[Resilience after Flight: Perspectives of Refugees and Supporting Practice Actors]. / Resilienz nach der Flucht: Perspektiven von Geflüchteten und unterstützenden Praxisakteur*innen.

STUDY OBJECTIVES: The study aims to identify (aim 1) and relate (aim 2) refugees' and practice actors' perspectives on resilience after a flight to broaden the depth of understanding of postflight resilience and to provide insights into relationships between practice actors and refugees. METHODS: Three guideline-based focus groups with refugees (N=9) and practice actors (N=13) to assess the perspectives of both groups on resilience after flight were conducted in German. They were analyzed iteratively according to Constructionist Grounded Theory. RESULTS: Refugees and practitioners report the strains of uncertainty and limitation, the adaptation processes of commonality and endeavor, and the adaptation goals of stability, connectedness, and positive emotionality (goal 1). The statements of refugees and supporting practice actors on resilience after flight concur strongly regarding their content and complement each other. Refugees report more individualized and more specifically than practice actors (goal 2). DISCUSSION: The aspects of resilience mentioned by refugees and supporting practitioners replicate the results of previous qualitative studies on post-flight resilience conducted with refugees. Both the strain of partly not knowing adequate adaptation options locally and attempts to create resilience-promoting conditions seem to be specific to the resilience of refugees. The content-related similarities between refugees and practice actors might stem from experiences of the practice actors in the context of support processes or from similar life experiences of the practice actors. The less individualized approach to post-flight resilience of the practice actors may be caused by a higher level of abstraction, role expectations, or coping with emotional distress. CONCLUSION: The results of the study suggest that refugee resilience is characterized by universal and population-specific aspects. That practice actors who support refugees and refugees concur on the content of post-refugee resilience validates the findings of previous qualitative studies on post-refugee resilience. The study also identified different approaches to post-flight resilience among refugees and practitioners, whose causes require further research.

[Services for persons with mental illness in Germany from the perspective of the health and social system: current needs for development]. / Die Versorgung von Menschen mit psychischen Erkrankungen in Deutschland aus Perspektive des Gesundheits- und Sozialsystems: Aktuelle Entwicklungsbedarfe.

SUBJECT: The article provides an overview on the current state of service provision for people with psychiatric illnesses, financed by health-insurance companies, the rehabilitation and participatory systems, and the German Federal States. Over the last 20 years, service capacities have continually improved. Three areas that are in need of further development are highlighted here: the coordination of services for mentally ill persons with complex needs; the long-term placement of persons with severe mental illness and challenging behavior; and a growing shortage of specialists. CONCLUSIONS: The mental health system in Germany is largely well to very well developed. Despite this, specific groups do not benefit from the available assistance, and these often end up as "long-term patients" in psychiatric clinics. Models for coordinated and outpatient-oriented service provision for persons with severe mental illness exist, but are only sporadic. Intensive and complex outreach services in particular are lacking, as are service concepts that are able to cross the boundaries of social security responsibilities. The shortage of specialists, which affects the whole mental health system, requires restructuring toward a more outpatient-care focus. The first tools for this exist within the health insurance-financed system. They should be used.

[Necessity and Ways to Develop Care Goals for the Health System in Germany - a Position Paper of the DNVF]. / Notwendigkeit und Wege zur Entwicklung von Versorgungszielen für das Gesundheitssystem in Deutschland ­ ein Positionspapier des DNVF.

Goals for health and health care are an indispensable basic requirement for a functioning health care system. The dilemma of the German health care system is that it has not been designed in a planned way, but that it has grown historically. In recent years, it has developed through the free play of forces into what it is today. The OECD characterizes the current state as follows: The costs of the German health system do not correspond to the often only average health outcomes for the population. To meet the legal requirements (especially SGB V §§ 12, 27 and 70), health care/the health system in Germany needs concrete goals. An orientation towards health care goals entails measures on all levels of health care: on the macro level (overall system/total population), on the meso level (subdivided according to regions, specific population groups, etc.) as well as on the micro level (patients and health care providers). Based on national and international experiences, this position paper of the DNVF e.V. (German Network for health services research) shows the potential of how operationalised health care targets can ensure effective, affordable and high-quality health care. The coalition agreement of the current government propagates a reorientation with patient-related health care goals. Now it is important to derive concrete and realisable goals from this declaration of intent and to involve all important groups in the process. In addition, values and ethical standards for implementation shall be agreed upon in this process. The Health Ministry (BMG) should facilitate and promote the process of societal will-building for the definition of national health care goals. This requires a clear political will. As a result, the National Health Care Goals are available at the end of the process, which are published and maintained together with evidence-based facts as well as valid and resilient data in a Manual "National Health Care Goals". The operational responsibility for implementation could lie with the newly to be founded Federal Institute of Public Health, as already announced in the agreement of the governing coalition. The DNVF is willing to actively participate in the development of health care targets.

[Burden in parents of school-aged children during different phases of the COVID-19 pandemic in Germany: an analysis within the COVID-19 snapshot monitoring (COSMO) study]. / Belastung von Eltern mit Kindern im Schulalter während verschiedener Phasen der COVID-19-Pandemie in Deutschland: Eine Analyse der COVID-19-Snapshot-Monitoring-(COSMO­)Daten.

BACKGROUND: Parents face a variety of personal challenges during the COVID-19 pandemic, while simultaneously being confronted with additional, school-related pandemic containment measures. OBJECTIVES: To investigate burden in parents of school-aged children across different phases of the COVID-19 pandemic in Germany and to identify particularly affected subgroups. METHODS: The COSMO project is a repetitive cross-sectional survey monitoring the psychosocial situation of the population in Germany during the pandemic with a sample size of approximately n = 1000 respondents per survey wave. A quantitative analysis of COSMO data was conducted using closed survey questions on the item "burden" as the main outcome, and, if applicable, on parenthood-associated burden from March 2020 until January 2021. RESULTS: During the first COVID-19 wave, parents of school-aged children were significantly more burdened compared to the general study population. However, burden decreased significantly from March/April to June 2020. During the second COVID-19 wave in January 2021, burden was homogeneously high across all groups. Single parenthood, a low household income, having a chronic health condition, a COVID-19 infection and a migration background were associated with higher burden, although none of these factors was consistently significant across the survey waves. Mothers reported to be more affected by parenthood-related burden than fathers. CONCLUSIONS: School measures for infection control have to be weighed carefully against the psychological impact on parental burden with subsequent negative impact on the family system. An English full-text version of this article is available at SpringerLink as Supplementary Information.

Systematic review on women's values and preferences concerning breast cancer screening and diagnostic services.

BACKGROUND: There is still lack of consensus on the benefit-harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health-related recommendations. In the context of the European Commission Initiative on Breast Cancer, we conducted a systematic review to inform the European Breast Guidelines. METHODS: We searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. We used a thematic approach to synthesise relevant data. The quality of evidence was determined with GRADE, including GRADE CERQual for qualitative research. RESULTS: We included 22 individual studies. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false-positive mammography findings, in return for the benefit of earlier diagnosis. The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden, emphasising the need for rapid and efficient screening services, and clear and efficient communication. The confidence in the findings was low to moderate for screening and moderate for diagnosis, predominantly because of methodological limitations, lack of adequate understanding of the outcomes by participants, and indirectness. CONCLUSIONS: Women value more the possibility of an earlier diagnosis over the risks of a false-positive result or overdiagnosis. Concerns remain that women may not understand the concept of overdiagnosis. Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide.

[Prevalences of Depression Among Adults: Comparative Analysis of a Nationwide Survey and Routine Data]. / Prävalenzen von Depressionen bei Erwachsenen ­ eine vergleichende Analyse bundesweiter Survey- und Routinedaten.

AIM: There are differences in the prevalence estimates of depressive disorders based on primary and secondary data. The reasons for this are, for instance, the use of divergent indicators and varying observation periods. This study examines the prevalence of depressive disorders using survey and routine data for a comparable survey period and age range. Effects of differences between data sources and indicators are estimated. METHODS: For 2010, 3 indicators are compared: in a population survey collected a) self-reported medical diagnosis of depression, b) diagnosis of depressive disorders identified by clinical interviews and c) administrative depression diagnoses collected from routine data of a statutory health insurance. In sensitivity analyses, privately insured participants of the population survey were excluded, and insured persons with care needs were excluded from routine data. The definition of administrative depression diagnosis was varied depending on the frequency of coded diagnoses and the specificity of the diagnoses. RESULTS: The highest prevalence (9.8%) was found for depression diagnoses from administrative data, the lowest prevalence (5.9%) in self-reported medical diagnoses of depression in the population survey. The prevalence of depression identified by clinical interviews was 8.4%. Differing age and gender-related courses of illness were found. The administrative prevalence dropped significantly if unspecific diagnoses (F3x.8, F3x.9) were excluded. DISCUSSION: Depending on the definition of depression diagnoses used in administrative data, there was a reduction in differences of prevalence compared to the self-reported medical diagnoses. Differences in prevalence based on a diagnosis of a depressive disorder identified in a clinical interview remained stable, which indicates different groups of persons.

Intensive follow-up for women with breast cancer: review of clinical, economic and patient's preference domains through evidence to decision framework.

BACKGROUND: Women treated for breast cancer are followed-up for monitoring of treatment effectiveness and for detecting recurrences at an early stage. The type of follow-up received may affect women's reassurance and impact on their quality of life. Anxiety and depression among women with breast cancer has been described, but little is known about how the intensity of the follow-up can affect women's psychological status. This study was undertaken to evaluate the effects of intensive vs. less-intensive follow-up on different health outcomes, to determine what are women's preferences and values regarding the follow-up received, and also assess the costs of these different types of follow-up. METHODS: A systematic review following standard Cochrane Collaboration methods was carried out to assess the efficacy of intensive follow-up versus non-intensive follow-up in breast cancer patients. Two additional reviews on women's preferences and economic evidence were also carried out. The search was performed up to January 2016 in: MEDLINE, EMBASE, PDQ, McMaster Health Systems Evidence, CENTRAL, and NHS EED (through The Cochrane Library). The quality of evidence was assessed by GRADE (for quantitative studies) and CerQUAL (for qualitative studies). Several outcomes including mortality, breast cancer recurrences, quality of life, and patient satisfaction were evaluated. RESULTS: Six randomised trials (corresponding to 3534 women) were included for the evaluation of health outcomes; three studies were included for women's values and preferences and four for an economic assessment. There is moderate certainty of evidence showing that intensive follow-up, including more frequent diagnostic tests or visits, does not have effects on 5- or 10-year overall mortality and recurrences in women with breast cancer, compared with less intensive follow-up. Regarding women's preferences and values, there was important variability among studies and within studies (low confidence due to risk of bias and inconsistency). Furthermore, intensive follow-up, as opposed to less intensive follow-up, is not likely to be cost-effective. CONCLUSIONS: Less intensive follow-up appears to be justified and can be recommended over intensive follow-up. Resources could thus be mobilised to other aspects of breast cancer care, or other areas of healthcare.

Integrated care in German mental health services as benefit for relatives--a qualitative study.

BACKGROUND: As mental health services undergo the process of deinstitutionalization, this is resulting in a higher burden of care for relatives. Evidence suggests that interventions for carers have a beneficial impact on their psychological health. A reduction of responsibility for relatives is linked with a significantly improved outcome for the severely mentally ill. The aim of the study was to explore the relatives' experiences with severely mentally ill patients in different integrated care service providers. METHODS: Semi-structured focus groups and interviews were conducted with 24 relatives of patients receiving community based integrated care for severe mental illness. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories. RESULTS: Four main categories were found related to the structural aspects of the integrated care services and for the experiences of the relatives within these services. Relatives reported that the services offered significant relief and substantial support in daily life. In addition, relatives felt a reduced burden of carer responsibility and therefore that they were provided with more protection and stability. This resulted in a sense of encouragement and not feeling left alone to face challenges. CONCLUSION: Relatives are a critical resource for patients suffering from mental health problems and benefit from formal structures and interventions to support them in carer role. An important need is to ensure continuity of care for patients and the bridging of gaps concerning information and support needs for relatives when providing integrated mental health services in the community.

Development of quality indicators and data assessment strategies for the prevention of central venous catheter-related bloodstream infections (CRBSI).

BACKGROUND: The number of catheter related bloodstream infections (CRBSI) could be reduced and the outcome improved if specific standards in the quality of care were maintained. Therefore, the development of quality assurance (QA) procedures was commissioned to be included in the national mandatory QA programme in Germany. METHODS: Indicators representing quality deficiencies and potential for improvement of quality in relation to prevention and management of central venous catheters (CVC) were developed by (1) evidence-based literature searches and the compiling of an indicator register; (2) a multi-professional expert panel including patient representatives who selected indicators from this register by using a modified RAND/UCLA Appropriateness Method; (3) defining methods for data assessment, risk adjustment and feedback of indicator results to service providers; and (4) consulting all relevant medical societies and other stakeholders with regard to the QA procedures that had been developed. RESULTS: Thirty-two indicators for CRBSI prevention and management were eventually approved by the expert panel. These indicators represent quality of care at predefined points with regard to indication, insertion and care of CVCs, management of sepsis, general hygiene and training of health care personnel. Fourteen indicators represent processes, together with 7 representing structures and 11 outcomes. For assessing these indicators, data was obtained from four sources: claims data from health insurance funds, routine claims data from hospital electronic information systems, case specific longitudinal documentation from service providers and cross-sectional annual assessment of structures. CONCLUSIONS: It was possible to develop indicators for mandatory QA procedures on CRBSI that take into account the different perspectives of all stakeholders involved. Despite efforts to use routine data for documentation wherever possible, most indicators required extra documentation.

Cost of illness for bipolar disorder: a systematic review of the economic burden.

OBJECTIVES: Recent reviews lack important information on the high cost-of-illness worldwide for bipolar disorder (BD). Therefore, the present study systematically analyzed those costs, their driving components, and the methodological quality with which the few existing cost-of-illness investigations have been performed. METHODS: In June 2012, we conducted a systematic literature review of electronic databases to identify relevant cost-of-illness studies published since 2000. Their methodological quality was assessed. Costs were standardized by first extrapolating them to 2009 using country-specific gross domestic product inflators and then converting them into US dollars via purchasing power parities (PPP). RESULTS: The main characteristics of 22 studies were evaluated. Ignoring outliers, costs per capita ranged from 8,000 to 14,000 US$-PPP for overall direct healthcare, from 4,000 to 5,000 US$-PPP for direct mental healthcare, and from 2,500 to 5,000 US$-PPP for direct BD-related care. Indirect costs ranged from 2,000 to 11,000 US$-PPP. Inpatient care was the main cost driver in three studies; drug costs, in two studies. Methodological quality was deemed satisfactory. CONCLUSIONS: The cost variance was great between studies. This was likely due to differences in methodology rather than healthcare systems, thereby making such comparisons difficult. The results showed that BD has a substantial economic burden on society. To gain more evidence, international standardized checklists are needed when undertaking cost-of-illness studies.

[Rescue Missions with Patients with Psychiatric and Psychosocial Symptoms: An Analysis from Eastern Lower Saxony]. / Notfallrettungseinsätze mit Patient*innen mit psychiatrischer oder psychosozialer Symptomatik: eine Analyse aus Ostniedersachsen.

OBJECTIVE: Characterization of medical emergencies of patients with psychiatric symptoms or in psychosocial crisis. METHODS: Analysis of emergency medical services (EMS) mission logs from four German EMS stations of patients aged 12-65 from 2019 to 2020. RESULTS: 23.4% of missions involved patients with psychiatric or psychosocial symptoms (1.6% psychotic, 3.0% suicidal, 7.1% psychosocial crisis, 15.7% intoxicated). On average, these patients were younger than those with other symptoms. 48.9% exhibited additional somatic complaints. The COVID-19 pandemic showed only little impact on the frequency of such emergencies. CONCLUSION: Psychiatric and psychosocial symptoms account for a significant proportion of rescue missions in our sample. Managing psychiatric and psychosocial emergencies should be an integral part of the training of medical and paramedical staff.

Effectiveness and efficiency of assertive outreach for Schizophrenia in Germany: study protocol on a pragmatic quasi-experimental controlled trial.

BACKGROUND: A model of assertive outreach (AO) in which office-based psychiatrists collaborate with ambulatory nursing services for providing intensive home-treatment is currently being implemented in rural areas of Lower Saxony, Germany. The costs of the model are reimbursed by some of the statutory health insurance companies active in Lower Saxony. Effectiveness and efficiency of this model for patients suffering from schizophrenia is evaluated in a pragmatic and prospective trial. METHODS: Quasi-experimental controlled trial: patients receiving the intervention are all those receiving AO; controls are patients not eligible for AO based on their health insurance affiliation. ELIGIBILITY CRITERIA: clinical diagnosis of schizophrenia (ICD-10 F.20), aged at least 18 years and being moderately to severely impaired in global functioning. PRIMARY OUTCOME: admission and days spent in psychiatric inpatient care; secondary outcomes: clinical and functional status; patient satisfaction with chronic care; health care costs. Follow-up time: 6 and 12 months. DISCUSSION: The study faces many challenges typical to pragmatic trials such as the rejection of randomisation by service providers, the quality of treatment as usual (TAU) to which the intervention will be compared, and the impairment of the study subjects. Solutions of how to deal with these challenges are presented and discussed in detail. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: http://ISRCTN34900108, German Clinical Trial Register: http://DRKS00003351.

What contributes to good patient outcomes in the home treatment of the severely mentally ill: study protocol of a multi-centre analysis.

BACKGROUND: While evidence is available that home treatment could be effective for treating severe mental illness, there is a lack of evidence on what exactly makes home treatment effective. The study presented here aims to develop recommendations for structures and processes in home treatment that are necessary for its effectiveness. METHODS/DESIGN: 14 provider networks of home treatment for severe mental illness will be analyzed and compared according to their structures, processes and patient-related outcomes. Data will be drawn from health care claims data, routine assessments of psychosocial functioning, and from questionnaires on structures and processes. The primary outcome will be psychosocial functioning; secondary outcomes, quality of life and days spent in hospital. The relation between structures and processes on one hand side and outcomes on the other side will be identified by multilevel analysis. In addition, focus groups with patients, relatives and network staff will be held to add further insight into relevant processes. All networks will receive individual quality reports, providing them with feedback on the results of this research and benchmarking them against the average. Based on this research, recommendations for processes and structures of home treatment will be developed. DISCUSSION: The research will use longitudinal data on outcomes routinely assessed since 2009 and claims data. Routine data is also used for the assessment of structures and processes. By way of additional questionnaires developed in discussion with providers, further relevant factors can be included. The approach of this study becomes more comprehensive by conducting focus groups with patients, relatives and providers and by having the chance to evaluate the results with the networks by providing feedback of results. Several factors such as outcomes related to regional availability of hospital beds or size of networks might limit this study.

[The Impact of Treatment Volumes of Psychiatric Clinics on the Risk for Applying Seclusion or Restraint]. / Der Einfluss des Behandlungsvolumens psychiatrischer Kliniken auf das Risiko der Anwendung besonderer Sicherungsmaßnahmen.

AIM: To determine the effect of treatment volumes on the frequency and duration of special safety measures (SSM) such as seclusion or restraint. METHOD: Register Data of the Lower Saxony Ministry of Social Affairs, Health and Equal Opportunities is analysed for the number of cases hospitalised under State Mental Health Act, the proportion of cases experiencing SSM, and the frequency and cumulative duration of SSM per case. RESULTS AND DISCUSSION: The larger the treatment volume of cases that are hospitalised under State Mental Health Act, the smaller the proportion of cases experiencing SSM. This result is robust, even if statistical outliers are exempted from analyses. CONCLUSIONS: In light of indications that also in mental health care treatment volumes may be related to the desired treatment outcome, discussion is need about the tension between hospital care that is provide.

[A Standard of Centers for Community Psychiatry in Lower-Saxonia - Checklist and Model Fidelity Scale]. / Ein Standard für Gemeindepsychiatrische Zentren in Niedersachsen ­ Checkliste und Modelltreueskala.

OBJECTIVE: Definition of a standard for structures and processes of Centers for Community Psychiatry (CCP) that aim at providing mobile, multiprofessional, complex and intensive outpatient care to patients with severe mental illness. METHODS: The standard was developed and consented using a mix-method approach and by involving all relevant stakeholders, including first hand experts and service providers of three CCP model-projects in Lower-Saxonia. RESULTS: The standard comprises a checklist with 12 binary and obligatory CCP features as well as a model fidelity scale with 45 scaled items in 9 dimensions. CONCLUSION: For the first time, a CCP-standard is available that offers a quantifiable and verifiable catalogue of features essential for CCPs. The standard orients at the S3 guideline "Psychosocial Therapies".

Who receives depression-specific treatment? A secondary data-based analysis of outpatient care received by over 780,000 statutory health-insured individuals diagnosed with depression.

PURPOSE: This study examined the effects of individual and regional characteristics on receiving depression-specific treatment in the statutory health-insured population of Bavaria (83% of the population). METHODS: Data of the Association of Statutory Health Insurance Physicians in Bavaria were analysed for prevalence, diagnosis of and treatment for depression in outpatient care by considering individual and regional characteristics. RESULTS: Prevalence of diagnosed depression was 9.2% for the statutory health-insured population aged 18-100 years. More than half of all individuals diagnosed with depression (F32.x/F33.x) and more than one-third of persons diagnosed with severe depression (F32.2/.3 and F33.2/.3) did not receive depression-specific treatment. Rates of a depression-specific treatment were higher for females, the middle aged, individuals with more severe depression diagnoses, those with psychiatric comorbidity and those without physical comorbidity and for individuals living in more rural areas. CONCLUSIONS: The pathways to depression-specific treatment for persons diagnosed with moderate and severe depression need to be improved. Training for physicians, stepped care approaches, psycho-education for patients and anti-stigma campaigns are possible measures to reach this goal. The knowledge on individual characteristics that influence receiving a depression-specific treatment is important to target the groups at increased risk for under-treatment.

[The Strandet Ill: Long-Term-Inpatients in Psychiatric Hospitals and Departments]. / Die gestrandeten Kranken: Langzeitpatientinnen und -patienten in psychiatrischen Fachkrankenhäusern und Abteilungen.

In contrast to official mental health policy, psychiatric clinics accomodate long-term patients. AIM: To quantify this problem. METHOD: Cross-sectional assessment of the number of long-term patients in psychiatric clinics in Lower Saxony. RESULTS: 13 clinics of adult psychiatry report 60 long-term patients and one clinic for child and adolescent psychiatry reports 2 patients. Median duration of stay 9.5, maximum 215 months. Reasons for long-term hospitalisation include patients' challenging behaviour and, consequently, difficulties to find an accommodating long-term facility. DISCUSSION AND CONCLUSION: Housing willing to accommodate mentally ill persons with challenging behaviour is lacking, as well as local responsibility for the placement of these persons. Systematic transfer management from hospital to residential homes does not exist.

Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set.

In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action 'Mental health promotion and prevention' indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders.

Prevalence of depression diagnosis and prescription of antidepressants in East and West Germany: an analysis of health insurance data.

AIM: This study aimed to analyse depression-related factors. The prevalence of depression has been shown in prior surveys to vary between East and West Germany. Do these differences also appear in health insurance data? METHOD: The outpatient data of a large German statutory health insurance company were analysed for regional differences in (a) the prevalence of depression diagnosis, (b) prescription rates of antidepressants and (c) risk factors of being diagnosed with depression or prescribed antidepressants. Diagnosis rates of depression in outpatient care (ICD-10 diagnosis F32/33) were analysed for the first quarter of 2004, and prescription rates of antidepressants were analysed for the first half of 2004. Odds ratios were calculated for the likelihood of being diagnosed with depression and of being prescribed antidepressants whilst considering socio-demographic and regional variables. RESULTS: The prevalence of depression diagnosis is up to 41% lower in East Germany than the expected mean rate and 30% above the expected mean rate in Berlin. Regional distribution rates of antidepressant prescriptions largely follow the same pattern as rates for depression diagnosis, with the exception of Berlin where prescription rates are 10% below the expected mean rate. Unemployed persons in West Germany have a higher chance of being diagnosed with depression and of being prescribed antidepressants than those unemployed in East Germany. DISCUSSION: Results correspond greatly to findings of epidemiologic surveys. However, the lower rate of depression diagnosis and prescription rates in East Germany might also be due to fewer mental health professionals practising there and possible differences in reporting style of emotional symptoms. This might contribute to the differences in diagnosis and prescription prevalence but cannot be solely responsible for this phenomenon. Probable causes of the different depression prevalence rates in East and West Germany will be discussed in this analysis. More research into factors impacting on regional differences in the prevalence of depression is needed.