The DGPPN research project on mental healthcare utilization in Germany: inpatient and outpatient treatment of persons with depression by different disciplines

Abstract

The analysis of the utilization of mental healthcare services using routine data provided by statutory health insurance companies and pension funds is a way to assess the frequency of service use, the distribution of the service use among various healthcare settings (inpatients vs. outpatients, rehabilitation according mainly to the German Social Code Book IX vs. curative treatment according to the German Social Code Book V [note that some elements of rehabilitation are financed according to Social Code Book V as well]) and medical disciplines (psychiatry and psychosomatic medicine vs. somatic disciplines and general medicine). In addition, these data can provide information on the social consequences of mental disorders, as assessed by the number of cases and the duration of sick leave or case numbers of early retirement due to mental disorders. In this study, healthcare utilization data from 10 million Germans were analysed. Within a 3 year observation period (2005-2007), about one-third (approx. 3.3 million) persons had a contact with a healthcare service due to a diagnosis of the ICD-10 groups F0-F5. Given the large number of persons with depression in Germany, the initial results of an analysis of mental healthcare utilization due to depression are presented here. Among the study group of 3.3 million Germans with mental healthcare utilization within the observation period, 1.4 million had at least one contact to healthcare system due to the diagnosis of depression. In most cases, depression was diagnosed without specification of severity. It was found that non-psychiatric disciplines like general practitioners were the most frequently used providers in outpatient mental health care, whereas inpatient treatment predominantly occurred in psychiatric departments. For those persons with depression for which a severity-indicating ICD-10 code was used, it was found that utilization of psychiatric and psychosomatic disciplines increased in both in- and outpatient treatment compared to use of general medical facilities with more severe depression. Specialists for psychosomatic medicine and psychological psychotherapists predominantly treated cases of mild and moderate depression, whereas severe cases were mostly cared for by psychiatrists or psychiatric departments.

Self‐reported utilization of mental health services in the adult German population – evidence for unmet needs? Results of the DEGS1‐Mental Health Module (DEGS1‐MH)

“…It also seems to differ from findings derived from German routine administrative data (Gaebel et al ., ), which highlighted the core role of the primary care and other somatic medical sectors. German health insurance data in persons with depression, analysed in that study showed that general practitioners and other somatic medical specialists were the most frequent providers of mental health care (Gaebel et al ., ). Comparisons of general population survey data with routine administrative data are generally difficult, due to substantially different methodologies of data collection and analysis.…”

Persistent depressive disorder across the adult lifespan: results from clinical and population-based surveys in Germany

“…Moreover, findings from national health care data suggest that the validity of medical depression diagnoses are questionable, particularly in primary care [62], and that improving treatment targeting [63,64] and treatment quality [19,[65][66][67][68] are desirable. In conclusion, these findings highlight the need for national public health initiatives in Germany to reduce barriers to accessing mental health care services in general and in individuals with low education in particular, to strengthen awareness using targeted information campaigns, and to improve the quality of medical recognition and specialized treatment provision for depression and its different courses.…”

Enhancing inpatient psychotherapeutic treatment with online self-help: study protocol for a randomized controlled trial

“…Depression is the most frequent diagnosis in inpatient psychotherapy [ 11 ], which is indicated when depression is severe, significantly impairing activities of daily living and work ability or if it is compounded by other mental disorders [ 12 ]. Depression can be improved considerably by inpatient psychotherapy [ 13 , 14 ].…”