BackgroundThe Network for Mental Health (NWpG-IC) is an integrated mental health care program implemented in 2009 by cooperation between health insurance companies and community mental health providers in Germany. Meanwhile about 10,000 patients have been enrolled. This is the first study evaluating the effectiveness of the program in comparison to standard mental health care in Germany.MethodsIn a parallel-group controlled trial over 18 months conducted in five regions across Germany, a total of 260 patients enrolled in NWpG-IC and 251 patients in standard mental health care (TAU) were recruited between August 2013 and November 2014. The NWpG-IC patients had access to special services such as community-based multi-professional teams, case management, crisis intervention and family-oriented psychoeducation in addition to standard mental health care. The primary outcome empowerment (EPAS) and the secondary outcomes quality of life (WHO-QoL-BREF), satisfaction with psychiatric treatment (CSQ-8), psychosocial and clinical impairment (HoNOS) and information about mental health service needs (CAN) were measured four times at 6-month intervals. Linear mixed-effect regression models were used to estimate the main effects and interaction effects of treatment, time and primary diagnosis. Due to the non-randomised group assignment, propensity score adjustment was used to control the selection bias.ResultsNWpG-IC and TAU groups did not differ with respect to most primary and secondary outcomes in our participating patients who showed a broad spectrum of psychiatric diagnoses and illness severities. However, a significant improvement in terms of patients’ satisfaction with psychiatric care and their perception of treatment participation in favour of the NWpG-IC group was found.ConclusionsProviding integrated mental health care for unspecific mentally ill target groups increases treatment participation and service satisfaction but seems not suitable to enhance the overall outcomes of mental health care in Germany. The implementation of strategies for ameliorating the needs orientation of the NWpG-IC should be considered.Trial registrationGerman Clinical Trial Register DRKS00005111, registered 26 July 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1441-9) contains supplementary material, which is available to authorized users.
BackgroundSince 2009 some German health insurance companies have implemented integrated mental health care services along the principles of assertive community treatment in collaboration with local mental health service providers across Germany. Focus of this study is the analysis of effectiveness and cost-effectiveness of this integrated care programme compared to care as usual in routine care surroundings in five regions in Germany.MethodsIn this 18-month multi-centre observational trial 250 patients enrolled in an integrated mental health care programme and 250 patients who receive treatment as usual from five catchment areas will be included. In addition, in each group about 125 relatives of the participating patients will be included. The primary outcome criterion is the improvement of empowerment; secondary outcomes are subjective quality of life, functional impairment and costs of illness. Data will be collected at baseline and three follow-ups after 6, 12 and 18 months. Data will be analysed by means of mixed effects regression models. Propensity score methods are used for selection bias control.DiscussionStudy results are expected to provide information about how integrated care programmes in their present form contribute to the improvement of mental health care. In addition, the study will provide hints to weaknesses of the current integrated care programme and options to overcome them. The major strengths of this study are the real-world character of the study intervention with a simultaneous high level of academic rigour. However, the fact that patients are not randomised to study groups and that there is no blinding might limit the study.Trial registrationGerman Clinical Trial Register DRKS00005111.
The aim of this study was to determine coping strategies which may represent important personal resources and have a buffering effect in preventing mental health problems in parents of children with Down syndrome. Forty-nine parents of children with Down syndrome completed self-administrated measures of psychological and physical health problems, and coping behaviour, using several established measuring instruments. According to the hierarchical regression analyses, parents who often used regenerative coping strategies, and who experienced positive personal changes in terms of posttraumatic growth suffered from less anxiety and somatisation symptoms, whereas dysfunctional coping was the best predictor for parental depression and physical symptoms. Regenerative coping mediated between parental tendency to recognize their emotional needs and somatisation symptoms. Intervention programs for families of children with Down syndrome may benefit if they address parents' reflection about their feelings, foster posttraumatic growth processes, and impart knowledge about long-term regenerative coping strategies.
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