "Transpersonal Trust" in a Representative Sample of the German Population]. / Psychometrische Überprüfung der Kurzversion der Skala "Transpersonales Vertrauen" in einer deutschlandweiten repräsentativen Bevölkerungsstichprobe.

INTRODUCTION: The aim of the present study was to show the development of the revised and shortened German version (6 items) of the scale "Transpersonales Vertrauen" (TPV-6R; 2017) as well as to examine its psychometric properties. METHODS: In a representative German sample the questionnaire has been given to 2513 subjects. Collected data from 2464 subjects could be analysed. Exploratory and confirmatory factor analysis has been made to prove the original one-factor model (Belschner, 2000) as well as the 2-factorial structure found by Albani et al. (2003). Measurement invariance was tested using multigroup analysis. Correlations were used to determine convergent and discriminant validity towards other items. RESULTS: After excluding 2 items due to their unsatisfactory scale fit, the 4 item model showed good item and scale characteristics as well as excellent model fit. The one factorial structure of the original work of Belschner and colleagues (2000) could be replicated. Metric invariance could be shown for gender and age, partial scalar invariance could be only generated for gender. No metric or scalar invariance could be shown for federal state and denomination. DISCUSSION: Due to the good psychometric properties of the TPV-4R questionnaire it should be further analyzed in future research with other validated instruments that are measuring spiritual or religious attitudes. CONCLUSIONS: The new German short version, the TPV-4R, is an economic, reliable and valid questionnaire to measure spiritual attitudes.

[Psychometric Properties of the Shortend Version of the "Systems of Belief Inventory" in a Representative Sample of the German Population]. / Psychometrische Überprüfung der Kurzversion des "Systems of Belief Inventory" in einer deutschlandweiten repräsentativen Bevölkerungsstichprobe.

INTRODUCTION: The aim of the present study was to show the development of the revised and shortened German version (6 items) of the "Systems of Belief Inventory" (SBI-6R-D) as well as to examine its psychometric properties. METHODS: In a representative German sample the questionnaire has been given to 2513 subjects. A confirmatory factor analysis has been made to prove the original American factor structure. Measurement invariance was tested using multigroup analysis. Correlations were used to determine convergent and discriminant validity towards other items. RESULTS: The SBI-6R-D showed good item and scale characteristics as well as good model fit. In difference to the work of Albani et al. (SBI-15R-D), the 2 factorial structure of the original American questionnaire could be replicated. Scalar invariance could be shown for gender and age, metric invariance for denomination and federal state. DISCUSSION: Due to the good psychometric properties of the questionnaire it should be further analyzed in future research with other validated religious instruments. CONCLUSIONS: The new German short version, the SBI-6R-D, is an economic, reliable and valid questionnaire to measure spiritual and religious attitudes.

[Is the influence of religiousness on fearful, depressive and somatic symptoms and psychic traumatization overestimated? A representative cross-sectional study]. / Religiosität: in ihrem Einfluss auf ängstliche und depressive Symptome sowie Körperbeschwerden und Traumata überschätzt? Eine repräsentative Querschnittstudie.

Is the influence of religiousness on fearful, depressive and somatic symptoms and psychic traumatization overestimated? A representative cross-sectional study Objectives: The aim of this study is to prove if religious faith, spirituality and religious praxis are joined with lower depression, anxiety and physical pain-level and if subjects with traumatic experiences report more spirituality. Methods: In this consecutive study, 2508 adults of a representative sample in Germany were interviewed about religious faith and spirituality in relation to depression, anxiety, physical disorders as well as traumatic experiences. Results: Unlike our hypotheses people who are charged with mental (PHQ-4; Löwe et al. 2010) or physical disorders (GBB_8; Kliem et al. 2017) report more spirituality and more private religious/spiritual praxis than people without mental or physical problems. As expected people with traumatic experiences in their childhood (CTS; Grabe et al. 2012) describe significantly more spirituality than people without these experiences. Conclusions: Other than expected people with more mental or physical disorders report more spirituality and more private religious/spiritual praxis. It is to discuss if spirituality is less a protective factor for mental or physical disorders than disorders activate to look for spirituality and private religious/spiritual praxis.

[Staffing level: Survey among psychosomatic-psychotherapeutic institutions in Germany]. / Personalausstattung: Befragung psychosomatischpsychotherapeutischer Kliniken und Abteilungen in Deutschland.

Staffing level: Survey among psychosomatic-psychotherapeutic institutions in Germany Objectives: To establish the first nationwide hospital survey to assess the level of staffing for inpatient and daycare treatment in psychosomatic hospitals and specialist departments in Germany. METHODS: Using a standardized written hospital survey from the Deutsches Krankenhausinstitut (DKI), we invited a total of 218 psychosomatic-psychotherapeutic hospitals and specialist departments to participate. The participation rate of the institutions was 35%. RESULTS: In the overall sample, one psychotherapist (physician/clinical psychologist) was responsible for treating a median of 3.9 beds/patients (interquartile range 3.1-5.1) and one nurse a median of 2.9 beds/patients (interquartile range 2.3-3.9). There were significant differences for the nurse-patient ratio depending on the organizational size of the institution. To ensure quality treatment, professional experts saw increased staffing needs of about 12-17% across both professions. For the professional groups of specialist therapists and social workers, broad variances were observed for the therapist-patient ratio in the overall sample. CONCLUSIONS: The study provides an important and relevant data basis for the further discussion to determine mandatory minimal staffing levels in German psychosomatic-psychotherapeutic institutions.

[Quality of life and mental health of patients with severe heart failure with or without technical support for the left cardiac ventricle - a cross-sectional study]. / Lebensqualität und psychisches Befinden von Patienten mit schwerer Herzinsuffizienz mit und ohne apparative Unterstützung der Funktion des linken Ventrikels ­ eine Querschnittsstudie.

Quality of life and mental health of patients with severe heart failure with or without technical support for the left cardiac ventricle - a cross-sectional study Objectives: Chronic heart failure is associated with reduced quality of life (QoL) and poor prognosis. Support via a left ventricular assist device (LVAD) is an alternative to optimised medical management for patients with advanced heart failure. This study evaluated health-related QoL with both therapy options. METHODS: In this consecutive cross-sectional study, patients with LVAD support (n = 50) and patients with optimised medical management (n = 50) were interviewed comprehensively about various domains of QoL, emotional stress, perceived self-efficacy, social support, life satisfaction, and communication. RESULTS: LVAD patients had a better overall QoL (KCCQ, clinical summary: MW: 67.4 vs. 52.9). Patients with medical management reported increased emotional stress stemming from depressed mood (HADS-D, MW: 7.1 vs.MW: 6.0). Depressed mood proved to be the most significant negative predictor for health-related QoL as well as for emotional well-being. CONCLUSIONS: Although they had a worse clinical situation preoperatively, LVAD patients had a significantly better QoL in both physical dimensions and functional competencies as well as significantly less psychological stress through depressed mood and anxiety.

[A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years]. / Evaluation von Gutachten einer Universitätsklinik für Psychosomatik und Psychotherapie für öffentliche und private Auftraggeber über einen Zeitraum von zwölf Jahren.

A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years Objectives: Both the public and the legislative have developed an increasingly critical awareness for the fact that expert witnesses need to be independent. In contrast, to date there have been few studies concerning the quantity and the results of psychosomatic-psychotherapeutic expert opinions for public and private clients. METHODS: In a retrospective study design, 285 expert opinions of a psychosomatic-psychotherapeutic university hospital stemming from consecutive, unselected random sampling over a 12-year time period (1990-2011) were analyzed using a predefined list of criteria. Besides client data, the study also noted the type and the objectives of the expertise, the sociodemographic data of the subjects, the biographic data of the subjects, the size of records, the particular psychopathological findings including conflict and structural diagnostics via the Operationalized Psychodynamic Diagnostics (OPD-2, Research Group 2006), syndromic diagnostics according to ICD-10 (WHO) including the related Impairment Scale Score (ISS, Schepank 1995), and the Global Assessment of Functioning-Scale (GAF, Heuft 2016). RESULTS: 54% of the subjects were men. All subjects were 46 years old at the time of examination; on average symptomatology had existed for 7 years, which made assessment of causality difficult. Most assignments referred to the effects of diseases or accidents in private contexts, followed by pension reports. Among the expert opinions related to possible implications of acts of violence, 95% were women. In 43.2% (n = 123) of the cases, the assessment had occurred in the context of legal action. In 65 cases at least one party had requested a supplemental written report during further procedure. In 17.8% (n = 22) of the cases sought by the courts, the expert witness was requested by at least one party to present the assessment verbally. DISCUSSION: It should be emphasized that OPD conflict and structural diagnostics appear indispensable also for assessing mental health prior to an external event (accident or assault). The use of the two severity ratings (ISS, GAF) is discussed. It is proposed that expert witnesses be requested to name all their clients fromthe last 5 years at the beginning or end of the expert opinion, so that their independence from possible conflicts of interest can be established.

Itch Perception and Skin Reactions as Modulated by Verbal Suggestions: Role of Participant's and Investigator's Sex.

This study investigated sex-specific differences in itch perception and skin reactions, as modulated by verbal suggestions, and the role of the investigator's sex. Healthy volunteers (50 males, 50 females), divided into 4 groups, were tested by male and female investigators. Itch was induced via prick testing with sodium chloride and histamine in 4 runs; 2 control conditions (with no exaggerated verbal comments about expected itch) and 2 experimental conditions (with exaggerated verbal comments). After 5 min, wheal and flare reactions were measured and itch intensity was rated by subjects on a numerical rating scale. Exaggerated verbal suggestions resulted in higher itch intensity ratings in the sodium chloride and histamine condition, and higher unpleasantness ratings and a wheal of greater extent in the sodium chloride condition, as well as a flare of greater extent in the histamine condition. The magnitude of the differences between the exaggerated verbal suggestion conditions and respective control conditions was only significantly different between male and female investigators concerning flare size in the histamine condition. There were no differences between male and female participants. Therefore, sex differences may play only a minor role in nocebo-induced itch perception.

[Normative-empirical determination of personnel requirements in psychosomatic medicine and psychotherapy]. / Normativ-empirische Bestimmung des Personalbedarfs in der Psychosomatischen Medizin und Psychotherapie.

OBJECTIVES: There is a high degree of misallocated medical care for patients with somatoform disorders and patients with concomitant mental diseases. This complex of problems could be reduced remarkably by integrating psychosomatic departments into hospitals with maximum medical care. Admitting a few big psychosomatic specialist clinics into the calculation basis decreased the Day-Mix Index (DMI). The massive reduction of the calculated costs per day leads to a gap in funding resulting in a loss of the necessary personnel requirements - at least in university psychosomatic departments. The objective of this article is therefore to empirically verify the reference numbers of personnel resources calculated on the basis of the new German lump-sum reimbursement system in psychiatry and psychosomatics (PEPP). METHODS: The minute values of the reference numbers of Heuft (1999) are contrasted with the minute values of the PEPP reimbursement system in the years 2013 and 2014, as calculated by the Institute for Payment Systems in Hospitals (InEK). RESULTS: The minute values derived from the PEPP data show a remarkable convergence with the minute values of Heuft's reference numbers (1999). CONCLUSIONS: A pure pricing system like the PEPP reimbursement system as designed so far threatens empirically verifiable and qualified personnel requirements of psychosomatic departments. In order to ensure the necessary therapy dosage and display it in minute values according to the valid OPS procedure codes, the minimum limit of the reference numbers is mandatory to maintain the substance of psychosomatic care. Based on the present calculation, a base rate of at least 285 e has to be politically demanded. Future developments in personnel costs have to be refinanced at 100 %.