Space for youth mental health-coercive measure use before and after architectural innovation at a department of child and adolescent psychiatry.

BACKGROUND: Influence of architectural features in child and adolescent psychiatric wards on coercive measure use has not been investigated so far. We aimed to assess the effect of altering the physical environment of an adolescent psychiatric inpatient unit on the proportion and frequency of adolescents experiencing mechanical coercive measures. METHOD: In a naturalistic observational design, coercive measures were compared before and after an architectural intervention facilitated by rebuilding a child and adolescent psychiatric department in October 2020. Age, gender, length of stay, main psychiatric diagnosis and indices of coercion in n = 782 admissions to inpatient child and adolescent psychiatry from April 2019 to April 2022 were extracted. Group comparisons were performed using chi-squared tests for categorical and Mann-Whitney U-tests for numerical variables. RESULTS: After structural modernization which included amplifying space and with the newly introduced availability of seclusion rooms, significantly fewer patients were affected by mechanical restraint (8.1% vs. 13.7%, p = .013). Rate of seclusion increased to 5.0% (vs. 0%, p < .001). Rate of seclusion and/or restraint decreased from 13.7% to 11.8% (p = .425). The median cumulative duration of all coercive measures per affected case decreased significantly (2.8 vs. 5.4 h, p = .005), as well as its proportion to length of stay (0.8% vs. 2.8%, p = .006). CONCLUSIONS: Modernisation and restructuring of buildings hosting psychiatric departments can contribute to a reduction of coercive measures in child and adolescent psychiatric units.

Impairments in psychological functioning in refugees and asylum seekers.

Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version's total and six subdomains' scores ('mobility', 'life activities', 'cognition', 'participation', 'self-care', 'getting along') as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in 'mobility' and 'participation', followed by 'life activities' and 'cognition'. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in 'participation', while past events of being close to death were associated with fewer issues with 'self-care'. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.

Impact of COVID-19 lockdown on suicide attempts : A retrospective analysis of the springtime admissions to the trauma resuscitation room at the Medical University of Vienna from 2015-2020.

BACKGROUND: In response to the current coronavirus disease 2019 (COVID-19) pandemic the Austrian government issued a lockdown from 16 March to 15 May 2020. As periods of economic and emotional burden have proven to detrimentally affect people's psychological health, healthcare officials warned that the strict measures could have a serious impact on psychological health, leading to an increase in suicide attempts. Thus, the objective was to provide evidence for this assumption. METHODS: All adult patients admitted to the trauma resuscitation room of the Medical University of Vienna during the lockdown period following a suicide attempt were included in this analysis, forming the study group. Suicidal patients treated during the same period in 2015, 2016, 2018, and 2019 were pooled to create the control group. The year 2017 was excluded because another major hospital in Vienna was partially closed due to a change in infrastructure, resulting in an increased number of severely injured patients treated at our department. As the lockdown caused a markedly decreased number of patients admitted due to other reasons than suicide the actual number was replaced with the average number of patients admitted in the relevant previous 4 years. RESULTS: By comparing the study and the control group based on this realistic estimate we revealed an increase in attempted suicides during the lockdown period (p = 0.001). Demographic, mental health-related, and injury specific patient data did not differ between the groups. CONCLUSION: The results strongly urge for an improvement in crisis intervention and suicide prevention measures in the event of a future lockdown.

[Criterion Validity of the 15-item Geriatric Depression Scale in the Austrian Population]. / Die Kriteriumsvalidität der 15-Item Geriatrischen Depressionsskala in der österreichischen Bevölkerung.

OBJECTIVE: The "Geriatric Depression Scale" consisting of 15 items (GDS-15) is a well-known screening tool for depression among the elderly. Until now the criterion validity of the German language GDS-15 was not investigated in a sample of the adult general population. METHODS: 504 persons of the Austrian general population completed the GDS-15. Using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) ICD-10 diagnoses were established. Receiver Operating Characteristics (ROC) analysis was conducted. Possible gender and age differences were explored. RESULTS: The overall discrimination of the GDS-15 was sufficient (ROC-AUC 0,851). The cut-off value developed on the basis of our sample was 2/3 with a sensitivity of 71.8 % und a specificity of 82.8 %. We could not find significant gender or age group differences. CONCLUSION: This is the first study investigating the criterion validity of the German language GDS-15 in the adult general population. The sensitivity and specificity are sufficient and comparable with the findings among other screening tools.

[Criterion Validity of the German Version of the CES-D in the General Population]. / Kriteriumsvalidität der deutschsprachigen Version der CES-D in der Allgemeinbevölkerung.

OBJECTIVE: The "Center of Epidemiologic Studies - Depression scale" (CES-D) is a well-known screening tool for depression. Until now the criterion validity of the German version of the CES-D was not investigated in a sample of the adult general population. METHODS: 508 study participants of the Austrian general population completed the CES-D. ICD-10 diagnoses were established by using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Receiver Operating Characteristics (ROC) analysis was conducted. Possible gender differences were explored. RESULTS: Overall discriminating performance of the CES-D was sufficient (ROC-AUC 0,836). Using the traditional cut-off values of 15/16 and 21/22 respectively the sensitivity was 43.2 % and 32.4 %, respectively. The cut-off value developed on the basis of our sample was 9/10 with a sensitivity of 81.1 % und a specificity of 74.3 %. There were no significant gender differences. CONCLUSION: This is the first study investigating the criterion validity of the German version of the CES-D in the general population. The optimal cut-off values yielded sufficient sensitivity and specificity, comparable to the values of other screening tools.