Vergleichende Untersuchung von Symptompräsentation und Akkulturationsprozessen bei ambulant-psychiatrischen vietnamesischen Patienten

Ein fundiertes Verständnis für kulturell geprägte Wahrnehmungen psychischer und somatischer Symptome zu entwickeln, die von westlichen Symptom-Erklärungsmodellen divergieren können, stellt eine wissenschaftliche Herausforderung mit Relevanz für die praktische psychosoziale Versorgung von Migrant*innen dar. Bisherige Studien zeigten uneinheitliche Ergebnisse bezüglich häufigerer Somatisierung bei Patient*innen (südost-) asiatischer Herkunft. Unterschiedliche Akkulturationsstile können die Wahrnehmung dieser Symptome bei Menschen mit Migrationshintergrund beeinflussen. Vietnamesische Migrant*innen stellen die größte südostasiatische Zuwanderungsgruppe in Deutschland dar, wobei vergleichende Studien zur Symptompräsentation bei dieser Patientengruppe noch ausstehen. Zudem gibt es keine Untersuchung zur Akkulturation und deren Einfluss auf die psychische Gesundheit in dieser Kohorte. Ziel der Studien im Rahmen dieses Dissertationsprojekts war es, die Unterschiede in Bezug auf psychische und somatische Symptome zwischen vietnamesischen und deutschen Patient*innen im Rahmen einer erstmaligen Vorstellung in einem ambulant-psychiatrischen Behandlungssetting anhand einzelner Skalen des Patient Health Questionnaire (PHQ) zu untersuchen. Zudem untersuchten wir bei vietnamesischen Patient*innen den Zusammenhang zwischen den Akkulturationsstrategien und dem Schweregrad depressiver Symptome. Trotz ähnlichem Schweregrad depressiver Symptome zeigten vietnamesische Patient*innen signifikant höhere Ausprägungsgrade somatischer Symptome im Vergleich zu gematchten deutschen Patient*innen. Vietnamesische Patient*innen, insbesondere solche mit geringeren deutschen Sprachkenntnissen, wiesen eine stärkere Wahrnehmung somatischer Symptome auf. Bezüglich Akkulturation konnten bei vietnamesischen Patient*innen mit gleichzeitiger Orientierung zur Herkunfts- oder Mehrheitsgesellschaft, also einem integrierenden Akkulturationsstil, niedrigere Werte depressiver Symptome im Vergleich zu Patient*innen mit einem marginalisierenden Akkulturationsstil festgestellt werden. Während eine Orientierung sowohl auf die Herkunfts- als auch Mehrheitsgesellschaft als eine mögliche protektive Ressource wirkt, könnte eine fehlende Orientierung mit einem erhöhten Risiko für die Entwicklung depressiver Störungen einhergehen. Diese Arbeit gibt klinische relevante Hinweise für die psychiatrische und psychotherapeutische Diagnostik und Behandlung und liefert zudem Hinweise für die Anpassung weiterführender psychiatrisch-psychotherapeutischer Interventionen bei Menschen mit vietnamesischem Migrationshintergrund.Achieving a better understanding of the modes of psychiatric symptom presentation in migrants and possible underlying processes constitutes challenges to researchers and clinicians alike. In terms of psychiatric symptom presentation, studies have produced inconclusive results in patients of East-Asian and South-East-Asian heritage, particularly concerning the phenomenon of somatization. Acculturation has been linked to mental health outcomes and is one of the factors associated with psychiatric symptom perception in the context of migration. Vietnamese migrants constitute the largest East-Asian migrant group in Berlin. Despite this fact, mental health care utilization of Vietnamese migrants in Berlin has only recently increased. Comparative studies on symptom presentation for these patients are still lacking and, as of now, no data exist on the relationship between mental health status and acculturation among this population in Germany. Our research aimed to compare Vietnamese and German patients regarding possible differences and cultural dynamics of symptom presentation upon first admission to psychiatric outpatient services by employing subscales of the Patient Health Questionnaire (PHQ). Further, we examined the relationship between acculturation strategies and severity levels of depression in Vietnamese outpatients. Despite similar levels of depression in Vietnamese and German patients, Vietnamese patients reported significantly higher levels of somatic symptoms. Vietnamese patients with poor language skills showed a significantly higher focus on somatic symptoms. Regarding dimensions of acculturation, patients with higher levels of orientation towards both the German or Vietnamese society reported less severe depressive symptoms. In terms of acculturation strategy, marginalized patients reported the highest severity of depression. While orientation towards the mainstream society and/or the heritage society may serve as a potential resource, a loss of orientation seems to be associated with an increased risk for depression. The results of these studies provide clinically relevant implications for examining Vietnamese migrants at first contact with a psychiatric outpatient clinic. They give insight into the understanding o

Liaison psychiatry - is it possible?

Consultation-Liaison Psychiatry (CLP) deals with clinical, research and training activities at the interface between psychiatry and the rest of medicine, most typically medical-psychiatric comorbidities, in the conceptual frame of the bio-psycho-social paradigm. It developed gradually during the 20th century around the world, as dramatic changes in the conceptualization and the clinical management of mental illness were taking place, and operates typically in the General Hospital and in Primary Care. The main clinical competencies of CLP include medical-psychiatric comorbidity (co-existing psychiatric and non-psychiatric disorders affecting reciprocally); medically unexplained physical symptoms, “somatization” and functional disorders; and liaison activities, addressed to medical workers and teams. CLP may effectively impact on prognosis of medical illnesses and consequently on quality of life, disability, use of health care resources. Furthermore, research in the field of CLP and psychosomatic medicine may massively contribute to the understanding of the aetiology of mental illness, by adoption of a translational, interdisciplinary perspective

Attitudes and stressors related to the SARS-CoV-2 pandemic among emergency medical services workers in Germany: a cross-sectional study

Background!#!The aim was to investigate attitudes and stressors related to the SARS-CoV-2 outbreak among emergency medical services (EMS) workers in Germany. We further aimed to detect possible changes within a 5-week period and potential determinants of attitudes and stressors.!##!Methods!#!We conducted two cross-sectional studies using an online questionnaire in early April 2020 (i.e., the first peak of the SARS-CoV-2 outbreak in Germany) and five weeks later. The study instrument comprised sociodemographic items, self-devised items on pandemic-related attitudes, stressors and work outcomes, and established instruments assessing depressive symptoms and symptoms of anxiety. Logistic regression was performed to identify possible determinants.!##!Results!#!Data of 1537 participants was included in the analysis (April: n = 1124, May: n = 413, 83.1% male, median age 32). Most participants agreed that their personal risk of infection was higher compared to the general population (April: 87.0% agreement, May: 78.9%). The greatest stressor was uncertainty about the pandemic's temporal scope (82.0 and 80.9%, respectively). Most participants (69.9, 79.7%) felt sufficiently prepared for the pandemic and only few felt burdened by their financial situation (18.8, 13.3%). Agreement to all stressors decreased from April to May except related to the childcare situation. Regression analysis identified subgroups to be burdened more frequently such as older employees, those with SARS-CoV-2 cases among their colleagues, and those with lower paramedic training levels.!##!Conclusions!#!We identified key SARS-CoV-2-related stressors whose levels generally decreased within a 5-week period. Our results indicate that EMS workers are less affected by existential fears and rather worry about their personal infection risk

Psychosocial working conditions and mental health among medical assistants in Germany: a scoping review

Abstract Background Medical assistants (MA) constitute one of the largest professions in outpatient health care in Germany. The psychosocial working conditions of health care staff are generally believed to be challenging and to thereby increase the risk of poor mental health. A review of MA’s psychosocial working conditions and mental health is lacking, however. We aimed to systematically identify and summarize existing research on psychosocial working conditions and mental health of MA by addressing (1) Which methods, concepts, and instruments have been used to capture the psychosocial working conditions and mental health among MA in Germany? (2) What findings are available? and (3) What are the research gaps? Methods We systematically searched Medline, Scopus, CCMed and Google Scholar. Using the Population Concept Context (PCC)-framework, we applied the following eligibility criteria: (a) Language: English or German, (b) publication between 2002-2022, (c) original study, (d) study population: mainly MA (i.e., ≥ 50% of the study population), (e) concept: psychosocial working conditions and/or mental health, and (f) context: Germany. Two reviewers extracted data independently, results were compared for accuracy and completeness. Results Eight hundred twenty-seven sources were identified. We included 30 publications (19 quantitative, 10 qualitative, and one mixed methods study). Quantitative studies consistently reported high job satisfaction among MA. Quantitative and mixed methods studies frequently reported aspects related to job control as favorable working conditions, and aspects related to job rewards as moderate to unfavorable. Qualitative studies reported low job control in specific work areas, high demands in terms of workload, time pressure and job intensity, and a desire for greater recognition. Social interactions seemed to be important resources for MA. Few studies (n = 8) captured mental health, these reported inconspicuous mean values but high prevalences of anxiety, burnout, depression, and stress among MA. Studies suggested poorer psychosocial working conditions and mental health among MA during the COVID-19 pandemic. Conclusions Quantitative studies tend to suggest more favorable psychosocial working conditions among MA than qualitative studies. We suggest mixed methods to reconcile this alleged inconsistency. Future research should examine discrepancies between job satisfaction and unfavorable working conditions and if psychosocial working conditions and mental health remain changed after the COVID-19 pandemic

Psychosocial working conditions, perceived patient safety and their association in emergency medical services workers in Germany – a cross-sectional study

Abstract Background Emergency medical service (EMS) workers face challenging working conditions that are characterized by high stress and a susceptibility to making errors. The objectives of the present study were (a) to characterize the psychosocial working conditions of EMS workers, (b) to describe the perceived quality of patient care they provide and patient safety, and (c) to investigate for the first time among EMS workers associations of psychosocial working conditions with the quality of patient care and patient safety. Methods For this cross-sectional study, we carried out an online survey among 393 EMS workers who were members of a professional organization. Working conditions were measured by the Demand-Control-SupportQuestionnaire (DCSQ) and seven self-devised items covering key stressors. Participants reported how often they perceived work stress to affect the patient care they provided and we inquired to what extent they are concerned to have made a major medical error in the last three months. Additionally, we used parts of the Emergency Medical Services – Safety Inventory (EMS-SI) to assess various specific errors and adverse events. We ran descriptive analyses (objective a and b) and multivariable logistic regression (objective c). Results The most common stressors identified were communication problems (reported by 76.3%), legal insecurity (69.5%), and switching of colleagues (48.9%) or workplaces (44.5%). Overall, 74.0% reported at least one negative safety outcome based on the EMS-SI. Concerns to have made an important error and the perception that patient care is impaired by work stress and were also frequent (17.8% and 12.7%, respectively). Most psychosocial working conditions were associated with the perception that patient care is impaired due to work stress. Conclusions Work stress in EMS staff is pronounced and negative safety outcomes or potential errors are perceived to occur frequently. Poor psychosocial working conditions were only consistently associated with perceived impairment of patient care due to work stress. It seems necessary to reduce communication problems and to optimize working processes especially at interfaces between emergency services and other institutions. Legal insecurity could be reduced by clarifying and defining responsibilities. Communication and familiarity between team colleagues could be fostered by more consistent composition of squads

Prevalence of burnout among German general practitioners: Comparison of physicians working in solo and group practices.

BACKGROUND:Studies from general practitioner (GP) populations from various European countries show a high prevalence of burnout, yet data from Germany are scarce and there are no data comparing GPs from solo versus group practices. METHODS:This cross-sectional survey addressed all GPs from a German network of family medicine practices comprising 185 practices. Participants were asked to fill in a self-administered questionnaire addressing socio-demographic and job-related characteristics. The German version of the Maslach Burnout Inventory was used to measure the dimensions emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Each participant was categorized as having high EE, high DP and low PA following pre-defined cut-offs. RESULTS:A total of 214 GPs from 129 practices participated: 65.9% male, 24.8% solo practice. Of all GPs, 34.1% (n = 73) scored high for EE, 29.0% (n = 62) high for DP, 21.5% (n = 46) low for PA and 7.5% (n = 16) for all three dimensions. A higher risk for EE was found among female physicians, those unsatisfied with their job, those using few stress-regulating measures regularly and those reporting bad work-life balance. Burnout prevalence was higher in GPs in group than in solo practices (37.9% vs. 28.8% had high EE, 33.1% vs. 18.9% had high DP and 22.8% vs. 18.9% had low PA). A significantly higher prevalence of burnout symptoms was found in group practice employees compared to group practice owners. CONCLUSION:Burnout prevalence was higher among physicians in group practices compared to solo practices. In group practices, employed, young, female and part-time working physicians showed a higher burnout risk