[Evaluating the reform of the psychotherapy guideline using a mixed-methods approach: a study protocol]. / Mixed-Methods-Ansatz zur Evaluation der Reform der Psychotherapie-Richtlinie: ein Studienprotokoll.

INTRODUCTION: In Germany, psychotherapy in outpatient statutory health care is regulated by the Psychotherapy Guideline (PT-GL). A discussion on waiting times and inadequate care for patients resulted in a structural reform of the PT-GL in 2017. The reform aims to improve access to psychotherapy and the entire course of care and treatment. The purpose of the present study was the evaluation of the new elements and identification of obstacles and barriers in their implementation. METHODS: Quantitative and qualitative methods were used to evaluate the reform of the PT-GL. In a retrospective cohort-based analysis of anonymized administrative claim data from the statutory health insurances BARMER and AOK, the health care situation before and after the reform were compared. In addition, a cross-sectional questionnaire survey evaluated the implementation of the new care elements from the perspective of psychotherapists, general practitioners and patients. The questionnaires were developed based on focus groups with stakeholders and a literature search. The survey results provided the data basis for the cross-sectional analysis together with the routine data on the care situation after the reform of the PT-GL as well as aggregated, anonymized data from the National Association of Statutory Health Insurance Physicians on statutory health insurance care and on the use of the appointment service centers. CONCLUSION: By combining quantitative and qualitative data, the effects of the structural reform of the PT-GL of 2016 can be analyzed at the individual and structural level as well as in relation to the entire care and treatment process. Based on this, proposals for a needs-oriented further development of the PT-GL will be prepared, considering the perspectives of various interest groups.

[The Structural Reform in Outpatient Psychotherapy Shows Effects in Health Service Utilization, Especially in Younger Patients]. / Nach der Strukturreform der ambulanten Psychotherapie zeigen sich vor allem in jüngeren Altersgruppen Effekte.

AIM OF THE STUDY: The aim of the structural reform of outpatient psychotherapy in Germany in 2017 was to make access to psychotherapy guideline easier and more flexible. The aim of the present study was to investigate whether more people gained access to outpatient psychotherapy after the reform and the treatment pathways they used in the process. METHODOLOGY: From the nationwide AOK routine data, 2 cohorts (2016 and 2019) of insured persons with a newly made diagnosis indicating the need for psychotherapy were identified and subdivided according to age and gender. The extent to which these insurees received treatment within the framework of psychotherapy guideline and the treatment elements used in the process were examined. RESULTS: After the reform, a greater percentage of insurees with a mental disorder received treatment under the psychotherapy guideline. More women accessed treatment, with pronounced increase among adolescents and young adults. The newly introduced services of psychotherapeutic consultation hours and acute treatment were widely used. CONCLUSIONS: The results indicate that the reform has succeeded in facilitating access to outpatient psychotherapy, at least in some population groups. In addition, the new psychotherapeutic consultation hours now seem to cover a psychotherapeutic counselling need that was previously not explicitly included in the fee schedule.

Age-specific norms and validation of the German SDQ parent version based on a nationally representative sample (KiGGS).

The Strengths and Difficulties Questionnaire (SDQ) is the most widely used mental health screening instrument for children and adolescents. It is a short questionnaire including 25 items that can be answered by parents, teachers or children. There are two studies which report norms for the German SDQ parent version. They do not include children younger than 6 years. Moreover, whether the German SDQ parent version is measurement invariant across age has not yet been investigated. The absence of measurement invariance across age would support the use of age-specific norms that are not yet available for the German SDQ parent version. We used data of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a nationally representative survey including 14,835 children aged 3-17 years, to assess measurement invariance of the German SDQ parent version across the full age range. Multi-group confirmatory factor analysis revealed that the hyperactivity and emotional symptoms subscales are not comparable between children of different ages. This supports the use of age-specific norms for these two subscales and for the total SDQ. We used methods of centile estimation to smoothly model the centiles of the SDQ total score and the subscale scores in dependence on age. These age-specific centiles reflect the developmental course of SDQ problems in children (including preschoolers) and adolescents living in Germany. They can be used to identify children and adolescents with abnormal behaviour, while accounting for the developmental course of emotional and behaviour problems.

Mental health problems in children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends.

Mental health problems in children and adolescents are associated with individual and family-related constraints as well as social costs. 20.0% of children and adolescents showed mental health problems at the KiGGS baseline study (2003-2006). This study investigates the current prevalence for KiGGS Wave 2 (2014-2017) as well as time trends in comparison with the KiGGS baseline study. Mental health problems were assessed for 3- to 17-year-old children and adolescents by using the parent-based version of the Strengths and Difficulties Questionnaire (SDQ). For KiGGS Wave 2, the prevalence of mental health problems was 16.9%. A decreasing trend is pronounced particularly among boys between 9 and 17 years of age. Mental health problems are displayed more frequently by girls and boys from families with a low socioeconomic status compared to their peers from families with a medium or high socioeconomic status. These findings are discussed in the light of various measures and actions in health promotion and health care.

Within-person changes in salivary testosterone and physical characteristics of puberty predict boys' daily affect.

Recent investigations highlighted the role of within-person pubertal changes for adolescents' behavior. Yet, little is known about effects on adolescents' daily affect, particularly regarding the hormonal changes underlying physical changes during puberty. In a study with 148 boys aged 10 to 20years, we tested whether within-person physical and hormonal changes over eight months predicted everyday affect fluctuations, measured with experience sampling. As expected, greater within-person changes in testosterone (but not in dehydroepiandrosterone) were associated with higher affect fluctuations in daily life. Additionally, greater physical changes predicted higher affect fluctuations for individuals in the beginning of puberty. The findings demonstrate the relevance of physical and hormonal changes in boys' affective (in)stability.

Hedonic orientation moderates the association between cognitive control and affect reactivity to daily hassles in adolescent boys.

People often seek to regulate their affective reactions when confronted with hassles. Hassle reactivity is lower for people with higher cognitive control, presumably because of better affect regulation. Many adolescents, however, show higher hassle reactivity than children, despite better cognitive control. The present study aims to understand whether motivational differences when seeking to regulate affective experiences moderate the association between cognitive control and hassle reactivity in adolescence. We hypothesized that higher cognitive control is related to lower hassle reactivity only for adolescents with a strong hedonic orientation, that is, for adolescents who seek to maintain or enhance positive or to dampen negative affect. We investigated 149 boys' (age range: 10-20 years) hedonic orientation and affect reactivity toward daily hassles during 2 weeks of experience sampling. Higher cognitive control, assessed with a working memory battery in the laboratory, was associated with stronger hassle reactivity in individuals with low hedonic orientation. The more hedonic-oriented individuals were, the lower was their hassle reactivity, but only in combination with high cognitive control. Our findings illustrate that higher cognitive control is not always related to lower hassle reactivity. Rather, when daily hassles compromise affect balance, hedonic orientation is equally important to understand affect reactivity in adolescent boys. (PsycINFO Database Record

Outside of the laboratory: Associations of working-memory performance with psychological and physiological arousal vary with age.

We investigated age differences in associations among self-reported experiences of tense and energetic arousal, physiological activation indicated by heart rate, and working-memory performance in everyday life. The sample comprised 92 participants aged 14-83 years. Data were collected for 24 hr while participants pursued their normal daily routines. Participants wore an ambulatory biomonitoring system that recorded their cardiac and physical activity. Using mobile phones as assessment devices, they also provided an average of 7 assessments of their momentary experiences of tense arousal (feeling nervous) and energetic arousal (feeling wide-awake) and completed 2 trials of a well-practiced working-memory task. Experiences of higher energetic arousal were associated with higher heart rate in participants younger than 50 years of age but not in participants older than that, and energetic arousal was unrelated to within-person fluctuations in working-memory performance. Experiences of tense arousal were associated with higher heart rate independent of participants' age. Tense arousal and physiological activation were accompanied by momentary impairments in working-memory performance in middle-aged and older adults but not in younger individuals. Results suggest that psychological arousal experiences are associated with lower working-memory performance in middle-aged and older adults when they are accompanied by increased physiological activation and that the same is true for physiological activation deriving from other influences. Hence, age differences in cognitive performance may be exaggerated when the assessment situation itself elicits tense arousal or occurs in situations with higher physiological arousal arising from affective experiences, physical activity, or circadian rhythms.