BackgroundHealthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental he... more BackgroundHealthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental health outcomes since the pandemic's beginning. The virulence of the initial COVID-19 surge in Spain and the urgency for rapid evidence constrained early studies in their capacity to inform mental health programs accurately. Here, we used a qualitative research design to describe relevant mental health problems among frontline HCWs and explore their association with determinants and consequences and their implications for the design and implementation of mental health programs.Materials and methodsFollowing the Programme Design, Implementation, Monitoring, and Evaluation (DIME) protocol, we used a two-step qualitative research design to interview frontline HCWs, mental health experts, administrators, and service planners in Spain. We used Free List (FL) interviews to identify problems experienced by frontline HCWs and Key informant (KI) interviews to describe them and explore their det...
People forced to leave their homes, such as refugees and internally displaced persons, are expose... more People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders. In view of the Russian military offensive in Ukraine, this review aimed at summarizing the evidence on the efficacy of transdiagnostic psychosocial interventions to promote mental health and/or to prevent mental symptoms in forcibly displaced persons of all ages. Four electronic databases and reference lists were searched for randomized controlled trials on interventions in this population from inception to March 11, 2022. Thirty-six studies were eligible, 32 were included in random-effects multilevel meta-analyses. Results on mental symptoms, M(SMD) = 0.26, p = .075, and positive mental health indicators like wellbeing, M(SMD) = 0.41, p = .182, provided no evidence for an effect favoring transdiagnostic interventions over control conditions in children/adolescents and adults. After exclud...
BACKGROUND Borderline personality disorder (BPS) is considered as a severe mental disorder with a... more BACKGROUND Borderline personality disorder (BPS) is considered as a severe mental disorder with a high burden for patients, family members and the healthcare system. Recent years have brought significant advances in understanding and treating BP, leading to an earlier diagnosis and better treatment outcomes. OBJECTIVE This article outlines the current state of knowledge on the epidemiology, diagnostics, psychopathology and treatment of BPD and identifies open questions. MATERIAL AND METHODS Based on a literature search in the PubMed, PsycINFO and EMBASE databases, the latest developments in the topic of BPD for the areas of diagnostics, epidemiology, etiology and treatment are illuminated in a narrative review. Where possible systematic review articles, meta-analyses and evidence-based practice guidelines were also considered. STATE OF THE SCIENCE At the core of BPS are disorders of emotion regulation, self-image, and interpersonal interaction. The suicide rates range from 2% to 5% and life expectancy is significantly shortened compared with the general population. The effectiveness of differentiated, disorder-specific psychotherapy (especially dialectic behavioral therapy, DBT) is well established. Psychotherapeutic care in the outpatient sector, especially in the field of pediatric and adolescent psychiatry, is still insufficient. PERSPECTIVES Questions about the etiopathology, especially genetic and postulated neurobiological parameters that determine affective hypersensitivity, are largely open. Nosologically, the differentiation from comorbid complex posttraumatic stress disorder (cPTSD) is certainly an important issue, which also has therapeutic consequences.
IntroductionThe heterogeneity in people with BPD and the range of specialised psychotherapies mea... more IntroductionThe heterogeneity in people with BPD and the range of specialised psychotherapies means that people with certain BPD characteristics might benefit more or less from different types of psychotherapy. Identifying moderating characteristics of individuals is a key to refine and tailor standard treatments so they match the specificities of the individual patient. The objective of this is to improve the quality of care and the individual outcomes. Thus, the aim of the current reviews is to investigate potential predictors and moderating patient characteristics on treatment outcomes for patients with BPD.Methods and analysisOur primary meta-analytic method will be the one-stage random-effects approach. To identify predictors, we will be using the one-stage model that accounts for interaction between covariates and treatment allocation. Heterogeneity in case-mix will be assessed using a membership model based on a multinomial logistic regression where study membership is the ou...
Regularly updated (every two months) living synthesis to identify and summarize the available lit... more Regularly updated (every two months) living synthesis to identify and summarize the available literature on the impact of the SARS-CoV-2 pandemic on the mental health and work ability in healthcare workers as well as possible (demographic, psychosocial etc.) risk and protective factors for mental health. This work is part of the CEOsys project (https://www.covid-evidenz.de; https://www.ceosys.de) which is funded by the German Federal Ministry for Education and Research (BMBF) within the national network of academic medical research into COVID-19, Germany (Nationales Netzwerk Universitätsmedizin, NUM).
Additional file 2: Results of the systematic review with meta-analyses. eTable 9. Details on numb... more Additional file 2: Results of the systematic review with meta-analyses. eTable 9. Details on number of included (pandemic and comparative) studies. eTable 10. Study characteristics of the prepandemic comparative studies. eTable 11. Cut-off values reported in included pandemic studies. eResults 1. Forest plots of main analyses. eTable 12. Quality assessment of included pandemic studies. eTable 13. Assessment of level of comparability between pandemic and prepandemic comparative studies. eResults 2. Forest plots of sensitivity analyses. eResults 3. Detailed results of subgroup analyses. eTable 14. Risk factors in the general population, healthcare workers, and patients. eTable 15. Protective factors in the general population, healthcare workers, and patients.
BackgroundHealthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental he... more BackgroundHealthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental health outcomes since the pandemic's beginning. The virulence of the initial COVID-19 surge in Spain and the urgency for rapid evidence constrained early studies in their capacity to inform mental health programs accurately. Here, we used a qualitative research design to describe relevant mental health problems among frontline HCWs and explore their association with determinants and consequences and their implications for the design and implementation of mental health programs.Materials and methodsFollowing the Programme Design, Implementation, Monitoring, and Evaluation (DIME) protocol, we used a two-step qualitative research design to interview frontline HCWs, mental health experts, administrators, and service planners in Spain. We used Free List (FL) interviews to identify problems experienced by frontline HCWs and Key informant (KI) interviews to describe them and explore their det...
People forced to leave their homes, such as refugees and internally displaced persons, are expose... more People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders. In view of the Russian military offensive in Ukraine, this review aimed at summarizing the evidence on the efficacy of transdiagnostic psychosocial interventions to promote mental health and/or to prevent mental symptoms in forcibly displaced persons of all ages. Four electronic databases and reference lists were searched for randomized controlled trials on interventions in this population from inception to March 11, 2022. Thirty-six studies were eligible, 32 were included in random-effects multilevel meta-analyses. Results on mental symptoms, M(SMD) = 0.26, p = .075, and positive mental health indicators like wellbeing, M(SMD) = 0.41, p = .182, provided no evidence for an effect favoring transdiagnostic interventions over control conditions in children/adolescents and adults. After exclud...
BACKGROUND Borderline personality disorder (BPS) is considered as a severe mental disorder with a... more BACKGROUND Borderline personality disorder (BPS) is considered as a severe mental disorder with a high burden for patients, family members and the healthcare system. Recent years have brought significant advances in understanding and treating BP, leading to an earlier diagnosis and better treatment outcomes. OBJECTIVE This article outlines the current state of knowledge on the epidemiology, diagnostics, psychopathology and treatment of BPD and identifies open questions. MATERIAL AND METHODS Based on a literature search in the PubMed, PsycINFO and EMBASE databases, the latest developments in the topic of BPD for the areas of diagnostics, epidemiology, etiology and treatment are illuminated in a narrative review. Where possible systematic review articles, meta-analyses and evidence-based practice guidelines were also considered. STATE OF THE SCIENCE At the core of BPS are disorders of emotion regulation, self-image, and interpersonal interaction. The suicide rates range from 2% to 5% and life expectancy is significantly shortened compared with the general population. The effectiveness of differentiated, disorder-specific psychotherapy (especially dialectic behavioral therapy, DBT) is well established. Psychotherapeutic care in the outpatient sector, especially in the field of pediatric and adolescent psychiatry, is still insufficient. PERSPECTIVES Questions about the etiopathology, especially genetic and postulated neurobiological parameters that determine affective hypersensitivity, are largely open. Nosologically, the differentiation from comorbid complex posttraumatic stress disorder (cPTSD) is certainly an important issue, which also has therapeutic consequences.
IntroductionThe heterogeneity in people with BPD and the range of specialised psychotherapies mea... more IntroductionThe heterogeneity in people with BPD and the range of specialised psychotherapies means that people with certain BPD characteristics might benefit more or less from different types of psychotherapy. Identifying moderating characteristics of individuals is a key to refine and tailor standard treatments so they match the specificities of the individual patient. The objective of this is to improve the quality of care and the individual outcomes. Thus, the aim of the current reviews is to investigate potential predictors and moderating patient characteristics on treatment outcomes for patients with BPD.Methods and analysisOur primary meta-analytic method will be the one-stage random-effects approach. To identify predictors, we will be using the one-stage model that accounts for interaction between covariates and treatment allocation. Heterogeneity in case-mix will be assessed using a membership model based on a multinomial logistic regression where study membership is the ou...
Regularly updated (every two months) living synthesis to identify and summarize the available lit... more Regularly updated (every two months) living synthesis to identify and summarize the available literature on the impact of the SARS-CoV-2 pandemic on the mental health and work ability in healthcare workers as well as possible (demographic, psychosocial etc.) risk and protective factors for mental health. This work is part of the CEOsys project (https://www.covid-evidenz.de; https://www.ceosys.de) which is funded by the German Federal Ministry for Education and Research (BMBF) within the national network of academic medical research into COVID-19, Germany (Nationales Netzwerk Universitätsmedizin, NUM).
Additional file 2: Results of the systematic review with meta-analyses. eTable 9. Details on numb... more Additional file 2: Results of the systematic review with meta-analyses. eTable 9. Details on number of included (pandemic and comparative) studies. eTable 10. Study characteristics of the prepandemic comparative studies. eTable 11. Cut-off values reported in included pandemic studies. eResults 1. Forest plots of main analyses. eTable 12. Quality assessment of included pandemic studies. eTable 13. Assessment of level of comparability between pandemic and prepandemic comparative studies. eResults 2. Forest plots of sensitivity analyses. eResults 3. Detailed results of subgroup analyses. eTable 14. Risk factors in the general population, healthcare workers, and patients. eTable 15. Protective factors in the general population, healthcare workers, and patients.
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Papers by Jutta Winterling