Ambulante fachärztliche Versorgung psychischer Störungen

Jacobi, Frank; Becker, Marc; Bretschneider, Julia; Müllender, Susanne; Thom, Julia; Hapke, Ulfert; Maier, Wolfgang

doi:10.1007/s00115-016-0147-4

Cited by 28 publications

(8 citation statements)

References 20 publications

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“…The extent to which this is reflected in care outcomes, such as more frequent drug therapy, more frequent inpatient admission or increased relapse, is a topic for future research. In any case, these findings – which are consistent with previous studies – militate against the hypothesis of a supplier-induced demand of psychotherapeutic and psychiatric care [ 19 ]. In well-supplied regions, utilization increases among people with current depressive symptoms; without these symptoms, it remains at a comparatively low level, despite the better levels of care provision.…”

Section: Discussionsupporting

confidence: 87%

The utilization of psychiatric and psychotherapeutic services in Germany – individual determinants and regional differences

Rommel

Bretschneider

Kroll

et al. 2019

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In Germany, the provision of health services to people with mental disorders is an issue that is subject to controversial debate. On the one hand, regional differences exist in the distribution of psychotherapists in Germany. On the other hand, patients are often willing to accept the extra effort of having to travel further in order to access treatment even in case of a low supply. Thus, in addition to issues of access, an analysis of care provision also needs to take into account the actual level of services utilization. The present paper analyses the utilization of outpatient psychiatric and psychotherapeutic services and identifies individual and regional determinants. The German Health Update (GEDA) is a nationwide survey of the adult population that is conducted by the Robert Koch Institute in the context of its population-based health monitoring. The GEDA 2014/2015-EHIS study (n=24,016) is based on a two-stage stratified random sample drawn from the population registers of 301 local authorities in Germany. The main outcome is the utilization of psychotherapeutic or psychiatric services during the last 12 months. In addition to the consideration of individual factors, the survey data was combined with information describing the regional distribution of providers of outpatient psychotherapeutic and neurological care. The data was analysed using logistic multi-level regression. In Germany, 11.3% of women and 8.1% of men report that they have used psychotherapeutic or psychiatric treatment within the last 12 months. Among respondents with current depressive symptoms, these rates are 35.0% in women and 31.0% in men. This means that approximately two thirds of people with current depressive symptoms do not seek the services of these health professionals during this period. Apart from current depressive symptoms the utilization of psychiatric and psychotherapeutic services is associated with not living with a partner and with low levels of social support. Furthermore, in regions with a high density of care providers, the proportion of people with current depressive symptoms using such services is about 15 percentage points higher than in regions with a low density. The conditions for the utilization of the respective services should not only be improved by increasing the number of care providers, but also by implementing accompanying measures. Innovations in health care aiming at rapid and low-threshold access as well as approaches for a better cooperation between primary and specialist care should therefore be evaluated regarding their contribution to an improved early treatment.

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Section: Discussionsupporting

confidence: 87%

The utilization of psychiatric and psychotherapeutic services in Germany – individual determinants and regional differences

Rommel

Bretschneider

Kroll

et al. 2019

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“…In Germany, only 34.6% of participants with 12-month MDD reported any service use due to mental health problems in 2009–2012 [65]. Locally varying access to mental health care has previously been identified as an important determinant of help-seeking behavior [66, 67]. In addition, increasing acceptance of mental health care services [55] and rising public knowledge appear to not have resulted in improved social acceptance of people with mental illness over time [54].…”

Section: Discussionmentioning

confidence: 99%

Time trends in depression prevalence and health-related correlates: results from population-based surveys in Germany 1997–1999 vs. 2009–2012

et al. 2018

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BackgroundAlthough an “epidemic” of depression is frequently claimed, empirical evidence is inconsistent, depending on country, study design and depression assessment. Little is known about changes in depression over time in Germany, although health insurance companies report frequency increases. Here we examined time trends in depression prevalence, severity and health-related correlates in the general population.MethodsData were obtained from the mental health module of the “German Health Interview and Examination Survey for Adults” (2009–2012, n = 3265) and the mental health supplement of the “German National Health Interview and Examination Survey 1998” (1997–1999, n = 4176), excluding respondents older than 65. 12-month major depressive disorder (MDD), severity and symptoms were assessed based on the WHO Composite International Diagnostic Interview. Health-related quality of life (SF-36), self-reported sick days or days with limitations in normal daily life activities were examined, too. Calculations were carried out population-weighted. Additional age-standardized analyses were conducted to account for demographic changes.ResultsOverall, MDD 12-month prevalence remained stable at 7.4%. Women showed a shifted age distribution with increased prevalence at younger ages, and increasing MDD severity. Time trends in health-related correlates occurred both in participants with and without MDD. Mental health disability increased over time, particularly among men with MDD, reflected by the mental component score of the SF-36 and days with activity limitation due to mental health problems. Demographic changes had a marginal impact on the time trends.ConclusionsIn contrast to the ongoing international debate regarding increased depression rates in western countries, we found no increase in overall MDD prevalence in Germany over a long period. In conclusion, increased depression frequencies in national health insurance data and growing health care costs associated with depression are not attributable to overall prevalence changes at a population level. However, shifted age distribution and increased severity among women may reflect a rising depression risk within this specific subgroup, and changes in health-related correlates indicate a growing mental health care need for depression, particularly among men.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1973-7) contains supplementary material, which is available to authorized users.

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“…Data collected between 2009 and 2012 within a comprehensive study in Germany revealed a median delay between the appearance of the illness and evidence-based treatment of six to seven years among individuals who did not make treatment contact in the first year [ 6 ]. Possible reasons are fear of stigmatization [ 10 ], long waiting periods for outpatient psychotherapy [ 11 ], regional differences in availability [ 12 , 13 ] or problems with referrals for psychotherapy treatment. Possible difficulties are the non-detection of the mental disorder or a lack of knowledge of additional health care options [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions

Rothermund

Michaelis

Jarczok

et al. 2018

IJERPH

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Collaboration among occupational health physicians, primary care physicians and psychotherapists in the prevention and treatment of common mental disorders in employees has been scarcely researched. To identify potential for improvement, these professions were surveyed in Baden-Württemberg (Germany). Four hundred and fifty occupational health physicians, 1000 primary care physicians and 700 resident medical and psychological psychotherapists received a standardized questionnaire about their experiences, attitudes and wishes regarding activities for primary, secondary and tertiary prevention of common mental disorders in employees. The response rate of the questionnaire was 30% (n = 133) among occupational health physicians, 14% (n = 136) among primary care physicians and 27% (n = 186) among psychotherapists. Forty percent of primary care physicians and 33% of psychotherapists had never had contact with an occupational health physician. Psychotherapists indicated more frequent contact with primary care physicians than vice versa (73% and 49%, respectively). Better cooperation and profession-specific training on mental disorders and better knowledge about work-related stress were endorsed. For potentially involved stakeholders, the importance of interdisciplinary collaboration for better prevention and care of employees with common mental disorders is very high. Nevertheless, there is only little collaboration in practice. To establish quality-assured cooperation structures in practice, participants need applicable frameworks on an organizational and legal level.

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Ambulante fachärztliche Versorgung psychischer Störungen

Cited by 28 publications

References 20 publications

The utilization of psychiatric and psychotherapeutic services in Germany – individual determinants and regional differences

The utilization of psychiatric and psychotherapeutic services in Germany – individual determinants and regional differences

Time trends in depression prevalence and health-related correlates: results from population-based surveys in Germany 1997–1999 vs. 2009–2012

Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions

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