Observed and personally experienced discrimination: findings of a cross-sectional survey of physicians and nursing staff

Background: Discrimination against hospital staff based on ascribed features is prevalent in healthcare systems worldwide. Detrimental effects on health and quality of patient care have been shown. Our study aims to describe and analyse the discrimination experiences of both physicians and nurses, specifically for the German hospital context. Methods: A cross-sectional online survey on observed and personally experienced discrimination at work addressed staff from 22 hospitals of two organizations in Germany. Sociodemographic and occupational as well as institutional characteristics served as independent variables. In multivariable analyses, block- and stepwise logistic regressions were calculated for the two dependent variables (witness and victim of discrimination). Sensitivity analyses with imputed data for missings were performed. Results: N = 800 healthcare professionals (n = 243 physicians, n = 557 nurses; response rate: 5.9%) participated in the survey. 305 respondents (38.1%) were witnesses of discrimination, while 108 respondents (13.5%) were victims of discrimination in their wards. Reasons for observed discriminatory acts were predominantly attributed to the ethnicity of the person concerned, their appearance and language, whereas personally affected staff most frequently cited gender as a reason, followed by ethnicity, and physical appearance. In multivariable models, cultural competence significantly increased the likelihood of witnessing discrimination (beta = .575; p = .037). In terms of the likelihood of being a victim of discrimination, in addition to cultural competence (beta = 2.838; p = < .001), the interaction of the effects of gender and professional group was statistically significant (beta = .280; p = .010). Conclusions: Given the extent of experienced and observed discrimination, appropriate institutional responses are needed. Further research on discriminatory structures in the German-speaking health care system should focus on discrimination at the intersection of ethnicity, gender and occupation

Organisational and staff-related effects on cultural competence in the hospital setting: a cross-sectional online survey of nursing and medical staff

Background: Cultural competence is considered a core qualification for dealing with socio-cultural diversity and balancing disparities in health care. Objectives: To explore features supporting and inhibiting cultural competence in the hospital at both organisational and staff levels. Design: Cross-sectional online survey in the form of a full census from May to November 2018. Setting: Two organisations that run a total of 22 hospitals in Germany. Participants: Eight hundred nursing and medical professionals [nurses: n = 557; doctors: n = 243]. Methods: Using the Short Form Cultural Intelligence SCALE (SFCQ), cultural competence was measured and its relation to potential influencing factors at staff level and organisational level examined, using bivariate (t-Test, one-way ANOVA, Pearson and Spearman correlations) and multivariate (multiple linear regression) approaches. Model 1 examined features at organisational level, Model 2 at individual level and Model 3 included organisational and individual features. Results: The mean cultural competence measured was 3.49 [min.: 1.3; max.: 5.0]. In the bivariate and isolated multivariate models [Models 1 and 2], factors on both organisational and individual levels were significantly related to the hospital staff's cultural competence. The multivariate overview [Model 3], however, revealed that individual features at staff level were the statistically relevant predictors. Positive influencing features included staff's assessment of the importance of cultural competence in their professional context [B: 0.368, 95% confidence interval 0.307; 0.429], participation in competence training [B: 0.193; 95% confidence interval 0.112; 0.276] and having a migration background [B: 0.175; 95% confidence interval 0.074; 0.278], while negative features included length of medical service [B: -0.004; 95% confidence interval -0.007; -0.001]. Conclusions: The development and practice of cultural competence appear to be determined less by organisational features and more on the level of individual actors. In addition to staff development, adequate organisational structures and an economic incentive system are required to promote sociocultural diversity in hospitals

The Prevalence of Mental Illness in Homeless People in Germany

BACKGROUND The number of homeless people in Germany is increasing. Studies from multiple countries have shown that most homeless people suffer from mental illnesses that require treatment. Accurate figures on the prevalence of mental illness among the homeless in Germany can help improve care structures for this vulnerable group. METHODS We carried out a systematic review and meta-analysis on the prevalence of mental illness among homeless people in Germany. RESULTS 11 pertinent studies published from 1995 to 2013 were identified. The overall study population consisted of 1220 homeless people. The pooled prevalence of axis I disorders was 77.4%, with a 95% confidence interval [95% CI] of [71.3; 82.9]. Substance-related disorders were the most common type of disorder, with a pooled prevalence of 60.9% [53.1; 68.5]. The most common among these was alcoholism, with a prevalence of 55.4% [49.2; 61.5]. There was marked heterogeneity across studies. CONCLUSION In Germany, the rate of mental illness requiring treatment is higher among the homeless than in the general population. The development and implementation of suitable care models for this marginalized and vulnerable group is essential if their elevated morbidity and mortality are to be reduced

Bank Account Ownership and Access Among In-Patients in Psychiatric Care in Berlin, Germany-A Cross-Sectional Patient Survey

Background: Access to a bank account is critical for overall participation in social life and an indicator for social integration. Worldwide about 1.7 billion people remain with no access to banking facilities as a form of financial exclusion which represents 31% of the world's general population. In contrast, in Western countries like Germany, 99% of the general population use bank accounts. Methods: We conducted an exploratory cross-sectional survey on bank account ownership and bank account access among psychiatric in-patients in a psychiatric hospital in Berlin. Out of 540 participants who were reached for an interview, 486 shared information about bank account ownership and 469 on access. Results: Out of 486 participants 49 (10.1%) did not own a bank account. Among the remaining 420 participants owning a bank account, 36 (8.3%) did not have direct access to their bank account, but only, e.g., their legal guardian. Regression results found psychosis, intellectual disabilities, a longer treatment duration, as well as being of male gender and a more instable housing status to be significantly associated with a missing bank account or a missing access to one's bank account. Conclusions: The lack of bank account ownership and access among this population of psychiatric patients is concerning. The interrelationship between factors of financial exclusion and mental health should be further explored in longitudinal studies. More attention is needed to support people with severe mental illness to be able to access resources associated with financial inclusion

Attitudes towards psychopharmacology and psychotherapy in psychiatric patients with and without migration background

Background: Sociodemographic factors, attitude towards treatment and acculturation may be important factors influencing the decision of immigrants to seek and maintain psychiatric treatment. A better understanding of these factors may significantly improve treatment adherence and outcome in these patients. Therefore, we investigated factors associated the attitude towards psychotherapy and medication in a sample of psychiatric outpatients with and without migration background. Methods: N = 381 patients in a psychiatric outpatient unit offering specialized treatment for migrants were included in this study. Attitude towards psychotherapy was assessed using the Questionnaire on Attitudes Toward Psychotherapeutic Treatment, attitude towards medication with the Drug Attitude Inventory-10. Acculturation, symptom load and sociodemographic variables were assessed in a general questionnaire. Statistical analyses included analyses of covariance and hierarchical regression. Results: Patients of Turkish and Eastern European origin reported a significantly more positive attitude towards medication than patients without migration background. When controlling for sociodemographic and clinical variables, we did not observe any significant differences in attitude towards psychotherapy. Acculturation neither influenced the attitude towards psychotherapy nor towards medication. Conclusion: Our study indicates that sociodemographic and clinical factors may be more relevant for patients´ attitudes towards treatment than acculturation. Considering these factors in psychiatric treatment of patients with migration background may improve treatment outcome and adherence

Listening to refugee and vulnerable migrant women of Somali origin about the bodily and psychosocial consequences of female genital mutilation in Germany

The World Health Organization (WHO) states that an expected 200 million women have experienced female genital mutilation (FGM) in Africa. The types of cutting vary depending on the individual’s society or location, with four different types presently being practised. The Horn of Africa comprises Somalia, Djibouti, Kenya, Eritrea and Ethiopia, and WHO has listed the following four countries in order of prevalence of FGM practice, with Somalia at 98%, followed by Ethiopia at 92%, Djibouti at 93% and Eritrea at 89% of the female population. In addition to efforts being made to eradicate FGM by WHO, Non-governmental organisations, governments and women organisations, there is also a demand from those who have already undergone this procedure, whether they are in Africa or elsewhere in the world for help with the biopsychosocial consequences of FGM. Method This paper presents the findings of a mixed-method study on the views of a group of vulnerable migrant women with FGM, as well as healthcare practitioners, who consider that there is an unmet demand for better interculturally sensitive healthcare in their adopted country –Germany. The mixed-method study comprised the participation of 48 female volunteers over 18 years of age, recruited with the help of Somali social workers. Using the Metaplan and a quantitative questionnaire, five workshops were conducted in the German towns of Fulda (N=16), Rathenau (N=9), Kassel (N=13) and Berlin (N=10). Results The investigation in Germany was conducted as part of MyHealth, which was a larger European project aimed at improving the healthcare access of vulnerable migrants and refugees (women and unaccompanied minors) newly arrived in Europe, by developing and implementing models based on information gained from a European multidisciplinary Learning Alliance. The overall data gathered revealed a high demand for information and attention to the FGM issue by the participants and healthcare professionals. The interaction during data gathering also suggested a transfer of knowledge between the researchers and the participants. Participants felt they had been heard and were then able to engage with the German healthcare system. Discussion The study highlights the fact that the provision of healthcare in the host country can be improved by providing healthcare workers with intercultural communication skills, tools and cultural awareness training approaches. Moreover, these types of interventions could be adapted to help other vulnerable groups in different healthcare systems worldwide, particularly women’s issues such as postnatal depression, FGM and menopause

Housing situation and healthcare for patients in a psychiatric centre in Berlin, Germany: a cross-sectional patient survey

OBJECTIVE: To determine the housing situation among people seeking psychiatric treatment in relation to morbidity and service utilisation. DESIGN: Cross-sectional patient survey. SETTING: Psychiatric centre with a defined catchment area in Berlin, Germany, March-September 2016. PARTICIPANTS: 540 psychiatric inpatients including day clinics (43.2% of all admitted patients in the study period (n=1251)). MAIN OUTCOME MEASURES: Housing status 30 days prior the interview as well as influencing variables including service use, psychiatric morbidity and sociodemographic variables. RESULTS: In our survey, 327 participants (68.7%) currently rented or owned an own apartment; 62 (13.0%) reported to be homeless (living on the street or in shelters for homeless or refugees); 87 (18.3%) were accommodated in sociotherapeutic facilities. Participants without an own apartment were more likely to be male and younger and to have a lower level of education. Homeless participants were diagnosed with a substance use disorder significantly more often (74.2%). Psychotic disorders were the highest among homeless participants (29.0%). Concerning service use, we did neither find a lower utilisation of ambulatory services nor a higher utilisation of hospital-based care among homeless participants. CONCLUSIONS: Our findings underline the need for effective housing for people with mental illness. Despite many sociotherapeutic facilities, a concerning number of people with mental illness is living in homelessness. Especially early interventions addressing substance use might prevent future homelessness

Increase in presentations with new-onset psychiatric disorders in a psychiatric emergency department in Berlin, Germany during the second wave of the COVID-19 pandemic – a retrospective cross-sectional study

IntroductionWhile numerous studies have identified an increase in symptoms of depression as well as anxiety and distress due to the COVID-19 pandemic, relatively few studies have investigated the new-onset of psychiatric diseases during the pandemic.MethodsThis study focuses on the number of psychiatric new-onset diagnoses in a psychiatric emergency department (pED) in Berlin, Germany during the second wave of the pandemic (i.e. from 09/15/2020 to 03/01/2021 = COVID-19-period) compared to pre-pandemic times (09/15/2019 to 03/01/2020 = control period). We focused on diagnostic subgroups and performed logistic regression analysis to investigate potential risk groups based on covariables such as age, gender, homelessness, attending in police custody and familial relationship.ResultsOverall, there was a 59.7% increase in new-onset psychiatric diagnoses during the COVID-19-period. Increases in the following diagnoses were observed: new-onset of substance-related and addictive disorders (+192.5%), depressive disorders (+115.8%), schizophrenia spectrum and psychotic disorders (+113.3%) and anxiety disorders (+63.6%). These diagnostic subgroups, together with attending in police custody, were found to predict pED presentations with new-onset during the COVID-19-period. Interestingly, in the group of new-onset psychiatric diseases in the COVID-19-period, higher amounts of job loss and living alone as well as a relative decrease in familial relationships were observed.DiscussionCOVID-19 infections and post-COVID-19 syndrome are unlikely to have played a substantial role in the increase of new-onset diseases in this study. Conclusion: Our findings underline the role of indirect factors in new-onset of psychiatric diseases during the pandemic and should be a caveat for future pandemic control policies

Digitalising mental health care: Practical recommendations from the European Psychiatric Association

The digitalisation of mental health care is expected to improve the accessibility and quality of specialised treatment services and introduce innovative methods to study, assess, and monitor mental health disorders. In this narrative review and practical recommendation of the European Psychiatric Association (EPA), we aim to help healthcare providers and policymakers to navigate this rapidly evolving field. We provide an overview of the current scientific and implementation status across two major domains of digitalisation: i) digital mental health interventions and ii) digital phenotyping, discuss the potential of each domain to improve the accessibility and outcomes of mental health services, and highlight current challenges faced by researchers, clinicians, and service users. Furthermore, we make several recommendations meant to foster the widespread adoption of evidence-based digital solutions for mental health care in the member states of the EPA. To realise the vision of a digitalised, patient-centred, and data-driven mental health ecosystem, a number of implementation challenges must be considered and addressed, spanning from human, technical, ethical–legal, and economic barriers. The list of priority areas and action points our expert panel has identified could serve as a playbook for this process

The utilization of psychiatric and psychotherapeutic health services for migrant patients

In verschiedenen Studien konnte ein höheres Risiko für das Vorliegen psychischer Beschwerden wie Depression, Ängstlichkeit oder ein erhöhtes Suizidrisiko bei Menschen mit Migrationshintergrund aufgezeigt werden (Hovey & Magaña, 2000; Merbach et al., 2008). In Deutschland existierte bislang wenig Forschung, die sich mit psychischen Störungen und deren Behandlung bei Menschen mit Migrationshintergrund befasste. Vorliegende Zahlen aus unterschiedlichen Versorgungsregionen wiesen darauf hin, dass Migranten von Teilen der psychiatrischen Versorgung oft nur unzureichend erreicht bzw. über- sowie unterversorgt wurden. Vor diesem Hintergrund war unser Ziel, Daten zur aktuellen Versorgungssituation bezüglich der Inanspruchnahme der stationären – psychiatrischen und der ambulanten in Psychiatrischen Institutsambulanzen in den Einrichtungen der Psychiatrie und Psychotherapie durch Menschen mit Migrationshintergrund zu erheben. Zugleich untersuchten wir die Häufigkeitsverteilungen der diagnostischen Zuordnungen bei diesen Patienten. Migranten im stationären Bereich erhielten im Vergleich zu einheimischen Patienten mehr diagnostische Zuordnungen aus dem Spektrum der F2 - Diagnosen. Im ambulanten Bereich waren Erkrankungen aus dem Affektiven Bereich häufiger. Unsere Untersuchungen wiesen darauf hin, dass die Inanspruchnahme der psychiatrischen Versorgung durch Patienten mit Migrationshintergrund in stationären und ambulanten Bereichen unterschiedlich ist. Während die Migranten im stationären - psychiatrischen Bereich im Durchschnitt entsprechend ihrem Bevölkerungsanteil repräsentiert sind, sind sie in Psychiatrischen Institutsambulanzen überrepräsentiert. Bezüglich der Prävalenz der Depression bei älteren Migranten wurde festgestellt, dass bei Menschen mit Migrationshintergrund im Alter von 50 Jahren und älter eine erhöhte Prävalenz für Depression im Vergleich zu gleichaltrigen Einheimischen bestand. Depression gilt auch als Risikofaktor für dementielle Erkrankungen, so dass diese Erkenntnisse auch diesbezüglich Bedeutung haben. Die Diagnostik, Behandlung und Vorbeugung der Depression bei alternden Migranten ist daher ein vorrangiges Ziel zukünftiger Interventionsstudien. In den Untersuchungen zu Erklärungsmodellen süchtigen Verhaltens konnten wir zeigen, dass die Erklärungsmodelle von türkisch-stämmigen Jugendliche sich von der westlichen Schulmedizin erheblich unterscheiden und die Betroffenen durch einfache Übersetzung gebräuchlicher Konzepte aus dem Deutschen schlecht erreicht werden können. Die bloße Übersetzung der Informationsmaterialien reicht nicht aus. Kulturspezifische Aspekte müssen mit dem Ziel einer besseren Versorgung abhängigkeitskranker Patienten mit Migrationshintergrund integriert werden. Zukünftigen Studien sollten weitere Untersuchungen zu epidemiologischen Daten bezüglich psychischer Erkrankungen und ihre Versorgung bei Patienten mit Migrationshintergrund fokussieren. Zudem sollten auch bei anderen Störungen Untersuchungen zu Erklärungsmodellen und Behandlungserwartungen erfolgen, um die Betroffenen besser erreichen und entsprechend auch behandeln zu können. Die Ausweitung der Versorgungs- und Migrationsforschung ist zu wünschen.To date research on mental health and treatment of mental disorders among migrants were limited locally. The here presented studies are among the first to present German wide representative data on utilization of psychiatric and psychotherapeutic health services by migrants. In these studies it was shown that the rate of migrants treated in in-patient care approaches the rate of migrants in the general public. Migrants are overrepresented in psychiatric outpatient services (Psychiatrische Institutsambulanzen). Significantly more migrants in in-patient treatment received F2-spectrum diagnoses than non- migrants. Yet, in out-patient services migrants more commonly received an affective disorder diagnosis. Barriers to mental health services can result from a culturally diverging understanding of disorders and their treatment. Thus, studying these differing culture-shaped beliefs can guide overcoming barriers to care. Furthermore, it was found that the prevalence of depression, a risk factor for dementia, was increased in older aged migrants. Future studies could focus on the epidemiology of mental disorders and treatment of migrants. Among other questions, such studies could focus on explanatory models, illness perception, and treatment expectations