Project management:

• Junior Professor Dr Nathalie Oexle, Department of Psychiatry and Psychotherapy II at the University of Ulm, Section of Public Mental Health
• Junior Professor Dr Vera Clemens, Ulm University Hospital, Department of Child and Adolescent Psychiatry/Psychotherapy
• Jun.-Prof. Dr Miriam Rassenhofer, Ulm University Hospital, Department of Child and Adolescent Psychiatry/Psychotherapy
• PD Dr Eva Rothermund, Ulm University Hospital, Psychosomatic Medicine and Psychotherapy

Project partners:

• Prof Dr Anne Barzel, Ulm University Hospital, Institute of General Medicine
• Competence Network for Continuing Education in General Practice Ulm

Ulm University staff:
Dr Katharina Grau
Maria Haun
Natalie Lamp
Beatriz Lloret
Lea Mayer

Funding: Ministry of Science, Research and the Arts Baden-Württemberg

Duration: 06/2021 - 12/2022

Summary:
Psychosocial problems such as financial difficulties, problems at work, loneliness and intra-family violence are often accompanied by psychological stress and even suicidal behaviour and are associated with consultations in GP surgeries. However, due to social taboos, these are often not disclosed and not sufficiently taken into account in the diagnosis and treatment plan. Primary care practitioners have a key role to play here. The prerequisites for this are recognising people at risk and an open attitude combined with the ability to act. The aim of the project is therefore to develop and evaluate an e-learning curriculum for primary care practitioners (_BASEPro) and medical students (_BASEStud) focussing on the above-mentioned topics. The aim is to increase awareness, self-efficacy and action competence in the target groups.

Project management:
Jun.-Prof. Dr Nathalie Oexle, Department of Psychiatry and Psychotherapy II, University of Ulm, Section Public Mental Health

Project partner:
AGUS e.V.

Ulm University staff:
Franziska Marek

Funding: German Research Foundation (DFG)

Duration: 10/2021 - 09/2024

Summary:
Social support is essential for coping with traumatic life events such as loss by suicide. However, people who have lost a loved one to suicide often report too little social support, with negative consequences for the grieving process. Social support is a complex phenomenon that fundamentally depends on both the personal willingness to seek and accept support and the willingness of others to provide support. In order to increase social support after loss by suicide in the context of interventions, an understanding of the barriers and facilitating factors among those affected and potential supporters (e.g. friends, neighbours, work colleagues) is essential. DE-LOSS aims to close this knowledge gap.

Junior research group leader:
Jun.-Prof. Dr Nathalie Oexle, Department of Psychiatry and Psychotherapy II, University of Ulm, Section Public Mental Health

Co-operation partner:

• Junior Prof. Dr Miriam Rassenhofer & Prof. Dr Jörg Fegert, Ulm University Hospital, Department of Child and Adolescent Psychiatry/Psychotherapy
• Dr Daniel Buschek, University of Bayreuth, Faculty of Mathematics, Physics and Computer Science
• Prof. Dr Nicolas Rüsch, Prof. Dr Thomas Becker & Prof. Dr Reinhold Killian, Department of Psychiatry and Psychotherapy II at the University of Ulm
• Prof Dr Ulrich Reininghaus, ZI Mannheim, Department of Public Mental Health
• Prof Dr Benjamin Mayer, University of Ulm, Institute for Epidemiology and Medical Biometry

Ulm University staff:
Nadine Bayer
Matthias Lühr
Sophie Rudolf

Funding: BMBF (junior research groups in health services research)

Duration: 10/2022 - 09/2027

Summary:
Suicide is a leading cause of death among adolescents and it is estimated that about one third of adolescents in Germany experience suicidal thoughts, while about 6-9% attempt suicide. The treatment of acute suicide risk among adolescents usually takes place in the context of an inpatient hospital stay, but a particularly high risk of suicidal behaviour can be observed in the days and weeks following discharge. An integral part of current measures to reduce this increased risk of suicide is safety planning. This includes a personalised action plan with so-called "skills" (e.g. distraction, seeking help), which, when applied in a possible suicidal crisis, should reduce the patient's suicide risk. An important limitation that could severely limit the effectiveness of traditional safety planning is its dependence on the availability and self-application of a paper-based action plan in everyday situations of high emotional stress. An innovative further development of safety planning is its implementation as a personalised smartphone app. However, here too there is the limitation of dependence on self-application in situations of high emotional stress. A significant increase in effectiveness could be achieved with an automatic trigger that automatically starts interventions in suicidal crises. The objective of EMIRA is therefore to develop and evaluate an automatically starting safety planning smartphone app to reduce the suicide risk of adolescents aged 14-21 after inpatient treatment in a child and adolescent psychiatric clinic.

Participating institutions and co-operations:

• Clinic and Polyclinic for Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf (UKE)
• Lüneburg Psychiatric Clinic, Department of Psychiatry, Psychotherapy and Psychosomatics
• Brandenburg Medical School, Immanuel Clinic Rüdersdorf
• Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin
• Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban, Berlin
• Clinic for Psychiatry and Psychotherapy II of the University of Ulm at Günzburg District Hospital
• Donauwörth District Hospital, Specialist Clinic for Psychiatry, Psychotherapy and Psychosomatics at the Donau-Ries Clinic

Funding: Volkswagen Foundation

Background:
In the current S3 guidelines "Psychosocial therapies for severe mental illness", home treatment and peer support are listed and recommended as two interventions in the treatment of people in severe mental crises. Despite positive evidence, both treatment approaches are not yet part of standard care. The aim of the HoPe project is to evaluate home treatment in combination with peer support for people in severe mental health crises. As part of a multi-centre randomised study, both treatment approaches (home treatment and peer support) are being offered and evaluated at several clinics.

Project management: Prof Dr Nicolas Rüsch, Department of Psychiatry and Psychotherapy II, University of Ulm, Section Public Mental Health

Project coordination: Jana Hörger

Participating scientists:

• Junior Professor Dr Nathalie Oexle, collaborator
• Prof. Dr Silvia Krumm, collaborator (focus on qualitative research)
• Prof. Dr Reinhold Kilian, collaborator (focus on health economics)

Cooperating clinics and practices for child and adolescent psychiatry:

• Sabine Müller and Jörg Fegert, Child and Adolescent Psychiatry, University of Ulm
• Isabel Böge, Child and Adolescent Psychiatry, Ravensburg-Weissenau
• Tomas Jarczok, Child and Adolescent Psychiatry, Josefinum Augsburg
• Gerhard and Elisabeth Libal, Libal Practice, Ulm
• Lena Rüsch and Ann-Kathrin Pfalzer, Perspektive practice, Ulm
• Martina Roth-Geiger, joint practice, Weingarten

Summary:
Mental illness in adolescents places an enormous burden on those affected and their environment. This burden is exacerbated by the fact that adolescents with mental illness are often stigmatised and socially excluded. Adolescents are therefore faced with the difficult decision of whether to disclose their illness to others or keep it a secret. Our group's first pilot RCT on IWS in adolescents with mental illness delivered promising results: It was possible to recruit participants for the study and participants in the IWS programme showed positive results in terms of reduced stigma stress and self-stigma as well as increased quality of life (QoL) and a more positive attitude towards help-seeking (Mulfinger et al. 2018). The group programme 'Standing by yourself with dignity' is a stigma management intervention developed for adults. One of the distinguishing features of the programme is that it is led by people with a history of mental illness (peers). The main aim of the randomised controlled trial is to investigate the effectiveness of the group programme in this target group. In addition, the role of the disclosure decision will be discussed and the health economic aspects evaluated.

Project management:
Jun.-Prof. Dr Nathalie Oexle, Department of Psychiatry and Psychotherapy II, University of Ulm, Section Public Mental Health

Ulm University staff:
Franziska Marek
Sophie Rudolf

Funding: Baden-Württemberg Foundation (elite programme for postdoctoral researchers)

Duration: 03/2021 - 09/2023

Summary:
Every year, around 10,000 people die by suicide in Germany, and the number of suicide attempts is estimated to be 10 times higher. Despite this high number of people affected, the topic is highly taboo. A lack of knowledge about suicide and negative attitudes towards people who experience suicidal behaviour have a number of negative consequences that make suicide prevention more difficult. For fear of rejection, negative reactions and out of shame, many of those affected keep their suicidal thoughts to themselves - as a result of which they receive no support or treatment. Many relatives also feel left alone in their grief due to the prejudices of others. At the same time, however, there are also indications that liberal social attitudes towards suicide, i.e. a normalisation of the topic, can encourage suicidal behaviour. The question therefore arises as to whether, and if so, how, knowledge and attitudes towards suicide can be improved without undesirable side effects. The project "Beneficial and harmful effects of reducing public suicide stigma" aims to answer this question. To this end, four potential interventions to increase knowledge and reduce stigma have been developed and their effectiveness and undesirable side effects are being tested in a web-based RCT.