Aus der Studie und den Ergebnissen können wertvolle Impulse abgeleitet werden. Es darf nicht aus den Augen verloren werden, dass junge Menschen mit traumatisierenden Erfahrungen spezifische Perspektiven (Kenny, Dooley, & Fitzgerald, 2016) und Bedenken in Bezug auf die Vertrauenswürdigkeit von KI (Grasser, 2020) haben können. Demzufolge ist wichtig, die subjektive Sicherheit sowie andere Einflussgrößen auf die Nutzung von KI und E-Health Angeboten zu kennen und in Betracht zu ziehen. Ferner zeigen Studien, dass E-Health Literacy (E-Health-Kompetenz) bei minderjährigen Geflüchteten eher gering ist (Bergmann, Nilsson, Dahlberg, Jaensson, & Wångdahl, 2021) und Forschung zur Erhöhung des Uptake von qualitativ hochwertigen Angeboten dringend benötigt wird. Die Integration der Zielgruppe kann jedoch nur dann gelingen, wenn die E-Health-Apps als wichtig erkannt werden und bei ihrer Umsetzung darauf geachtet wird, dass sie praktikabel sind. [Aus: Zusammenfassung]

Die Posttraumatische Belastungsstörung (PTBS) nach sexueller Gewalt in der Kindheit geht häufig mit komorbiden Symptomen einher. Kognitiv-behaviorale Therapien haben sich als effektiv in der Behandlung der PTBS erwiesen. Die Datenlage zur PTBS nach sexueller Gewalt in der Kindheit ist jedoch gering. In der vorliegenden Dissertation wurden Fragestellungen zur Diagnostik und Therapie der PTBS nach sexueller Gewalt verfolgt. In Schrift 1 werden die Ergebnisse einer ambulanten Assessmentstudie präsentiert, in der 28 Patientinnen wiederholt zum intrusiven Wiederleben befragt wurden. Mit durchschnittlich 75 Intrusionen und 24 Flashbacks pro Woche fand sich eine hohe Symptombelastung. Die Schriften 2, 3 und 4 beziehen sich auf eine randomisiert-kontrollierte Studie. Patientinnen (N=74) wurden randomsiert einer 12-wöchigen stationären DBT-PTBS oder einer treatment-as-usual Warteliste zugewiesen. Die Ergebnisse, die in Schrift 2 beschrieben sind, zeigen eine signifikante Reduktion der posttraumatischen Symptomatik mit einer großen Zwischengruppen-Effektstärke (g=1.35). In Schrift 3 wird dargestellt, dass die Effekte auf die posttraumatische Symptomatik in Bezug auf mehrere traumatische Ereignisse geringer sind als die Effekte in Bezug auf das am stärksten belastende Ereignis. Schrift 4 beinhaltet Ergebnisse zu der Inanspruchnahme psychiatrisch-psychotherapeutischer Behandlung und den assoziierten Kosten. Im Jahr vor der DBT-PTBS fanden sich im Mittel jährliche Pro-Kopf-Kosten von  18100 € und 57 stationäre Tage. Im Jahr nach der DBT-PTBS waren die Inanspruchnahme mit durchschnittlich 14 Tagen und die mittleren Kosten von 7233 € deutlich geringer. Zusammengefasst sprechen die Ergebnisse für eine hohe Effektivität der DBT-PTBS. Zudem scheint die DBT-PTBS mit einer Reduktion stationärer Tage und entsprechender Kosten einherzugehen. Die Ergebnisse zur Diagnostik deuten darauf hin, dass ein Teil der Symptomatik mit dem üblichen diagnostischen Vorgehen nicht erfasst wird. / Posttraumatic stress disorder (PTSD) with co-occurring severe psychopathology is a frequent sequel of childhood sexual abuse (CSA). Cognitive-behavioral therapy has been shown to be efficacious in treating PTSD, but there is only limited data regarding patients with PTSD related to CSA. This dissertation focused on both the assessment and the treatment of PTSD related to CSA. Paper 1 presents data from an ambulatory assessment study. Patients (N=28) were provided with electronic diaries for repeated real-time assessment of intrusions and flashbacks. They reported an average of 75 intrusions and 24 flashbacks during the week of assessment. Papers 2, 3, and 4 present data from a randomized controlled trial. Patients (N=74) were randomized to either a 12-week residential DBT-PTSD program or a treatment-as-usual wait list. The results for primary and secondary outcomes are shown in Paper 2. Data revealed a significant reduction of posttraumatic symptoms with a large between-group effect size (g=1.35). Paper 3 provides results on the impact of the definition of the index trauma. When the index trauma included multiple traumas, PTSD severity scores were significantly higher, and improvements from pre- to post-treatment were significantly lower, compared to when the index trauma was defined as the worst trauma. Paper 4 presents data on the utilization of mental health care. The mean total costs were 18000 €  per patient during the year before and  7233 € during the year after DBT-PTSD. The significant cost reduction was due to large reductions in inpatient treatment days (on average 57 days before and 14 days after DBT-PTSD). To sum up, the findings show clear evidence for the efficacy of the DBT-PTSD program. Data further indicate that DBT-PTSD might contribute to reducing the mental health care costs. Also, the results suggest that the currently applied methods of assessing PTSD in patients with severe symptoms might miss aspects of clinically relevant symptomatology.

Objective: Many women experience traumatic events already prior to or during pregnancy, and delivery of a child may also be perceived as a traumatic event, especially in women with prior post-traumatic stress disorder (PTSD). Birth-related PTSD might be unique in several ways, and it seems important to distinguish between lifetime PTSD and birth-related traumatization in order to examine specific consequences for mother and child. This post-hoc analysis aims to prospectively examine the relation of both, lifetime PTSD (with/without interpersonal trauma) and birth-related traumatization (with/without postpartum depression) with specific maternal and infant outcomes. Methods: In the prospective-longitudinal Maternal in Relation to Infants’ Development (MARI) study, N = 306 women were repeatedly assessed across the peripartum period. Maternal lifetime PTSD and birth-related traumatization were assessed with the Composite International Diagnostic Interview for women. Maternal health during the peripartum period (incl. birth experience, breastfeeding, anxiety, and depression) and infant outcomes (e.g., gestational age, birth weight, neuropsychological development, and regulatory disorders) were assessed via standardized diagnostic interviews, questionnaires, medical records, and standardized observations. Results: A history of lifetime PTSD prior to or during pregnancy was reported by 25 women who indicated a less favorable psycho-social situation (lower educational level, less social support, a higher rate of nicotine consumption during pregnancy). Lifetime PTSD was associated with pregnancy-related anxieties, traumatic birth experience, and anxiety and depressive disorders after delivery (and in case of interpersonal trauma additionally associated with infant feeding disorder). Compared to the reference group, women with birth-related traumatization (N = 35) indicated numerous adverse maternal and infant outcomes (e.g., child-related fears, sexual problems, impaired bonding). Birthrelated traumatization and postpartum depression was additionally associated with infant feeding and sleeping problems. Conclusion: Findings suggest that both lifetime PTSD and birth-related traumatization are important for maternal and infant health outcomes across the peripartum period. Larger prospective studies are warranted. Implications: Women with lifetime PTSD and/or birth related traumatization should be closely monitored and supported. They may benefit from early targeted interventions to prevent traumatic birth experience, an escalation of psychopathology during the peripartum period, and adverse infant outcomes, which in turn may prevent transgenerational transmission of trauma in the long term.

In den Jahren 1992-1995 kamen ca. 35 Tausend bosnische Kriegsflüchtlinge nach Berlin und wurden vorübergehend geduldet. Nach Kriegsende 1995 sollten sie schnellstmöglich wieder zurückkehren. Traumatisierte und Ältere ohne Angehörige im Heimatland wurden weiterhin geduldet bis Bosnien-Herzegowina wieder aufgebaut ist. Doch der Wiederaufbau verlief schleppend. Mit dem Friedensvertrag von Dayton begannen nicht Frieden und Wiederaufbau, sondern die Konsolidierung der ethnischen Grenzen in demokratischen Strukturen. Deshalb sahen viele Flüchtlinge keine Möglichkeit in ihre Heimatorte zurückzukehren und versuchten ihre Rückkehr hinauszuschieben. Möglich war dies mithilfe der Attestierung einer kriegsbedingten Posttraumatischen Belastungsstörung und ihre psychotherapeutische Behandlung, die den Inhabenden und ihren Familienmitgliedern eine Aufenthaltsverlängerung ermöglichte und ab dem Jahr 2000 den Erhalt eines dauerhaften Aufenthaltstitels. Die Verbindung einer psychischen Krankheit und ihrer Psychotherapie mit einem Aufenthaltsrecht ist neu in der Geschichte des deutschen Ausländerrechts und obwohl Berliner Psychiater, Psychiaterinnen, Psychologinnen und Psychologen maßgeblich an der Schaffung der „Traumatisiertenregelung“ beteiligt waren, wurden ihre Atteste von der Berliner Verwaltung in Frage gestellt. In der Dissertation werden die Standpunkte der Flüchtlinge, Behandelnden und der Verwaltung dargelegt und ihre Interaktionen beschrieben.Die Rolle des Krankheitskonzeptes der Posttraumatischen Belastungsstörung wird als "boundary object" (Star/Griesemer 1989) untersucht. Der Schwerpunkt liegt auf den Lebenswelten und Taktiken der Flüchtlinge, sich in Berlin zurechtzufinden und Anerkennung und Verständnis für ihre Situation zu finden. Ihre Bedürfnisse wurden in einen psychotherapeutischen Bedarf übersetzt und damit den Berliner Psychotherapeutinnen und -therapeuten ein neues Betätigungs- und Professionalisierungfeld geboten, was kritisch hinterfragt wird. / From 1992 until 1995 about 35 thousand Bosnian war refugees fled to Berlin and were allowed to stay temporarily. After the end of the war in 1995 they were expected to leave as soon as possible. Traumatized persons and elderly without relatives in Bosnia had the possibility to prolong their visa until Bosnia is reconstructed. But the rebuilding process progressed only slowly. With the end of the war did not start the expected peace time and rebuilding but the consolidation of ethnic borders inside democratic structures. Therefore many refugees did not see a possibility to return to their property and tried to delay their return. This was possible with an medical statement certifying a war related posttraumatic stress disorder and their psychotherapeutic treatment. These medical statements ensured the extension of the visa for the concerned person and its family members. From 2000 onwards they could receive a permanent residence title. The connection of a mental illness and psychotherapy with residence entitlements is a novelty in the German aliens law. And despite the fact that psychiatrists and psychologists from Berlin were leading actors in the establishment of the „regularization of the traumatized“ their medical/psychological statements were impeached by the authorities. The dissertation describes the viewpoints of refugees, treating physicians and psychologists and the authorities and how they interact with each other. Additionally is the concept of posttraumatic stress disorder examined and discussed as „boundary object“ (Star/Griesemer 1989). An important aspect is the description of life worlds and tactics of the refugees to get along in Berlin, to gain respect and appreciation for their situation. Their needs were translated into a psychotherapeutic demand and this led to the invention of a new field of work and professionalization for psychotherapists in Berlin. This development is critically reflected.

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.

Objective. Major depressive disorder (MDD) is a common condition following treatment in the Intensive Care Unit (ICU). Long-term data on MDD in chronically critically ill (CCI) patients are scarce. Hence, the primary aim of the present study was to investigate the frequency and predictors of MDD after intensive care of CCI patients. Materials and Methods. In a prospective cohort study, patients with long-term mechanical ventilation requirements () were assessed with respect to a diagnosis of MDD, using the Structured Clinical Interview for DSM-IV, three and six months after the transfer from acute ICU to post-acute ICU. Sociodemographic, psychological, and clinical risk factors with values ≤ 0.1 were identified in a univariate logistic regression analysis and entered in a multivariable logistic regression model. A mediator analysis was run using the bootstrapping method, testing the mediating effect of perceived helplessness during the ICU stay, between the recalled traumatic experience from the ICU and a post-ICU MDD. Results. 17.6% () of the patients showed a full- or subsyndromal MDD. Perceived helplessness, recalled experiences of a traumatic event from the ICU, symptoms of acute stress disorder, and the diagnosis of posttraumatic stress disorder (PTSD) after ICU could be identified as significant predictors of MDD. In a mediator analysis, perceived helplessness could be proved as a mediator. Conclusions. Every fifth CCI patient suffers from MDD up to six months after being discharged from ICU. Particularly, perceived helplessness during the ICU stay seems to mainly affect the long-term evolvement of MDD. CCI patients with symptoms of acute stress disorder/PTSD should also be screened for MDD.

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.