Project management:
Prof. Dr phil. Silvia Krumm, M. A., Department of Psychiatry and Psychotherapy II at the University of Ulm, Head of the Qualitative Social Research Working Group

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

Collaborators University of Ulm:
Dr Yamara-Monika Wessling, M.A.
Dr Susanne Jaeger
Sophia Just (student assistant)

Funding: Federal Ministry of Health

Funding amount: € 321,663

Duration: 2020 - 2024

Summary:
ELSA PSY is a sub-project of the Germany-wide study ELSA: Experiences and life situations of unintentionally pregnant women - counselling and care services(https://elsa-studie.de/). The aim of the overall study is to draw conclusions for improving the health and psychosocial care of unintentionally pregnant women on the basis of scientific and empirical findings. On the one hand, the burdens and resources of women who carry an unwanted pregnancy to term or terminate it are determined over time. On the other hand, the status of support and care services is analysed and the perspective of professionals and associations is examined.

The sub-projects of the study take into account women who can be assumed to be particularly vulnerable. These include women with psychological stress, who are the focus of the ELSA PSY sub-project at the University of Ulm. Previous findings show that women with psychological stress are more likely to become pregnant unintentionally and that they face particular challenges in dealing with pregnancy due to specific reproductive risks and socio-cultural factors. There are also indications that unwanted pregnancies can be associated with psychological stress. Overall, it can be assumed that women with psychological stress have a specific need for support. However, the research situation is very patchy.

The aim of the ELSA PSY sub-project is therefore to investigate the psychosocial problems at the onset and in the further course of an unintended pregnancy, attitudes and behaviour in dealing with an unintended pregnancy as well as the subjective need for and use of counselling and support services by women with psychological distress. Methodologically, the analysis is initially based on a representative online survey of women with unintended pregnancies that have been carried to term and women with abortions. Building on this, in-depth analyses of the subjective constructions of meaning in dealing with an unwanted pregnancy in the context of psychological stress are carried out using narrative-biographical instruments. The results form the basis for the development of appropriate services for women with psychological stress who have unintentionally become pregnant.

Project management:
Prof. Dr Silvia Krumm, Sociologist M.A., Department of Psychiatry and Psychotherapy II at the University of Ulm, Head of the Qualitative Social Research Working Group

Prof Dr Georg Schomerus, Director of the Clinic and Polyclinic for Psychiatry and Psychotherapy, Leipzig University Hospital

Project partners:
Clinic and Polyclinic for Psychiatry and Psychotherapy, Leipzig University Hospital (Prof Dr Georg Schomerus)

Ulm University staff:
Dr Anita Scheuermann (project coordinator)
Melanie Pouwels (research assistant)
Sophia Just (student assistant)
Hanna Rock (student assistant)

Funding: German Research Foundation (DFG), Department of Empirical Social Research

Funding amount: € 980,000 (Ulm's share: € 510,000)

Summary:
The starting point of the EVIO study is the empirical finding of a significantly increased risk of mentally ill people experiencing physical violence. In addition to physical harm, experiences of victimisation and violence have a negative impact on mental health and make recovery processes more difficult. In clinical and therapeutic contexts, victimisation and experiences of violence, including the violent behaviour of mentally ill people themselves, are generally only insufficiently recognised and addressed. There has also been a lack of empirical research in Germany to date. In order to develop suitable measures to prevent and reduce the victimisation of mentally ill people, it is important to understand the subjective meanings of violence in the context of social, biographical and institutional factors, in addition to systematically recording violent incidents.

The aim of the EVIO study is a comprehensive investigation of physical and sexualised experiences of violence by mentally ill persons in the context of social, biographical and institutional factors. Following a mixed methods approach, three interrelated sub-projects are being carried out:

1. In a representative sample of 500 patients receiving outpatient or (partial) inpatient treatment in psychiatric hospitals, we survey the frequency and forms of victimisation and own acts of violence, stigmatisation and self-stigmatisation in the context of violence as well as barriers to disclosing experiences of violence in the therapeutic context. The sample is obtained through key date surveys at psychiatric clinics. An online sample representative of the population serves as a comparative sample.
2. Building on this, we are investigating the experience of violence and the social, biographical and normative contextual factors of violent experiences in a group of around 40 people with mental illnesses using biographical-narrative interviews.
3. We also use qualitative and quantitative methods to ask mental health professionals about their experiences and how they deal with victimisation and violent behaviour and their therapeutic work in connection with patients' experiences of violence.

The EVIO study is intended to create a basis for the development of both violence prevention programmes and targeted, needs-based interventions to improve the handling of experiences of violence.

Krumm S, Checchia C, Kilian R, Becker T. Victimisation in adulthood of persons with psychiatric experience. Psychiatric Practice 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. Risk of violence, mental illness and stigma. A challenge for social psychiatry. Social psychiatric information 2019, 4, 13-14.

Krumm S. Mental illness, violence and gender. A blind spot in social psychiatric care? Social psychiatric information 2019, 1, 40-43.

Head of the participatory accompanying research:
Prof. Dr phil. Silvia Krumm, M. A., Clinic for Psychiatry and Psychotherapy II at the University of Ulm, Head of the Qualitative Social Research Working Group

Management of the overall project:
Prof. Dr Ulrich Reininghaus (Head of the Public Mental Health Department, ZI Mannheim)

Project partner:
Central Institute (ZI) for Mental Health, Mannheim

• Department of Public Mental Health
• Department of Theoretical Neuroscience

Practitioners involved:
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

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

Employees Central Institute (ZI) for Mental Health:
Prof. Dr Daniel Durstewitz (Head of Theoretical Neuroscience Department)
Dr Georgia Koppe (Theoretical Neuroscience Department)
Christian Rauschenberg, M. Sc.

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

Funding amount: € 216,644 (TP Ulm)

Duration: 01/2021 - 06/2024

Summary:
Mental illness is one of the main causes of the burden of disease among young people, with three quarters of lifelong mental disorders first occurring in adolescence. At the same time, studies show that despite their need for support and high media affinity, young people are often inadequately reached by health promotion programmes, as these are often not tailored to their needs or real-life environment. Measures to contain the SARS-CoV-2 pandemic (social distancing, homeschooling) and the resulting psychosocial stress have also led to louder calls for digital interventions that can be used by young people without personal contact and can be individually adapted.

The AI4U "Artificial Intelligence for Digital Personalised Mental Health Promotion" real-world laboratory in Mannheim is investigating how the digital transformation in the healthcare sector can succeed through the innovative application of AI methods. To this end, mobile digital training (so-called health or mHealth apps) for mental health promotion and prevention among adolescents and young adults is being developed that is tailored to the real life world of the person, moment and context. Modern AI algorithms could support the mental health promotion and prevention of young people in key areas by evaluating multimodal mobile data, determining predictive factors, predicting progression and translating this back into suggestions for behavioural options.

AI4U will be carried out in a 3-year project phase with the direct participation of young people in the form of focus groups and research workshops as well as key practitioners from the fields of educational counselling, school psychological counselling, school social work and media education. The primary aim is to strengthen emotional resilience and other protective factors in adolescents and young adults. To this end, quality assessments will be included in the development of an mHealth app with regard to a) the impact, acceptance and use of the AI-based training, as well as b) implementation conditions, structural embedding, opportunities, risks and obstacles to implementation. The participation of non-scientific stakeholders and future users is intended to maximise transparency and participation.

Are you interested in taking part in a study?
For further information, please contact our staff on 08221 96-29210 or send an e-mail to christian.goetzl@uni-ulm.de.

1. Hiller, S., Rauschenberg, C., Götzl, C., Fechtelpeter, J., Koppe, G., Durstewitz, D., Reininghaus, U., & Krumm, S. (2023). Shaping together! How young people, practice and science come together in the development of a smartphone app. The AI4U (Artificial Intelligence for Youth) real-world laboratory - interim results of a participatory project to develop a smartphone app based on artificial intelligence to promote the health of young people. unsere jugend, 75(2), 77-91. http://dx.doi.org/10.2378/uj2023.art11d
2. Götzl, C., Hiller, S., Rauschenberg, C. et al. Artificial intelligence-informed mobile mental health apps for young people: a mixed-methods approach on users' and stakeholders' perspectives. Child Adolesc Psychiatry Ment Health 16, 86 (2022). doi. org/10.1186/s13034-022-00522-6

Project management:
Priv. Doz. Dr Silvia Krumm, M. A., Department of Psychiatry and Psychotherapy II at the University of Ulm, Head of the Qualitative Social Research working group

Project partners:
Edith Almer (Chairwoman of the Board)
MutMacherMenschen gemeinnützige e.G.
Blücherstraße 145
86165 Augsburg

Employees University of Ulm:
Nicole Stasch, MSc

Funding: Federal Ministry of Labour and Social Affairs

Funding amount: € 332,642

Duration: 2022 - 2025

Summary:
Gainful employment in the primary labour market contributes significantly to the social participation of people with mental illness. Despite good evidence on the effectiveness of supported employment on professional participation and the strong recommendation of rapid placement on the primary labour market by professional associations, broad implementation is difficult. There is a lack of provision of competitive jobs that are adapted to the special needs of people with mental illness and of low-threshold access to simple jobs. Companies and employers have a central role to play in improving the professional participation of people with mental illness. However, so far there are only isolated findings on the experiences, attitudes and views of the key players and the support needs of employers with regard to setting up and allocating suitable jobs.

The two-part, participatory TAPE project therefore has the following objectives:

1. identifying barriers and facilitating factors for professional participation in the general labour market from the perspective of employers and people with experience of psychiatry
2. systematically analysing practical experiences of solutions in the employment of people with mental illnesses and
3. the participatory development of practical tools for employers and companies to improve the professional participation of people with mental illnesses.

Sub-project 1 involves empirical data collection using a mixed-method approach. The aim is to record the experiences, attitudes and needs of key stakeholders (employers and people with psychiatric experience) with regard to the professional participation of people with mental illness in the primary labour market. A particular focus is on the practical experience of successful participation-orientated workplace design and successful forms of support.

Based on the results of sub-project 1, sub-project 2 will develop practical tools and recommendations for action to support employers in the recruitment and employment of people with mental illnesses.

Project management:
Prof. Dr Silvia Krumm, sociologist M.A., Department of Psychiatry and Psychotherapy II at the University of Ulm, head of the Qualitative Social Research working group

Prof. Dr rer. soc. Reinhold Kilian, Department of Psychiatry and Psychotherapy II at the University of Ulm, Head of the Health Economics and Health Services Research Section

Project partners:
Clinic for Psychosomatic Medicine and Psychotherapy, University of Ulm (Prof. Dr Harald Gündel)

Clinic for Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg at Augsburg District Hospital (Prof Dr Alkomiet Hasan)

kbo-Isar-Amper-Klinikum gGmbH, specialist hospital for psychiatry, psychotherapy, psychosomatic medicine and neurology, academic teaching hospital of the LMU Munich (Prof. Dr Peter Brieger)

Clinic for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Kempten, Academic Teaching Hospital of the University of Ulm (Prof. Dr. Peter Brieger). Teaching Hospital of the University of Ulm (Prof. Dr Markus Jäger)

Heidenheim Hospital, Clinic for Psychiatry, Psychotherapy and Psychosomatics (Dr Martin Zinkler)

Specialist Clinic for Psychiatry, Psychotherapy and Psychosomatics, Donau-Ries Clinic at Donauwörth District Hospital (PD Dr Karel Frasch)

Collaborators University of Ulm:
Natalie Lamp, M. Sc.
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 at BKH Donauwörth:
Maria Panzirsch. M. Sc.

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

Funding: German Research Foundation (DFG)

Funding amount: 587,000 €

Duration: 2022 - 2025

Summary:
According to the "gender paradox of depression", women are affected by depression about twice as often, although men have up to three times the risk of suicide. The reasons for the low rates of depression among men are the inadequate recognition of male-specific symptoms of depression, low uptake of help and a lack of gender-sensitive services. Traditional masculinity norms play a central role here. However, beyond the often stereotypical images of risky male health behaviour, there are hardly any differentiating analyses of the connection between masculinity orientations and mental health as well as the different ways in which men deal with depression. Building on the results of the MenDe study, in the TRANSMODE study we are investigating the gender-related characteristics in the treatment of depressive disorders in men.

Questions:

• How do traditional masculinity and work orientations of men with depressive disorders change in the course of psychiatric treatment and in what way are these changes linked to the course of depressive symptoms as well as stigmatisation tendencies and quality of life?
• What are the affected men's subjective constructions of meaning with regard to the processes of change?
• What significance do couple-related gender role negotiation processes have?

1. Krumm, S., Krieg, G., Lamp, N. et al. The transformation of masculinity orientations and work-related attitudes in men treated for depression (TRANSMODE): study protocol for a mixed-methods observational study. BMC Psychiatry23, 492 (2023). doi.org/10.1186/s12888-023-04979-3

Project management:
Prof. Dr sc. hum. habil. Dipl.-Psych. Matthias Schützwohl, Clinic and Polyclinic for Psychiatry and Psychotherapy, University Hospital of the TU Dresden

Project partners:
Priv. Doz. Dr Silvia Krumm, M. A., Department of Psychiatry and Psychotherapy II, University of Ulm, Head of the Qualitative Social Research Group

Ulm University staff:
Lea Mayer
Nicole Stasch

Funding: Innovation Fund of the Federal Joint Committee (G-BA)

Funding amount: € 249,504

Duration: 2021 - 2022

Summary:
Current studies indicate a pronounced lack of implementation of existing guidelines on psychopharmacotherapy for people with intellectual developmental disorder (IE) in institutionalised residential facilities. Against the background of this lack of care, the project aims to promote the implementation of existing guideline recommendations on psychopharmacotherapy for people with intellectual developmental disorder (IE).
In a first project phase, experts in Baden-Württemberg and Saxony will be interviewed who have specific knowledge regarding the barriers and potential measures for guideline implementation. In a second project phase, focus groups will be conducted in workshops in cluster-randomised selected residential facilities in Baden-Württemberg and Saxony based on the results of this expert survey and the preliminary work of the project management. The aim of the focus groups is to develop instructions for action in as concrete and practical a form as possible, compliance with which will contribute to better implementation of the existing guideline recommendations within the facilities. In a third phase of the project, the developed guidelines will be compared and analysed for commonalities.
As a result, a catalogue of measures that is as generally applicable as possible will be made available and disseminated, which should contribute to more guideline-compliant psychopharmacological treatment of people with IE living in institutionalised forms of housing throughout Germany.

Project management:
Priv. Doz. Dr Silvia Krumm, MAsoz, Department of Psychiatry and Psychotherapy II at the University of Ulm, Research Assistant
Prof. Dr Reinhold Kilian, Department of Psychiatry and Psychotherapy II at the University of Ulm, Head of the Health Economics and Health Services Research Section
Prof. Dr Harald Gündel, Department of Psychosomatic Medicine and Psychotherapy at the University of Ulm, Medical Director

Persons involved:
Prof. Dr Thomas Becker, Department of Psychiatry and Psychotherapy II at the University of Ulm's Günzburg District Hospital, Medical Director
Dr Petra Beschoner, Department of Psychosomatic Medicine and Psychotherapy at the University, Senior Physician and Head of the Behavioural Therapy Treatment Group

Research assistants:
Dr PH Tobias Staiger
Maja Stiawa, MAsoz
Dr biol. hum. Annabel Sandra Müller-Stierlin
Dr phil. Felicitas Söhner
Christian Götzl

Funding: German Research Foundation (DFG)

Funding amount: € 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 double that of men, while men clearly outnumber men in suicides. This 'gender paradox of depression' indicates that gender-specific differences in the underlying biopsychosocial processes are insufficiently taken into account in the diagnosis and treatment of depressive disorders in men. The realisation of the need for appropriate psychiatric-psychotherapeutic help contrasts with a lack of knowledge about the treatment and need for help of men with depressive disorders. With reference to traditional ideals of masculinity, individual study findings paint a one-dimensional picture of male health behaviour that is characterised by low utilisation of therapeutic services. Beyond stereotypical images, little is known about how men construct their masculinity in the context of a depressive illness, what resources and conflicts they perceive in dealing with normative discourses on masculinity or depression and what different strategies they develop in dealing with the depressive symptoms. There is a lack of findings on how men's need for help is perceived and taken into account in psychiatric care.
The mixed-method study aims to analyse constructions of masculinity in the context of depressive illnesses and their significance for men's psychosocial health behaviour. First, masculinity constructions of men suffering from depression (or burnout) are recorded in their connection with social and health-related factors and typologised using a latent class analysis. Building on this, qualitative methods are used to reconstruct types of masculinity with regard to the subjective meaningfulness of health behaviour. The findings are communicatively validated in group discussions with affected men. Finally, the subjective perceptions and evaluations of mental health professionals in dealing with men and masculinity in the context of depressive disorders are analysed.
Against the background of increasing treatment figures for depressive disorders (including burnout), the study provides an empirical basis for the development of gender-equitable psychiatric-psychotherapeutic care that takes account of specific subgroups by analysing the user and professional view of male-specific treatment methods and help needs. The gender-theoretical research interest of the study is to analyse concepts of masculinity in the context of depression as well as their connection with individual factors, discursive social contexts and their potential for change under the conditions of changing gender regimes. By analysing the diversity of concepts of masculinity, the study makes an important contribution to a differentiated picture of 'male depression'.

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. Exhausted fathers? Fatherhood and mental illness. Social Psychiatric Information 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. Men with depressive disorders in inpatient treatment. Needs and treatment goals from the perspective of mental health professionals. Psychiatric Practice 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 and masculinity: illness theories and coping - A biographical-narrative study. Psychiatric Practice 2020, 47:65-70.
7. Krumm S, Kilian R, Beschoner P, Becker T, Gündel H: When being a man becomes a problem. On the relationship between masculinity orientation and depression. Social psychiatric information 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.