[Implementation of the principle of supported employment in Germany : Position paper of a task force of the DGPPN]. / Umsetzung der Prinzipien des Supported Employment in Deutschland : Positionspapier einer Task-Force der DGPPN.

The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers.

Validation of the motivational phase of the integrated motivational-volitional model of suicidal behavior in a German high-risk sample.

BACKGROUND: The Integrated Motivational-Volitional (IMV) model of suicidal behavior proposes in its motivational phase that perceptions of defeat and entrapment (total, internal and external entrapment) lead to the development of suicidal ideation and that thwarted belongingness and perceived burdensomeness moderate this process. The aim of this study was to test the motivational phase of the IMV model cross-sectionally in a German sample of psychiatric inpatients. METHODS: A total of 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.92, SD = 14.30) were included in the study and investigated within 14 days after psychiatric admission due to suicide attempt (53%) or acute suicidal crisis (47%). Statistical analyses included a mediation analysis and moderation analyses. RESULTS: Results demonstrate a simple mediation of defeat via entrapment (total, internal and external entrapment) on suicidal ideation. The interaction between thwarted belongingness and perceived burdensomeness was confirmed as a motivational moderator. LIMITATIONS: Limiting factors of the present study are the cross-sectional design and the retrospective assessment of suicidal ideation. CONCLUSION: The main assumptions of the motivational phase of the IMV model could empirically be confirmed. Perceptions of defeat, internal and external entrapment, thwarted belongingness, and perceived burdensomeness should be taken into account with regard to prevention, risk assessment and interventions of suicidal ideation and attempts. However, future investigations based on prospective data are warranted.

[The German Association for Psychiatry, Psychotherapy and Psychosomatics participation compass II : Implementation of social participation for people with mental illnesses]. / Der DGPPN-Teilhabekompass II : Umsetzung sozialer Teilhabe für Menschen mit psychischen Erkrankungen.

For most people living with mental illnesses, participating in society is of existential importance; however, psychosocial care often fails to recognize its significance and therefore rarely includes the patient's interaction with society in the course of treatment. The reasons for this are both substantial and organizational in nature. The endless opportunities for participating in society, current areas as well as ways of taking part in social life even beyond the terms of the social legislative definition are, in addition to institutional variety and regional differences, all too often barriers to providing the very urgently needed support. Further aspects are insufficient knowledge of therapists about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. The presented compass of participation for social integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both this article and planned online versions should help professionals to timely and successfully assist people, particularly those with severe mental illnesses, to navigate the broad spectrum of services for social and vocational integration in Germany.

[DGPPN compass of participation for vocational integration of persons with mental illnesses]. / DGPPN-Teilhabekompass zu beruflichen Integrationsmaßnahmen für Menschen mit psychischen Erkrankungen.

Working and living for persons with mental illnesses are a major concern of rehabilitative psychiatry. In Germany the definition of rehabilitation for persons with mental illnesses is closely linked to different sectors of social welfare and to the strongly organized supply chain of prevention, acute treatment, rehabilitation and care. In successfully supporting people with mental health problems in terms of vocational integration, professionals face various obstacles. Besides finding the correct content, structural and organizational difficulties can also arise. The welfare system with its specific institutions and settings is complicated which often leads to delays in the onset of rehabilitation. Some essential reasons are insufficient knowledge about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. Also information and (positive) experiences from pilot projects working in an inclusive, cross-sectional way and across different settings are practically unavailable in Germany. The presented compass of participation from the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for vocational integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both the paper and planned online versions should help professionals to help people, particularly those with severe mental illnesses to navigate the system of services for vocational integration in Germany.

[Medical and vocational rehabilitation in rehabilitation facilities for people with mental illnesses in Germany: Analysis of admission and discharge data]. / Medizinisch-berufliche Rehabilitation in Rehaeinrichtungen für psychisch Kranke in Deutschland : Analyse der Aufnahme- und Entlassungsdaten.

BACKGROUND: Integrative medical and vocational rehabilitation has been implemented in Germany in rehabilitation facilities for people with mental illnesses (RPK). MATERIAL AND METHODS: In all 52 RPK facilities in Germany the admission and discharge data of all rehabilitation patients are collected and accumulated at facility level before they are combined at the registration office of the Federal Association of RPKs (BAG RPK). This study is based on a descriptive analysis of admission and discharge data of 1311 rehabilitation patients in the year 2010. RESULTS: Nearly two thirds of the 1311 RPK rehabilitation patients met the diagnostic criteria for schizophrenia or affective disorders. A subgroup of 39.1 % of all patients participated in vocational RPK measures (programs for participation in working life, LTA) after having received medical RPK measures. After completion of the vocational RPK measures 38 % of the rehabilitation patients were employed and 26 % were in education and retraining, i.e. 64 % of the patients were employed in the labor market or in educational measures. The housing and living conditions of the majority of patients changed in the direction of increased autonomy after completion of the RPK measures. DISCUSSION AND CONCLUSION: For people with severe mental illnesses, RPKs can be a place of successful rehabilitative measures facilitating participation in community life. Future studies need to investigate predictors of outcome.

[Assertive community treatment in patients with severe obsessive-compulsive disorders]. / Aufsuchende gemeindepsychiatrische Behandlung bei Patienten mit schweren Zwangsstörungen.

For the use of psychosocial treatments for severe mental illness, there is a high evidence level. Obsessive-compulsive disorders are accompanied by severe disabilities in one third of the cases, however, there is little scientific research on the use of psychosocial therapies in patients with obsessive-compulsive disorders. In the following, the concept of an outreaching multi-professional treatment based on the assertive community treatment (ACT) method for severe compulsive illnesses is presented and discussed based on two case studies. There was an obvious reduction in clinically rated severity of obsessive-compulsive disorder symptoms, as measured by the Yale-Brown obsessive-compulsive scale (Y-BOCS), over the course of ACT. Comparison between pre- and post-treatment states demonstrated a reduction in the total Y-BOCS score after the treatment (case 1: total Y-BOCS score 37 versus 26; case 2: total Y-BOCS score 36 versus 16).

[Work rehabilitation in people with severe mental illnesses]. / Berufliche Rehabilitation bei schweren psychischen Erkrankungen.

Work and employment are basic human rights. Work therapy has a long-standing tradition in mental health care. Integrating people with severe mental illness into jobs has always been considered indispensable. Germany has a good legal framework for work rehabilitation and there is solid evidence of effectiveness for a range of interventions. International models of work integration have not been implemented to a sufficient degree and this may be one of the reasons for limited success in work rehabilitation for people with mental illnesses. The need for work rehabilitation measures and the available evidence are outlined. Social legislation, conceptual and organizational aspects of rehabilitation are described. International comparisons suggest that the care system will have to integrate prevention, curative treatment, rehabilitation and long-term care in a better way.

[On the history of obsessive compulsive disorders: their place in the nosological classifications up to the beginning of the 20th century]. / Die Geschichte der Zwangserkrankung: Ihre Stellung im Wandel der psychiatrischen Formenlehre bis Anfang des 20. Jahrhunderts.

Influenced by French psychiatry, the first German works on obsessive-compulsive phenomena were published in the second half of the 19th century. First they were seen as one form of the unitary psychosis, later they became involved in the dispute about the concept of paranoia. The first German definition, proposed by Carl Westphal in 1877 and of crucial importance in the conceptual history of obsessive disorders as an illness (OCD) ever since, stood in this tradition. Still the adequate nosological classification of obsessive phenomena was still heavily disputed. As more and more varied forms of obsessive disorders were described, the highly unspecific concept of neurasthenia gained importance. Then degeneration theory was a widespread aetiological concept to integrate the large number of obsessive phenomena. Towards the end of the 19th century, when psychoanalysis emerged, psychological aspects started to interest psychiatrists and psychoanalytical suggestions like Sigmund Freud's concept of obsessional neurosis were discussed. However, none of these different nosological suggestions, nor any of the proposed definitions, found general approval. Above all the question to what extent affects were involved and whether certain phenomena were compulsive in nature or not remained the subject of (ongoing) controversy. This led to a variety of highly inconsistent aetiopathogenetic concepts being proposed.

[Mental health and work: concepts, evidence and implications for research and practice]. / Psychische Gesundheit und Arbeit : Konzepte, Evidenz und Implikationen für Forschung und Praxis.

This paper reviews the concepts, evidence and implications regarding mental health at the workplace. The theoretical background with the most common theories (e.g. effort-reward imbalance model and job-demand control model) are briefly reviewed and findings from systematic reviews and from a meta-analysis regarding psychosocial factors at the workplace and common mental disorders, which indicate that psychosocial factors increase the risk of mental disorder are outlined. Implications for primary prevention as well as early intervention and treatment following a stepped care model including a variety of agents from different backgrounds are discussed. Implications to enhance research in the field are outlined.

[Sickness absence and disability due to psychiatric disorders from a gender perspective - a systematic literature review]. / Geschlechtsspezifische Analyse von Fehlzeiten am Arbeitsplatz und Erwerbsunfähigkeit aufgrund psychischer Erkrankungen - ein systematischer Literaturreview.

OBJECTIVE: This work is aimed at providing a review of the literature on gender differences in the prevalence of mental disorders at the workplace. METHODS: A systematic literature search of all original works on sickness absence and disability due to psychiatric disorders published in PubMed from 2000 through to 2011 was undertaken. RESULTS: Female employees have more frequent and longer sickness absences due to psychiatric disorders. Male employees are at a high risk of disability due to psychiatric disorders. CONCLUSION: Gender-specific prevention strategies at the workplace should target the prevention of short and long-term consequences for female employees and the long-term impact of psychiatric disorders in male employees. However, there is still a lack of knowledge about implications for gender specific prevention strategies at the workplace.

[Future medical specialists' objectives of further education and their decision to establish a practice. A gender-specific analysis]. / Weiterbildungsziel und Niederlassungsentscheidung bei zukünftigen Fachärztinnen und Fachärzten in Deutschland. Eine genderspezifische Analyse.

This study investigated future medical specialists' objectives of further qualification, their intention, and their decision to establish a practice. Data of 5,053 young physicians, obtained from five German Federal Chambers of Physicians, were analyzed. Data included sociodemographic variables, intended area of specialization, intention, and aspects relevant to the establishment of a practice. Based on preliminary studies, 18 questions were broken down into six factors. The relevance of each of these factors in the decision to establish a practice was analyzed from a gender perspective. Both female and male physicians prioritized general medicine and internal medicine. In addition, female physicians preferred pediatrics and gynecology, while male physicians more frequently chose surgery. Women view professional cooperation opportunities, framework conditions for their family, and job-related commitments as important factors in their decision to establish a practice; quality of life, financial and working conditions are more important to men. The results point out gender-specific approaches which are of relevance for planning medical specialty training.

The impact of psychiatric comorbidity on quality of life in patients undergoing herniated disc surgery.

BACKGROUND: Recent studies examined the role of psychiatric comorbidity in the process of rehabilitation in patients undergoing herniated disc surgery. These patients suffer from physical and psychosocial complaints or symptoms, which impact their everyday life negatively and the success of rehabilitation potentially. The objectives of this study are (1) to examine the quality of life (QoL) in disc surgery patients and to compare the findings with reference data from the general German population, and (2) to investigate the impact of psychiatric comorbidity on QoL of patients undergoing herniated disc surgery. METHODS: This study consists of 305 patients aged between 18 and 55 years who took part in face-to-face interviews during their hospital stay. Psychiatric comorbidity was assessed with the Composite International Diagnostic Interview (CIDI-DIA-X). By means of the 36-Item Short-Form Health Survey (SF-36), QoL was assessed in patients undergoing herniated disc surgery with and without psychiatric comorbidity. These findings were compared with the QoL of a representative sample of the general German population. RESULTS: Compared with the general population, QoL in patients with herniated disc surgery was lower in all domains of the SF-36. Psychiatric comorbidity impacts the QoL in patients with herniated disc surgery in all SF-36 domains except "physical function". The patients with psychiatric comorbidity showed significantly lower levels of QoL in the domains "bodily pain", "vitality", "social function", "role emotional", and "mental health". CONCLUSIONS: Psychiatric comorbidity has a substantial adverse effect on QoL in patients undergoing disc surgery. Therefore, it will be necessary to diagnose psychiatric comorbidities at an early stage and to include psychosocial interventions in the treatment of herniated disc patients aimed at improving deficits in psychosocial functioning and QoL.