Transkulturelle Aspekte der Psychotherapie: Psychotherapiemotivation und die Erfassung von Depressivität bei Patienten mit Migrationshintergrund

Die vorliegende Dissertation beschäftigt sich mit Fragestellungen der transkulturellen klinischen Psychologie. Zu den Bereichen messtheoretische Grundlagen, kulturvergleichende Studien sowie psychische Gesundheit von Migranten wird jeweils eine Studie durchgeführt. Alle Studien fokussieren auf türkische Migranten, die in Deutschland mit 17,6% aller Migranten die größte ethnische Minderheit darstellen. Die erste Studie beschäftigt sich mit der kultur- und sprachübergreifenden Vergleichbarkeit des PHQ-9, einer der weltweit am häufigsten verwendeten Depressionsfragebögen. Mit Hilfe von Modellen der Item Response Theory wird überprüft, ob die Werte der deutschen und türkischen Versionen des PHQ-9 zwischen türkischen Migranten und Menschen ohne Migrationshintergrund vergleichbar sind. Zu diesem Zwecke werden Daten aus vorhergehenden Untersuchungen zusammengeführt und reanalysiert. Die Analysen zeigen, dass zwar Gruppenunterschiede in der Funktionsweise einzelner Items bestehen, dass diese aber keinen bedeutsamen Einfluss auf Skalenebene haben. Folglich sind die Summenwerte des PHQ-9 zwischen türkischen Migranten und Menschen ohne Migrationshintergrund voll vergleichbar – unabhängig davon, ob die türkische oder die deutsche Version des PHQ-9 verwendet wird. Die zweite und dritte Studie befassen sich mit dem Thema Psychotherapiemotivation. Dies ist von besonderer Bedeutung, da in der psychotherapeutischen Behandlung von Patienten mit türkischem Migrationshintergrund wiederholt von Schwierigkeiten berichtet wurde. Folglich werden diese Studien an klinischen Stichproben von Patienten in stationärer Behandlung mit einer vorrangigen depressiven, somatoformen, Angst- oder Anpassungsstörung durchgeführt. Studie II untersucht Psychotherapiemotivation und Krankheitsüberzeugungen im Vergleich zwischen Patienten mit türkischem Migrationshintergrund und Patienten ohne Migrationshintergrund. Die Ergebnisse zeigen, dass Psychotherapiemotivation und internale Kontrollüberzeugungen bei türkischen Migranten geringer ausgeprägt sind, während fatalistisch-externale Kontrollüberzeugungen sowie der Glaube an fatalistische und übernatürliche Krankheitsursachen stärker ausgeprägt sind als in der Vergleichsgruppe. Auf diese Befunde aufbauend wird in einer dritten Studie eine kulturell angepasste Intervention entwickelt, die die Psychotherapiemotivation von Patienten mit türkischem Migrationshintergrund zu Beginn der Behandlung steigern soll. Die Intervention nutzt Prinzipien des Motivational Interviewing und des Ethnographic Interviewing und setzt diese web-basiert um. In einer randomisiert-kontrollierten Pilotstudie werden Akzeptanz, Machbarkeit und Nützlichkeit der Intervention bei Patienten mit türkischem Migrationshintergrund untersucht. Im Vergleich mit der Kontrollbedingung (web-basierte progressive Muskelentspannung) erhält die motivationssteigernde Intervention eine positivere Gesamtbewertung und die Patienten geben an, sich besser auf die Therapie vorbereitet zu fühlen. Bei den Patienten, die mit der motivationssteigernden Intervention arbeiten, steigt im Prä-Post-Vergleich die Selbstwirksamkeit an, während gleichzeitig ein Rückgang external-fatalistischer Kontrollüberzeugungen zu beobachten ist. Die vorliegende Dissertation liefert durch methodisch vielfältige Studien einige neue Erkenntnisse zu transkulturellen Aspekten der klinischen Psychologie. Besonders wichtig sind dabei der Beitrag zur interkulturellen Validierung des PHQ-9 sowie vielversprechende Ansätze zur Steigerung der Psychotherapiemotivation türkischer Migranten

The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review

Objective To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing. Methods Following PRISMA guidelines, we searched six scientific databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible. Results We identified 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type “Job and task modifications” and a moderate level of evidence for the types “Flexible work and scheduling” and “Changes in the physical work environment”. For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed. Conclusion Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses

Massive cortical reorganization in sighted Braille readers

The brain is capable of large-scale reorganization in blindness or after massive injury. Such reorganization crosses the division into separate sensory cortices (visual, somatosensory...). As its result, the visual cortex of the blind becomes active during tactile Braille reading. Although the possibility of such reorganization in the normal, adult brain has been raised, definitive evidence has been lacking. Here, we demonstrate such extensive reorganization in normal, sighted adults who learned Braille while their brain activity was investigated with fMRI and transcranial magnetic stimulation (TMS). Subjects showed enhanced activity for tactile reading in the visual cortex, including the visual word form area (VWFA) that was modulated by their Braille reading speed and strengthened resting-state connectivity between visual and somatosensory cortices. Moreover, TMS disruption of VWFA activity decreased their tactile reading accuracy. Our results indicate that large-scale reorganization is a viable mechanism recruited when learning complex skills

Importance of RNA-protein interactions in bacterial ribonuclease P structure and catalysis

Ribonuclease P (RNase P) is a ribonucleoprotein (RNP) complex that catalyzes the metal-dependent maturation of the 5′ end of precursor tRNAs (pre-tRNAs) in all organisms. RNase P is comprised of a catalytic RNA (P RNA), and at least one essential protein (P protein). Although P RNA is the catalytic subunit of the enzyme and is active in the absence of P protein under high salt concentrations in vitro, the protein is still required for enzyme activity in vivo. Therefore, the function of the P protein and how it interacts with both P RNA and pre-tRNA have been the focus of much ongoing research. RNA-protein interactions in RNase P serve a number of critical roles in the RNP including stabilizing the structure, and enhancing the affinity for substrates and metal ions. This review examines the role of RNA-protein interactions in bacterial RNase P from both structural and mechanistic perspectives. © 2007 Wiley Periodicals, Inc. Biopolymers 87: 329–338, 2007. This article was originally published online as an accepted preprint. The “Published Online” date corresponds to the preprint version. You can request a copy of the preprint by emailing the Biopolymers editorial office at [email protected] Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57327/1/20846_ftp.pd

A LOFAR observation of ionospheric scintillation from two simultaneous travelling ionospheric disturbances

This paper presents the results from one of the first observations of ionospheric scintillation taken using the Low-Frequency Array (LOFAR). The observation was of the strong natural radio source Cassiopeia A, taken overnight on 18–19 August 2013, and exhibited moderately strong scattering effects in dynamic spectra of intensity received across an observing bandwidth of 10–80 MHz. Delay-Doppler spectra (the 2-D FFT of the dynamic spectrum) from the first hour of observation showed two discrete parabolic arcs, one with a steep curvature and the other shallow, which can be used to provide estimates of the distance to, and velocity of, the scattering plasma. A cross-correlation analysis of data received by the dense array of stations in the LOFAR “core” reveals two different velocities in the scintillation pattern: a primary velocity of ~20–40 ms−1 with a north-west to south-east direction, associated with the steep parabolic arc and a scattering altitude in the F-region or higher, and a secondary velocity of ~110 ms−1 with a north-east to south-west direction, associated with the shallow arc and a scattering altitude in the D-region. Geomagnetic activity was low in the mid-latitudes at the time, but a weak sub-storm at high latitudes reached its peak at the start of the observation. An analysis of Global Navigation Satellite Systems (GNSS) and ionosonde data from the time reveals a larger-scale travelling ionospheric disturbance (TID), possibly the result of the high-latitude activity, travelling in the north-west to south-east direction, and, simultaneously, a smaller-scale TID travelling in a north-east to south-west direction, which could be associated with atmospheric gravity wave activity. The LOFAR observation shows scattering from both TIDs, at different altitudes and propagating in different directions. To the best of our knowledge this is the first time that such a phenomenon has been reported

Developing a framework for evaluation: a Theory of Change for complex workplace mental health interventions

Background There is a gap between the necessity of effective mental health interventions in the workplace and the availability of evidence-based information on how to evaluate them. The available evidence outlines that mental health interventions should follow integrated approaches combining multiple components related to different levels of change. However, there is a lack of robust studies on how to evaluate multicomponent workplace interventions which target a variety of outcomes at different levels taking into account the influence of different implementation contexts. Method We use the MENTUPP project as a research context to develop a theory-driven approach to facilitate the evaluation of complex mental health interventions in occupational settings and to provide a comprehensive rationale of how these types of interventions are expected to achieve change. We used a participatory approach to develop a ToC involving a large number of the project team representing multiple academic backgrounds exploiting in tandem the knowledge from six systematic reviews and results from a survey among practitioners and academic experts in the field of mental health in SMEs. Results The ToC revealed four long-term outcomes that we assume MENTUPP can achieve in the workplace: 1) improved mental wellbeing and reduced burnout, 2) reduced mental illness, 3) reduced mental illness-related stigma, and 4) reduced productivity losses. They are assumed to be reached through six proximate and four intermediate outcomes according to a specific chronological order. The intervention consists of 23 components that were chosen based on specific rationales to achieve change on four levels (employee, team, leader, and organization). Conclusions The ToC map provides a theory of how MENTUPP is expected to achieve its anticipated long-term outcomes through intermediate and proximate outcomes assessing alongside contextual factors which will facilitate the testing of hypotheses. Moreover, it allows for a structured approach to informing the future selection of outcomes and related evaluation measures in either subsequent iterations of complex interventions or other similarly structured programs. Hence, the resulting ToC can be employed by future research as an example for the development of a theoretical framework to evaluate complex mental health interventions in the workplace

Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial

Background Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. Methods Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. Conclusions At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace