Health & Health Services across the lifespan
This working group focuses on health-related issues from childhood through adulthood to old age. On the one hand, it includes projects for the care of young people with chronic illnesses in the transition from paediatric to adult medicine, in which young people are supported and encouraged through training (transition). On the other hand, biographical aspects such as the long-term consequences of traumatic life events and biographical interventions to maintain and promote the health of older people are being investigated.
Projects
Funded by the BMBF. Duration: February 2023 - January 2026
E-mail: stipexuni-greifswaldde
Phone: 03834 420 3848
DDR-PSYCH - GDR past and mental health
Sub-project: Biographical transitions, psychosocial resources & subjective quality of life. Funded by the BMBF. Duration: April 2019 - March 2023.
The sub-project of the University of Greifswald analyses the long-term effects of collectively shared biographical transitions in the context of GDR socialisation on quality of life, well-being and subjective health as well as the adaptive function and mediating effect of psychosocial resources on the basis of data from the ‘Study of Health in Pomerania’ (SHIP), the associated LEGENDE project and data from selected representative surveys throughout Germany.
Responsible for the sub-project:
- University Professor Dr Silke Schmidt
- Dr phil. Holger Muehlan
- Dipl.-Psych. Stefanie Hahm
- Laura Altweck PhD
Overcoming the challenges of a successful transition of young adults with disabilities: participation, health and quality of life in a life-span approach
funded by the DFG (FKZ: SCHM 2683/6-1)
Duration: 01.03.2017 - 28.02.2020
The research project focuses on the needs of young people with disabilities who are in the transition phase from adolescence to adulthood and examines the influence of physical, social and psychological environmental factors on participation in society and the quality of life of young adults with cerebral palsy.
Young people with disabilities form a growing group of fellow citizens who can achieve an inclusive lifestyle thanks to increasingly better healthcare, new communication technologies and changing social attitudes in society. They have both the right and the desire to participate in society on an equal footing. However, barriers and limitations remain due to fragmented healthcare provision beyond childhood and adolescence, lack of integration of health, social, educational and vocational care services, barriers in the physical living environment and the community and stigmatising attitudes. These factors result in isolation, increased vulnerability, restricted access and reduced participation. Due to lower employment rates and poorer educational attainment, the poverty rate of 70% is significantly higher compared to non-disabled young people.
The aim of the project is to analyse the determinants of a successful transition to adulthood for young people with cerebral palsy living in different regions in France and Germany. Cerebral palsy will be analysed as a characteristic example of a disability with a broad spectrum of manifestations. Supportive, positive influencing factors as well as barriers will be identified, focussing on factors of the physical environment and health care that can be influenced. Comparisons with the general population at the same stage of life allow an assessment of the areas of life in which restrictions are most common. In a longitudinal cohort, data is already available from the childhood and adolescence of the participants with cerebral palsy, so that the influencing factors can be analysed in a life-span approach. The primary endpoint is participation as defined by the WHO's International Classification of Functioning, Disability and Health (ICF) (2001). The endpoint is measured as the quantity of social, age-appropriate activities as well as the subjective perception of participation. Secondary endpoints are health status and health-related quality of life, a multidimensional concept of the positive and negative aspects of life. Predictors are social and physical environmental factors, social status, health care and employment, which take regional variation into account.
Personal attitudes, the threat of self-stigmatisation and seeking help
funded by the Deutsche Forschungsgemeinschaft (DFG) - FKZ SCHM 2683/4-1
Start 2015 - Duration 30 Monate
Although structural barriers to accessing medical help are generally low in Germany, many people with mental illness do not seek any medical or therapeutic help. In this context, the stigma of mental illness is often cited as a barrier to seeking help, although prospective studies on untreated people with mental illness are still lacking. Previous studies have shown that the fear of other people's negative reactions has little influence on the decision to seek help or not. In the planned study of untreated people with mental illness, we are extending previous work by focussing on the personal attitudes of those affected in a prospective study. We are investigating the effects of personal stigmatising attitudes towards other people with mental illness on the use of help. Building on our own preliminary work and a pilot study of 25 subjects with untreated depressive syndrome, we hypothesise that personal stigma is associated with a lower perception of symptoms, with a stronger attribution of symptoms to non-psychological causes, with lower self-identification as mentally ill, with lower subjective need for help and with lower help-seeking. In an observational study of 200 people with untreated depressive syndrome or anxiety disorder, we will use explicit and implicit attitudinal measures to predict help-seeking behaviour at 3 and 6 months. Participants will be recruited via newspaper advertisements and emails describing symptoms of depression or anxiety disorder, but without mentioning the diagnosis or other potentially stigmatising terms. This procedure was successfully tested in the pilot study. A personal interview at T0 is followed by telephone interviews after 3 and 6 months. The study will help to better understand the gap in mental health care and will enable targeted anti-stigma initiatives in this area. Based on the study results, a brief instrument will be developed to assess relevant attitudes within large epidemiological studies to quantify the impact of stigma on help-seeking at the population level. Assuming that the avoidance of an identity as mentally ill serves to protect a positive self-concept, we also investigate the extent to which help-seeking or avoidance (and thus avoidance of stigma) influences self-esteem, quality of life and general well-being. In this way, we would like to generate new hypotheses about the possible positive effects of not seeking professional help.
funded by the Federal Ministry of Education and Research (BMBF) - FKZ 01 GX 1005
Duration: 04/2011 - 11/2014
Background
For young people with chronic illnesses, the transition from child-centred to adult-centred care systems presents a particular challenge. It is known that after discharge from paediatric care, the number of regular visits to the doctor and the course of the illness can deteriorate.
Transition programmes vary in quality and transitional consultations have only been introduced very occasionally in Germany to date. In paediatrics and adolescent medicine, there are quality-assured patient training programmes for relatively common illnesses, but many questions of care are still clarified with the parents and not the affected chronically ill young people. The aim of the project is to develop a cross-disease, patient-centred training course for adolescents to increase their self-competence in dealing with care issues that are particularly relevant for transitional care.
Aim and research question
The transitional care of chronically ill adolescents is analysed from their own perspective and that of their doctors. The aim is to develop transition training for chronically ill adolescents and thus improve self-management of the illness, strengthen motivation and autonomy, assume personal responsibility in healthcare and make sensible and efficient use of healthcare services (empowerment).
Methodology
In preparation for the intervention study, focus groups and individual interviews with chronically ill adolescents (N=28) with type 1 diabetes, cystic fibrosis and chronic inflammatory bowel disease and expert interviews with doctors/psychologists will be conducted and analysed in a structured manner using qualitative content analysis in order to be able to take into account the needs and wishes of chronically ill adolescents in transitional care from their subjective perspective in the further course of the study and in the development of the training module.
At the same time, psychometric testing of questionnaires on satisfaction with medical care (CHC-SUN, adapted version for young adults) and on the self-perceived health literacy of chronically ill adolescents will be carried out in various paediatric clinics and rehabilitation facilities and as an online survey.
In cooperation with the ModuS project group of the Competence Network for Patient Education in Childhood and Adolescence (KomPaS), a transition training programme is being developed to support young people in the transition process and make them competent for the transition. The transition training deals with the transfer to adult medicine, i.e. the change of care institutions and treating doctors, as well as growing up with a chronic illness in terms of work, living alone, partnership and separation from parents. It is designed to be low-threshold and resource-orientated and includes specialist input from the management and affected young adults as experts, small group work (e.g. research exercises on the internet), sharing experiences in the group, moderated discussions and self-reflection exercises.
As part of a controlled intervention study, the transition training programme will be evaluated on a sample of 240 young people (15-19 years old). The adolescents (with type 1 diabetes, cystic fibrosis and chronic inflammatory bowel disease) will be recruited via special outpatient clinics in specialist hospitals, special consultation hours in GP practices (diabetology, pneumology, gastroenterology) and via cooperating paediatricians and general practitioners.
In addition to self-management, motivation and autonomy, the project also aims to improve patient and doctor satisfaction, the clinical course of illnesses and quality of life.
The project will run for three years (04/2011 - 04/2014). The project is headed by Prof Silke Schmidt from the Chair of Health and Prevention, Institute of Psychology at the University of Greifswald. The cooperation partners of the project are the University Hospitals for Children and Adolescents Greifswald, the University Hospital Schleswig-Holstein, Campus Lübeck and Kiel in cooperation with specialist outpatient clinics in private practice; paediatricians and adolescent physicians in private practice; adult medical specialists, the Competence Network for Patient Training in Childhood and Adolescence (KomPaS) with the ModuS working group headed by Dr Rüdiger Szczepanski. Rüdiger Szczepanski; the mobile diabetes training programme in Schleswig-Holstein and the cystic fibrosis self-help group.
funded by the Federal Ministry of Education and Research (BMBF) - FKZ 01 ET 100 2B
Duration:01/2011 - 12/2012
Background
Turning to one's own life and early memories is a need felt by many older people. Many people are familiar with this from everyday life, but it is also an important finding of sub-project 4 of the LUCAS precursor study (1st funding phase).
In this Hamburg preliminary study, the participants showed a need to talk about their own biography, especially about their childhood and youth during the Second World War. On the other hand, there are already studies that prove the health-promoting effect of dealing with one's own life.
For example, writing about autobiographical content has a positive effect on the mental and physical health of writers. International research groups (WHOQoL-OLD consortium) also showed that the biography-related part of a research session was perceived as particularly important by older people. Although autobiographical approaches can be found in the current research literature, they are rarely aimed at older people outside of a professional therapeutic setting. Against this background, the idea arose to place biographical writing at the centre of sub-project 4 (LUCAS 2nd funding phase): The BIOGRAPHY project.
Goals
The objective of this study is to offer a patient-centred autobiographical intervention for older people with the aim of preventing the onset of frailty.
The intervention aims to increase the subjective well-being, perceived coherence (meaningfulness) regarding one's own life, autonomy and quality of life of the participants. It will be investigated whether the variation in the method of the autobiographical approach (written vs. oral communication, structured vs. free form) leads to different results with regard to the target criteria (see Methods).
In the future, it will be examined whether the results of the intervention can also be transferred to future generations of older people. A further aim is to assess the applicability of a short biographical survey instrument in preventive health care and nursing. The findings of the study should contribute to the explanation of psychological determinants of frailty and thus to health in old age.
Determinants of mental health of displaced persons in old age
funded by the Federal Ministry of Education and Research (BMBF) - FKZ 01 ET 0710
Duration: 01/2008 - 12/2010
A large number of studies have shown that people who have experienced war in their lives and have been displaced from their homeland are also more mentally stressed in old age and subjectively rate their health worse. Health studies show in particular that migrants differ from the native population in their utilisation of health services.
The aim is to investigate and understand how mental stress manifests itself in old age and which resources contribute to coping with it. This study asks what contribution age-related and biography-related differences make with regard to positive ageing and compensating for the loss of resources. Which factors in age and biography contribute to the development of health or prevent the emergence of psychosocial stress?
Furthermore, it will be investigated whether people with psychological stress and poor health in old age are offered appropriate health services, how the health services offered are perceived and whether older patients have a higher or lower subjective need. In particular, it will be shown under which conditions doctors are consulted, whether the healthcare services offered meet the needs of the patient and which factors prevent this and cause dissatisfaction or non-utilisation.
People aged 60 and over in Hamburg are being analysed by means of a postal questionnaire and personal interviews in order to investigate these questions. The personal attitudes and experiences of citizens who did not experience displacement in childhood and adolescence are compared with people living in Hamburg today who were also displaced from their homeland during the Second World War.