European Mental Health Research Articles

Reductions in inpatient and outpatient mental health care in germany during the first year of the COVID-19 pandemic - What can we learn for a better crisis preparedness?

During the COVID-19 pandemic, reports from several European mental health care systems hinted at important changes in utilization. So far, no study examined changes in utilization in the German mental health care inpatient and outpatient mental health care system comprehensively. This longitudinal observational study used claims data from two major German statutory health insurances, AOK PLUS and BKK, covering 162,905 inpatients and 2,131,186 outpatients with mental disorders nationwide. We analyzed changes in inpatient and outpatient mental health service utilization over the course of the first two lockdown phases (LDPs) of the pandemic in 2020 compared to a pre-COVID-19 reference period dating from March 2019 to February 2020 using a time series forecast model. We observed significant decreases in the number of inpatient hospital admissions by 24-28% compared to the reference period. Day clinic admissions were even further reduced by 44-61%. Length of stay was significantly decreased for day clinic care but not for inpatient care. In the outpatient sector, the data showed a significant reduction in the number of incident outpatient diagnoses. Indirect evidence regarding the consequences of the reductions in both the inpatient and outpatient sector of care described in this study is ambiguous and direct evidence on treatment outcomes and quality of trans-sectoral mental healthcare is sparse. In line with WHO and OECD we propose a comprehensive mental health system surveillance to prepare for a better oversight and thereby a better resilience during future global major disruptions.

Legislation and policy for involuntary mental healthcare across countries in the FOSTREN network: rationale, development of mapping survey and protocol.

Several countries are currently revising or have already revised their mental health laws to align with the global movement to reduce the use of coercive care. No government has yet fully implemented the recommendation of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) to eliminate the use of coercion in mental healthcare. Consequently, the international field of mental health law and policy is in a degree of flux. To describe the rationale, development and protocol for a project that will map and examine how mental health laws, policies and service capacity across European countries relate to the use of coercive measures, including involuntary admissions and treatment, restraints and seclusion. This will help to better understand the current situation and explore future directions of policies regarding coercive care. The project is being carried out under the purview of the European Cooperation in Science and Technology (COST) action network, entitled FOSTREN (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services). A multidisciplinary group of experts developed a comprehensive survey assessing mental health laws, policies and service frameworks, based on World Health Organization and UNCRPD recommendations. The survey was piloted in three countries, revised and disseminated to 30 FOSTREN country representatives. The survey will provide data for three strands of work on legislation, policies and service-level context. A comprehensive evaluation will be conducted, drawing on findings from all work packages. The project could inform the development of strategies, interventions and legislation to address gaps and promote compliance with international standards.

Expert opinions on improving coercion data collection across Europe: a concept mapping study.

Coercion is frequently used in mental health practice. Since it overrides some patients' fundamental human rights, adequate use of coercion requires legal and ethical justifications. Having internationally standardised datasets to benchmark and monitor coercion reduction programs is desirable. However, only a few countries have specific, open, publicly accessible registries for this issue. This study aims to assemble expert opinions regarding strategies that might be feasible for promoting, developing, and implementing an integrated and differentiated coercion data collection system in Europe at national and international levels. A concept mapping methodology was followed, involving 59 experts from 27 countries in generating, sorting and rating strategies regarding relevance and feasibility. The experts were all researchers and/or practitioner members of an EU-COST-Action focused on coercion reduction Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services (FOSTREN). A hierarchical cluster analysis revealed a conceptual map of 41 strategies organized in seven clusters. These clusters fit into two higher-order domains: "Advancing Global Health Research: Collaboration, Accessibility, and Technological Innovations/Advancing International Research" and "Strategies for Comprehensive Healthcare Data Integration, Standardization, and Collaboration." Regarding the action with the higher priority, relevance was generally rated higher than feasibility. No differences could be found regarding the two domains regarding the relevance rating or feasibility of the respective strategies in those domains. The following strategies were rated as most relevant: "Collection of reliable data", "Implementation of nationwide register, including data on coercive measures", and "Equal understanding of different coercive measures". In analysing the differences in strategies between countries and their health prosperity, the overall rating did not differ substantially between the groups. The strategy rated as most relevant was the collection of reliable data in the nationwide health register, ensuring that countries share a standard understanding/definition of different coercive measures. Respondents did not consider the feasibility of establishing a shared European database for coercive measures to be high, nor did they envision the unification of mental health legislation in the future. There is some consensus on the most suitable strategies that can be adopted to enable international benchmarking of coercion in mental health settings.

Clinical pharmacy services in mental health in Europe: a commentary paper of the European Society of Clinical Pharmacy Special Interest Group on Mental Health

A large proportion of the world’s disease burden is attributable to mental illnesses. Although effective interventions are available, many patients still have limited access to evidence-based treatments. Aside from access, treatment gaps, including inappropriate medication selection and monitoring, are also routinely recognised. Mental health clinical pharmacists can help address these gaps and enable patients to receive optimised pharmaceutical care, particularly appropriate medication selection and monitoring. The European Society of Clinical Pharmacy (ESCP) Special Interest Group on Mental Health was established to improve standardised service provision in mental health settings across Europe. The Special Interest Group identified significant barriers (predominantly associated with reimbursement and position within the multidisciplinary team) to effective pharmaceutical care amongst those with mental illnesses. This commentary presents recommendations to address these gaps through improved mental health clinical pharmacy service provision.

(Grand)childlessness and depression across men and women’s stages of later life

ABSTRACT The literature on how family status and health in later life relate is extensive. Although research has focused on the health effects of grandparenthood and grandparenting, explorations of whether ageing without children can lead to mental health impairments have achieved mixed results. We bridge empirical traditions to investigate the relationship between family status and mental health in Europe by using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and sampling roughly 160,000 men and women aged 50–89 from 17 European countries. Mental health is evaluated through depressive symptoms on the EURO-D scale and compared between childless or grandchildless people and grandparents at different ages. To identify the association between (grand)parenthood and mental health status net of confounders, we perform inverse probability-weighted regression adjustment (IPWRA). The rich information SHARE provides facilitates considering the common factors that may influence (grand)parenthood and depressive symptoms. Results show that the three groups hardly differ in mental health: grandchildless men and grandfathers reported fewer depressive symptoms, if any, than childless men aged 70–79. Overall, while mental health does not seem to relate to family status per se, it could be crucial when accounting for the entire individual life course.

Coping with the mental health impact of COVID-19: A study protocol for a multinational longitudinal study on coping and resilience during the COVID-19 pandemic.

Mental health is challenged due to serious life events such as the COVID-19 pandemic and can differ by the level of resilience. National studies on mental health and resilience of individuals and communities during the pandemic provide heterogeneous results and more data on mental health outcomes and resilience trajectories are needed to better understand the impact of the pandemic on mental health in Europe. COPERS (Coping with COVID-19 with Resilience Study) is an observational multinational longitudinal study conducted in eight European countries (Albania, Belgium, Germany, Italy, Lithuania, Romania, Serbia, and Slovenia). Recruitment of participants is based on convenience sampling and data are gathered through an online questionnaire. gathering data on depression, anxiety, stress-related symptoms suicidal ideation and resilience. Resilience is measured with the Brief Resilience Scale and with the Connor-Davidson Resilience Scale. Depression is measured with the Patient Health Questionnaire, Anxiety with the Generalized Anxiety Disorder Scale and stress-related symptoms with the Impact of Event Scale Revised- Suicidal ideation is assessed using item 9 of the PHQ-9. We also consider potential determinants and moderating factors for mental health conditions, including sociodemographic characteristics (e.g., age, gender), social environmental factors (e.g., loneliness, social capital) and coping strategies (e.g., Self-efficacy Belief). To the best of our knowledge, this is the first study to multi-nationally and longitudinally determine mental health outcomes and resilience trajectories in Europe during the COVID-19 pandemic. The results of this study will help to determine mental health conditions during the COVID-19 pandemic across Europe. The findings may benefit pandemic preparedness planning and future evidence-based mental health policies.

Digital transcultural psychiatry in times of crisis: the Help for helpers webinar series

AbstractThe COVID-19 pandemics brought numerus changes in the European mental health systems. One of the major, was the widespread introduction of digital psychiatry across the globe, as the only possible option to maintain the psychiatric care. On February 28th 2022, the European Psychiatric Association has started a network of solidarity for Ukraine to respond to the needs of people in Ukraine as verbalized by the Ukrainian mental health professionals, but also to the need of surrounding countries where people from Ukraine fled to. As verbalized by the colleagues from Ukraine and surrounding countries, one of the unmet educational needs was the education for first line helpers and volunteers from Ukraine and countries surrounding Ukraine where displaced persons fled to. This resulted in the series of webinars on the topics detected as unmet needs (what is normal response to trauma, how to triage dispaced persons in need of help, how to provide first psychological help, how to approach to children of different ages, how to take care of one-self and what is the role of supervision). The webinars were delivered by experienced clincians, trauma experts and experts with lived experince in the war zones, incliding the ones from Ukraine. These are available freely at the EPA website https://www.europsy.net/resource-page/, in several languages.Disclosure of InterestNone Declared

Implementation of European experience in the digitalization of health care institutions of Ukraine for the provision of psychological and psychiatric care to the population in modern conditions

Annotation. The purpose of this work is to study the European experience of digitization of psychological and psychiatric care for patients with mental illnesses in European Mental Health Centers and its integration into health care institutions of Ukraine. Methods used in the work: bibliosemantic, content analysis. The article is devoted to the study of the experience of providing telepsychiatric (cyber-psychiatric) care to patients with mental disorders of the psyche and behavior using modern digital technologies for the remote provision of medical services via the Internet using various Internet platforms, applications installed on smartphones, tablets, computers/ laptops, and its integration into the medical space of Ukraine.

Lessons Learned from the Covid-19 Crisis: Recommendations for Action to Optimize Occupational Health in Mental Health Professionals in Europe.

ObjectiveThe Covid-19 health crisis has disrupted the organization and functioning of European mental health and psychiatric services, impacting the working conditions – already difficult before the epidemic – of professionals working therein. The Psy-GIPO2C project investigated the impact of the pandemic on these professionals. The Psy-GIPOC2C project has been co-funded by the Agence Nationale de la Recherche française (ANR, French National Research Agency) and the Centre-Val de Loire region (France).MethodThis research took the form of a collaborative mixed methods study. The data collected through qualitative and quantitative research were analyzed during a working session held by the research consortium, which resulted in the formulation of recommendations for action to optimize the occupational health of European mental health professionals.ResultsThis research made it possible to identify and explain the extent to which, and the ways in which, the reorganization of European mental health services has impacted the mental health of the professionals working therein, and, in particular, to highlight the fact that the unprecedented use of digital devices has generated stress, and even tension, within these services.ConclusionsIt is important to promote well-being at work among European mental health professionals, by involving them in the development of ad hoc measures (in addition to the existing psychological support measures available) to enable them to recharge their batteries. It is also important to support current and future professionals in their appropriation of digital tools for professional use.

ВКЛАД МЕДИЦИНЫ ТРУДА В ПРОФИЛАКТИКУ ПАГУБНОГО УПОТРЕБЛЕНИЯ АЛКОГОЛЯ

Abstract. Introduction. The European Mental Health Action Plan, approved by the World Health Organization in 2013, outlines the objectives of the strategy for reducing harmful alcohol use, including reducing harmful effects and reducing alcohol-associated mortality. The implementation of the set goals will make it possible to improve the health, quality of life and increase the working capacity of population. Аim. Тo assess the involvement of occupational medicine in the prevention of harmful alcohol use. Material and methods. Аnalytical review of the current scientific databases for the period from 2004 to 2022 was carried out. Results and discussion. Тhe analysis of 32 data’s, including reviews and current legislative acts, which reflect the provisions on the state of mental health in connection with the occupational environment, the job-place conditions and the influence of harmful working factors on the health of workers, including data related to the harmful use of alcohol. Conclusion. Тo identify such a behavioral risk factor as «harmful alcohol consumption» (or consumption with harmful consequences), encoded by F10.1 in the International Classification of Diseases of the 10th revision, it is necessary to include in the list of mandatory, if a psychiatrist detects suspicion of alcohol abuse during a periodic medical examination, studies on the concentration of carbohydrate deficient transferrin - a marker of alcohol abuse.

Factors Affecting Treatment Regress and Progress in Forensic Psychiatry: A Thematic Analysis.

International variability and shifting trends in forensic psychiatry lead to gaps in national service provision and needs for service development. This study explores these needs through the subjective narratives of those involved in Finnish forensic services, either as forensic psychiatric patients, their parents, or service providers. Data was gathered by means of thematic interview and subjected to thematic analysis. Three main themes emerged: (1) pre-treatment challenges, (2) institutional/treatment-related concerns about therapeutic security and (3) adapting and recovery. The research highlights the need to develop forensic psychiatric services at three levels. First, it calls for increased risk awareness and risk assessment skills at the general psychiatric level. Second, it emphasizes the need for increased therapeutic engagement throughout the rehabilitative process. Third, it calls for structured and meaningful post-discharge aftercare. At all three levels, gradated security-aware standardization and patient triage in forensic services would help to develop and maintain an intact care pathway. This would decrease offending, marginalization, and suffering. Only then can we begin to meet the requirements of the WHO European Mental Health Action Plan. These findings can contribute to the development of international, standardized treatment models for clinical forensic psychiatric practices.

Gendered impact of COVID-19 containment measures on unpaid care work and mental health in Europe: a scoping review protocol

IntroductionWomen are more likely than men to provide unpaid care work. Previous research has shown that lack of support for various forms of unpaid care work and work-family conflicts have...

Prevalence, progress, and subgroup disparities in pharmacological antidepressant treatment of those who screen positive for depressive symptoms: A repetitive cross-sectional study in 19 European countries.

SummaryBackgroundThe European Mental Health Action Plan (EMHAP) 2013–2020 promoted community-based mental health services. One potential success indicator is the provision of antidepressant medication to those needing it.MethodsPublic data from two surveys (Health Survey for England, UK; Survey of Health, Ageing and Retirement in Europe) covered 19 European countries across EMHAP phases one (2011–2015) and two (2015–2018). People screening positive for depressive symptoms by self-report were included. The primary outcome was antidepressant use: using country-specific weighted regression models, we estimated temporal trends and subgroup disparities in antidepressant receipt, with secondary analysis by country-level measures including healthcare expenditure.FindingsAcross 37,250 participants, after controlling for age, sex, wealth, and physical disability, antidepressant use (amongst those screening positive) increased significantly in 14/19 countries, with the smallest increase being in Slovenia (adjusted OR[AOR] for trend=1.68[1.20–2.36]) and the highest increase being in Germany (AOR for trend=10.07[7.54–13.46]) and Austria (AOR for trend=10.07[7.32–13.74]). The overall proportion using antidepressants was positively associated with national health expenditure (coefficient=5.43[1.62–9.25]), but not with gross national income per capita or the number of psychiatrists, general practitioners, or psychiatric hospital beds. In 15/19 countries, antidepressants were used less by ≥65-year-olds than 50–64-year-olds, with the smallest differential reported in Luxembourg (AOR=0.70[0.49, 0.98]) and the highest in Germany (AOR=0.28[0.21, 0.37]); this disparity widened in 12/15 countries. Men used antidepressants less than women in 8/19 countries, across phases. In 13/19 countries, people with physical disability were more likely to receive antidepressants, with the smallest gap in Italy (AOR=1.42[1.12–1.80]) and the largest in Israel (AOR=2.34[1.46–3.74]); this disparity narrowed in 5/13 countries. Disparity by wealth was found in 8/19 countries, but its temporal trend varied.InterpretationUsage of antidepressants by those with depressive symptoms has increased, with wide variation between countries and subgroups. Disparities across age, sex, and disability should prompt further research.FundingMedical Research Council (grants MC_PC_17213 and MR/W014386/1), UK National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).

Precarious employment and mental health across European welfare states: a gender perspective.

The aim of this article was to examine the relationship between precarious employment (PE), welfare states (WS) and mental health in Europe from a gender perspective. Data were derived from the European Working Conditions Survey 2015. PE was measured through the Employment Precariousness Scale for Europe (EPRES-E), validated for comparative research in 22 European countries, and categorized into quartiles. Countries were classified into Continental, Anglo-Saxon, Scandinavian, Southern and Central-Eastern WS. Mental health was assessed through the WHO-5 Well-Being Index and dichotomized into poor and good mental health. In a sample of 22,555 formal employees, we performed gender-stratified multi-level logistic regression models. Results showed greater prevalences of PE and poor mental health among women. However, the association between them was stronger among men. Cross-country differences were observed in multi-level regressions, but the interaction effect of WS was only significant among women. More precisely, Central-Eastern WS enhanced the likelihood of poor mental health among women in high precarious employment situations (quartiles 3 and 4). These findings suggest the interaction between contextual and individual factors in the production of mental health inequalities, both within and across countries. They also call for the incorporation of gender-sensitive welfare policies if equitable and healthy labor markets are to be achieved in Europe.

Impact of axial spondyloarthritis on mental health in Europe: results from the EMAS study

ObjectiveTo determine the presence of mental disorder risk and associated factors in European patients with axial spondyloarthritis (axSpA).MethodsData from 2,166 patients with axSpA in 12 European countries were collected from...

Stakeholder consultation to facilitate implementation of interventions for prevention and promotion in mental health in Europe: introducing the design of the ICare Stakeholder Survey.

BackgroundOnline interventions to prevent mental health problems have proven to be effective. However, knowledge about their implementation in real-world practice as well as for dissemination to the target groups in different settings is scarce. The goal of the ‘ICare’ network is to establish a comprehensive model of eMental-health service delivery in and across different European countries. Since implementation and dissemination are influenced by many contextual factors, in the first phase of ICare a stakeholder survey was conducted. The survey aim was to explore stakeholders’ experiences, needs and attitudes regarding Internet-based prevention of mental health problems and hindering and fostering factors for implementation and dissemination. This article is part of a supplement and describes the design of the stakeholder survey. Survey results are published in separate articles in the same supplement.MethodsBased on a literature review and the individual characteristics of the ICare interventions, stakeholder groups were identified in different settings across six European countries. The RE-AIM framework guided the development of the research questions and survey instruments. A concurrent mixed methods design was applied comprising focus groups with the intended target groups of ICare interventions, an online questionnaire with potential facilitators/delivery staff and semi-structured interviews with policy makers.ConclusionThe challenge was to develop a design that allowed flexibility but at the same did not jeopardize the validity of the study. Implications drawn from this survey are not restricted to specific preventive interventions but will provide general information on how online mental illness prevention can be best implemented in various settings.

Transitioning to community-based mental healthcare: reform experiences of five countries

Following the growing global focus on deinstitutionalisation in the past 50 years, accessible community mental health services was a highlighted commitment in the European Mental Health Action Plan 2013–2020 to improve well-being of patients and families. The progress of transition has been uneven in some Eastern European countries. This paper aims to update and reflect on the examples of five countries across the region.

Self-reported fears and mental health in elementary school children across Europe.

Fears are common in the general population and particularly among children. The number of fear subtypes (animals, natural environment, situational, blood-injection-injury or other type) has been shown to be associated with psychopathology. Furthermore, there is evidence suggesting that some subtypes may be more often associated with mental disorders than others. The present study uses data from a large cross sectional survey, the School Children Mental Health in Europe (SCMHE) study, conducted in eight European countries on children ages 6 through 13-years-old attending elementary school (n = 9613). Fear subtypes and self-reported mental health were assessed using the Dominic Interactive (DI), a self-administered computerized image-based questionnaire. The findings show that the number of fear subtypes is strongly associated with self-reported internalizing and externalizing problems. In addition, adjusting for the number of subtypes, fear of animals was less likely than other fears to be associated with psychopathology. The findings support the notion that children who report excessive and generalized fear should be targeted for prevention, consistent with research identifying childhood onset generalized specific phobia as a probable precursor to subsequent psychopathology.

A proverbial double-edged sword


 
 
 The notion of family and carer involvement appears throughout European mental health policy and guidelines. However, it has been noted that carer involvement policy may derive from a responsibilization agenda rather than from evidence that it genuinely supports re- covery. We review qualitative research on family life with depression from the perspective of people with depression. Studies were included if they elicited accounts from adults with a professional diagnosis of depression. Nineteen studies were included which incorporated the experiences of 493 adults with depression. A metasynthesis of findings from these stu- dies is discussed within three themes: family issues and depression interact; family support as a double-edged sword; benefits and limitations of psychosocial interventions. Findings reveal a complex inter-relationship between family roles, relationship dynamics, gender, culture and attitudes towards depression. Family involvement in primary care and medical settings can be a double-edged sword and the perceived benefit may depend on the extent to which family perspectives on treatment fit with the depressed person’s understanding of their depression as medical or psychosocial. Psychosocial interventions for individual cli- ents have several limitations in terms of improving family relationships while family-based group interventions may be more beneficial, depending on the engagement of the family and the partner in particular. The review findings emphasise the complexity of family life with depression indicating that the requirement for ‘carer involvement’ as simplified in cur- rent policies and guidelines is naïve policy at best and that family or couple psychosocial interventions may often be more appropriate.
 
 

Managing the challenges in implementing digital mental health in europe

Abstract BodyThe demand for mental health care is increasing globally as a result of societal challenges such as automation, increased economic competition, unemployment and the growing impact of climate change. The direct and indirect economic costs of mental health problems are substantial, totalling over € 600 billion yearly across the EU (OECD 2018). The COVID-19 crisis has led to an additional increase in demand and has changed the way care is delivered. Since March 2020 there has been a significant increase in the use of e-mental health (eMH), telemental health in particular. eMH can contribute to keeping services, accessible, affordable and patient focused. The eMEN project (funded by the EU Interreg North-West-Europe programme) is promoting the latter through a European cooperation platform for eMH development, research and implementation. This platform focuses on high quality and professional ‘blended care’, which combines face-to-face and online treatment. The implementation of eMH has been slow and varies considerably between EU countries, even though this technology has been on the market for over 20 years. The reasons for this are related to quality problems (e.g. validation, usability), resistance from clinicians, lack of blended care treatment protocols, digital skills, reimbursement systems and policies and other barriers. Many service providers and public health authorities are increasing their efforts to overcome these barriers. This presentation will give a short overview of how the eMEN project is trying to overcome these barriers and accelerate the eMH implementation process.DisclosureNo significant relationships.