The stigma of psychiatric treatment and help-seeking intentions for depression

AIMS

The stigma of mental illness has often been considered a potential cause for reluctant willingness to seek help for mental problems, but there is little evidence on this issue. We examine two aspects of stigma related to seeing a psychiatrist and their association with help-seeking intentions for depression: anticipated discrimination by others when seeking help and desire for social distance from those seeking help.

METHODS

Representative population survey in Germany 2007 (n = 2,303), containing a depression vignette with a question on readiness to seek psychiatric care for this problem, a focus group developed scale anticipated discrimination when seeing a psychiatrist (ADSP), and a scale on desire for social distance from someone seeing a psychiatrist (SDSP). We further elicited previous contact to psychiatric treatment, depressive symptoms, and socio-demographic data.

RESULTS

Both scales had good internal consistency (Cronbach's alpha ADSP 0.87, SDSP 0.81). Exploratory factor analysis of all items revealed a distinct factor representing the social distance scale and three factors "anticipated discrimination", "anticipated job problems" and "anticipated shame" derived from the ADSP scale. In both the general population and in those with current depressive syndrome, personal desire for social distance significantly decreased willingness to seek psychiatric help, but anticipated discrimination by others did not. Other factors related to likely help-seeking were female gender and previous contact to psychiatric treatment or to psychotherapy.

CONCLUSION

Contrary to expectations, anticipated discrimination from others was unrelated to help-seeking intentions, while personal discriminatory attitudes seem to hinder help-seeking. Our findings point to self-stigmatization as an important mechanism decreasing the willingness to seek psychiatric help.

Is it always the same? Variability of depressive symptoms across six European countries

Using common diagnostic systems together with structured interviews to assess mental disorders has made it possible to compare diagnostic groups of mental disorders across countries. The implicit assumption is that the symptomatology of a particular disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) will not vary between different countries. However, it is conceivable that there will be some variability in the symptom patterns. The present study examines if differences in depressive symptom patterns across European countries can be found and if there are different associations between symptoms and the latent construct depression. Data from 4025 individuals of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project were analysed. Individuals were interviewed using the Composite International Diagnostic Interview (CIDI 3.0). Confirmatory factor analysis was used to examine the associations between depressive symptoms and the latent construct of depression in each country. The proportions of endorsed symptoms of depression showed only slight variation across European countries and only minor to moderate differences in the associations between depressive symptoms and the latent construct depression. The results demonstrated that in European countries using a fully structured and standardized interview based on European-American diagnostic concepts leads to similar results with regard to depressive symptom patterns.

DSM-IV personality disorders in the WHO World Mental Health Surveys

BACKGROUND

Little is known about the cross-national population prevalence or correlates of personality disorders.

AIMS

To estimate prevalence and correlates of DSM-IV personality disorder clusters in the World Health Organization World Mental Health (WMH) Surveys.

METHOD

International Personality Disorder Examination (IPDE) screening questions in 13 countries (n = 21 162) were calibrated to masked IPDE clinical diagnoses. Prevalence and correlates were estimated using multiple imputation.

RESULTS

Prevalence estimates are 6.1% (s.e. = 0.3) for any personality disorder and 3.6% (s.e. = 0.3), 1.5% (s.e. = 0.1) and 2.7% (s.e. = 0.2) for Clusters A, B and C respectively. Personality disorders are significantly elevated among males, the previously married (Cluster C), unemployed (Cluster C), the young (Clusters A and B) and the poorly educated. Personality disorders are highly comorbid with Axis I disorders. Impairments associated with personality disorders are only partially explained by comorbidity.

CONCLUSIONS

Personality disorders are relatively common disorders that often co-occur with Axis I disorders and are associated with significant role impairments beyond those due to comorbidity.

Comparison of different valuation methods for population health status measured by the EQ-5D in three European countries

OBJECTIVE

The purpose of this study was to analyze and compare different valuation methods for population health status measured by the EuroQol-5D (EQ-5D) in three European countries.

METHODS

A representative survey of the noninstitutionalized population aged 18 and above was conducted in three European countries (Germany, The Netherlands, and Spain). A total of 11,932 respondents were interviewed using the EQ-5D self-classifier. Health state values based on community preferences (EQ-5D index) were calculated for each country using four different value sets: national value sets based on the time trade-off (TTO) and the visual analogue scale (VAS), the UK TTO-based value set and the European VAS-based value set. Linear regression analysis was conducted to evaluate the factors associated with different EQ-5D index scores depending on the value set used. Loss of quality-adjusted life-years (QALYs) was calculated for each country using the four value sets by multiplying the age and gender-specific values with the respective population size.

RESULTS

In all countries, means of all EQ-5D index scores were higher for men than women, and decreased with age. Index scores calculated using the national value set based on TTO were higher than those calculated using the UK TTO-based value set and, also, slightly higher than those calculated using the European VAS-based value set or the national value set based on the VAS. The mean loss of QALYs estimated for Germany per inhabitant varied between 0.062 (national value set based on TTO) and 0.094 (European VAS-based value set). In The Netherlands, the mean loss of QALYs per inhabitant ranged from 0.090 (national value set based on TTO) to 0.125 (national value set based on VAS). In Spain, the mean loss of QALYs per inhabitant ranged between 0.072 (national value set based on TTO) and 0.085 (European VAS-based value set).

CONCLUSIONS

In general, the differences among countries and valuations were rather small; nevertheless, some important variations should be taken into account while applying different valuation methods to the EQ-5D descriptive system. The associations between sociodemographic variables and health state scores remained the same across countries regardless of which value sets were used. Using different valuation methods lead to different QALY losses. To overcome this problem in international surveys aimed to compare health state scores or QALYs, it is advisable to use a single valuation method, making these scores comparable.

Direct medical mental health care costs of schizophrenia in France, Germany and the United Kingdom - findings from the European Schizophrenia Cohort (EuroSC)

OBJECTIVES

To quantify and compare the resource consumption and direct costs of medical mental health care of patients suffering from schizophrenia in France, Germany and the United Kingdom.

METHODS

In the European Cohort Study of Schizophrenia, a naturalistic two-year follow-up study, patients were recruited in France (N=288), Germany (N=618), and the United Kingdom (N=302). Data about the use of services and medication were collected. Unit cost data were obtained and transformed into United States Dollar Purchasing Power Parities (USD-PPP). Mean service use and costs were estimated using between-effects regression models.

RESULTS

In the French/German/UK sample estimated means for a six-month period were respectively 5.7, 7.5 and 6.4 inpatient days, and 11.0, 1.3, and 0.7 day-clinic days. After controlling for age, sex, number of former hospitalizations and psychopathology (CGI score), mean costs were 3700/2815/3352 USD-PPP.

CONCLUSIONS

Service use and estimated costs varied considerably between countries. The greatest differences were related to day-clinic use. The use of services was not consistently higher in one country than in the others. Estimated costs did not necessarily reflect the quantity of service use, since unit costs for individual types of service varied considerably between countries.

Direct costs associated with mild cognitive impairment in primary care

BACKGROUND/AIMS

Little is known about the direct costs of individuals with Mild Cognitive Impairment (MCI). This study investigates the direct costs associated with MCI according to recent diagnostic criteria from a societal perspective.

METHODS

Four hundred and fifty-two primary care patients aged 75+ from Leipzig, Germany, were investigated in face-to-face interviews regarding MCI according to the current diagnostic criteria of the International Working Group on MCI, resource utilisation and costs (questionnaire of service utilisation and costs), as well as chronic medical illness (Chronic Disease Score). Resource utilisation was monetarily valued using 2004/2005 prices.

RESULTS

Mean annual direct costs were 4,443 euro for patients with MCI (n=39) and 3,814 euro for patients without MCI (n=413) (p=0.34). Looking at the cost components, patients with and without MCI only significantly differed regarding pharmaceutical costs (1,210 euro vs 1,062 euro; p<0.05) not caused by antidementive drugs.

CONCLUSION

Direct costs of individuals having MCI are not significantly increased in comparison to direct costs of individuals without cognitive deficits.

Time until institutionalization in incident dementia cases--results of the Leipzig Longitudinal Study of the Aged (LEILA 75+)

BACKGROUND

Information on the time until institutionalization and its predictors in demented subjects has so far been based on studies with selected samples or prevalent dementia cases. Thus, the aim of the study is to analyze the time until institutionalization and associated patient-related factors in incident dementia cases.

METHODS

Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA 75+), a population-based study of individuals aged 75 years and older. Kaplan-Meier survival analysis was used to determine the time until institutionalization. Factors associated with time until institutionalization were analyzed using Cox proportional hazards models.

RESULTS

One hundred and nine subjects with incident dementia who resided in a private home setting at the time of the dementia diagnosis were identified. Fifty-two (47.7%) of these subjects had become residents of a nursing home by the end of the study. The median time until institutionalization was 1,005 days (95% CI = 808-1,202). Being widowed/divorced (compared to being married) was associated with a significantly shorter time until institutionalization (univariate model: HR = 4.50, 95% CI = 1.09-18.57).

CONCLUSION

Being without a spouse seems to be an important factor for a shorter time until institutionalization in incident dementia cases. Tailored interventions for these subjects at risk are required.

Service utilization and health-care costs in the advanced elderly

OBJECTIVES

Despite their increasing importance, the advanced elderly are often neglected in service utilization and costing studies. The purpose of this study was to analyze from societal perspective service utilization and direct health-care costs and its predictors in the advanced elderly population.

METHODS

A bottom-up costing study was conducted using a cross-sectional primary care sample aged 75+ (n = 452) in Germany. The main instruments were a questionnaire of service utilization and costs administered by an interviewer and the chronic disease score (CDS). Predictors were derived by means of multivariate regression models.

RESULTS

Respondents caused mean direct costs of Euro 3730 (95% CI 3203-4257) in prices of 2004/2005. This included inpatient care 34%, pharmaceuticals 29%, outpatient physician services 15%, nursing care 10%, medical supply and dentures 6%, outpatient nonphysician providers 5%, assisted living 1%, and transportation 2%. A shift from lower to middle education and a one-point increase in CDS were associated with an increase of 1678 Euro (95% CI 250-3369) and 482 Euro (95% CI 316-654), respectively. Total mean direct costs did not differ significantly between sexes. Ischemic heart disease and diabetes mellitus were associated with excess costs of 711 Euro and 290 Euro, both being not significant. Altogether 55% of the respondents accounted for 90% of total direct costs.

CONCLUSIONS

Advanced elderly used a wide range of health services. Our study still underestimates the true costs to society. Further research should focus on economic evaluation of new health-care programs for this increasingly important age group.

[Social representation of a psychoanalytical concept: what is the popular meaning of an "unconscious conflict"?]

OBJECTIVE

A majority of the population regards unconscious conflict as a possible cause for depression or schizophrenia. We examine to what extent people associate psychoanalytical concepts with this term.

METHOD

Population-based telephone survey (n = 1010), open questions about the meaning and origin of the term unconscious conflict.

RESULTS

5 % gave a definition with clearly psychoanalytical elements, another 13 % perceived an internal conflict. 24 % thought of a conflict between persons, 23 % had no answer. Regarding the origin of the term, 4 % associated Freud or psychoanalysis, 27 % psychology. For both questions, answers closer to Freudian ideas were more common in West compared to East Germany.

CONCLUSION

A concretised understanding far from Freud's original conception of unconscious conflict dominates, which is even stronger in the former communist parts of Germany. Psychoanalytical terms do not necessarily carry a psychoanalytical significance with the public.

Adverse parenting as a risk factor in the occurrence of anxiety disorders : a study in six European countries

OBJECTIVE

The aim of the study was to test the homogeneity of the association between adverse parenting and anxiety disorders within these disorders as well as among six European countries.

METHOD

Based on data from 8,232 respondents (part II sample) originating from the European study of the epidemiology of mental disorders (ESEMeD), we examined the association between three dimensions of parental rearing (care, overprotection, authoritarianism) measured by a short form of the parental bonding instrument (PBI) and anxiety disorders by computing one logistic regression model per disorder.

RESULTS

A similar pattern of recalled parenting behaviour across the four anxiety disorders assessed was found, with care and overprotection having the strongest associations. There were only minor country-specific variations of this pattern.

CONCLUSION

Our results suggest an association between adverse parenting and the risk of anxiety disorders in particular as well as psychiatric disorders in general that is rather non-disorder specific.

Public attitudes towards prevention of depression

BACKGROUND

Various programs for depression prevention have been shown to be effective, but preventive efforts population wide are only beginning. We examine public attitudes towards prevention of depression and beliefs about helpful preventive measures.

METHOD

Fully structured telephone interview with a representative population sample including people of German nationality older than 14 years (n=1016).

RESULTS

75.4% of the sample agreed on the possibility to prevent depression. Of those, 403 (52.6%) stated that they would take part in prevention programs, and in this group 234 (58.1%) indicated readiness to pay out of their pocket for such programs. Out of a catalogue of 37 proposed actions, psychosocial and lifestyle related measures were preferred. Exploratory factor analysis revealed three factors--proactive lifestyle, relying on medicine, and relaxing--inherent in public beliefs about helpfulness of preventive measures. Higher education reduced willingness, high perceived personal risk of depression and previous contact to the disease increased willingness to take part in preventive programs.

CONCLUSION

The public entertains favourable attitudes and beliefs about prevention of depression that do not conflict with evidence-based programs. Our study thus encourages implementation of population based prevention programs.

Cost effectiveness of ibandronate for the prevention of fractures in inflammatory bowel disease-related osteoporosis: cost-utility analysis using a Markov model

BACKGROUND

Osteoporosis is a frequent complication in patients with inflammatory bowel disease. Recent studies have shown bisphosphonates to considerably reduce fracture risk in patients with osteoporosis, and preventing fractures with bisphosphonates has been reported to be cost effective in older populations. However, no studies of the cost effectiveness of these agents in preventing fractures in patients with inflammatory bowel disease are available.

OBJECTIVE

To investigate the cost effectiveness of the bisphosphonate ibandronate combined with calcium/colecalciferol ('ibandronate') in patients with osteopenia or osteoporosis due to inflammatory bowel disease in Germany. Treatment strategies used for comparison were sodium fluoride combined with calcium/colecalciferol ('fluoride') and calcium/colecalciferol ('calcium') alone.

STUDY DESIGN AND METHODS

A cost-utility analysis was conducted using data from a randomized controlled trial (RCT). Changes in bone mineral density (BMD) were adjusted and predicted for a standardized population receiving each respective treatment. A Markov model was developed, with probabilities of transition to fracture states consisting of BMD-dependent and -independent components. The BMD-dependent component was assessed using predicted change in BMD from the RCT. The independent component captured differences in bone quality and micro-architecture resulting from prevalent fractures or treatment with anti-resorptive drugs. The analysis was conducted for a population with a mean age of the RCT patients (women aged 36 years, men aged 38 years) with osteopenia (T-score about -2.0 at baseline), a population of the same age with osteoporosis (T-score of -3.0 at baseline) and for an older population (both sexes aged 65 years) with osteoporosis (T-score of -3.0). Outcomes were measured as costs per QALY gained from a societal perspective. The treatment duration in the RCT was 42 months. A 5-year period was assumed to follow, during which the treatment effects linearly declined to 0. The simulation time was 10 years. Prices for medication and treatment were presented as year 2004 values; costs and effects were discounted at 5%. To test the robustness of the results, univariate and probabilistic sensitivity analyses (Monte Carlo simulation) were conducted.

RESULTS

The calcium strategy dominated the fluoride strategy. When the ibandronate strategy was compared with the calcium strategy, the base-case cost-effectiveness ratios (costs per QALY gained) were between euro 407 375 for an older female population with osteoporosis and euro 6 516 345 for a younger female population with osteopenia. Univariate sensitivity analyses resulted in variations between 4% of base-case results and dominance of calcium. In Monte Carlo simulations, conducted for the various populations, the probability of an ICER of ibandronate below euro 50 000 per QALY was never greater than 20.2%.

CONCLUSION

The ibandronate strategy is unlikely to be considered cost effective by decision makers in men or women with characteristics of those in the target population of the RCT, or in older populations with osteoporosis.

Traces of freud--the unconscious conflict as a cause of mental disorders in the eyes of the general public

BACKGROUND

We aim to elicit how far the public has incorporated Freudian theory in its understanding of mental illness in different countries, focussing on the unconscious conflict as a possible cause of mental disorders.

SAMPLING AND METHODS

We conducted representative population surveys with identical sampling procedures and face-to-face interviews in Germany (1990, n = 3,078; 2001, n = 5,025), Novosibirsk (Russia, 2002, n = 745), and Bratislava (Slovakia, 2003, n = 1,000) and a representative telephone survey in Germany in 2006.

RESULTS

Two thirds of respondents in Germany endorsed an unconscious conflict as a cause of mental disorder. Endorsement was stronger for depression than for schizophrenia, increased with duration of schooling, and was less prevalent in Bratislava and Novosibirsk and in East compared to West Germany. Endorsement in Germany increased between 1990 and 2001. However, only 5% of respondents could offer a definition of unconscious conflict that resembled Freud's initial theory.

DISCUSSION

The observed West-East gradient is likely to mirror the past political undesirability of psychoanalysis in former communist countries. The popularity of psychoanalytical concepts seems to lag behind their actually declining influence within psychiatry in Germany. Public conception of unconscious conflict however hardly resembles Freud's original ideas.

CONCLUSIONS

Although psychoanalytical concepts warrant consideration when exploring patients' causal beliefs about mental illness, psychiatrists should focus on the subjective meaning of seemingly psychoanalytic phrases.

Direct costs associated with depression in old age in Germany

BACKGROUND

Depression in old age is common. Only few studies, exclusively conducted in the USA, have examined the impact of depression on direct costs in the elderly (60+). This study aims to determine the effect of depression on direct costs of the advanced elderly in Germany from a societal perspective.

METHODS

451 primary care patients aged 75+ were investigated face-to-face regarding depressive symptoms (Geriatric Depression Scale), chronic medical illness (Chronic Disease Score) and resource utilisation and costs (cost diary). Resource utilisation was monetarily valued using 2004/2005 prices.

RESULTS

Mean annual direct costs of the depressed (euro5241) exceeded mean costs of non-depressed individuals (euro3648) by one third (p<.01). Significant differences were found for pharmaceutical costs, costs for medical supply and dentures, and for home care. Only few costs were caused by depression treatment. Depression has a significant impact on direct costs after controlling for age, gender, education, chronic medical illness and cognitive functions. A one-point increase in the GDS-Score was associated with a euro336 increase in the annual direct costs.

LIMITATIONS

Reported costs can be considered as rather conservative estimates. There were no nursing home residents and no patients with dementia disorders in the sample. Furthermore, recall bias cannot be ruled out completely.

CONCLUSION

Depression in old age is associated with a significant increase of direct costs, even after adjustment for chronic medical illness. Future demographic changes in Germany will lead to an increase in the burden of old age depression. Therefore health policy should promote the development and use of cost-effective treatment strategies.

[The burden of depressive disorders in Germany - results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)]

OBJECTIVE

The purpose of this study was to estimate and compare the disease burden of depression in Germany using preference-based valuations of depressive health states.

METHODS

The data came from the European Study of the Epidemiology of Mental Disorders (ESEMeD) in which a representative sample of 3555 non-institutionalised adults aged 18 years or older was interviewed in Germany. Computer assisted personal interviews included EQ-5D, SF-12, time trade-off (TTO) and contingent valuation (willingness-to-pay, WTP). Respondents in whom 12-month prevalence for a depressive disorder according to DSM-IV was identified, were compared to respondents without depressive disorders (controls). Disease burden was measured in terms of loss of quality-adjusted life years (QALYs) and loss of monetary benefit due to depression per year. Valuations of health-related quality of life (HRQL) were derived from EQ-5D (EQ VAS and EQ-5D Index), SF-12 (SF-6D Index) and TTO. Disease burden was estimated by calculating the difference between individual valuation of HRQL/WTP for full health of cases and mean valuation/WTP of controls matched by age and gender. Results were extrapolated to the total population.

RESULTS

Depending on the valuation method, the loss of QALYs per year due to depression in Germany was 144,886 (TTO), 239,152 (EQ-5D Index VAS), 265,085 (EQ-5D Index TTO), 307,139 (EQ VAS) and 403,373 (SF-6D Index). The additional WTP for full health amounted to 4.3 billion Euro.

CONCLUSIONS

Depressive disorders caused a substantial disease burden. Subjects affected by depression showed lower preference-based scores compared to subjects without depression. However, calculated QALY losses varied strongly by valuation method.

[An error of the educated--split personality and schizophrenia]

OBJECTIVE

Among the public schizophrenia is often thought to denote split personality. Our aim is to identify factors influencing the prevalence of this error. METHODS In a representative population survey in Germany (n=5,025), respondents received an open question about their associations with the word schizophrenia and a closed question how strongly they agree that split personality is a symptom of the disease.

RESULTS

27% associated split personality with schizophrenia, 67.4% agreed this being a symptom. Higher education was associated with answering/endorsing split personality in both questions. Familiarity with mental illness and living in the old German Laender increased unprompted mention of the concept.

CONCLUSION

Mistaking schizophrenia for split personality is an error of the well-educated that is not favourably altered by familiarity with mental illness. Targeting this misconception seems to be difficult and could necessitate a new illness denomination.

The association of schizophrenia with split personality is not an ubiquitous phenomenon: results from population studies in Russia and Germany

A widely prevalent stereotype connected with schizophrenia is its misperception as split personality. We examine whether the popular meaning of the term schizophrenia differs in countries of different cultural imprint by conducting an international cross-cultural comparison of public associations with the word schizophrenia in a Western and a Non-Western industrialized country. We analyze data from two representative population surveys in Novosibirsk, Russia (n = 745), and large German cities (n = 952) that used identical questions and sampling procedures. Unprompted associations with schizophrenia are compared by assigning them to a differentiated categorical system. 31.6% of respondents in Germany associated split personality with schizophrenia, compared to 2.0% in Novosibirsk. Logistic regression analysis controlling for age, gender and educational achievement demonstrated that country differences were independent of socio-demographic variables. Mention of split personality increased significantly with higher education. In Novosibirsk, associations with abnormality and unpredictability prevailed. We hypothesize on those cultural particularities in both countries that have shaped the different public understanding of the term and discuss implications for anti-stigma interventions.

Health habits of patients with schizophrenia

BACKGROUND

The aim of the study was to analyze the physical activity, dietary, drinking, and smoking habits of schizophrenia patients (SP).

METHODS

Data from 194 schizophrenia outpatients collected using sections of the German National Health Interview and Examination Survey were compared with data from the German general population (GP). In addition to univariate data analyses, a multivariate regression analysis was performed.

RESULTS

Schizophrenia patients have a supper snack more frequently, consume instant meals and calorie-reduced food more frequently, and eat healthy groceries more rarely. Though they drink less alcohol, a greater proportion currently smokes, smoking on average 4 cigarettes more per day. On workdays they spend less time with strenuous activities, and in leisure time a greater proportion is involved in no sports. Regression analysis revealed that schizophrenia by itself or in interaction with demographic variables influences physical activity as well as alcohol, nicotine, and healthy grocery consumption. Health habits were particularly disadvantageously affected by schizophrenia in connection with unemployment.

CONCLUSIONS

Schizophrenia patients are an appropriate target group for public health interventions. They need information about a healthy diet and motivation to prepare their own meals, to quit smoking, and to exercise.

[Validating the efficacy of a group intervention program on the quality of life of depressed patient's spouses]

A new group intervention program has been assessed, rating its ability to increase the quality of life in partners of patients suffering under depression. Over a period of six months 66 subjects participated in an intervention group for a total of twelve sessions. The control group consisted of 50 persons, and quality of life was assessed with the WHOQOL-BREF. The five WHOLQOL domains were used as independent variables in random-effects regression models measuring the time effect. Although the quality of life of the subjects was below that of the general population at the beginning of the intervention, the study resulted in no significant improvement in quality of life. In contrast, satisfaction of participants with the intervention was high.

Quality of life in obsessive-compulsive disorder: the different impact of obsessions and compulsions

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) are troubled by repeated obsessions and/or compulsions, which seem senseless and frequently repugnant.

OBJECTIVE

The study examines the differential impact of obsessions and compulsions on the quality of life (QoL) of patients with OCD.

METHODS

Seventy-five patients (43 females, 32 males) between 21 and 62 years old with OCD (ICD 10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. The severity of OCD symptoms was assessed by the Yale Brown Obsessive-Compulsive Scale (a standardized, clinician-administered scale), and depressiveness was assessed with the Beck Depression Inventory (a self-report instrument). QoL was assessed by means of the WHOQOL-BREF, a self-administered questionnaire developed by WHO.

RESULTS

Compulsions reduced patients' QoL in the WHOQOL-BREF domains 'physical well-being', 'psychological well-being' and 'environment', whereas obsessions did not have any impact on QoL ratings. Depressive symptoms were a strong predictor of poor QoL in OCD patients.

CONCLUSIONS

In order to judge the QoL of OCD patients, obsessions and compulsions have to be considered differently. Diagnosing and treating depressive symptoms is important for improving the QoL in OCD.

Auswirkungen struktureller Faktoren auf die Inanspruchnahme Sozialpsychiatrischer Dienste - eine Mehrebenenanalyse

OBJECTIVE

To analyse the influence of structural (service) aspects and context (catchment area) variables on the individual use of socio-psychiatric services in Saxony.

METHOD

Data collected in 34 services were used. For the analysis of the variance components a multi-level model with random effects was computed using data at two levels ([1] client, and [2] service/catchment area).

RESULTS

Service use was substantially influenced by structural/context factors which accounted for a proportion of 10 to 50 % of the variance depending on the (sub-)group of users included in the analysis. The impact of service structure and context on service use was particularly strong in the subgroup of service users with very high service utilisation.

Familiarity with mental illness and approval of structural discrimination against psychiatric patients in Germany

Structural discrimination against psychiatric patients may occur as a result of distribution of resources in the health system. We examine whether familiarity with mental illness, which reduces discrimination on the individual level, also moderates the approval of structural discrimination in health care funding. We conducted a representative survey of the German population (N=5025) in 2001 using a fully structured personal interview, including a measure of preferences for the allocation of health resources and an assessment of familiarity with mental illness. The approval of structural discrimination was inversely related to the individual's familiarity with mental illness in depression and, to a lesser extent, in schizophrenia. This relationship was absent for alcoholism and generally weak for contacts to mentally ill persons outside one's own family. Strategies successful in reducing individual discrimination are thus not necessarily suitable for combating structural discrimination and need to be tailored to their specific target.