Ravens-Sieberer, Ulrike

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Ravens-Sieberer, Ulrike
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Ravens-Sieberer, Ulrike

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    Mental Health in context : Impact of social structures and the built environment on mental wellbeing and mental distress
    (2017-02-14)
    Dreger, Stefanie
    ;
    Ravens-Sieberer, Ulrike
    ;
    Zeeb, Hajo
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    Bolte, Gabriele
    Introduction: Not only individual factors but also factors of the social and built environment influence mental distress and ill-health and mental wellbeing. This dissertation aimed to gain further insight into the relationship between individually attributed factors of the social and built environment and mental distress and mental wellbeing. The first objective was to investigate prevalences and variations in mental health by characteristics at the individual level. The second objective was to assess the relationship between social structures at the macro level (here the focused factor was on welfare regimes) and mental health. The third objective was to investigate the relationship between factors of the built environment at the meso level (here the focused factor was environmental noise) and mental health. Methods: The three objectives were addressed by four conceptually independent but topic wise interrelated studies: i) material, psychosocial and sociodemographic determinants of mental wellbeing in Europe, ii) socioeconomic determinants of mental distress and mental wellbeing in school children iii) association between gender, welfare regimes and mental wellbeing, and iv) noise and mental distress in school-aged children. Data from the third wave of the European Quality of Life Survey (2011-2012) and the Health Monitoring Units in Bavaria served as the basis for these studies. Odds ratios were calculated using multilevel and multivariate logistic regression analyses. Poisson regression analyses were used to calculate relative risks for the incidences. Results: In adults material, psychosocial and sociodemographic factors were independently associated with low levels of mental wellbeing. In children, the analyses showed that several indicators of familiesa social disadvantage were associated with mental distress, in contrast to mental wellbeing, where only a few factors were associated. At the macro level prevalence of good mental wellbeing was in most instances higher among men compared to women at welfare regime level, with the exception of the Former Soviet Union welfare regime, where women report slightly higher prevalence of good mental wellbeing. Gender inequalities in good mental wellbeing were identified independent of further individual sociodemographic variables and independent of the welfare regimes that people lived in. People in the Former Soviet Union and the Central and Eastern European Countries welfare regimes showed statistically significantly lower chances to report good mental wellbeing compared to the Scandinavian welfare regime. Gender inequalities in good mental wellbeing were not modified by welfare regimes. At the individual level of the built environment, exposure to road traffic noise at day or night was the main risk factor for incident mental health problems in children. Exposure to noise by neighbours day and night also appeared to be a risk factor for some subcategories of the strength and difficulties questionnaire. Both noise from construction work and aircraft noise during the day were not associated with incident mental health problems. Discussion: Findings of this dissertation highlight an association between individual factors, aspects of the social and built environment and mental wellbeing and mental distress. The study of mental wellbeing is relatively young, therefore, especially in this field further studies are needed to confirm and expand the findings of this dissertation. To plan effective prevention and health promotion interventions a thorough understanding of the underlying mechanisms and pathways is needed. Further studies are warranted to gain knowledge on the impact of (further aspects of) the social and built environment on mental wellbeing and mental distress in adults and in children to identify underlying mechanisms and to identify vulnerable groups for targeted preventions.
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    Verschreibungen von Psychopharmaka für Kinder und Jugendliche in Deutschland : eine Analyse von Verordnungspraxis und -trends anhand ausgewählter Erkrankungen und Substanzgruppen
    (2015-10-30)
    Bachmann, Christian
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    Ravens-Sieberer, Ulrike
    ;
    Garbe, Edeltraut
    ;
    Glaeske, Gerd
    In this dissertation thesis, health insurance funds data on psychotropic prescriptions for children and adolescents in Germany are presented and analysed. The data refer to prescription patterns in different child and adolescent psychiatric disorders (depressive disorders, autism spectrum disorders, tic disorders, eating disorders, functional urinary incontinence) and also to prescription of defined pharmacological substance groups (antidepressants, antipsychotics). The psychotropic prescriptions were stratified by age groups, sex and sub-diagnosis of the respective child and adolescent psychiatric disorder. In some of the papers compiled in this thesis, the specialty of the prescribing physician was also evaluated. The use of the mentioned health insurance funds data allowed to study the data of up to 1.6m children and adolescents (population under risk). Study designs involved both cross-sectional and longitudinal analyses over time periods of up to eight years, employing various statistical methods. The two papers analysing time trends in the prescription of antidepressants and antipsychotics show a marked increase in the prescription of these substance groups over recent years. Regarding antipsychotics, a considerable increase in the prescription of atypical antipsychotics and a substantial proportion of non-guideline adherent therapies was found. The study on antidepressant prescriptions showed a distinct increase in SSRI prescriptions, with TCA still accounting for a significant percentage of prescriptions. The papers on psychotropic prescriptions in various child and adolescent psychiatric disorders (autism spectrum disorders, depressive disorders, tic disorders, eating disorders, functional urinary incontinence) constitute a foundational inventory of psychopharmacological therapy in German children and adolescents with mental health problems. They show that for some of these conditions, current guidelines are applied only in a fraction of patients. Concluding, the findings compiled in this thesis indicate a general trend towards increased psychotropic prescriptions in children and adolescents and point to the need of implementation of child and adolescent psychiatric guidelines into daily practice.
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    Multimodale Therapie bei Kindern und Jugendlichen mit chronischen Erkrankungen am Beispiel von psychischen Störungen und Cystischer Fibrose
    (2014-09-09)
    Sauer, Kristin Marina
    ;
    Ravens-Sieberer, Ulrike
    ;
    Glaeske, Gerd
    ;
    Glaeske, Gerd
    The current thesis elucidates the state of the art of interdisciplinary teamwork and so called multimodal therapy for chronic conditions in children and adolescents. Specifically, it covers cystic fibrosis (CF) and mental health problems, conditions of high relevance for public health. First, two analyses of a) survey data of a nationwide representative German sample and b) claims data of a statutory health insurance fund present frequencies of children and adolescents with common mental health problems and CF. Survey analyses show results depending on statistical and clinical case definition strategies on the one hand and differences between parent- and self-report on the other hand. Estimates on the incidence of CF based on claims data analyses are in line with the existing literature. Second, two systematic guideline reviews synthesize recommendations on multimodal therapy for concerned children and adolescents and discuss the results against the background of social legislation in the statutory health care system. Results show defi-cits in statutory conditions for interdisciplinary teamwork in the outpatient health care setting, revealing a need for change in the general conditions for multimodal therapy. Third, a) a survey on the health care utilization in a sample of patients of a CF-centre indicates high rates of children and adolescents with CF who do not receive multimodal therapy despite of a below average health related quality of life and a clear need for treatment. b) A claims data analysis presents important insight into the current utilization patterns of children and adolescents with common mental health problems. Against guideline recommendations for later pharmacological treatment, age is hardly ever associated with drug prescription in the common mental health problems. Fourth, emphasizing the need of scientific pilot projects, an action plan is suggested to improve the structural and process quality of multimodal therapy. A theoretical concept illustrates the development of a database that provides more transparency in health care and enables the development of a care flat rate within a capitated payment system. Considering strength and limitations of different databases, this thesis indicates an explicit need for multimodal treatment that is inadequately met and discusses the gap between guideline recommendations and statutory conditions. Implications for better health care provision are specified in the end.
    Dissertation
      408  328