How socio-political change is associated with the number of individually reported negative life events: a population-based study using the German reunification 1989/1990 as an example.

BACKGROUND: Socio-political change often leads to disruptions in employment and social networks, which can exacerbate health issues and increase mortality rates. These consequences are likely observed as an increase in negative life events (NLEs), serving as indicators of the broader social and health impacts. Using the German reunification in 1989/1990 as an example, this study investigates changes in reported numbers of NLEs and differences regarding sociodemographic characteristics. METHODS: We used data from the population-based Study of Health in Pomerania (SHIP-START-0, SHIP-Life-Events and Gene-Environment Interaction in Depression; N=1932). Numbers of NLEs in different categories (work/financial, social/interpersonal, illness (own) and illness/death (others)) were measured retrospectively in 5-year intervals (1980-2004) using a semistructured interview. Pre-reunification and post-reunification changes were modelled using piecewise mixed-effects Poisson regressions with the 1990-1994 interval (reunification) as change point. Interactions with age, sex and education were examined. RESULTS: The number of most NLE categories, except social/interpersonal NLEs, increased at reunification. Whereas work/financial NLEs slightly decreased post-reunification, illness-related NLEs continued to increase. Higher numbers of social/interpersonal NLEs were found with younger age. More illness-related NLEs were reported with older age, lower education (illness (own)) and by women (illness/death (others)). However, the majority reported no NLEs at reunification (68.2%-80.7%, varying by category). CONCLUSION: Our findings suggest that although some individuals experience a marked increase in NLEs due to socio-political changes, many remain unaffected, emphasising the need for a differentiated understanding of these effects. This increase in NLEs may partly account for ongoing health and well-being disparities among countries with differing transformation histories.

Value-related attitudes towards mental health problems and help-seeking barriers: a sequential mixed-methods design investigating participants with reported depressive episodes in rural Northern Germany with and without treatment experience.

BACKGROUND: Seeking help for severe depressive symptoms remains a major obstacle for particular groups within the general population. Value-related attitudes might contribute to this treatment gap, particularly in rural regions with a low density of psychiatric-psychotherapeutic services. We aimed to investigate narratives of socialization, value systems, and barriers of help-seeking to better understand social milieus at increased risk for underuse of psychiatric-psychotherapeutic services in a rural area in East Germany. This could complement the explanatory power of classical socio-demographic determinants and provide guidance for possible interventions. METHOD: Based on results of an analysis of a population-based German cohort study (SHIP-TREND-1), 20 individual semi-structured interviews were conducted with participants who met criteria for having been moderately or severely depressed at least once in their life. Qualitative analyses of interview data were guided by grounded theory methodology. RESULTS: Participants with severe symptoms of depression were more frequent among non-responders of this study. We identified key aspects that influence help-seeking for mental health problems and seem to be characteristic for rural regions: family doctors serve as initial contact points for mental health problems and are considered as alternatives for mental health professionals; norms of traditional masculinity such as being more rational than emotional, needing to endure hardships, embodying strength, and being independent were frequently mentioned as inhibiting help-seeking by middle-aged men; anticipated adverse side-effects of therapy such as worsening of symptoms; a frequently expressed desire for less pathologically perceived treatment options. CONCLUSIONS: Our results suggest that barriers regarding help-seeking in rural regions are multifaceted and seem to be influenced by traditional norms of masculinity. We believe it is critical to strengthen existing and already utilized services such as family doctors and to implement and evaluate tailored interventions targeting the needs of the rural milieu.

[Dealing with Lived Crisis Experience During Self-Experience: A Standardized Survey in Psychiatric Hospitals in Berlin and Brandenburg]. / Umgang mit eigenen Krisenerfahrungen in der Selbsterfahrung: Eine standardisierte Befragung in psychiatrischen Einrichtungen in Berlin und Brandenburg.

OBJECTIVE: The current study follows the question if psychotherapists with lived experiences of crisis and treatment address these experiences during their processes of self-experience. Further, the conceptual differentiation between self-experience and psychotherapy of this group of staff is explored. METHODS: 108 professionals with psychotherapeutic qualification were surveyed on their training self-experience. Relationships between processing of crisis experiences, crises frequency, and experienced benefit were analyzed using correlation analyses. Conceptual differences between self-experience and psychotherapy were gauged via nine content categories whose importance for self-experience and psychotherapy were rated by the participants. The means of these ratings were compared via t-test. RESULTS: Most participants reported that they had used their self-experience to process lived crisis experiences, and that they benefited from their self-experience, with processing and benefit being correlated significantly and positively. Conceptual differentiation of the two formats appeared to be complex. Participants ascribed biographical and personal categories rather to psychotherapy, and professional categories to self-experience. DISCUSSION: Given the prevalence of stigmatization towards individuals with mental health problems, it was surprising that most of the participants were able to address and process their lived experiences during their self-experience. It was surprising too that personal factors were ascribed to psychotherapy rather than self-experience, as the major importance of the therapeutic relationship and, by extension, personality development is well-known. CONCLUSION: Training self-experience should be a stigma-free setting, where future therapists are able to address their biographical burdens freely and thereby develop their personalities.

'Concept creep' in perceptions of mental illness - an experimental examination of prevalence-induced concept change.

The perception of what constitutes mental illness is influenced by various social and medical developments. Prevalence-induced concept change is a phenomenon where decreasing the prevalence of a category leads people to expand their judgment of that concept. In this study, we tested whether changing the prevalence of statements describing mental illness results in a change in the concept of mental illness. Based on a population survey (n = 1031), we created a validated set of 273 brief statements depicting either clear symptoms of mental illness, clear examples of healthy behaviour, or ambiguous situations. We presented a subset of statements to 138 students, asking them to judge whether each statement represented mental illness, or not. After 96 statements, we reduced the prevalence of clearly mentally ill statements in one group, while the proportion of statements denoting clear mental illness remained the same in the other group. In the group where the proportion of clearly mentally ill statements was reduced during the experiment, a concept change of mental illness evolved: participants were more likely to identify a statement as denoting a mental illness. The results indicate that the perceived prevalence of symptoms of mental illness is important for conceptualizing mental illness and that decreasing prevalence broadens the concept of mental illness. These findings add a novel perspective to current debates around diagnostic thresholds, the treatment-prevalence paradox, the medicalization of emotions, and the focus of anti-stigma campaigns.

Leaving the stigma to the patients? Frequency of crisis experiences among mental health professionals in Berlin and Brandenburg and how they cope with it.

BACKGROUND: Although mental health professionals' mental health problems are gaining increased attention, there is little systematic research on this topic. AIMS: This study investigated the frequency of crisis experiences among mental health professionals and examined how they approach these experiences in terms of their personal and social identities. METHODS: An online survey was conducted among mental health professionals in 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg (N = 215), containing questions about personal crisis experiences, help sought, service use, meaningfulness of lived experiences, causal beliefs of mental illness and psychotherapeutic orientation. Social identification was assessed via semantic differential scales derived from preliminary interview studies. To investigate relationships between the variables, explorative correlation analyses were calculated. RESULTS: Results showed a high frequency rate of crisis experiences, substantial rates of suicidal ideation and incapacity to work and high service use. Most participants regarded their experiences as meaningful for their personal identity. Meaningfulness was positively related to a psychosocial causation model of mental illness, to psychodynamic psychotherapeutic orientation and to a high degree of disidentification with users and crisis experienced colleagues. CONCLUSION: The (paradoxical) disintegration of personal and social identity of may be understood as a strategy to avoid stigmatization. A more challenging coping style among professionals is discussed.

Explorative analyses on spatial differences in the desire for social distance toward people with mental illness in a diverging city.

Introduction: Stigma is an individual and societal process based on attitudes and power and relates to both spatial disparities and social distinction. In this study, we examined differences in desire for social distance toward people with mental illness within a city using social and spatial information. Methods: ANOVAs and Scheffé post-hoc tests analyzed varying desires for social distance toward people with mental illness within Leipzig (East Germany). Joint Correspondence Analyses (JCA) explored correspondences between desire for social distance, socio-economic status, age, life orientation, social support, duration of living in Leipzig, and shame toward having a mental illness in five city districts of Leipzig in LIFE study participants (by Leipzig Research Center for Civilization Disease, data collected 2011-2014 and 2018-2021, n = 521). Results: Stigma varied among Leipzig's districts (F(df = 4) = 4.52, p = 0.001). JCAs showed that a higher desired social distance toward people with mental illness corresponded with spatial differences, high levels of pessimism, high shame of being mentally ill, low social support, low socio-economic status, and older age (75.74 and 81.22% explained variances). Conclusion: In terms of stigma, where people with mental illness live matters. The results identified target groups that should be addressed by appropriate intervention and prevention strategies for mental health care.

[Life events related to the German reunification and their associations with psychosocial health in a sample of northeast Germany]. / Nach-Wende-Ereignisse und deren Assoziation mit psychosozialer Gesundheit in einer nordostdeutschen Stichprobe.

Objectives: The aim of the present study was to investigate (1) the type and frequency of reported life events of the East German population related to the German reunification and (2) their associations with psychosocial health. Methods: Data of 2247 participants of the Study of Health in Pomerania was used.These qualitative responses were analysed using quantitative content analysis. Their associations with subjective physical and mental health, optimism, social support, depressive symptoms, and chronic stress were examined. Results: Eight life event categories were identified (education, employment-related changes, material changes, new opportunities, personal life events, politics, separations, reunifications). Especially, experiencing new opportunities was associated with a higher level of optimism as well as a lower level of depressive symptoms and chronic stress. Conclusions: In this study, events frequently described in the literature (e.g., employment-related and social changes) were confirmed and systematized.The observed associations of these events with psychosocial factors should be examined further in future studies.

Mental resources, mental health and sociodemography: a cluster analysis based on a representative population survey in a large German city.

BACKGROUND: Mental resources such as optimism and social support are important to face different stressors. The aim of this study is to identify groups in the population that are similar in terms of their mental resources. METHODS: For this purpose, a randomly selected general population community sample was used, representative for the city of Leipzig, Germany. In a two-stage process, three clusters were identified using hierarchical cluster analysis and the K-means method and then tested with a multinomial logistic regression analysis for differences in sociodemographic characteristics. RESULTS: Three clusters were identified which vary in their extent of social support and optimism. In distinguishing between those with higher and lower (medium or poor) mental resources, male gender, unemployment, being born abroad and low household income are risk factors for having fewer mental resources. Internal migrants from West Germany and persons with children at home have a higher chance of being in the type with good mental resources. The groups with medium and lower mental resources differ significantly only by variables living with a partner and employment. CONCLUSION: Our results indicate that good mental resources are associated with good mental health. Special mental health care programs, focusing in particular on the needs of vulnerable groups with poor mental resources within a society, should be implemented.

An explorative cross-sectional analysis of mental health shame and help-seeking intentions in different lifestyles.

To identify und support particular target groups for mental health prevention, we explore the links between shame and help-seeking intentions concerning mental health in different lifestyles (based on socioeconomic status as well as health-related behaviors). Lifestyles were operationalized by nine confirmatory, homogenous clusters of the sample. These clusters are based on individuals' similarities in sociodemographic aspects and health behavior. Analyses included t tests, Chi-square, ANOVA, regressions investigating in sociodemographic characteristics. Hierarchical linear models examining cross-sectional associations of shame and willingness to seek help for different lifestyles of participants of the Study of Health in Pomerania (SHIP-START-1 and SHIP-START-3, data collected 2002-2006 and 2014-2016; n = 1630). Hierarchical linear models showed small context effects for lifestyle-related associations of shame and willingness to seek help. For younger as well as male participants, lifestyles indicated different associations of shame and help-seeking intentions: Especially the lifestyles with unhealthy behaviors and high as well as low socioeconomic status resulted in higher shame being associated with low help-seeking intentions in case of mental illness. Lifestyle clusters might be a useful tool to identify marginalized groups with unhealthy behaviors, which should be addressed by interventions and prevention programs.

[The German population's attitude towards mental disorders]. / Die Einstellung der deutschen Bevölkerung zu psychischen Störungen.

For many of those affected, a mental illness also means dealing with the reactions of their environment. These are shaped by culturally prevailing ideas about the cause, treatment, course, and biographical significance of the illness. This article provides an overview of the development of population attitudes towards individuals with mental illness in Germany between 1990 and 2020 with a focus on depression and schizophrenia.A look at the last 30 years shows that attitudes toward mental illness are not static; rather, they are subject to certain dynamics that can vary considerably depending on the type of mental illness. In summary, depression evokes far fewer negative emotions than is the case with schizophrenia. This gap in attitudes has widened over the last 30 years: people with depression are met with more understanding today than 30 years ago, while the stigma of schizophrenia seems to have increased. In addition to an increasing openness in dealing with mental stress, ideas of normality and concepts of mental illness seem to have also changed. Depressive states are more closely connected with people's perceptions of their own experiences today than they were ten years ago. Schizophrenia, in turn, seems to be perceived as even more unfamiliar. While the recommendation of both psychotherapy and medication increases over time, and both psychotherapists and psychiatrists are more readily recommended as a source of help, recommendation of spiritual support (pastor, priest) declines steadily since 1990. We discuss potential causes and consequences of these divergent time trends.

Lived experiences matter: The role of mental health professionals' psychological crises and vulnerability in shaping their health beliefs and concepts.

Background: Mental health professionals are often affected by mental health problems and disorders. Yet, the effects of these lived experiences on their causal beliefs and health concepts have not been investigated. The current study investigates how professionals' lived depressive experiences and their perceived vulnerability to mental illness affect their causal beliefs about mental disorders, their general concept of mental health and their specific concepts of depression and burnout. Methods: An online survey was conducted with 218 mental health professionals from 18 psychiatric clinic departments in the German federal states of Berlin and Brandenburg, investigating their experiences with depression, self-assessed vulnerability, their causal beliefs of mental illness, their general health concept and specific illness concepts of depression and burnout. A path model was calculated to examine the relationships between these variables. Participants with and without lived experience of depression were grouped. Results: Lived experience of depression was indicated by 126 participants. For participants with no experience of depression, perceived vulnerability negatively predicted beliefs in biological causation, which positively predicted higher differentiation between depression and burnout. For participants with previous depression experiences, perceived vulnerability positively predicted beliefs in psychological and social causation. Continuum belief was predicted only in this group by the three variables of causal beliefs. Psychological and social causation was positively associated, while biological causes were negatively associated with continuum beliefs. Conclusion: Mental health professionals are not external to the clinical situation. Their lived experiences do matter, shaping their beliefs and concepts and, thus, possibly also their actions toward patients.

[How Outpatient Psychotherapists Deal with Patients' Traumatic Experiences in Consideration of an Additional Qualification in Trauma Therapy]. / Umgang ambulanter Psychotherapeut*innen mit traumatischen Erfahrungen von Patient*innen unter Berücksichtigung einer traumatherapeutischen Zusatzqualifikation.

OBJECTIVE: Investigation of the differences in dealing with traumatic experiences of patients between psychotherapists with and without further training in trauma therapy or partial qualification. METHODS: Online survey of outpatient psychotherapists (N = 148) on possible obstacles in addressing traumatic experiences of patients and self-reported professional practice. RESULTS: Further training in trauma therapy is associated with a higher level of competence in professional practice and fewer obstacles in addressing traumatic experiences. CONCLUSION: A lower level of competence among psychotherapists without further training in trauma therapy speaks for the need for compulsory trainings. The expansion of low-threshold treatment offers for those affected by traumatic experiences and the dismantling of access barriers is urgently needed.

[Understanding Change Helps Conceptualise Current Action: History of Mental Health Reform in Great Britain and Italy]. / Vergangenheit verstehen hilft Zukunt denken: Psychiatrie-Reformgeschichte in Großbritannien und Italien.

Mental health reform processes in Great Britain and Italy have been discussed. Recent publications permit a comparative reflection. In England, the reform started earlier and ran continuously, with its focus changing from deinstitutionalisation and community care to (also) user involvement, managerialism, evidence-based medicine, guidelines and budget cuts. Government policies can be identified. In Italy, the reform process started later and was more disruptive. It was influenced by Basaglia und the political-historical context. The reform process has been continuous, deficits are discussed, it has stood the test of time. Similarities and differences (GB vs I) are highlighted, a social history framework is proposed to understand mental health reform processes as one aspect of societal development. This research process could help identify and shape alliances for further reforms of mental health care.

[Sex- and Regionalspecific Differences in Child Abuse and Violence Before the German Reunification. Results from GESA, a Multi-Cohort Study]. / Geschlechts- und regionalspezifische Unterschiede von Kindesvernachlässigung und Gewalt vor der deutschen Wiedervereinigung. Ergebnisse aus GESA, einem Multi-Kohorten Konsortium.

Results from a population-based study suggest sex-specific patterns of self-reported child maltreatment, more frequently reported in former West than East Germany. Aim of the current study was to examine these patterns in two regional samples of the former East- (SHIP, 2008 - 2012) and West German (KORA, 2013 - 2014) population. Child maltreatment was assessed using the Childhood Trauma Screener (CTS). Overall, child maltreatment was less often reported in the East German sample, compared to the West German sample. The most prominent differences were identified in self-rated emotional violence (east 6.1%, west 8.7%), physical violence (east 5.7%, west 10.3%) and physical neglect (east 10.0%, west 19.2%). However, we could not find differences in sex-specific patterns between the East and West German samples. Results were discussed within a historical context, since the events took place before the German reunification in two oppose political systems.

Understanding the Association between Alcohol Stigma and Alcohol Consumption within Europe: A Cross-Sectional Exploratory Study.

INTRODUCTION: Stigma towards alcohol-related conditions is more pronounced than stigma against any other mental illness and has remained high throughout past decades. Although alcohol consumption is a known and persistent contributor to the burden of disease and interpersonal threat and may thus shape public attitudes towards consumption, no study to date has provided an overview of the prevalence of alcohol stigma and its association with (a) alcohol consumption and (b) harm attributable to alcohol across Europe. As a social reaction to thresholds of accepted use of alcohol, stigma could impact consumption, resulting in a reduced quantity or at least less harmful drinking patterns. This contribution provides an initial overview by addressing the following research questions. (i) What are the country-level prevalence rates of alcohol stigma compared across European countries? (ii) Is alcohol stigma associated with (a) alcohol consumption and (b) alcohol-attributable harm? (iii) Is there an association between alcohol stigma and alcohol consumption by type of beverage? METHODS: We combined data on country-level desire for social distance towards "heavy drinkers" (European Values Survey, operationalization of "alcohol stigma") with indicators of alcohol consumption, including adult per capita consumption (APC), heavy episodic drinking, consumption by type of beverage (wine, beer, spirits), and harm attributable to alcohol, namely age-standardized disability-adjusted life years lost to alcohol consumption (AADALYs) for 28 countries. Linear regression models were applied. RESULTS: (i) Social distance varied noticeably across countries (M = 62.9%, SD = 16.3%) in a range of 28.3% and 87.3%. (ii) APC was significantly positive related to social distance (ß = 0.55, p = 0.004). (iii) Wine consumption was significantly negative related to social distance; the opposite was true for spirits consumption. No association was found for beer consumption. The best model fit was achieved with APC (ß = 0.48, p = 0.002) and wine per capita consumption (ß = -0.55, p < 0.001) explaining 57.0% (adjusted R2) of the variance in social distance. CONCLUSION: Our study shows a strong relationship between country-level alcohol stigma and alcohol consumption. If stigma was to deter people from harmful alcohol consumption, it would be expected that higher levels of alcohol stigma are associated with lower levels of overall alcohol consumption or consumption of spirits in particular. Instead, stigma seems to be a reaction to harmful drinking patterns without changing these patterns for the better.

Differential Diagnosis Between Alzheimer's Disease-Related Depression and Pseudo-Dementia in Depression: A New Indication for Amyloid-ß Imaging?

BACKGROUND: Alzheimer's disease and depression can start with combined cognitive and depressive symptoms [1, 2]. Accurate differential diagnosis is desired to initiate specific treatment. OBJECTIVE: We investigated whether amyloid-ß PET imaging can discriminate both entities. METHODS: This retrospective observational study included 39 patients (20 female, age = 70±11years) with both cognitive and depressive symptoms who underwent amyloid-ß PET imaging and in whom clinical follow-up data was available. Amyloid-ß PET was carried out applying [18F]Florbetaben or [11C]PiB. The PET images were analyzed by standardized visual and relative-quantitative evaluation. Based on clinical follow-up (median of 2.4 years [range 0.3 to 7.0 years, IQR = 3.7 years] after amyloid PET imaging which was not considered in obtaining a definite diagnosis), discrimination ability between AD-related depression and pseudo-dementia in depression/depression with other comorbidities was determined. RESULTS: Visually, all 10 patients with pseudo-dementia in depression and all 15 patients with other depression were rated as amyloid-ß-negative; 2 of 14 patients with AD-related depression were rated amyloid-ß-negative. ROC curve analysis of the unified composite standardized uptake value ratios (cSUVRs) was able to discriminate pseudo-dementia in depression from AD-related depression with high accuracy (AUC = 0.92). Optimal [18F]Florbetaben discrimination cSUVR threshold was 1.34. In congruence with the visual PET analysis, the resulting sensitivity of the relative-quantitative analysis was 86% with a specificity of 100%. CONCLUSION: Amyloid-ß PET can differentiate AD-related depression and pseudo-dementia in depression. Prospective clinical studies are warranted to confirm this result and to potentially broaden the spectrum of clinical applications for amyloid-ß PET imaging.

The stigma of alcohol-related liver disease and its impact on healthcare.

People with alcohol-related liver disease (ALD) experience stigma and discrimination. This review summarises the evidence on stigma in healthcare and its implications for people with ALD, drawing from the literature on the stigma associated with mental illness and, specifically, alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to failure to seek help or delays in seeking help, inferior healthcare, and negative health outcomes, which increase the overall burden of ALD. Stigma can be experienced, but also anticipated and avoided, with both scenarios negatively impacting on ALD healthcare. Blaming people with ALD for their condition is central to the stigma of ALD. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigmatisation of patients with ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD-related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low- and middle-income countries and in countries with restrictive drinking norms. Interventions to reduce the stigma of ALD and facilitate early help-seeking need to be developed and evaluated.

Add-on Cariprazine in Patients with Long-term Clozapine Treatment and Treatment Resistant Schizophrenia: Two Cases of Psychotic Deterioration and Pisa Syndrome.

An increasing number of studies deal with medical options for treatment resistant schizophrenia. If no remission can be achieved with clozapine, a combination of antipsychotics can be considered. The combination of clozapine and cariprazine is rarely studied. Cariprazine is a partial agonist on dopamine D2 and D3 receptors and a pharmaceutically rational add-on to clozapine. Stimulating D3 receptors has been linked to improved cognition and mood, with negligible extrapyramidal side effects. We present two patients with long-term treatment resistant schizophrenia receiving cariprazine and clozapine. Whereas psychotic symptoms worsened, the patients developed extrapyramidal side effects with a Pisa syndrome. The syndrome remitted after discontinuation of cariprazine. Possible explanations by pharmacodynamic interactions and drug specific receptor profiles are discussed.

Trauma assessment in outpatient psychotherapy and associations with psychotherapist's gender, own traumatic events, length of work experience, and theoretical orientation.

BACKGROUND: Traumatic events are strongly associated with mental health problems. At present, traumatic events and trauma-specific needs are commonly underdetected in therapeutic settings. Many mental health professionals lack key competencies for trauma inquiry and treatment. OBJECTIVE: In this study, we aimed to investigate the everyday practices of dealing with traumatic events in outpatient psychotherapy in Germany as well as the influence of the therapist's gender, own traumatic events, length of professional experience, and theoretical orientation. METHOD: A total of 148 outpatient psychotherapists completed a purpose-designed online questionnaire. Therapists rated barriers and attitudes towards trauma assessment, possible requirements for enquiring about trauma, and practical aspects of trauma assessment. RESULTS: Barriers reported in previous studies, e.g. fear of offending the patient or exacerbating their psychological state, could not be confirmed in our sample. Overall, participating therapists felt confident in engaging with traumatic events and considered enquiring about trauma important in all patients. Group differences were found for therapist's gender, own traumatic events, length of work experience, and theoretical orientation. CONCLUSIONS: Our results suggest that trauma training lowers barriers and raises therapists' self-confidence in dealing with patients´ traumatic experiences. Therapists' characteristics effecting trauma assessment should be considered during training. Due to the increasing demand for psychotherapy, especially considering people with severe mental illness affected by traumatic events, trauma training should be obligatory for all mental health professionals.

Antecedentes: Los eventos traumáticos están fuertemente asociados a problemas de salud mental. En la actualidad, los eventos traumáticos y las necesidades específicas asociadas al trauma no suelen ser detectadas en entornos terapéuticos. Muchos profesionales de salud mental carecen de las competencias para indagar sobre el trauma y tratarlo.Objetivo: En este estudio, el objetivo fue el investigar las prácticas cotidianas del abordaje de los eventos traumáticos en la psicoterapia ambulatoria de Alemania, así como investigar la influencia que el género del terapeuta, sus propios eventos traumáticos, el tiempo de su experiencia laboral y su orientación teórica tiene sobre esto.Métodos: Ciento cuarenta y ocho (148) psicoterapeutas de atención ambulatoria completaron un cuestionario en línea diseñado para el propósito del estudio. Los psicoterapeutas calificaron las barreras y actitudes respecto a la evaluación del trauma, los posibles requisitos para preguntar sobre el trauma y los aspectos prácticos de la evaluación del trauma.Resultados: No se pudieron confirmar las barreras reportadas en estudios previos como, por ejemplo, el temor a ofender al paciente o el empeorar su estado psicológico. En general, los psicoterapeutas participantes sentían confianza al momento de abordar los eventos traumáticos y consideraron que el preguntar sobre el trauma era importante en todos los pacientes. Se encontraron diferencias según el género del psicoterapeuta, sus propios eventos traumáticos, el tiempo de su experiencia laboral y su orientación teórica.Conclusiones: Nuestros resultados sugieren que el entrenamiento en trauma disminuye las barreras e incrementa la confianza de los psicoterapeutas consigo mismos para abordar las experiencias traumáticas de los pacientes. Las características de los psicoterapeutas que afectan la evaluación del trauma deben ser consideradas durante el entrenamiento. Debido a que existe un incremento en la demanda de psicoterapia, considerando especialmente a las personas con enfermedad mental severa afectadas por eventos traumáticos, el entrenamiento en trauma debería ser obligatorio para todos los profesionales de salud mental.