Objectives Real world implementation of proactive screening and brief intervention in health care is threatened by high cost. Using e‐health interventions and screening for multiple health risk factors may provide more efficiency. We describe methodological details of a proactive multipurpose health risk screening in health care settings and report on participation rates, participants' characteristics, and participation factors. Methods Patients between 18 and 64 years from ambulatory practices and hospitals were proactively approached by study assistants at three sites for a computerized screening on harmful alcohol and tobacco consumption, depressive symptoms, insufficient fruit/vegetable consumption, physical inactivity and overweight. On the basis of their health risk pattern, a computerized algorithm allocated patients to one of five studies each of them addressing a psychiatric research question. Results Among all eligible patients, 13,763 (86.5%) were screened. Younger age and being female predicted screening participation. Of those with complete data (n = 12,828), 82.9% reported at least two health risks and 34.0% were eligible for a study. Study participation ranged between 35.2% and 50.8%, and was associated with socio‐demographics and problem severity. Conclusions This study supports the use of systematic proactive screening for multiple health risks in health care settings as it is more resource‐saving than single focused screening.

Background: A pre-post pilot study was conducted to test the feasibility, acceptability, and potential effectiveness of a fully automatized computer-based intervention targeting hazardous drinking and depressiveness in proactively recruited health care patients (HCPs). To address the importance of the sample selection when testing interventions, HCPs were compared to media recruited volunteers (MVs). Method: In a multicenter screening program 2,773 HCPs were screened for hazardous drinking and depressive symptoms. MVs were recruited via media solicitation. Over a period of 6 months, study participants received 6 individualized counseling letters and weekly short messages. Pre-post data were analyzed for 30 participants (15 HCPs, 15 MVs). Intervention acceptability was assessed in post-intervention interviews conducted with 32 study participants. Results: MVs showed higher problem severity and motivation to change than HCPs. Over the course of the intervention both subsamples reduced regular binge drinking (HCPs: p = 0.016; MVs: p = 0.031) and depressiveness (HCPs: p = 0.020; MVs: p < 0.001). MVs further reduced average daily alcohol consumption (p = 0.034). The intervention received positive ratings from both subsamples, the alcohol module was rated more favorably by MVs than by HCPs (p = 0.012). Subsamples further differed in terms of intervention usage (p = 0.013). Conclusion: The intervention was technically and logistically feasible, well accepted, and may have the potential to reduce hazardous drinking and depressive symptoms in different populations. Subsamples differed in terms of problem severity, motivation to change, intervention usage, pre-post changes, and attitudes toward the intervention, showing that intervention development should involve the intended target populations to avoid biased conclusions on intervention effectiveness and acceptability.

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Aims To investigate latent patterns of alcohol use and bingeing by gender and their association with depressive symptom severity and individual depressive symptoms. Design Cross‐sectional data were collected from January 2017 to March 2018 as part of a joint screening recruiting for different intervention studies. Setting Ambulatory practices and general hospitals from three sites in Germany. Participants A total of 5208 male and 5469 female proactively recruited alcohol users aged 18–64 years. Measurements Frequency and typical quantity of alcohol use, frequency of bingeing, alcohol‐related problems (assessed by the Alcohol Use Disorder Identification Test); depressive symptom severity, individual depressive symptoms (assessed with the Patient Health Questionnaire‐8); and socio‐demographics and health‐related variables. Findings Latent categorical analysis identified six patterns of alcohol use, with the majority of patients engaging in ‘light use plus no or occasional bingeing’ (males: 41.85%; females: 64.04%), followed by ‘regular use plus occasional bingeing’ (males: 34.03%; females: 16.17%). Multinomial logistic regression analyses (three‐step approach with correction for classification uncertainty, as implemented in the Mplus R3STEP command) controlling for socio‐demographics and health‐related variables revealed that severity of depressive symptoms was positively associated with ‘frequent use plus frequent bingeing’ when compared with ‘light use plus no or occasional bingeing’ [relative risk ratio (RRR)male = 1.07, 95% confidence interval (CI) = 1.03–1.11; RRRfemale = 1.09, 95% CI = 1.04–1.14]. Severity of depressive symptoms was negatively associated with ‘regular use plus occasional bingeing’ for males (RRRmale = 0.98, 95% CI = 0.95–1.00) and positively with ‘occasional use plus occasional bingeing’ for females (RRRfemale = 1.03, 95% CI = 1.01–1.05) when compared with ‘light use plus no or occasional bingeing’. Individual depressive symptoms were differentially associated with alcohol use patterns, with depressed mood, poor appetite or overeating, feelings of worthlessness or guilt and psychomotor agitation or retardation, being especially pronounced in the ‘frequent use plus frequent bingeing’ class (RRRsmale = 1.72–2.36; RRRsfemale = 1.99–2.17). Conclusions Patterns of ‘frequent alcohol use plus frequent bingeing’ and ‘occasional alcohol use plus occasional bingeing’ appear to have positive associations with depression when compared with ‘light alcohol use plus no or occasional bingeing’.

Background and aimsSymptoms of pathological gambling (SPG) and depression often co-occur. The nature of this relationship remains unclear. Rumination, which is well known to be associated with depression, might act as a common underlying factor explaining the frequent co-occurrence of both conditions. The aim of this study is to analyze associations between the rumination subfactors brooding and reflection and SPG.MethodsParticipants aged 14–64 years were recruited within an epidemiological study on pathological gambling in Germany. Cross-sectional data of 506 (80.4% male) individuals with a history of gambling problems were analyzed. The assessment included a standardized clinical interview. To examine the effects of rumination across different levels of problem gambling severity, sequential quantile regression was used to analyze the association between the rumination subfactors and SPG.ResultsBrooding (p = .005) was positively associated with the severity of problem gambling after adjusting for reflection, depressive symptoms, and sociodemographic variables. Along the distribution of problem gambling severity, findings hold for all but the lowest severity level. Reflection (p = .347) was not associated with the severity of problem gambling at the median. Along the distribution of problem gambling severity, there was an inverse association at only one quantile.Discussion and conclusionsBrooding might be important in the development and maintenance of problem gambling. With its relations to depression and problem gambling, it might be crucial when it comes to explaining the high comorbidity rates between SPG and depression. The role of reflection in SPG remains inconclusive.