Körperliche Aktivität bei ambulanten Patient*innen mit psychischen Erkrankungen: Prävalenz, motivationale und volitionale Determinanten als Ansatzpunkte zur Förderung körperlicher Aktivität

Körperliche Aktivität hat einen positiven Einfluss auf die psychische Gesundheit und kann zur Prävention und Therapie psychischer Erkrankungen eingesetzt werden. Da nur eine Minderheit der Menschen mit psychischen Erkrankungen ein gesundheitsförderliches Ausmaß körperlicher Aktivität betreibt, scheint die Entwicklung von Interventionen, die Patient*innen dabei unterstützen, ihr Aktivitätsniveau zu steigern, dringend geboten. In den vorliegenden Arbeiten wird zunächst die Prävalenz körperlicher Aktivität bei ambulanten Patient*innen mit psychischen Erkrankungen und die Übereinstimmung von subjektiven und objektiven Messverfahren zur Erfassung körperlicher Aktivität bei dieser Population untersucht. Zudem wird untersucht, inwieweit sich das Motivations-Volitions-Modell (MoVo-Modell), das sozial-kognitive Determinanten körperlicher Aktivität zusammenfasst, auch auf Menschen mit psychischen Erkrankungen übertragen lässt. Daraufhin wird evaluiert, ob eine auf diesem Modell basierende psychologische Gruppenintervention zur Steigerung körperlicher Aktivität, die für Populationen ohne psychische Erkrankungen entwickelt wurde, auch bei ambulanten Patienten mit psychischen Erkrankungen effektiv ist. Zudem wird evaluiert, ob körperliche Aktivität unmittelbar vor der Exposition bei der Verhaltenstherapie der Panikstörung und Agoraphobie eine wirksame Kombinationstherapie darstellt. Die Ergebnisse zeigen, konsistent mit dem aktuellen Forschungsstand, dass auch in unserer Stichprobe nur eine Minderheit der Menschen mit psychischen Erkrankungen ein ausreichendes Maß körperlicher Aktivität betreibt. Bezüglich der Messbarkeit körperlicher Aktivität zeigt sich eine gute Übereinstimmung von subjektiven und objektiven Messverfahren für globale Gruppenmittelwerte. Bei der Messung auf Individualebene oder der Differenzierung in verschiedene Intensitätslevel zeigen sich jedoch deutlich Differenzen zwischen subjektiver und objektiver Messung, sodass sich die Kombination beider Messverfahren für zukünftige Studien, in denen die solche Parameter von Interesse sind, dringend empfiehlt. Zudem ergeben sich Hinweise darauf, dass das MoVo-Modell grundsätzlich auch bei Menschen mit psychischen Erkrankungen Anwendung finden kann. Bezüglich der darauf aufbauenden Intervention zur Steigerung körperlicher Aktivität zeigt sich, dass dieses auch bei ambulanten Patienten mit psychischen Erkrankungen wirksam ist. Bezüglich der Rolle körperlicher Aktivität zur Kombination mit expositionsbasierter Verhaltenstherapie bei Panikstörung und Agoraphobie zeigen sich erste Hinweise auf eine mögliche Reduktion der Wirklatenz der Verhaltenstherapie durch körperliche Aktivität unmittelbar vor der Exposition. Zusammengefasst zeigt sich, dass viele Menschen mit psychischen Erkrankungen die Empfehlungen bezüglich gesundheitsförderlicher Aktivität nicht erfüllen, dass die untersuchte Intervention effektiv ist, den Anteil dieser zu steigern und dass körperliche Aktivität effektiv sein könnte, um die Wirklatenz expositionsbasierter Verhaltenstherapie zu reduzieren.Physical activity has a positive effect on mental health and can be used in prevention and treatment of mental disorders. As only a minority of patients with mental disorders shows a health beneficial level of physical activity, there is a strong need for the development of interventions that support patients to increase their level of physical activity. The present work examines the prevalence of physical activity and the congruence of subjective and objective measurements of physical activity in outpatients with mental disorders. It further examines if the Motivation-Volition-Model (MoVo-Model), that summarizes social-cognitive determinants of physical activity, is suitable for patients with mental disorders as well. A psychological group intervention to increase physical activity, that is based on this model and was developed for populations without mental disorders, is tested on its effectiveness in patients with mental disorders. Additionally, it is investigated, if physical activity is an effective combination therapy with cognitive behavioural therapy, when applied directly prior to in-vivo exposure in patients with agoraphobia and panic disorder. Consistently with other research, our findings show that only a minority of patients with mental disorders shows a sufficient level of physical activity. Concerning the measurement of physical activity, there is a good accordance of subjective and objective measurement for global group averages. When it comes to measurement on individual-level or the differentiation into different intensity levels, there are noticeable differences between subjective and objective measurement. Therefore, the combination of both forms of measurement is strongly advised for studies where these parameters are of interest. Furthermore, from the present work arises evidence that the MoVo-Model is suitable for patients with mental disorders as well. The examined group intervention was effective in increasing physical activity in outpatients with mental disorders. Concerning the role of physical activity as a combination therapy with exposure based cognitive behavioural therapy in agoraphobia and panic disorder, from the present work arises some evidence that physical activity prior to exposure might accelerate the effect of cognitive behavioural therapy. Summarized the present work shows that a large proportion of patients with mental diseases does not reach the recommendations for health beneficial physical activity, that the used intervention is effective in increasing this proportion and that physical activity might be effective to accelerate the effect of exposure based cognitive behavioural therapy

Longitudinal changes in anxiety and psychological distress, and associated risk and protective factors during the first three months of the COVID‐19 pandemic in Germany

Background: The COVID-19 pandemic is related to multiple stressors and therefore may be associated with psychological distress. The aim of this study was to longitudinally assess symptoms of (un-)specific anxiety and depression along different stages of the pandemic to generate knowledge about the progress of psychological consequences of the pandemic and to test the role of potential risk and resilience factors that were derived from cross-sectional studies and official recommendations. Methods: The present study uses a longitudinal observational design with four waves of online data collection (from March 27 to June 15, 2020) in a convenience sample of the general population in Germany. A total of N = 2376 participants that completed at least two waves of the survey were included in the analyses. Findings: Specific COVID-19-related anxiety and the average daily amount of preoccupation with the pandemic decreased continuously over the four waves. Unspecific worrying and depressive symptoms decreased on average but not on median level. Self-efficacy, normalization, maintaining social contacts, and knowledge, where to get medical support, were associated with fewer symptoms relative to baseline. Suppression, unhealthy habits, and a longer average daily time of thinking about the pandemic were correlated with a relative increase of symptoms. Interpretation: Our findings provide insight into the longitudinal changes of symptoms of psychological distress along the first three months of the COVID-19 pandemic in Germany. Furthermore, we were able to reaffirm the anticipated protective and risk factors that were extracted from previous studies and recommendations

Mental Health in German Paralympic Athletes During the 1st Year of the COVID-19 Pandemic Compared to a General Population Sample

Introduction: The COVID-19 pandemic has huge influences on daily life and is not only associated with physical but also with major psychological impacts. Mental health problems and disorders are frequently present in elite paralympic athletes. Due to the pandemic situation, new stressors (e.g., loss of routine, financial insecurity) might act upon the athletes. Therefore, the assessment of mental health in athletes during the COVID-19 pandemic is important to identify prevalence of psychological problems and propose countermeasures. Methods: The mental health of German paralympic athletes was longitudinally monitored (starting in May 2019). The athletes completed the Patient Health Questionnaire 4 (PHQ-4) on a weekly basis and reported a stress level, training hours, and training load. During the pandemic, 8 measurement time points (March 2020 to April 2021) were used to reflect the psychological health course of the athletes. In parallel, a convenience sample of the general population was questioned about their psychological distress, including the PHQ-4. To be included in the analysis, participants of both groups had to complete at least 4 measurement time points. Matching of the para-athletes and the general population sample was prioritized upon completion of the same measurement time points, gender, and age. Results: Seventy-eight paralympic athletes (40 women, 38 men, age: 29.8 ± 11.4 years) met the inclusion criteria. Seventy-eight matched pairs of the general population (40 women; 38 men; age: 30.5 ± 10.9 years) were identified. The para-athletes had a significantly (p < 0.0001; 0.39 < r < 0.48) lower PHQ-4 value at each measurement time point compared to the matched control group. No significant age or sex differences were evident regarding the symptom burden. In para-athletes, no significant and a weak positive correlation was found between decreased training load and PHQ-4 values and Mental Health in Para-Athletes During COVID-19 a stress level, respectively. Reduced physical activity was significantly (p < 0.0001) associated with higher PHQ-4 values in the general population sample. Discussion: Lower PHQ-4 values were reported by the para-athletes compared to the general population sample. However, small sample sizes must be considered while interpreting the data. Nevertheless, adequate support for individuals suffering from severe psychopathological symptoms should be provided for para-athletes as well as for the general population

Dealing with psychological distress by healthcare professionals during the COVID-19 pandemia

Hintergrund: Im Rahmen der aktuellen Covid-19-Pandemie stehen Gesundheitsfachkräfte aller Berufsgruppen vor großen Herausforderungen in der Bewältigung der Krise. Dabei treten zahlreiche außergewöhnliche Stressoren und Risiken nicht nur für die körperliche, sondern auch die psychische Gesundheit der Gesundheitsfachkräfte auf. Ziel der Arbeit: Der Artikel fasst erste Empfehlungen zur Reduktion von Stress und psychischer Belastung bei Gesundheitsfachkräften im Rahmen der aktuellen Covid-19-Pandemie zusammen. Methode: Dargestellt werden Empfehlungen zur Reduktion von Stress und psychischen Belastungen bei Gesundheitsfachkräften und wichtige Aspekte, die Führungskräfte zur Reduktion von Stress und psychischer Belastung bei ihren Mitarbeiter*innen beachten sollten. Insbesondere werden die Empfehlungen der Weltgesundheitsorganisation, des Internationalen Roten Kreuzes und der Vereinten Nationen berücksichtigt. Ergebnisse: Eine Normalisierung psychischer Belastungen, eine ausreichende Befriedigung der Grundbedürfnisse, soziale Unterstützung, eine klare Kommunikation und Aufgabenverteilung und flexible Möglichkeiten zur Arbeitsgestaltung und Inanspruchnahme von Hilfsangeboten ohne Stigmatisierung scheinen besonders wichtige Maßnahmen zu sein. Diskussion: Der Artikel verschafft Gesundheitsfachkräften und ihren Führungskräften einen ersten Überblick über wichtige Faktoren zum Erhalt der psychischen Gesundheit während der Covid-19-Pandemie.Background: In the current COVID-19 pandemia, health workers from all professions are facing great challenges in coping with the crisis. In this situation health professionals are confronted with specific stressors and risks not only for the physical but also for the mental health. Objective: This article summarizes the first recommendations for the reduction of stress and psychological burden in health professionals during the current COVID-19 pandemia. Methods: The recommendations of the World Health Organization, the United Nations and the International Red Cross Society are summarized. Recommendations for the reduction of stress and psychological distress in health professionals as well as important factors that team leaders can consider in order to reduce psychological distress in employees are presented. Results: The normalization of strong emotions and stress, the fulfillment of basic needs, social support, clear communication and distribution of tasks, flexible working hours and the utilization of psychosocial and psychological help without stigmatization seem to be particularly important measures. Conclusion: This article presents guidelines for health professionals and team leaders in healthcare that help to maintain mental health during the COVID-19 pandemia

Umgang mit psychischer Belastung bei Gesundheitsfachkräften im Rahmen der Covid-19-Pandemie

BACKGROUND: In the current COVID-19 pandemia, health workers from all professions are facing great challenges in coping with the crisis. In this situation health professionals are confronted with specific stressors and risks not only for the physical but also for the mental health. OBJECTIVE: This article summarizes the first recommendations for the reduction of stress and psychological burden in health professionals during the current COVID-19 pandemia. METHODS: The recommendations of the World Health Organization, the United Nations and the International Red Cross Society are summarized. Recommendations for the reduction of stress and psychological distress in health professionals as well as important factors that team leaders can consider in order to reduce psychological distress in employees are presented. RESULTS: The normalization of strong emotions and stress, the fulfillment of basic needs, social support, clear communication and distribution of tasks, flexible working hours and the utilization of psychosocial and psychological help without stigmatization seem to be particularly important measures. CONCLUSION: This article presents guidelines for health professionals and team leaders in healthcare that help to maintain mental health during the COVID-19 pandemia.HINTERGRUND: Im Rahmen der aktuellen Covid-19-Pandemie stehen Gesundheitsfachkräfte aller Berufsgruppen vor großen Herausforderungen in der Bewältigung der Krise. Dabei treten zahlreiche außergewöhnliche Stressoren und Risiken nicht nur für die körperliche, sondern auch die psychische Gesundheit der Gesundheitsfachkräfte auf. ZIEL DER ARBEIT: Der Artikel fasst erste Empfehlungen zur Reduktion von Stress und psychischer Belastung bei Gesundheitsfachkräften im Rahmen der aktuellen Covid-19-Pandemie zusammen. METHODE: Dargestellt werden Empfehlungen zur Reduktion von Stress und psychischen Belastungen bei Gesundheitsfachkräften und wichtige Aspekte, die Führungskräfte zur Reduktion von Stress und psychischer Belastung bei ihren Mitarbeiter*innen beachten sollten. Insbesondere werden die Empfehlungen der Weltgesundheitsorganisation, des Internationalen Roten Kreuzes und der Vereinten Nationen berücksichtigt. ERGEBNISSE: Eine Normalisierung psychischer Belastungen, eine ausreichende Befriedigung der Grundbedürfnisse, soziale Unterstützung, eine klare Kommunikation und Aufgabenverteilung und flexible Möglichkeiten zur Arbeitsgestaltung und Inanspruchnahme von Hilfsangeboten ohne Stigmatisierung scheinen besonders wichtige Maßnahmen zu sein. DISKUSSION: Der Artikel verschafft Gesundheitsfachkräften und ihren Führungskräften einen ersten Überblick über wichtige Faktoren zum Erhalt der psychischen Gesundheit während der Covid-19-Pandemie

Step Away from Depression—Study protocol for a multicenter randomized clinical trial for a pedometer intervention during and after in‐patient treatment of depression

Objectives: Increasing the number of daily steps by using a pedometer and a diary leads to an activity increase and improved health outcomes in a variety of somatic disorders. Hence, for the inpatient treatment of depression, supervised exercise interventions are more widespread. We aim to examine if a self-managed pedometer intervention (PI) with the option of being proceeded after discharge leads to reduction of depression and to a physical activity (PA) increase. Methods: The Step Away from Depression (SAD) study is a multicenter randomized controlled trial targeting 400 patients with major depressive disorder. Treatment as usual (TAU) is compared to TAU plus PI after 4 weeks, at discharge, and 6 months after hospital admission. Primary outcomes are clinically rated depression severity and accelerometer-measured step counts. Secondary outcomes include self-reported depression symptoms and PA level, psychiatric symptoms, health-related quality of life, self-efficacy, and components of the Motivation Volition Process Model. Results: We report the design of the SAD study considering several methodological aspects for exercise studies, in general. Conclusions: Results of our study will provide information about efficacy of PI for inpatient treatment and about interrelating processes of change concerning depression, PA, and aspects of motivation and volition

Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany

In context of the current COVID-19 pandemic the consumption of pandemic-related media coverage may be an important factor that is associated with anxiety and psychological distress. Aim of the study was to examine those associations in the general population in Germany. 6233 participants took part in an online-survey (March 27th-April 6th, 2020), which included demographic information and media exploitation in terms of duration, frequency and types of media. Symptoms of depression, unspecific anxiety and COVID-19 related anxiety were ascertained with standardized questionnaires. Frequency, duration and diversity of media exposure were positively associated with more symptoms of depression and unspecific and COVID-19 specific anxiety. We obtained the critical threshold of seven times per day and 2.5 h of media exposure to mark the difference between mild and moderate symptoms of (un)specific anxiety and depression. Particularly the usage of social media was associated with more pronounced psychological strain. Participants with pre-existing fears seem to be particularly vulnerable for mental distress related to more immoderate media consumption. Our findings provide some evidence for problematical associations of COVID-19 related media exposure with psychological strain and could serve as an orientation for recommendations-especially with regard to the thresholds of critical media usage

Medical exemplary function with respect to physical activity for patients with mental disorders - Recommendation behavior and self-concordance of psychiatrists and medical psychotherapists

Hintergrund: Körperliche Aktivität spielt eine bedeutende Rolle bei der Behandlung psychischer Störungen. Psychiatern/ärztlichen Psychotherapeuten kommt eine Schlüsselrolle dabei zu, ihren Patienten körperliche Aktivität zu empfehlen. Zum Empfehlungsverhalten dieses Kollektivs liegen bisher keine Untersuchungen vor. Ziele der Arbeit: Das Empfehlungsverhalten in Bezug auf körperliche Aktivität sowie verhaltensbezogene und motivationale Korrelate, die das Empfehlungsverhalten potenziell beeinflussen, bei deutschen Psychiatern/ärztlichen Psychotherapeuten sollte untersucht werden. Material und Methoden: Insgesamt beantworteten 151 deutsche Psychiater/ärztliche Psychotherapeuten (Alter: M = 32,5 Jahre; Geschlecht: 47,0 % weiblich) einen Onlinefragebogen bezüglich körperlicher Aktivität. Dabei wurden das Empfehlungsverhalten körperlicher Aktivität, die Einstellung, das eigene Aktivitätsverhalten und die Selbstkonkordanz eigener Motivation, körperlich aktiv zu sein, erfasst. Ergebnisse: Die meisten Psychiater/ärztliche Psychotherapeuten gaben an, körperliche Aktivität einigen (54,5 %, n = 82) oder all ihren Patienten zu empfehlen (33,8 %, n = 51). Das Empfehlungsverhalten korrelierte signifikant positiv mit der Selbstkonkordanz der Motivation (r = 0,19) sowie mit der Einstellung zur Bedeutsamkeit körperlicher Aktivität (r = 0,16). Hingegen bestand keine signifikante Korrelation zwischen dem eignen Aktivitätsniveau und dem Empfehlungsverhalten der Psychiater/ärztlichen Psychotherapeuten (r = 0,04). Schlussfolgerung: Ein Großteil der Psychiater/ärztlichen Psychotherapeuten empfiehlt körperliche Aktivität. Positiv auf das Empfehlungsverhalten wirkten sich insbesondere die Einschätzung der körperlichen Aktivität als bedeutsam sowie eine hohe Selbstkonkordanz der eigenen Motivation, körperlich aktiv zu sein, aus. Interventionsprogramme, die das Empfehlungsverhalten von Psychiatern/ärztlichen Psychotherapeuten steigern wollen, sollten auf die Selbstkonkordanz der Motivation der Psychiater/ärztlichen Psychotherapeuten, körperlich aktiv zu sein, fokussieren und sich nicht nur auf die Bedeutsamkeit körperlicher Aktivität konzentrieren.Background: Physical activity (PA) plays an important role in the treatment of mental disorders. Psychiatrists and medical psychotherapists play a key role in this context by recommending PA to their patients. There are no previous studies on the recommendation behavior of psychiatrists for PA. Objective: The aim of this study was to assess the PA recommendation behavior as well as behavioral and motivational correlates that potentially influence the recommendation behavior of psychiatrists and medical psychotherapists in Germany. Material and methods: A total of 151 German psychiatrists and medical psychotherapists (age: mean = 32.5 years; sex: 47.0% female) answered an online questionnaire on PA assessing recommendation behavior, attitudes, own PA behavior and self-concordance of the motivation to be physically active. Results: Most psychiatrists and medical psychotherapists recommend PA to some (54.5%, n = 82) or all of their patients (33.8%, n = 51). Recommendation behavior was significantly positively correlated with self-concordance of the motivation to perform PA (r = 0.19) as well as the attitude with respect to the personal importance of PA (r = 0.16). In contrast, there was no significant correlation between the personal activity level and the recommendation behavior of the psychiatrists and medical psychotherapists (r = 0.04). Conclusion: The results show that a large proportion of psychiatrists and medical psychotherapists recommend PA. Attitudes on the importance of PA as well as self-concordance of the motivation to perform PA showed positive correlations with the recommendation behavior. Intervention programs that aim to improve the recommendation behavior of psychiatrists and medical psychotherapists should focus on the self-concordance of the psychiatrists and not only on the importance of PA