E-Mental Health in older age Ulrich Hegerl, Caroline Oehler Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe Universität Frankfurt/M, Germany European Alliance against Depression ...e.V. (www.EAAD.net) The implementation and uptake of digital tools for self management or psychotherapy for people suffering from depression or other mental disorders has gained momentum during the Covid-19 pandemia. While studies using waiting list or treatment as usual control groups are of limited value, meta-analyses of RCTs with face-to-face psychotherapy as control condition have found a comparable antidepressant effect, especially when the interventions were provided together with professional guidance. The iFightDepression-tool offered by the European Alliance against Depression (EAAD) is available in 10 different languages and is broadly used in several European countries. Data will be presented concerning the attitude of older people concerning iCBT and also concerning effects of age, guidance, and gender on both adherence to the iFightDepression-tool and antidepressant effects.
Disclosure
No significant relationships.
Media coverage of suicidal behaviour can induce copycat suicides. This has been clearly confirmed by analysis of suicides following the huge media coverage of the railway suicide of the German ...national goal keeper in 2009. A socalled ‘Werther effect’ was not only visible in Germany, but also in neighbouring countries (1). Even more disturbing is the fact that these effects were not only short-lived, but a higher number of railway suicides was observed compared to baseline over a two year period (2). Increased cognitive availability of railway suicides might explain this finding. It adds to the important discussion concerning the risks and benefits of public antisuicidal campaigns. Destigmatisaton and normalisation of suicidal behaviour will on the one hand, facilitate helpseeking behaviour of people at risk, but on the other hand, will lower the threshold for committing suicide. Even when the wording within a antisuicide campaign is in line with recomendations of media guidelines, secondary reporting e.g. within social media will not be controllable. Social media are likely to contribute to the spreading and the choice of more lethal suicide methods, as has been shown for carbon monoxide poisoning and poisoning by other gasses (3). An increase of knowledge about and access to more lethal poisoning methods will have a major impact on suicide rates. 1) KOBURGER et al (2015), J Affect Disord 185:38-46 2) HEGERL et al (2013), J Affect Disord. 146: 39-44. 3) PAUL et al (2017), PLoS One 12: e0190136.
Disclosure
No significant relationships.
Ulrich Hegerl and the EAAD members A variety of factors such as undertreatment of depression and other psychiatric disorders, access to lethal means, media coverage of suicidal acts, stigmatisation ...of patients with mental disorders and alcohol consumption contribute to the high numbers of completed and attempted suicides in Europe. The 4-level-intervention concept developed within the model project’Nuremberg Alliance against Depression’ provided evidence for the efficiency of an intervention approach targeting simultaneously several of the above mentioned factors (1). Up to now, similar 4- level interventions have been implemented in more than 100 regions in Europe (2). This was done via large EU-funded projects, namely the’European Alliance against Depression’ (EAAD; www.eaad.net ) and OSPI-Europe ( www.OSPI-europe.com ; 7 th Framework Programme ). From these projects data on suicidal behaviour during interventions in comparison to baseline and control regions (3) and on process evaluation will be presented. Via the EAAD, the intervention concept, the intervention materials and the broad experiences with the implementation of 4-level interventions in different cultures are offered to interested regions in and outside of Europe.
Both depression and chronic obstructive pulmonary disease (COPD) are prevalent, severe and often comorbid disorders. There is a risk of undertreatment for depression in patients with COPD as ...depressive symptoms, including suicidal tendencies, can erroneously be conceptualised as an understandable reaction to COPD and not as signs of an independent depressive disorder. In this context, the comorbidity rates of COPD and depression, the risk of suicidal behaviour in patients with COPD, and the evidence base for pharmaco- and psychotherapy in these patients are reviewed. Because symptoms of depression and COPD overlap it remains unclear how far the prevalence of major depression in COPD exceeds that in the general population. The suicide risk appears to be increased in COPD. Methodological studies providing evidence for the antidepressant efficacy of antidepressants or psychotherapy in patients with COPD are lacking. Recommendations for clinicians on how to separate depression from an understandable reaction to COPD are provided. Given the profound effects of depression on quality of life, life expectancy, COPD prognosis and suicide risk it is important to carefully diagnose and treat depression in patients with COPD according to national guidelines.
Fatigue is considered to be an important and frequent factor in motivation problems. However, this term lacks clinical and pathophysiological validity. Semantic precision has to be improved. Lack of ...drive and tiredness with increased sleepiness as observed in fatigue in the context of inflammatory and immunological processes (hypoaroused fatigue) has to be separated from inhibition of drive and tiredness with prolonged sleep onset latency as observed in major depression (hyperaroused fatigue). Subjective experiences as reported by patients, as well as clinical, behavioral, and neurobiological findings support the validity and importance of this distinction. A practical clinical procedure for how to separate hypo- from hyperaroused fatigue will be proposed.
A tendency to perceive feelings of guilt is a typical symptom of depression. ...the patients tend to blame themselves for their depressed state and do not perceive themselves as a victim of a medical ...disorder needing professional help. ...it was possible to analyse how many of the suicide victims were affected by at least one severe somatic disorders (stroke, cancer, asthma, cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, epilepsy, chronic lower back pain, osteoporosis, osteoarthritis). According to these data, severe somatic disorders do not strongly increase the suicide risk. ...in line with model B, in many cases, depression and other mental disorders are the reasons for getting unemployed and for having difficulties getting back to work.
Objective:To identify the most frequent gender-specific suicide methods in Europe.Design:Proportions of seven predominant suicide methods utilised in 16 countries participating in the European ...Alliance Against Depression (EAAD) were reported in total and cross-nationally. Relative risk (RR) relating to suicide methods and gender was calculated. To group countries by pattern of suicide methods, hierarchical clustering was applied.Setting and participants:Data on suicide methods for 119 122 male and 41 338 female cases in 2000–4/5 from 16 EAAD countries, covering 52% of European population were obtained.Results:Hanging was the most prevalent suicide method among both males (54.3%) and females (35.6%). For males, hanging was followed by firearms (9.7%) and poisoning by drugs (8.6%); for females, by poisoning by drugs (24.7%) and jumping from a high place (14.5%). Only in Switzerland did hanging rank as second for males after firearms. Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three. In all countries, males had a higher risk than females of using firearms and hanging and a lower risk of poisoning by drugs, drowning and jumping. Grouping showed that countries might be divided into five main groups among males; for females, grouping did not yield clear results.Conclusions:Research on suicide methods could lead to the development of gender-specific intervention strategies. Nevertheless, other approaches, such as better identification and treatment of mental disorders and the improvement of toxicological aid should be put in place.
The COVID-19 pandemic has necessitated a reduction in face-to-face consultations, resulting in significant limitations in healthcare for individuals with depression. To ensure safe and adequate care, ...e-health services, such as telemedicine, gained a more prominent role. Governments have eased restrictions on the use of telemedicine, enabling healthcare professionals to increasingly offer video and telephone consultations.
This study examines, 1) possible changes over the course of the pandemic in reported use of video and telephone consultations and intended future use of video consultations with healthcare professionals among adults with diagnosed depression; 2) their attitudes towards video and telephone consultations and perceived barriers towards using e-health after prolonged time of the pandemic; and 3) differences in results between subgroups based on sociodemographic and clinical characteristics.
Three population-representative online surveys were conducted in Germany at different timepoints (t) during the COVID-19 pandemic. Respondents aged 18–69 years with a professionally diagnosed depression were included in the present analyses (t1: June/July 2020 with n = 1094; t2: February 2021 with n = 1038; t3: September 2021 with n = 1255).
The overall proportion of adults with depression who used video or telephone consultations did not change significantly in the time surveyed (t1: 16.51 %, n = 179; t2: 20.23 %, n = 210; t3: 18.47 %, n = 230). However, among users, reported use of video consultations with a psychotherapist increased significantly from t1 (34.83 %, n = 62) to t3 (44.98 %, n = 102, p = .023). Intended future use of VC for healthcare varied depending on the purpose of the consultation. Significant differences over time were only found for the purpose of using VC to discuss clinical findings, laboratory results and diagnostic analyses with a doctor, with higher intentions reported at t2 during lockdown in Germany. At t3, the majority of adults with depression felt that video and telephone consultations were too impersonal and considered them more as a helpful support rather than an alternative to face-to-face psychotherapy. Key barriers to using e-health were found within the societal context and the lacking support from significant others for using e-health, while knowledge and skills represented facilitators for using e-health.
Despite ambivalent attitudes towards video and telephone consultations among adults with depression, reported use of video consultations with a psychotherapist increased during the COVID-19 pandemic.
•The use of video consultations with a psychotherapist increased significantly during the COVID-19 pandemic•Telemedicine was considered more as a helpful support than an alternative to face-to-face consultations or pharmacotherapy•Key barriers to e-health were related to societal factors: Both institutional and private support were deemed insufficient.
Hypothalamus enlargement in mood disorders Schindler, S.; Schmidt, L.; Stroske, M. ...
Acta psychiatrica Scandinavica,
January 2019, 2019-01-00, 20190101, Volume:
139, Issue:
1
Journal Article
Peer reviewed
Open access
Objective
The purpose of this study was to determine, in vivo, whether the hypothalamus volume is reduced in patients with mood disorders.
Methods
The cross‐sectional study included 20 unmedicated ...(MDDu) and 20 medicated patients with major depressive disorder, 21 patients with bipolar disorder, and 23 controls. Twenty of the controls were matched to the MDDu. Seven Tesla, T1‐weighted magnetic resonance images were acquired and processed using methods specifically developed for high‐precision volumetry of the hypothalamus.
Results
An overall group difference was observed for the left hypothalamus volume corrected for intracranial volume. Planned contrasts identified that the left hypothalamus was approximately 5% larger in each patient group compared with the control group. A paired t‐test with the 20 matched pairs of MDDu and controls and without correction for covariates confirmed the larger left hypothalamus volume in MDDu.
Conclusions
Contrary to our expectations, the hypothalamus volume was increased in patients with uni‐ and bipolar affective disorders. The effect was left‐sided and independent of medication status or statistical correction for covariates. Supported by emerging evidence that the stress response may be related to structural and functional asymmetry in the brain, our finding suggests a crucial role of the hypothalamus in mood disorders.
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