Biomedical subjects

H Matschinger

Publications and source records attributed to H Matschinger.

At least 19 recordsLinked to original sources

PubMed2006

Does the context matter? Utilization of sedative drugs in nursing homes--a multilevel analysis.

BACKGROUND: The aim of this study is to assess the utilization of sedative drugs in nursing homes by means of a multilevel approach taking into account individual as well as institutional characteristics. METHODS: A retrospective chart review of the drugs consumed in nursing homes in an urban region of Germany was conducted. Individual characteristics were measured by analyzing nursing home files, by staff assessment and by a structured interview conducted by trained psychologists and physicians. Institutional characteristics were assessed by interviewing the management of each facility and ward and by using a staff questionnaire survey. The sample consisted of 1903 residents from 27 nursing homes with a total of 96 wards. Data analysis was carried out by means of a multilevel analysis, a strategy for analyzing hierarchically structured data. RESULTS: The utilization of sedative drugs (low potency neuroleptics, anxiolytics, hypnotics) in nursing homes is remarkably high. Thus, 33.3 % of the residents used sedative drugs on a regular basis. PRN prescriptions existed for 13.1 % of the residents, 5.3 % had been using sedative medication prescribed as PRN. Results indicate the influence of individual as well as institutional characteristics on residents' sedative drug utilization. In particular, the use of PRN medicine is determined by characteristics of the ward the individuals are living in. CONCLUSION: Methodological implications: The data analysis concerning the drug utilization of residents of nursing homes requires multilevel models and a distinction between regular and PRN medicine. Further research should focus on explaining institutional variance. PRACTICAL IMPLICATIONS: Staff training in nonpharmacological strategies to manage disturbing behavior of residents is required.

Adult↗

PubMed2005

Alcoholism: Illness beliefs and resource allocation preferences of the public.

BACKGROUND: Alcohol-dependent patients are at risk of being denied necessary care because of their diagnosis. We sought to find out whether public illness beliefs influence resource allocation decisions of the public, thus putting alcohol-dependent patients at a disadvantage compared to those suffering from other medical and mental disorders. METHOD: A telephone survey involving the adult German population was conducted in 2004 (n = 1012). Participants were asked to name three out of nine conditions for which they would prefer resources not to be cut should general cutbacks within the health care budget be necessary. For all conditions we asked about personal attitudes and illness beliefs. RESULTS: Schizophrenia and alcoholism were chosen least frequently when it was a question of being spared from budget reductions. Compared to other diseases, alcoholism was considered to be particularly self-inflicted and evoked a high desire for social distance. The perceived severity of the disease, the perceived own risk of becoming alcohol dependent, and the notion that alcoholics are themselves responsible for their illness were associated with resource allocation decisions. CONCLUSION: Alcohol-dependent patients are at risk of being structurally discriminated within the health care system.

Adolescent↗

PubMed2005

Media consumption and desire for social distance towards people with schizophrenia.

There is ample evidence for a distorted presentation of the mentally ill in the media. However, only little is known about its impact on attitudes towards people with mental disorders. Therefore, we investigated the relationship between watching TV and reading the newspaper on the one hand, and the desire for social distance towards people with schizophrenia on the other. In 2001, a representative population survey was conducted in Germany, using a fully structured personal interview. We found that the desire for social distance towards people with schizophrenia increases almost continuously with the amount of TV consumption. The association between reading the newspaper and social distance is less pronounced and depends on the type of newspaper people read. Since, obviously, there is a relationship between media consumption and attitudes towards people with schizophrenia, inaccurate and one-sided messages about mental disorders should be replaced by accurate and more balanced messages.

Adolescent↗

PubMed2005

Have there been any changes in the public's attitudes towards psychiatric treatment? Results from representative population surveys in Germany in the years 1990 and 2001.

OBJECTIVE: During the 1990s, the reform of German mental health care made considerable progress. In addition, important advances in the treatment of mental disorders took place. The question arises as to whether these improvements were accompanied by a greater acceptance of psychiatric treatment by the public. METHOD: In 1990 and 2001, representative surveys were conducted among the adult German population, using the same sampling procedure and interview. RESULTS: In the course of the 1990s, the German public became more inclined to recommend to seek help from psychiatrists or psychotherapists in case of schizophrenia or major depression. There was also an increase in the willingness to recommend therapy in general, which was particularly pronounced with regard to drug treatment and psychotherapy of schizophrenia. CONCLUSION: Our findings seem to support the notion that improvements in mental health care are reflected in the public's attitudes towards psychiatric treatment. This may, in turn, positively impact help-seeking behaviour.

Adult↗

PubMed2004

Public attitudes towards psychotropic drugs: have there been any changes in recent years?

BACKGROUND: Two representative surveys conducted in the early 1990 s found very negative views on psychotropic medication among the German public. The question arises whether this reservation about drug treatment of mental disorders has persisted over the following decade, or whether there have been any changes. Furthermore, it will be examined whether the preexisting differences between East and West Germany can still be observed. METHODS: In 2001, a representative survey was conducted among the German population aged 18 years and older, using the same instrument for the assessment of perceived effects of psychotropic medication as in a previous survey in 1990. RESULTS: As expected, in 2001, those questioned were more ready to acknowledge beneficial effects of drug treatment. However, contrary to our expectation, the difference between East and West Germany has persisted, with people in the East still being more sceptical in their assessment of drug effects. CONCLUSION: Although public attitudes towards psychotropic drugs have improved somewhat over the last decade, the actual situation is far from being satisfying. Further efforts to improve public knowledge about the psychopharmacotherapy of mental disorders are needed.

Adolescent↗

PubMed2004

Effects of labelling on public attitudes towards people with schizophrenia: are there cultural differences?

OBJECTIVE: A representative survey which was recently conducted in Germany came to the conclusion that labelling as mental illness has an impact on public attitudes towards people with schizophrenia, with negative effects clearly outweighing positive effects. In this study, we will examine whether this result can be replicated in other countries. METHOD: In the summer of 2002, representative surveys were carried out in Novosibirsk (Russia) and in Ulaanbaatar (Mongolia), using the same sampling procedure and interview as in Germany. RESULTS: As in Germany, in Novosibirsk and Ulaanbaatar labelling as mental illness was positively correlated with the endorsement of the belief that the individual depicted in the vignette is in need for help. However, unlike in Germany, labelling had no significant effect on the endorsement of the stereotype of dangerousness. CONCLUSION: Our findings support the notion that labelling effects are culture-related. Therefore, anti-stigma efforts need to be tailored to the specific conditions in a particular country.

Adult↗

PubMed2004

Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: The European Study of Epidemiology of Mental Disorders (ESEMeD) project was designed to evaluate the prevalence, the impact and the treatment patterns in Europe. This paper presents an overview of the methods implemented in the project. METHOD: ESEMeD is a cross-sectional study in a representative sample of 21 425 adults, 18 or older, from the general population of Belgium, France, Germany, Italy, the Netherlands and Spain. The Composite International Diagnostic Interview (WMH-CIDI) was administered by home interviews from January 2001 to August 2003 using Computer Assisted Personal Interview (CAPI) technology. Data quality was controlled to ensure reliability and validity of the information obtained. RESULTS: Response rate varied from 78.6% in Spain to 45.9% in France. Less than 4% of the individuals had errors in the checking procedures performed. CONCLUSION: The sampling methodologies, comprehensive psychiatric instruments and quality control procedures used have rendered the ESEMeD database a unique and important source of information about the prevalence, the disability burden and unmet medical needs of mental disorders within Europe.

Adolescent↗

PubMed2004

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. METHOD: A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. CONCLUSION: ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.

Adolescent↗

PubMed2004

12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews. RESULTS: In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both. CONCLUSION: High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.

Adolescent↗

PubMed2004

Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: This manuscript examines the impact of mental health state and specific mental and physical disorders on work role disability and quality of life in six European countries. METHOD: The ESEMeD study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an in-home computer-assisted interview. Common mental disorders, work loss days (WLD) in the past month and quality of life (QoL) were assessed, using the WMH-2000 version of the CIDI, the WHODAS-II, and the mental and physical component scores (MCS, PCS) of the 12-item short form, respectively. The presence of five chronic physical disorders: arthritis, heart disease, lung disease, diabetes and neurological disease was also assessed. Multivariate regression techniques were used to identify the independent association of mental and physical disorders while controlling for gender, age and country. RESULTS: In each country, WLD and loss of QoL increased with the number of disorders. Most mental disorders had approximately 1.0 SD-unit lower mean MCS and lost three to four times more work days, compared with people without any 12-month mental disorder. The 10 disorders with the highest independent impact on WLD were: neurological disease, panic disorder, PTSD, major depressive episode, dysthymia, specific phobia, social phobia, arthritis, agoraphobia and heart disease. The impact of mental vs. physical disorders on QoL was specific, with mental disorders impacting more on MCS and physical disorders more on PCS. Compared to physical disorders, mental disorders had generally stronger 'cross-domain' effects. CONCLUSION: The results suggest that mental disorders are important determinants of work role disability and quality of life, often outnumbering the impact of common chronic physical disorders.

Adult↗

PubMed2004

Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comprehensive information about access and patterns of use of mental health services in Europe is lacking. We present the first results of the use of health services for mental disorders in six European countries as part of the ESEMeD project. METHOD: The study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an computer-assisted interview done at home. The 21 425 participants were asked to report how frequently they consulted formal health services due to their emotions or mental health, the type of professional they consulted and the treatment they received as a result of their consultation in the previous year. RESULTS: An average of 6.4% of the total sample had consulted formal health services in the previous 12 months. Of the participants with a 12-month mental disorder, 25.7% had consulted a formal health service during that period. This proportion was higher for individuals with a mood disorder (36.5%, 95% CI 32.5-40.5) than for those with anxiety disorders (26.1%, 95% CI 23.1-29.1). Among individuals with a 12-month mental disorder who had contacted the health services 12 months previously, approximately two-thirds had contacted a mental health professional. Among those with a 12-month mental disorder consulting formal health services, 21.2% received no treatment. CONCLUSION: The ESEMeD results suggest that the use of health services is limited among individuals with mental disorders in the European countries studied. The factors associated with this limited access and their implications deserve further research.

Adult↗

PubMed2004

Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To assess psychotropic drug utilization in the general population of six European countries, and the pattern of use in individuals with different DSM-IV diagnoses of 12-month mental disorders. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000), a cross-sectional psychiatric epidemiological study in a representative sample of 21 425 adults aged 18 or older from six European countries (e.g. Belgium, France, Germany, Italy, the Netherlands and Spain). Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. A colour booklet containing high-quality pictures of psychotropic drugs commonly used to treat mental disorders was provided to help respondents recall drug use. RESULTS: Psychotropic drug utilization is generally low in individuals with any 12-month mental disorder (32.6%). The extent of psychotropic drug utilization varied according to the specific DSM-IV diagnosis. Among individuals with a 12-month diagnosis of pure major depression, only 21.2% had received any antidepressants within the same period; the exclusive use of antidepressants was even lower (4.6%), while more individuals took only anxiolytics (18.4%). CONCLUSION: These data question the appropriateness of current pharmacological treatments, particularly for major depression, in which under-treatment is coupled with the high use of non-specific medications, such as anxiolytics.

Adolescent↗

PubMed2003

A longitudinal analysis of the impact of social and clinical characteristics on the costs of schizophrenia treatment.

OBJECTIVE: The aim of the study was the longitudinal analysis of the influence of social and clinical factors on the mid-term costs of schizophrenia treatment. METHOD: Treatment costs as well as clinical and social characteristics of 307 patients with the ICD-10 diagnosis of schizophrenia were assessed at five follow-ups over 2.5 years. Between and within effects of clinical and social characteristics on treatment costs were estimated by error component regression models. RESULTS: Effects caused by differences between individuals were found for age, partnership, in-patient history, objective and subjective role functioning, life-events and psychotic relapse. Effects of idiosyncratic transitory changes of social and clinical characteristics were found for symptoms, psychotic relapse, and for social role-functioning. CONCLUSION: Treatment costs can be reduced to a limited extent not only by the prevention of psychotic symptoms and relapse but also by the improvement of role-functioning capacities.

Adult↗

PubMed2003

The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder.

OBJECTIVE: Aim of the study is to examine the impact of labelling on public attitudes towards people with schizophrenia and major depression. METHOD: In Spring 2001, a representative survey was carried out in Germany involving adults of German nationality (n = 5025). RESULTS: Labelling as mental illness has an impact on public attitudes towards people with schizophrenia, with negative effects clearly outweighing positive effects. Endorsing the stereotype of dangerousness has a strong negative effect on the way people react emotionally to someone with schizophrenia and increases the preference for social distance. By contrast, perceiving someone with schizophrenia as being in need for help evokes mixed feelings and affects people's desire for social distance both positively and negatively. Labelling has practically no effect on public attitudes towards people with major depression. CONCLUSION: Our findings illustrate the need for differentiation, differentiation between the different components of stigma as well as differentiation between the various mental disorders.

Adult↗

PubMed2003

Crazy? So what! Effects of a school project on students' attitudes towards people with schizophrenia.

OBJECTIVE: Aiming at promoting young people's mental health and reducing stigma towards people with schizophrenia, project weeks were carried out with secondary school students aged 14-18 years (n=90). Key to the project week is meeting a (young) person with schizophrenia. METHOD: Students' attitudes and behavioural intentions towards people with schizophrenia were assessed before and after the project. Parallelly, a control group of students were questioned (n=60). Assessment was repeated after 1 month. RESULTS: Despite expected ceiling effects, the project led to a significant reduction of negative stereotypes. For social distance, a positive trend could be observed. These developments were not present with the controls. Attitude changes were still evident at the 1-month follow-up. CONCLUSION: Results support the hypothesis that young people's attitudes about schizophrenia are susceptible to change. Antistigma projects at school level could thus be a promising approach to improving public attitudes and to preventing stereotypes from becoming reinforced.

Adolescent↗

PubMed2003

[Longitudinal analysis of factors influencing direct costs of schizophrenia treatment].

In a prospective longitudinal study with 5 points of measurement the direct service costs as well as the clinical and social characteristics of 307 outpatients with the diagnosis of schizophrenia (ICD 10 F 20.0) were assessed over a period of 2.5 years. A random-effect regression model was computed for the assessment of the impact of clinical and social variables on cost variance. Within-effect and between-effect of independent variables on the cost variance were identified by comparing of within and between effect models. Results of the study show that 10 % of the within variance and 32 % of the between variance were explained by the random effect model. Significant within effects were found for a deterioration of emotional health status and for general level of functioning. Significant between effects were found for living situation, partnership, number of inpatient episodes, psychopathological symptoms, depression, alcohol abuse and number of life events. The study results suggest that interventions aiming at the reduction of direct costs should not be restricted to medical treatment but must also include psychosocial interventions for the enhancement of general functioning. However, the explained proportions of within and between variance reveal that the possibilities of manipulating direct treatment costs by means of patient-related interventions may be limited.

Adult↗

PubMed2002

[Age- and education-specific reference values for the cognitive test of the SIDAM (Structured interview for the diagnosis of dementia of the Alzheimer type, multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-IV)].

The SIDAM (Structured Interview for the diagnosis of Dementia of the Alzheimer type, Multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-IV) is a standardized interview for the diagnosis of dementia. It can also be used as a screening instrument for the diagnosis of different syndromes of dementia and mild cognitive impairment. At present there is no age- or education-specific standardization. This report presents age- and education-specific norms for the cognitive assessment of the SIDAM, obtained in a population-based sample of elderly people aged 75 and over (n=1001).

Age Factors↗

PubMed2002

[Adaptation of a dementia test for use in visually handicapped persons exemplified by SIDAM (Structured Interview for the Diagnosis of Alzheimer disease, Multi-Infarct Dementia and Dementias of other Etiology)].

In epidemiological field studies on the prevalence and incidence of dementia, the problem of cognitive testing of visually impaired individuals is rarely discussed. In the Leipzig Longitudinal Study of the Aged (LEILA 75+) a version of the SIDAM (SIDAM-Structured Interview for the Diagnosis of dementia of the Alzheimer type, Multi-infarct dementia and dementias of other etiology) for the visually impaired was employed from which all items requiring image processing had been omitted (SIDAM-blind). In order to be able to interpret the test results, the final scores for the full SIDAM were estimated by linear transformation of the scores in the blind-version. The method of linear transformation is based on certain theoretical assumptions which are examined in this paper. Linear transformation of scores has proved to be a valid procedure only for individuals with high cognitive performances. Thus, an evaluation of estimated scores based on the norms for the original SIDAM has limitations. Consequently, age-specific norms for the SIDAM-blind are presented. Sensitivities and specificities for different cut-off points used to discriminate between demented and non-demented vision-impaired individuals are given.

Aged↗