Wird die Rolle von psychischen Erkrankungen beim Suizid überbewertet?

In the scientific literature, it is often said that 90% of all suicides are the consequences of a~mental illness. Nevertheless, recent reports and comments cast doubt on this view and point out that such a~limitation might hamper effective suicide prevention. In this overview we will outline and discuss important results on how often suicides are the consequence of mental illnesses and whether the association between mental illnesses and suicide might be overestimated.Mental illnesses and especially affective disorders increase the risk of suicide by 30 to 50~times. Nevertheless, they explain only a~certain percentage of all suicides. Observational and treatment studies indicate that mental illness is only one factor of several that lead to suicide. Among other factors are relationship problems, drug abuse, severe somatic illnesses, job problems, financial worries or juridical threats.Suicidal behaviour is an indicator of deep unhappiness but not necessarily caused by a~mental illness. Many persons with mental illnesses do not show suicidal behaviour. On the other hand, not all people who take their own lives have a~mental illness. This has significant consequences for universal and indicated prevention of suicide. ZUSAMMENFASSUNG Die Aussage, dass Suizide zu 90 % Folge psychischer Erkrankungen sind, wird häufig in der wissenschaftlichen Literatur zitiert. Neuere Analysen und Kommentare ziehen das aber in Zweifel und betonen die Notwendigkeit, vielfältigere Ursachen für Suizidereignisse zu beachten, auch um die Prävention von Suiziden nicht auf das Erkennen und Behandeln psychischer Erkrankungen zu reduzieren. Das Ziel dieser Übersichtsarbeit ist die Darstellung und Bewertung wichtiger empirischer Befunde zu der Frage, ob die Rolle psychischer Störungen beim Suizid überbewertet wird.Psychische Störungen erhöhen das Risiko eines Suizides um das bis zu 30- bis 50-Fache gegenüber der Allgemeinbevölkerung, dennoch wird dadurch nur ein Teil aller Suizide erklärt. Aus Beobachtungs- und Therapiestudien ergeben sich deutliche Hinweise, dass psychische Störungen nur ein Faktor unter mehreren sind, die zu Suizid führen. Eine Rolle spielen beispielsweise auch Beziehungsprobleme, Substanzmissbrauch, Belastungen durch schwere körperliche Erkrankungen, akute Krisen im Beruf, Probleme mit Finanzen und juristische Belastungen.Suizidales Verhalten weist auf eine tiefe Unzufriedenheit hin, aber nicht notwendigerweise auf eine psychische Erkrankung. Viele Menschen mit einer psychischen Erkrankung zeigen kein suizidales Verhalten und nicht alle Menschen, die sich ihr Leben nehmen, haben eine psychische Erkrankung. Diese Erkenntnisse haben erhebliche Konsequenzen für die universale und indizierte Prävention von Suiziden

Stability of remission rates in a 3-year follow-up of naturalistic treated depressed inpatients

Background Remission is a common outcome of short-term trials and the main goal of acute and longterm treatment. The longitudinal stability of remission has rarely been investigated under naturalistic treatment conditions. Methods Naturalistic multisite follow-up study. Three-year symptomatic long-term outcome of initially hospitalized tertiary care patients (N = 784) with major depressive episodes. Remission rates as well as the switch rates between remission and non-remission were reported. Results After one, two and three years 62 %, 59 % and 69 % of the observed patients met criteria for remission. During the follow-up 88 % of all patients achieved remission. 36 % of maintained remission from discharge to 3-years, 12 % of all patients never reached remission and 52 % percent showed a fluctuating course switching from remission to non-remission and vice versa. There was considerable transition between remission and non-remission. For example, from discharge to 1 year, from 1 to 2, and from 2 to 3 years 25 %, 21 % and 11 % lost remission. Conclusion Cumulative outcome rates are encouraging. Absolute rates at predefined endpoints as well as the fluctuations between these outcomes reflect the variable and chronic nature of major depression

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

BackgroundMental 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.MethodsAn 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.ResultsLived 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.ConclusionMental 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

Results from the Randomized Controlled Multicenter German Algorithm Project 3 Trial

Background Treatment algorithms are considered as key to improve outcomes by enhancing the quality of care. This is the first randomized controlled study to evaluate the clinical effect of algorithm-guided treatment in inpatients with major depressive disorder. Methods Inpatients, aged 18 to 70 years with major depressive disorder from 10 German psychiatric departments were randomized to 5 different treatment arms (from 2000 to 2005), 3 of which were standardized stepwise drug treatment algorithms (ALGO). The fourth arm proposed medications and provided less specific recommendations based on a computerized documentation and expert system (CDES), the fifth arm received treatment as usual (TAU). ALGO included 3 different second-step strategies: lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switch to a different antidepressant (ALGO SW). Time to remission (21-item Hamilton Depression Rating Scale ≤9) was the primary outcome. Results Time to remission was significantly shorter for ALGO DE (n=91) compared with both TAU (n=84) (HR=1.67; P=.014) and CDES (n=79) (HR=1.59; P=.031) and ALGO SW (n=89) compared with both TAU (HR=1.64; P=.018) and CDES (HR=1.56; P=.038). For both ALGO LA (n=86) and ALGO DE, fewer antidepressant medications were needed to achieve remission than for CDES or TAU (P<.001). Remission rates at discharge differed across groups; ALGO DE had the highest (89.2%) and TAU the lowest rates (66.2%). Conclusions A highly structured algorithm-guided treatment is associated with shorter times and fewer medication changes to achieve remission with depressed inpatients than treatment as usual or computerized medication choice guidance

Predictors of competitive employment in individuals with severe mental illness: results from an observational, cross-sectional study in Germany

BACKGROUND: Employment is of great importance as it is associated with various positive effects. Individuals with severe mental illness (SMI) are often excluded from competitive employment. Current data on employment of individuals with mental illness are rare, and influencing factors are under-researched. The present study examines possible predictors of competitive employment among individuals with SMI. METHODS: This was a cross-sectional and multicentered study of 300 individuals with SMI aged 18 to 65 years. The following inclusion criteria were used: (I) diagnosis of schizophrenia, schizotypal and delusional disorders (ICD-10 F2x), or affective disorders (ICD-10 F3x), (II) duration of psychiatric illness ≥ 2 years, and (III) substantial impact of illness on social functioning. Participants were interviewed by trained staff using standardised instruments. The relationship between potential predictors (age, sex, education, marital status, living situation, migration background, psychosocial functioning, age at first mental problem, physical illness, work ability) and employment was analysed using a hierarchic binary logistic regression model. RESULTS: Only one-third (34%) of participants were competitively employed. Almost one-third were unemployed (30%), and 28% reported early retirement due to mental illness. Psychosocial functioning was positively associated with competitive employment (OR = 1.09, 95% CI: 1.05 – 1.13, p < 0.001); concurrent chronic physical illness was negatively associated with competitive employment (OR = 0.38, 95% CI: 0.21 – 0.71, p = 0.002). CONCLUSIONS: Findings confirm a high risk of exclusion from competitive employment among individuals with SMI. Nonetheless, a substantial proportion of individuals are employed. Findings call for efforts to maintain or enhance workforce participation among individuals with SMI. A special focus should be placed on improving physical health and strengthening psychosocial functioning. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019)

Employment status and desire for work in severe mental illness: results from an observational, cross-sectional study

PURPOSE: People with a severe mental illness (SMI) are at particular risk of occupational exclusion. Among the approaches to occupational rehabilitation, supported employment (SE) has been proven to be the most effective. A requirement to enter SE-programs is that individuals must want to seek competitive employment. The aim of this work is to investigate the relationship between serious mental illness and the desire to work including potential predictors. METHODS: This is a cross-sectional observational study of patients with SMI aged 18–65 years (n = 397). Patients were interviewed by trained staff using standardised instruments. The relationship between potential predictors and a strong preference for employment were analysed using a hierarchic binary logistic regression model. RESULTS: Only about one-quarter (27.9%) of SMI patients is in competitive employment. Another quarter is unemployed (25.9%). Results show that the desire for competitive employment is strong among more than half of the SMI patients. Among the unemployed, two-thirds express a strong desire for work. These individuals are an ideal target group for SE interventions. Comorbid chronic physical illness, diagnosis, and the subjectively judged ability to work are associated with the desire for work. CONCLUSION: Our data confirm a substantial exclusion of individuals with SMI from the workforce. In general, care needs for workplace interventions are not being met and leave much room for improvement. In addition to employment status, the desire for work should be routinely assessed. STUDY REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS) (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015801) and under the WHO-Platform “International Clinical Trials Registry Platform” (ICTRP) (https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015801) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019)

The role of migration in mental healthcare: treatment satisfaction and utilization

Migration rates increase globally and require an adaption of national mental health services to the needs of persons with migration background. Therefore, we aimed to identify differences between persons with and without migratory background regarding (1) treatment satisfaction, (2) needed and received mental healthcare and (3) utilization of mental healthcare. In the context of a cross-sectional multicenter study, inpatients and day hospital patients of psychiatric settings in Southern Germany with severe affective and non-affective psychoses were included. Patients’ satisfaction with and their use of mental healthcare services were assessed by VSSS-54 and CSSRI-EU; patients’ needs were measured via CAN-EU. In total, 387 participants (migratory background: n = 72; 19%) provided sufficient responses for analyses. Migrant patients were more satisfied with the overall treatment in the past year compared to non-migrant patients. No differences between both groups were identified in met and unmet treatment needs and use of supply services (psychiatric, psychotherapeutic, and psychosocial treatment). Despite a comparable degree of met and unmet treatment needs and mental health service use among migrants and non-migrants, patients with migration background showed higher overall treatment satisfaction compared to non-migrants. The role of sociocultural and migrant-related factors may explain our findings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-022-03722-8

Settle down! Ranging behaviour responses of roe deer to different capture and release methods

16openInternationalInternational coauthor/editorThe fitting of tracking devices to wild animals requires capture and handling which causes stress and can potentially cause injury, behavioural modifications that can affect animal welfare and the output of research. We evaluated post capture and release ranging behaviour responses of roe deer (Capreolus capreolus) for five different capture methods. We analysed the distance from the centre of gravity and between successive locations, using data from 14 different study sites within the EURODEER collaborative project. Independently of the capture method, we observed a shorter distance between successive locations and contextual shift away from the home range centre of gravity after the capture and release event. However, individuals converged towards the average behaviour within a relatively short space of time (between 10 days and one month). If researchers investigate questions based on the distance between successive locations of the home range, we recommend (1) initial investigation to establish when the animals start to behave normally again or (2) not using the first two to three weeks of data for their analysis. We also encourage researchers to continually adapt methods to minimize stress and prioritize animal welfare wherever possible, according to the Refinement of the Three R’sopenBergvall, Ulrika A; Morellet, Nicolas; Kjellander, Petter; Rauset, Geir R; Groeve, Johannes De; Borowik, Tomasz; Brieger, Falko; Gehr, Benedikt; Heurich, Marco; Hewison, A J Mark; Kröschel, Max; Pellerin, Maryline; Saïd, Sonia; Soennichsen, Leif; Sunde, Peter; Cagnacci, FrancescaBergvall, U.A.; Morellet, N.; Kjellander, P.; Rauset, G.R.; Groeve, J.D.; Borowik, T.; Brieger, F.; Gehr, B.; Heurich, M.; Hewison, A.J.M.; Kröschel, M.; Pellerin, M.; Saïd, S.; Soennichsen, L.; Sunde, P.; Cagnacci, F

Settle Down! Ranging Behaviour Responses of Roe Deer to Different Capture and Release Methods

Simple Summary The study of animal movement in wild, free ranging species is fundamental for advancing knowledge on ecosystem relationships and for conservation. The deployment of bio-logging devices to this purpose (often GPS-collars in large mammals) requires relatively invasive procedures, such as capture, handling and release. Capture and manipulation cause behavioural modifications that are largely understudied in wild species and may affect both the welfare of animals and the output of the studies. We evaluated post capture and release ranging behaviour responses of a small deer species (roe deer Capreolus capreolus) for five different capture methods across 14 study sites within the EURODEER collaborative project. Roe deer showed modifications in their movement behaviour, independently of the capture method. However, individuals recovered rapidly, converging towards the average behaviour within a relatively short interval of time (between 10 days and one month), demonstrating a general resilience to such stressful events. We encourage researchers to continually adapt capture and handling methods so as to minimize stress and prioritize animal welfare. The fitting of tracking devices to wild animals requires capture and handling which causes stress and can potentially cause injury, behavioural modifications that can affect animal welfare and the output of research. We evaluated post capture and release ranging behaviour responses of roe deer (Capreolus capreolus) for five different capture methods. We analysed the distance from the centre of gravity and between successive locations, using data from 14 different study sites within the EURODEER collaborative project. Independently of the capture method, we observed a shorter distance between successive locations and contextual shift away from the home range centre of gravity after the capture and release event. However, individuals converged towards the average behaviour within a relatively short space of time (between 10 days and one month). If researchers investigate questions based on the distance between successive locations of the home range, we recommend (1) initial investigation to establish when the animals start to behave normally again or (2) not using the first two to three weeks of data for their analysis. We also encourage researchers to continually adapt methods to minimize stress and prioritize animal welfare wherever possible, according to the Refinement of the Three R's