The increasingly dynamic nature of modern workplaces and the growing complexity of factors influencing mental health challenge conventional understandings of evidence in occupational health research. Drawing on critical realism (CR) as a contemporary philosophy of science, this article examines limitations of narrow conceptions of evidence that continue to shape intervention research at the intersection of work and mental health. Using an abductive approach, we develop a CR-lens for examining how evidence conceptions might be generated and interpreted in occupational mental health research. Three interrelated themes guide the analysis: (1) understanding change in the flux of events, (2) considering emergent forces operating within open systems, and (3) critically reflecting on the risk of epistemic fallacies. Building on these themes, we identify limitations of approaches that prioritize decontextualized outcome measures and isolated causal relationships. We further discuss how a broader understanding of evidence could inform research on workplace mental health interventions. Rather than rejecting evidence-based approaches, the article argues for complementing them with greater attention to context, mechanisms, and emergence. Finally, implications are outlined for occupational mental health research, including the value of interdisciplinary inquiry, methodological pluralism, and more context-sensitive approaches to intervention evaluation and implementation.

Background It is estimated that around 21 million patients are treated in emergency rooms (ERs) in German hospitals every year. The psychiatric emergency alone accounts for about 5-10%. At this point in time, there is little knowledge of typical characteristics related to admission status (treated as outpatients or admitted as inpatients). Objectives The aim of this study was to support the decision-making process for further treatment especially for paramedics and ER staff. Materials and methods We undertook a retrospective examination of all psychiatric emergency patients presenting to an emergency room at a general hospital in the year 2015. The patients had to be at least 18 years old. We included only patients who were brought to the emergency room by the rescue and fire department. Results Overall, patients who presented to the ER by paramedics or emergency physicians made up to 29.4% of all psychiatric emergency contacts. Over two thirds of the patients were admitted to the hospital. The most frequent presentation was caused by psychotropic substances (F1), followed by schizophrenia (F2) and organic mental disorders (F0). The most common diagnosis of patients treated only on an outpatient basis was the F4 spectrum (neurotic, stress-related and somatoform disorders), followed by F1 and affective disorders (F3). Patients under the age of 25 were more likely to receive outpatient treatment. Furthermore, 96.5% of the admitted patients met the criteria of being a psychiatric emergency. Conclusion The patient presented by the rescue service is of high relevance within the psychiatric emergency cohort. Patients treated as outpatients or admitted as inpatients show clearly different characteristics. The high proportion of patients who met emergency criteria makes the syndromic severity of the patients presented by emergency services clear.

Zusammenfassung Gegenwärtig baut die Stadt Hamm einen Gemeindepsychiatrischen Verbund auf, in dem sich wesentliche Leistungserbringer zusammenschließen. Individualität, „health for all“ und gesundheitliche Chancengleichheit stehen dabei im Mittelpunkt. So werden Schnittstellen zwischen Öffentlichem Gesundheitsdienst und Public Mental Health genutzt, umfassende Hilfen für psychisch Kranke mit komplexen Hilfebedarfen koordiniert und Netzwerke für Betroffene, Angehörige und Leistungserbringer gestärkt (Abbildung 1).

The International Classification of Diseases (10 th Version) categorizes major depressive disorder (MDD) according to severity. Guidelines provide recommendations for the treatment of MDD according to severity. Aim of this study was to assess real-life utilization of psychotropic drugs based on severity of MDD in psychiatric inpatients. Drug utilization data from the program “Drug Safety in Psychiatry” (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) were analyzed according to the severity of MDD. From 2001 to 2017, 43,868 psychiatric inpatients with MDD were treated in participating hospitals. Most patients were treated with ≥ 1 antidepressant drug (ADD; 85.8% of patients with moderate MDD, 89.8% of patients with severe MDD, and 87.9% of patients with psychotic MDD). More severely depressed patients were more often treated with selective serotonin–norepinephrine reuptake inhibitors and mirtazapine and less often with selective serotonin reuptake inhibitors ( p < 0.001 each). Use of antipsychotic drugs (APDs), especially second-generation APDs, increased significantly with severity (37.0%, 47.9%, 84.1%; p < 0.001 each). APD + ADD was the most used combination (32.8%, 43.6%, 74.4%), followed by two ADDs (26.3%, 29.3%, 24.9%). Use of lithium was minimal (3.3%, 6.1% ,7.1%). The number of psychotropic drugs increased with severity of MDD—patients with psychotic MDD had the highest utilization of psychotropic drugs (93.4%, 96.5%, 98.7%; p < 0.001). ADD monotherapy was observed to a lesser extent, even in patients with non-severe MDD (23.2%, 17.1%, 4.4%). Findings reveal substantial discrepancies between guideline recommendations and real-life drug utilization, indicating that guidelines may insufficiently consider clinical needs within the psychiatric inpatient setting.

Objective The rigid separation of outpatient and inpatient care in the German health care system prevents continuity of care, although it has been shown to be of great importance for psychiatric patients. This study analyzes continuity of care of a model hospital with a global treatment budget according to 64b SGB V and constant treatment staff across all settings in comparison to a control hospital with regular financing without such a team. Methods In a prospective cohort study with a 20-month observation period, we collected data on continuity of care of 220 model and 215 control clinic patients. Results The model clinic achieved significant higher continuity of care than the control clinic, both during inpatient treatment at the time of recruitment and across all settings during the observation period. Conclusion A global treatment budget can create the necessary conditions for more flexible psychiatric care and better implementation of continuity of care.

Schätzungsweise werden jährlich ca. 21 Millionen Fälle in Notaufnahmen deutscher Krankenhäuser behandelt. Der psychiatrische Notfallkontakt macht hiervon allein ca. 5–10

Background Several researchers have shown higher concentration-dose ratios of psychotropic drugs in women and the elderly. Therefore, lower dosages of psychotropic drugs may be recommended in women and the elderly. This study describes sex- and age-related dosage of psychotropic drugs prescribed to patients with major depressive disorder (MDD) in routine clinical practice. Method Influence of sex and age on dosages are analysed for the 10 most commonly prescribed drugs in our dataset consisting of 32,082 inpatients with MDD. Data stems from the European drug safety program "Arzneimittelsicherheit in der Psychiatrie". The observed sex and age differences in prescriptions are compared to differences described in literature on age- and gender-related pharmacokinetics. Results Among patients over 65 years, a statistically significant decrease in dosages with increasing age (between 0.65% and 2.83% for each increasing year of age) was observed, except for zopiclone. However, only slight or no influence of sex-related adjustment of dosage in prescriptions was found. Conclusion Age appears to influence adjustment of dosage in most psychotropic drugs, but to a lower extent than data on age-related pharmacokinetics suggests. Although literature also suggests that lower dosages of psychotropic drugs may be appropriate for females, this study found women are usually prescribed the same dosage as men.

Sporttherapie hat sich in der Behandlung vieler psychischer Erkrankungen als nachweislich wirksame Therapieform erwiesen. Aufgrund der hohen individuellen Belastung für Betroffene sowie der immensen Kosten für das Gesundheitssystem, die durch psychische Erkrankungen entstehen, sollten alle Bestrebungen dahin gehen, eine möglichst gute Versorgung zu gewährleisten, die dem aktuellen Forschungsstand entspricht. Erste Studien ergaben jedoch bereits 2016 Hinweise darauf, dass nur ein Bruchteil der Patienten während ihrer stationären Behandlung Sporttherapie erhält. Die hier vorgestellte Studie hatte daher zum Ziel, die reale Versorgungssituation stationär psychiatrisch behandelter Patienten mit Sporttherapie in Deutschland zu erfassen und somit eine wissenschaftliche Grundlage für die Forderung nach einer Verbesserung der Versorgung zu bilden. In einer retrospektiven Analyse der Abrechnungsdaten von 4 Universitätskliniken wurden hierfür 2693 Patientendaten auf die Frage nach der Versorgungssituation mit Sporttherapie hin untersucht. Dabei zeigte sich, dass nur 23 % der Patienten während des Beobachtungszeitraums von einer Woche an Sporttherapie teilnehmen mit einer durchschnittlichen wöchentlichen Therapiedauer von 36 min. Patienten mit Schizophrenie sowie stark komorbide Patienten nahmen sogar noch seltener und weniger Sporttherapie in Anspruch. Insgesamt konnte in der vorliegenden Studie also gezeigt werden, dass die Versorgungslage mit Sporttherapie in der stationär-psychiatrischen Behandlung mangelhaft ist und somit optimiert werden sollte. Vor dem Hintergrund der guten Evidenz von Sporttherapie in der Behandlung psychischer Erkrankungen, aktueller Leitlinienempfehlungen sowie des günstigen Nebenwirkungsprofils im Vergleich zur Pharmakotherapie sollte die Etablierung von Sporttherapie in den Kliniken gezielt verbessert werden.

Aims: As the specific acculturative tasks and challenges involved in the migration process can lead to an increased risk for depressive symptoms, the study was designed to gain further insight into the interrelation between acculturation styles and mental health.Methods: A total of n=90 patients with different ethnic backgrounds from an outpatient consultation service for immigrants at the Hannover Medical School were investigated by the Hannover Migration and Mental Health Interview (HMMH), the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Frankfurt Acculturation Scale (FRAKK).Results: The majority of the subjects (84.4%) had a clinically significant depression. The extent of depressive symptoms was determined by the selected acculturation style (1) (F=3.29, p=.025): Subjects with integration as acculturation style showed less depressive symptoms than subjects with assimilation as acculturation style. Furthermore, subjects with segregation as acculturation style also showed less depressive symptoms than subjects with assimilation.Conclusion: The results suggest that even when undergoing extreme emotional distress, eventually leading to mental disorder, integration, as an acculturation style, seems to serve as a protective resource and possibly prevents further decline.

Im vergangenen Jahr hat sich der seit 2008 abzeichnende Trend eines wieder wachsenden Zustroms von Asylsuchenden nach Deutschland fortgesetzt und augenscheinlich verstärkt. Von den über 200 000 im Jahr 2014 in Deutschland gestellten Asylanträgen handelte es sich in über 85 % um Erstanträge auf Asyl, was im Vergleich zum Vorjahr einen Anstieg um rund 58 % bedeutet. Gemessen an der Gesamtzahl der gestellten Asylanträge handelte es sich beim Jahr 2014 um das Jahr mit den vierthöchsten Antragszahlen seit Bestehen der Bundesrepublik.

Objective. The purpose of the study was to determine the therapeutic effect of physical exercise for patients with unipolar depression. Participants took part in an 8-week walking/running aerobic exercise program at a local sports club. Methods. Forty-six outpatients aged 18-65 years and diagnosed with mild to severe depression (ICD-10 criteria) were randomly assigned to an intervention group or wait list. Treatment as usual was continued. The Hamilton Rating Scale for Depression (HRSD-17) served as the main outcome measure. Secondary outcome measures were Beck Depression Inventory (BDI-II), Fitness Index (FI), and VO2 max as estimated by Urho Kaleka Kekkonen or UKK 2-km Walk Test. Results. Out of forty-six participants, 24% dropped out. Participants attended 58% of exercise sessions. All randomized participants were included in intention-to-treat (ITT) analysis. Analysis of covariance or ANCOVA showed a large reduction of depressive symptoms in HRSD-17 scores (Cohen's d: 1.8; mean change 8.2, p < .0001). BDI-II (Cohen's d: 0.50; mean change: 4.7, p = 0.09), FI scores (Cohen's d: 0.27; mean change: 5.3, p = 0.08), and VO2 max did not change significantly. Conclusions. We observed a large and clinically significant change in HRSD-17 scores. Moderate changes in BDI-II scores without clinical significance and small changes in physical fitness assessments were observed.

Im vergangenen Jahr hat sich der seit 2008 abzeichnende Trend eines wieder wachsenden Zustroms von Asylsuchenden nach Deutschland fortgesetzt und augenscheinlich verstarkt. Von den uber 200000 im Jahr 2014 in Deutschland gestellten Asylantragen handelte es sich in uber 85% um Erstantrage auf Asyl, was im Vergleich zum Vorjahr einen Anstieg um rund 58% bedeutet. Gemessen an der Gesamtzahl der gestellten Asylantrage handelte es sich beim Jahr 2014 um das Jahr mit den vierthochsten Antragszahlen seit Bestehen der Bundesrepublik. Bisher sind nur in den Jahren 1991–1993 mehr Asylantrage verzeichnet worden, wobei alleine in 1993 knapp 440000 Erstund Folgeantrage auf Asyl gestellt wurden. Anhand der Statistik des Bundesamts fur Migration und Fluchtlinge lasst sich seit den 1970erJahren ein wellenartiger Verlauf der Asylantragszahlen nachvollziehen. Dabei wechseln auch die zugangsstarksten Herkunftslander der Asylsuchenden, was imWesentlichen die jeweilige politische Situation in Europa und in der Weltgemeinschaft reflektiert. Im Jahr 2014 kam annahernd ein Viertel aller Asylerstantragsteller aus Syrien [1]. Knapp 10% aller Asylerstantrage stellten im gleichen Jahr Menschen aus Serbien, gefolgt von Eritrea (7,6%) und Afghanistan (5,3%). Wenn sich die jungste Entwicklung der Asylantragszahlen fortsetzt, werden am Ende des laufenden Jahres nochmal deutlich mehr Asylsuchende in Deutschland Zuflucht gesucht haben als in 2014. Da die Aufnahme von Asylsuchenden bereits 2014 die Lander, Stadte und Kommunen in Deutschland vor zum Teil erhebliche Probleme gestellt hat, erscheinen die offenen Fragen nach einer angemessenen Unterbringung, den Moglichkeiten einer Integration oder der gesundheitlichen Versorgung von Asylsuchenden gegenwartig umso drangender. Psychodynamik der Fremdenfeindlichkeit !

BACKGROUND:In May 2011 an outbreak of Shiga toxin-producing enterohaemorrhagic E. coli (STEC) O104:H4 in Northern Germany led to a high number of in-patients, suffering from post-enteritis haemolytic-uraemic syndrome (HUS) and often severe affection of the central nervous system. To our knowledge so far only neurological manifestations have been described systematically in literature. AIM:To examine psychiatric symptoms over time and search for specific symptom clusters in affected patients. METHODS:31 in-patients suffering from E. coli O104:H4 associated HUS, were examined and followed up a week during the acute hospital stay. Psychopathology was assessed by clinical interview based on the AMDP Scale, the Brief Symptom Inventory and the Clinical Global Impressions Scale. RESULTS:At baseline mental disorder due to known physiological condition (ICD-10 F06.8) was present in 58% of the examined patients. Patients suffered from various manifestations of cognitive impairment (n = 27) and hallucinations (n = 4). Disturbances of affect (n = 28) included severe panic attacks (n = 9). Psychiatric disorder was significantly associated with higher age (p<0.0001), higher levels of C-reactive protein (p<0.05), and positive family history of heart disease (p<0.05). Even within the acute hospital stay with a median follow up of 7 days, symptoms improved markedly over time (p <0.0001). CONCLUSIONS:Aside from severe neurological symptoms the pathology in E.coli O104:H4 associated HUS frequently includes particular psychiatric disturbances. Long term follow up has to clarify whether or not these symptoms subside.

Der wissenschaftliche Diskurs über das Verhältnis von Kultur und Persönlichkeit wurde maßgeblich von einer zentralen Kontroverse um Kulturrelativismus und Kulturuniversalismus geprägt (Van de Vijver u.Leung 2001).Die kulturrelativistische Position vertrat dabei die Auffassung, dass Menschen,