Lead:
Prof. Dr. phil. Silvia Krumm, M. A., Department of Psychiatry II, Ulm University, Head of Workgroup Qualitative Social Research

Project partners:
Hochschule Fulda (Prof. Dr. Daphne Hahn, Gesamtkoordination)
Evangelische Hochschule Freiburg, SoFFi F. (Prof. Dr. Cornelia Helfferich, Tilmann Knittel)
Hochschule Merseburg (Prof. Dr. Maika Böhm)
Freie Universität Berlin (Prof. Dr. Christine Knaevelsrud)
Hochschule Nordhausen (Prof. Dr. Petra Brzank)

Staff Ulm University:
Dr. Yamara-Monika Wessling, M. A.
Dr. Susanne Jaeger

Finance: Federal Ministry of Health 

Funding: 321.663 €

Duration: 2020 – 2024

Summary:
ELSA PSY is a sub-project of the nationwide study ELSA: Experiences and life situations of women with unwanted pregnancies - counseling and care services https://elsa-studie.de/). The overall aim of the study is to draw evidence based conclusions for the development and improvement of health and psychosocial services for women experiencing unwanted pregnancies. On the one hand, we aim at the identification of the burdens and resources over time of women who carry or terminate an unwanted pregnancy. On the other hand, we will analyze women’s service and support needs. Finally, the perspective of health professionals and relevant institutions will be examined.

The sub-projects of the overall study take women into account who are considered to be particularly vulnerable. This includes women with mental health problems, who are the focus of the sub-project ELSA PSY at Ulm University. Previous findings show that women with mental health problems more often become pregnant unintentionally and that they are confronted with special challenges in dealing with the pregnancy due to specific reproductive risks and sociocultural factors. At the same time, there are indications that an unwanted pregnancy can be related to considerable psychological distress. Overall, it can therefore be assumed that women with mental health problems have specific support needs. However, the research on this is still deficient.

The aim of the subproject ELSA PSY is therefore to examine the psychosocial problems at the onset and in the further course of an unwanted pregnancy, to inquire about attitudes and behavior in dealing with an unwanted pregnancy, as well as to examine the subjective need and the use of counseling and support services by women with mental health problems. Methodically, the analysis is carried out on the basis of a representative online survey of women with unwanted pregnancies carried to term as well as women who terminated the pregnancy. Building on this, in-depth analyzes of the subjective constructions of meaning in dealing with an unwanted pregnancy in the context of mental health are carried out using narrative-biographical approaches. The results provide an empirical basis for developing appropriate services for women with mental health problems who have become pregnant unintentionally.

Lead:
Prof. Dr. phil. Silvia Krumm, M. A., Department of Psychiatry II, Ulm University, Head of Workgroup Qualitative Social Research

Prof. Dr. Georg Schomerus, Head of Department of Psychiatry and Psychotherapy, University Clinic Leipzig

Project partner: 
Department of Psychiatry and Psychotherapy, University Clinic Leipzig (Prof. Dr. Georg Schomerus)

Staff Ulm University:
Dr. Anita Scheuermann (project coordination)
Melanie Pouwels (research assistant)
Sophia Just (student assistant)
Hanna Rock (student assistant)

Finance: German Research Foundation (DFG)

Funding: 980,000 € (Ulm: 510,000 €)

Summary:
The starting point of the EVIO study is the empirical finding of a significantly increased risk for people with mental disorders to experience physical violence. Victimisation not only causes physical injuries but has negative effects on mental health and recovery processes. In mental health settings, services users’ violence experiences (including violent acts) are often not sufficiently addressed by mental health professionals. Moreover, in Germany, there has been a lack of empirical research on this topic. To develop adequate interventions for the prevention and reduction of victimization in mentally ill individuals, it is crucial to not only systematically document violent events but also to understand the subjective meanings of violence in the context of social, biographical, and institutional factors.

In a mixed-method study including quantitative methods and a sequential explanatory design, we will aim at the investigation of the prevalence of violent incidents among people with severe mental disorders, a comprehensive understanding of the social, biographical and institutional context factors, and the identification of barriers for adressing experiences of violence within mental health settings. Our study includes the following sub-projects:

1. In a representative sample (n=500) of people with severe mental disorders, treated in in-patient and out-patient mental health settings, we will investigate the prevalence of victimization and violent behavior, stigmatization and self-stigmatization with regard to violence, and barriers for disclosure of violence experiences within mental health settings. Data will be obtained from different samples at psychiatric hospitals on a fixed day. For comparisons with the general population, we use a representative online sample (n=1000).
2. Based on this, we conduct qualitative interviews with a sub-sample of persons with severe mental disorders (n=40) who reported violence experiences . Using biographic-narrative interviews, we focus on the social, biographical, and normative context.
3. In addition, we use qualitative and quantitative measures to investigate mental health professionals’ experiences and strategies to deal with mental health clients’ experiences of violence.

The EVIO study aims to provide an evidence base for the development of both violence-preventive services and targeted, needs-based interventions to improve professionals’ dealing with their clients’ violence experiences.

Krumm S, Checchia C, Kilian R, Becker T. Viktimisierung im Erwachsenenalter von Personen mit Psychiatrieerfahrung. Psychiatrische Praxis 2018; 45(02): 66-77.

Schomerus G, Rechenberg T, Gfesser T, Sander C, Liebergesell M, Schindler S., Ulke C, Grabe H, Speerforck S. Stigma as a barrier to addressing childhood trauma in conversation with trauma survivors: A study in the general population. PLoS One  2021 (16), e0258782.

Schomerus G, Spindler P. Gewaltrisiko, psychische Krankheit und Stigma. Eine Herausforderung für die Sozialpsychiatrie. Sozialpsychiatrische Informationen 2019, 4, 13-14.

Krumm S. Psychische Erkrankung, Gewalt und Geschlecht. Ein blinder Fleck in der sozialpsychiatrischen Versorgung? Sozialpsychiatrische Informationen 2019, 1, 40-43.

Head of Participatory Health Research:
Priv. Doz. Dr. phil. Silvia Krumm, M. A., Department of Psychiatry II, Ulm University, Head of Workgroup Qualitative Social Research

Lead:
Prof. Dr. Ulrich Reininghaus, Head of Department Public Mental Health, Central Institute of Mental Health, Mannheim (CIMH)

Project partners:

Central Institute of Mental Health, Mannheim (CIMH)

• Department of Public Mental Health
• Department of Theoretical Neurosciences

Involved stakeholders:
Jugendgemeinderat Baden-Württemberg
Jugendstiftung Baden-Württemberg
Zentrum für Schulqualität und Lehrerbildung
Landesverband Schulpsychologie Baden-Württemberg
Landesarbeitsgemeinschaft für Erziehungsberatung Baden-Württemberg
Netzwerk Schulsozialarbeit Baden-Württemberg
Landesmedienzentrum Baden-Württemberg (LMZ)
War Child Deutschland
Fachbereich Schulpsychologie Mannheim
movisens GmbH

Staff Ulm University:
Selina Hiller, B. Sc.
Christian Götzl, M. A.

Staff Central Institute of Mental Health, Mannheim (CIMH):
Prof. Dr. Daniel Durstewitz (Professor in Theoretical Neuroscience / Head of Department)
Dr. Georgia Koppe (Head of RG Computational Psychiatry)
Christian Rauschenberg, M. Sc.

Finance: Federal Ministry of Science, Education and Culture of Baden-Württemberg (MWK)

Funding: 216,644 € (Evaluation Ulm)

Duration: 01/2021 – 12/2023

Summary:
Mental disorders are among the main causes of disease burden in young age groups, with three fourths of all mental disorders first emerge before the age of 24. At the same time, studies have shown that young people, despite evidence on an objective and subjective need, are often insufficiently reached by health promotion and preventive interventions, as these are often not tailored to their individual needs or daily routines. Measures to contain the SARS-CoV-2 pandemic (social distancing, homeschooling) and the resulting psychosocial distress in young people further emphasize the need for novel intervention strategies, which can be used individually, in any given context and without personal contact.

The Living Lab AI4U “Artificial Intelligence for personalized digital mental health promotion in youth”, which is conducted in Mannheim and Ulm, aims to examine how the digital transformation in health care based on the new application of AI methods can succeed. For this purpose, a digital mobile health training for mental health promotion and prevention in adolescents and young adults is being developed, which is tailored to person, moment and context in individuals' daily life. Modern AI algorithms, recurrent neural networks in particular, can support mental health promotion and prevention in young people by evaluating multimodal ecological momentary assessment data, determining predictive factors, process forecasts and their translation back into suggestions for behavioral options.

AI4U will be carried out in a 3-year project phase with the direct participation of young people through focus groups and research workshops as well as expert interviews with relevant stakeholders from the areas of educational counseling, school psychological counseling, school social work, and media education. The primary goal is to strengthen emotional resilience and other protective factors in adolescents and young adults. For this purpose, quality assessments will be conducted primarily focusing on a) quality from the user perspective, safety, feasibility and effectiveness of the AI-based mHealth training, as well as b) initial process and outcome quality and barriers and facilitators of implementation and structural embedding. The participation of non-academic actors and potential users will ensure ongoing quality assurance, sustainability assessment, public relations and networking.

Lead:
Prof. Dr. phil. Silvia Krumm, M. A., Department of Psychiatry II, Ulm University, Head of Workgroup Qualitative Social Research

Prof. Dr. rer. soc. Reinhold Kilian, Department of Psychiatry II, Ulm University, Head of Section Health economics and health services research

Project partners:
Clinic of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm (Prof. Dr. Petra Beschoner)

Clinic of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Augsburg (Prof. Dr. Alkomiet Hasan)

kbo-​Isar-Amper Hospital (Prof. Dr. med. Peter Brieger)

District Hospital Kempten (Prof. Dr. Markus Jäger)

Clinic of Psychiatry, Psychotherapy and Psychosomatic Medicine, Heidenheim (José-Marie Koussemou)

District Hospital Donauwörth (PD Dr. Karel Frasch)

Staff Ulm University:
Natalie Lamp, M. Sc.
Paulo Kling-Lourenco, Dipl.-Jur. 
Gironimo Krieg, M. A.
Dr. biol. hum. Maja Stiawa, M. A.
Paul Nickel, B. Mus.; Cand. Med.
Katharina Senk (student assistant), B.A. 
Jenny Seiler (student assistant)

Staff Ulm University:
Natalie Lamp, M. Sc.
Gironimo Krieg, M. A.
Dr. biol. hum. Maja Stiawa, M. A.
Paul Nickel, B. Mus.; Cand. Med.
Katharina Senk (stud. Hilfskraft), B.A. 
Jenny Seiler (stud. Hilfskraft)

Staff BKH Donauwörth: 
Maria Panzirsch, M. Sc.

former employees: Paulo Kling-Lourenco, Dipl.-Jur.

Finance: German Research Foundation (DFG)

Funding: 587,000 €

Summary:
According to the „gender paradox of depression“, women are twice as often affected by depression, while men have a threefold risk of committing suicide. Several reasons for the lower depression rates among men are discussed including a lack of recognizing men’s depressive symptoms, men’s lower service use and a lack of gender-sensitive services. Traditional masculinity norms play a central role here. However, beyond stereotyping images of men’s risky health behavior, there is a lack of knowledge about the variety of mens‘ mental health behavior and sophisticated studies on the complex interrelations between masculinity orientations and mental health are rare.

With our previous study „Masculinity Constructions and Mental Health Behaviour among Men with Depression” we could fill a research gap by identifying three latent classes of a specific combination of masculinity orientations and work-related attitudes among men treated for depression. Furthermore, we found a significant interrelation between class membership and mental health variables. In addition, based on in-dephts interviews with class representatives we identified differences in men’s subjective views on masculinity orientations, illness theories and everyday coping with depression. Also, we could show that mental health staff actively encourages male patients to change their gender role attitudes and mental health behaviors. However, due to the cross-sectional design of the study, we cannot make any assumptions about the processes of change and thus, about the direction of the interrelations between masculinity orientations, work-related attitudes and mental health.

Therefore, within a prospective mixed-method observational study we will focus on the changes and transformations of masculinity orientations and work-related attitudes among depressed men within a specific (therapeutic) setting. Statistical analysis of the change processes of masculinity orientations, work-related attitudes and relevant clinical parameters will be completed by reconstructive analysis of the subjective meaning of theses changes (transformations). The findings will be triangulated by the perspectives of the partners of depressed men on the transformations.

A better understanding of the transformation processes of masculinity orientations and work-related attitudes in the context of a depression will serve as the basis for the development of gender-sensitive services for depressed men.

Lead:
Prof. Dr. sc. hum. habil. Dipl.-Psych. Matthias Schützwohl, Department of Psychiatry and Psychotherapy, Technical University Dresden 

Project partners:
Priv. Doz. Dr. phil. Silvia Krumm, M. A., Department of Psychiatry II, Ulm University, Head of Workgroup Qualitative Social Research

Staff Ulm University:
Lea Mayer
Nicole Stasch

Finance: Innovationsfonds des Gemeinsamen Bundesausschusses (G-BA)

Funding: 249,504 €

Duration: 2021 – 2022

Summary:
Recent studies indicate a lack of implementation of existing guidelines on psychopharmacotherapy for individuals with Intellectual Disability (ID) living in institutionalized residential settings. Therefore, the current project aims to support the implementation of existing guidelines by developing recommendations for action.
In a first step, we plan to interview professionals from residential settings for individuals with ID in two German federal states (Baden-Wuerttemberg and Saxony) about promoting factors and barriers for the implementation of guidelines on psychopharmacotherapy for individuals with ID. With the results of the interviews, focus groups will be developed in a second step. Focus groups will be conducted with professionals from residential settings for individuals with ID in Baden-Wuerttemberg and Saxony. The aim of focus groups is to develop recommendations for action for existing guidelines on psychopharmacotherapy for individuals with ID. In a third step, the recommendations will be summarized and disseminated. The recommendation for action can contribute to a more guideline-compliant psychopharmacological treatment of persons with IE living in institutionalized residential settings in Germany.

Lead:
Priv. Doz. Dr. phil. Silvia Krumm, M. A. soc., Department of Psychiatry II, Ulm University, Head of Workgroup Qualitative Social Research
Prof. Dr. rer. soc. Reinhold Kilian, Department of Psychiatry II, Ulm University
Prof. Dr. med. Harald Gündel, Klinik für Psychosomatische Medizin und Psychotherapie der Universität Ulm, Medical director

Project partners:
Prof. Dr. med. Thomas Becker, Department of Psychiatry II, Ulm University, Medical director
Dr. med. Petra Beschoner, Klinik für Psychosomatische Medizin und Psychotherapie der Universität, Oberärztin und Leitung Verhaltenstherapeutische Behandlungsgruppe

Staff Ulm University:
Dr. PH Tobias Staiger
Maja Stiawa, M. A. soc.
Dr. biol. hum. Annabel Sandra Müller-Stierlin
Dr. phil. Felicitas Söhner
Christian Götzl, M. A.

Finance: German Research Foundation (DFG)

Funding: 416,482 €

Duration: October 2016 – September 2019, Cost-neutral extension until June 2021: Special evaluation of paternity in men with depression

Summary:   
The prevalence of depression in women is twice the rate in men while men have much higher suicide rates. It is assumed that this ´gender paradox in depression´ is related to the fact that gender-specific bio-psychosocial factors are not adequately taken into account in the treatment of depressed men. Despite a broad consensus on the need for adequate mental health services for men and women suffering from depression, there is a knowledge gap regarding men´s needs with regard to depressive illness. By focusing on the concept of traditional masculinity some studies provide a one-dimensional understanding of men´s (mental) health behavior including reduced service use. Beyond such stereotypes, little is known about male mental health behavior, service needs and masculinity constructions in the context of depression, as well as men´s coping strategies in relation to discourses of masculinity and/or depression. Furthermore, there is a lack of knowledge on how men´s specific needs are addressed and/or met by mental health services.
Against the background of rising health service use due to depression among both men and women the mixed-method-study aims at a comprehensive analysis of men´s masculinity constructions and consequences for their mental health behavior: First, depressed men´s masculinity constructions with regard to social factors, job involvement, and attitudes towards mental illness will be analysed by cluster analysis on the basis of interviews with men suffering from depression. Masculinity types will then be identified and related to specific indicators of mental health behavior. Second, on the basis of these types, qualitative interviews will be conducted with exemplary cases in order to gain a deeper understanding of men´s subjective perspectives regarding their coping with depression. These results, on the basis of focus groups with depressed men, will be validated communicatively. Finally, semi-structured interviews will be conducted with mental health professionals to understand their views and attitudes towards depressed men and their service needs.
By analyzing male patients´ and professionals´ perspectives on male coping strategies and mental health needs the study provides an empirically based starting point for the development of gender sensitive mental health services. From a gender perspective the study aims at a better understanding of masculinity constructions in the context of depression with regard to social and discursive factors. Furthermore, through an analysis of the diversity of masculinity concepts, the study contributes to a more detailed picture of depression in men.

Publications: 

1. Staiger T, Stiawa M, Mueller-Stierlin A, Kilian R, Beschoner P, Gündel H, Becker T, Frasch K,  Panzirsch M, Schmauß M, Krumm S. Masculinity and Help-Seeking Among Men With Depression: A Qualitative Study. Frontiers in Psychiatry 2020, 11:599039.
2. Götzl C, Staiger T, Krumm S. Erschöpfte Väter? Vaterschaft und psychische Erkrankung. Sozialpsychiatrische Informationen 2020, 50(3):42-45.
3. Kilian R, Müller-Stierlin A, Söhner F, Beschoner P, Gündel H, Staiger T, Stiawa M, Becker T, Frasch, K, Panzirsch M, Schmauß M, Krumm S. Masculinity norms and occupational role orientations in men treated for depression. PLOS ONE 2020, 15(5):e0233764.
4. Stiawa M, Müller-Stierlin A, Staiger T, Kilian R, Becker T, Götzl C, Gündel H, Beschoner P, Grinschgl A, Frasch, K, Schmauß M, Krumm S. Männer mit depressiven Erkrankungen in der stationären Behandlung. Bedarf und Behandlungsziele aus Sicht psychiatrischer Fachkräfte. Psychiatrische Praxis 2020, DOI: 10.1055/a-1149-5429.
5. Stiawa M, Müller-Stierlin A, Staiger T, Kilian R, Becker T, Götzl C, Gündel H, Beschoner P, Grinschgl A, Frasch, K, Schmauß M, Krumm S. Mental Health Professionals View About the Impact of Male Gender for the Treatment of Men With Depression - A Qualitative Study. BMC Psychiatry 2020, 20(1):276.
6. Staiger T, Stiawa M, Müller-Stierlin A, Kilian R, Beschoner P, Gündel H, Becker T, Frasch, K, Panzirsch M, Schmauß M, Krumm S. Depression und Männlichkeit: Krankheitstheorien und Bewältigung – Eine biografisch-narrative Studie. Psychiatrische Praxis 2020, 47:65-70.
7. Krumm S, Kilian R, Beschoner P, Becker T, Gündel H: Wenn Mann sein zum Problem wird. Zum Verhältnis von Männlichkeitsorientierung und Depression. Sozialpsychiatrische Informationen 2018, 48, 23-26 
8. Krumm S, Checchia C, Koesters M, Kilian R, Becker T. Men's Views on Depression: A Systematic Review and Metasynthesis of Qualitative Research. Psychopathology. 2017;50(2):107-124