Die psychische Gesundheit von Kindern, Jugendlichen und jungen Erwachsenen – Teil 2: Krankheitslast, Defizite des deutschen Versorgungssystems, Effektivität und Effizienz von „Early Intervention Services“

A. Karow; T. Bock; D. Naber; B. Löwe; M. Schulte-Markwort; I. Schäfer; A. Gumz; P. Degkwitz; B. Schulte; H. H. König; A. Konnopka; M. Bauer; A. Bechdolf; C. Correll; G. Juckel; J. Klosterkötter; K. Leopold; A. Pfennig; M. Lambert

doi:10.1055/s-0033-1355840

Fortschritte der Neurologie · Psychiatrie, Table of Contents

Fortschr Neurol Psychiatr 2013; 81(11): 628-638
DOI: 10.1055/s-0033-1355840

Übersicht

Die psychische Gesundheit von Kindern, Jugendlichen und jungen Erwachsenen – Teil 2: Krankheitslast, Defizite des deutschen Versorgungssystems, Effektivität und Effizienz von „Early Intervention Services“

Mental Health of Children, Adolescents and Young Adults – Part 2: Burden of Illness, Deficits of the German Health Care System and Efficacy and Effectiveness of Early Intervention Services

A. Karow

¹Arbeitsbereich Psychosen, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

T. Bock

¹Arbeitsbereich Psychosen, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

D. Naber

¹Arbeitsbereich Psychosen, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

B. Löwe

²Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

M. Schulte-Markwort

³Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

I. Schäfer

⁴Zentrum für Interdisziplinäre Suchtforschung (ZIS), Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

A. Gumz

²Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

P. Degkwitz

⁵Center for Health Care Research (CHCR), Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

B. Schulte

⁴Zentrum für Interdisziplinäre Suchtforschung (ZIS), Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

H. H. König

⁷Institut für Medizinische Soziologie, Sozialmedizin und Gesundheitsökonomie (IMSG), Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

A. Konnopka

⁷Institut für Medizinische Soziologie, Sozialmedizin und Gesundheitsökonomie (IMSG), Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

,

M. Bauer

⁸Klinik und Poliklinik für Psychiatrie und Psychotherapie Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden

,

A. Bechdolf

⁹Klinik für Psychiatrie und Psychotherapie, Universität zu Köln

¹⁰Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin

,

C. Correll

¹¹The Zucker Hillside Hospital, Division of Psychiatry Research, North Shore-LIJ Health System, Glen Oaks/NY, USA

,

G. Juckel

¹²Klinik für Pychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr-Universität Bochum

,

J. Klosterkötter

¹⁰Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin

,

K. Leopold

⁸Klinik und Poliklinik für Psychiatrie und Psychotherapie Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden

,

A. Pfennig

⁸Klinik und Poliklinik für Psychiatrie und Psychotherapie Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden

,

M. Lambert

¹Arbeitsbereich Psychosen, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

› Author Affiliations

Abstract

Zusammenfassung

In einer Vielzahl von Geburtskohortenstudien, epidemiologischen Studien und klinischen Beobachtungsstudien wurden psychische Erkrankungen bei Kindern, Jugendlichen und jungen Erwachsenen in Bezug auf Häufigkeit, Ersterkrankungsalter, Belastungsfaktoren, Störungspersistenz, Service-Inanspruchnahme, Behandlungsverzögerung und Krankheitsverlauf untersucht. Eine Vielzahl von Publikationen befasste sich darüber hinaus mit den Konsequenzen psychischer Erkrankungen hinsichtlich der Krankheitslast, den Versorgungsdefiziten sowie der Effektivität und Effizienz von „Early Intervention Services“. Die Ergebnisse zeigen, dass die Mehrzahl aller psychischen Erkrankungen bereits in der Kindheit, Jugend und im jungen Erwachsenenalter erstmals auftreten. Es lassen sich dabei kombinierte und dauerhafte Belastungsfaktoren nachweisen, die das Risiko, (früh und chronisch) psychisch zu erkranken, erhöhen. In der Kindheit und Jugend erstmals aufgetretene psychische Störungen persistieren häufig bis in das Erwachsenenalter. Als wesentliche Ursachen hierfür wurden eine niedrigere Inanspruchnahme von Behandlung und eine lange Behandlungsverzögerung mit verschiedenen negativen Konsequenzen sowie eine allgemein unzureichende Behandlungsqualität bei Kontakt zum Hilfesystem identifiziert. Zahlreiche andere Länder haben dementsprechend begonnen, an der Schnittstelle zwischen Kinder- und Jugend- und Erwachsenenpsychiatrie sog. „Early Intervention Services (EIS)“ zu implementieren. Teil 2 des Reviews befasst sich mit der Krankheitslast inklusive der Kosten psychischer Erkrankungen, Versorgungsdefiziten in Deutschland sowie dem Stand der Forschung zur Effektivität und Effizienz sogenannter „Early Intervention Services“ (EIS).

Abstract

Numerous birth-control studies, epidemiological studies, and observational studies investigated mental health and health care in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, treatment delay and course of illness. Moreover, the impact of the burden of illness, of deficits of present health care systems, and the efficacy and effectiveness of early intervention services on mental health were evaluated. According to these data, most mental disorders start during childhood, adolescence and early adulthood. Many children, adolescents and young adults are exposed to single or multiple adversities, which increase the risk for (early) manifestations of mental diseases as well as for their chronicity. Early-onset mental disorders often persist into adulthood. Service use of children, adolescents and young adults is low, even lower than in adult patients. Moreover, there is often a long delay between onset of illness and first adequate treatment with a variety of linked consequences for poorer psychosocial prognosis. This leads to a large burden of illness with respect to disability and costs. As a consequence several countries have implemented so-called “early intervention services” at the border of child and adolescent and adult psychiatry. Emerging studies show that these health care structures are effective and efficient. Part 2 of the present review focuses on illness burden including disability and costs, deficits of the present health care system in Germany, and efficacy and efficiency of early intervention services.

Schlüsselwörter

Prävention - psychische Erkrankungen - Jugendliche - junge Erwachsene

Key words

prevention - mental disorders - adolescents - young adults

Full Text

References

Literatur
1 Gore FM, Bloem PJ, Patton GC et al. Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 2011; 377: 2093-2102
2 Vos T, Flaxman AD, Naghavi M et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163-2196
3 Kawakami N, Abdulghani EA, Alonso J et al. Early-life mental disorders and adult household income in the World Mental Health Surveys. Biological psychiatry 2012; 72: 228-237
4 Gustavsson A, Svensson M, Jacobi F et al. Cost of disorders of the brain in Europe 2010. European Neuropsychopharmacology 2011; 21: 718-779
5 Wittchen HU, Jacobi F, Rehm J et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology 2011; 21: 655-679
6 Olesen J, Gustavsson A, Svensson M et al. The economic cost of brain disorders in Europe. European Journal of Neurology 2012; 19: 155-162
7 Jacobi F, Wittchen HU, Hölting C et al. Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). In: Cambridge Journals Online 2004; 34 (4) 597-611
8 Thornicroft G. Most people with mental illness are not treated. Lancet 2007; 370: 807-808
9 Wang PS, Angermeyer M, Borges G et al. Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 2007; 6: 177-185
10 Shatkin JP, Belfer ML. The global absence of child and adolescent mental health policy. Child and Adolescent Mental Health 2004; 9: 104-108
11 Singh SP. Transition of care from child to adult mental health services: the great divide. Current opinion in psychiatry 2009; 22: 386-390
12 Costello EJ, Egger H, Angold A. 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child and Adolescent Psychiatry 2005; 44: 972-986
13 Saha S, Chant D, McGrath J. Meta-analyses of the incidence and prevalence of schizophrenia: conceptual and methodological issues. International journal of methods in psychiatric research 2008; 17: 55-61
14 Kirkbride JB, Errazuriz A, Croudace TJ et al. Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analysis. PLoS One 2012; 7: e31660
15 Jablensky A, Sartorius N, Ernberg G et al. Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr Suppl 1992; 20: 1-97
16 Kieling C, Baker-Henningham H, Belfer M et al. Child and adolescent mental health worldwide: evidence for action. Lancet 2011; 378: 1515-1525
17 Brockington I, Chandra P, Dubowitz H et al. WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders. World Psychiatry 2011; 10: 93-102
18 Kohn R, Saxena S, Levav I et al. The treatment gap in mental health care. Bulletin of the World Health Organization 2004; 82: 858-866
19 McGorry P, Purcell R, Hickie I et al. Investing in youth mental health is a best buy. Medical Journal of Australia 2007; 5: 187
20 McGorry PD, Purcell R, Hickie IB et al. Clinical staging: a heuristic model for psychiatry and youth mental health. The Medical Journal of Australia 2007; 187: S40-S42
21 McGorry P, Purcell R. Youth mental health reform and early intervention: encouraging early signs. Early intervention in psychiatry 2009; 3: 161-162
22 Haggerty RJ, Mrazek PJ. Can We Prevent Mental Illness?. Bulletin of the New York Academy of Medicine 1994; 71: 300-306
23 Janusic T. Promoting youth mental health. Medical Journal of Australia 2012; 196: 54
24 Park MJ, Adams SH, Irwin CEJ. Health care services and the transition to young adulthood: challenges and opportunities. American Academy of Pediatrics 2011; 11: 115-122
25 McGorry P, Hazell P, Hickie I et al. The 'youth model' in mental health services. Australias Psychiatry 2008; 16: 136-137
26 McGorry P. Should youth mental health become a speciality in its own right? Yes. Bmj 2009; 339: b3373
27 McGorry PD, Edwards J, Mihalopoulos C et al. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull 1996; 22: 305-326
28 Srihari VH, Shah J, Keshavan MS. Is early intervention for psychosis feasible and effective?. The Psychiatric clinics of North America 35: 613-631
29 Malla A, Schmitz N, Norman R et al. A multisite Canadian study of outcome of first-episode psychosis treated in publicly funded early intervention services. Canadian journal of psychiatry 2007; 52: 563-571
30 Bertelsen M, Jeppesen P, Petersen L et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of general psychiatry 2008; 65: 762-771
31 Norman RM, Manchanda R, Malla AK et al. Symptom and functional outcomes for a 5 year early intervention program for psychoses. Schizophrenia research 2011; 129: 111-115
32 Gafoor R, Nitsch D, McCrone P et al. Effect of early intervention on 5-year outcome in non-affective psychosis. Br J Psychiatry 2010; 196: 372-376
33 Larsen TK, Melle I, Auestad B et al. Early detection of psychosis: positive effects on 5-year outcome. Psychological medicine 2011; 41: 1461-1469
34 de Girolamo G, Dagani J, Purcell R et al. Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. Epidemiology and psychiatric sciences 2012; 21: 47-57
35 IRIS. Guidelines for Early Intervention in Psychosis. IRIS Guidelines Principles. http://www.iris-initiative.org.uk In
36 Joa I, Johannessen JO, Auestad B et al. The key to reducing duration of untreated first psychosis: information campaigns. Schizophr Bull 2008; 34: 466-472
37 Wright A, McGorry PD, Harris MG et al. Development and evaluation of a youth mental health community awareness campaign – The Compass Strategy. BMC public health 2006; 6: 215
38 Morgan A, Jorm A. Awareness of beyondblue: the national depression initiative in Australian young people. Australias Psychiatry 2007; 15: 329-333
39 Jorm AF, Christensen H, Griffiths KM. Changes in depression awareness and attitudes in Australia: the impact of beyondblue: the national depression initiative. The Australian and New Zealand journal of psychiatry 2006; 40: 42-46
40 Jorm AF. Australian young people’s awareness of headspace, beyondblue and other mental health organizations. Australias Psychiatry 2009; 17: 472-474
41 Yap MB, Reavley NJ, Jorm AF. Associations between awareness of beyondblue and mental health literacy in Australian youth: Results from a national survey. The Australian and New Zealand journal of psychiatry 2012; 46: 541-552
42 Yap MB, Reavley NJ, Jorm AF. Intentions and helpfulness beliefs about first aid responses for young people with mental disorders: findings from two Australian national surveys of youth. Journal of affective disorders 2012; 136: 430-442
43 Hoven CW, Doan T, Musa GJ et al. Worldwide child and adolescent mental health begins with awareness: a preliminary assessment in nine countries. International review of psychiatry (Abingdon, England) 2008; 20: 261-270
44 Slade EP. Effects of school-based mental health programs on mental health service use by adolescents at school and in the community. Mental health services research 2002; 4: 151-166
45 Langeveld J, Joa I, Larsen TK et al. Teachers’ awareness for psychotic symptoms in secondary school: the effects of an early detection programme and information campaign. Early intervention in psychiatry 2011; 5: 115-121
46 Jorm AF, Kitchener BA, Fischer JA et al. Mental health first aid training by e-learning: a randomized controlled trial. The Australian and New Zealand journal of psychiatry 2010; 44: 1072-1081
47 Cappella E, Hamre BK, Kim HY et al. Teacher consultation and coaching within mental health practice: classroom and child effects in urban elementary schools. Journal of consulting and clinical psychology 2012; 80: 597-610
48 Tait L, Lester H, Birchwood M et al. Design of the BiRmingham Early Detection In untREated psyChosis Trial (REDIRECT): cluster randomised controlled trial of general practitioner education in detection of first episode psychosis [ISRCTN87898421]. BMC health services research 2005; 5: 19
49 Lester H, Birchwood M, Freemantle N et al. REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis. Br J Gen Pract 2009; 59: e183-e190
50 Power P, Iacoponi E, Reynolds N et al. The Lambeth Early Onset Crisis Assessment Team Study: general practitioner education and access to an early detection team in first-episode psychosis. The British Journal of psychiatry 2007; 51: s133-s139
51 Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems?. The Medical Journal of Australia 2007; 187: S35-S39
52 Vanheusden K, Mulder CL, van der Ende J et al. Young adults face major barriers to seeking help from mental health services. Patient education and counseling 2008; 73: 97-104
53 Wilson CJ, Bushnell JA, Caputi P. Early access and help seeking: practice implications and new initiatives. Early intervention in psychiatry 2011; 5 (Suppl. 01) 34-39
54 Amone-P'Olak K, Ormel J, Oldehinkel AJ et al. Socioeconomic position predicts speciality mental health service use independent of clinical severity: the TRAILS study. Journal of the American Academy of Child and Adolescent Psychiatry 2010; 49: 647-655
55 Davidson L, Bellamy C, Guy K et al. Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry 2012; 11: 123-128
56 Druss BG, Zhao L, von Esenwein SA et al. The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophrenia research 2010; 118: 264-270
57 McGorry PD. Is early intervention in the major psychiatric disorders justified? Yes. Bmj 2008; 337: a695
58 Johannessen JO, McGlashan TH, Larsen TK et al. Early detection strategies for untreated first-episode psychosis. Schizophrenia research 2001; 51: 39-46
59 Melle I, Larsen TK, Haahr U. Reducing the duration of untreated first-episode psychosis: Effects on clinical presentation. Archives of general psychiatry 2004; 61: 143-150
60 Larsen TK, McGlashan TH, Johannessen JO et al. Shortened duration of untreated first episode of psychosis: changes in patient characteristics at treatment. The American journal of psychiatry 2001; 158: 1917-1919
61 Chen EY, Tang JY, Hui CL et al. Three-year outcome of phase-specific early intervention for first-episode psychosis: a cohort study in Hong Kong. Early intervention in psychiatry 2011; 5: 315-323
62 Malla A, Norman R, Scholten D et al. A community intervention for early identification of first episode psychosis: impact on duration of untreated psychosis (DUP) and patient characteristics. Social psychiatry and psychiatric epidemiology 2005; 40: 337-344
63 Chong SA, Mythily S, Verma S. Reducing the duration of untreated psychosis and changing help-seeking behaviour in Singapore. Social psychiatry and psychiatric epidemiology 2005; 40: 619-621
64 Dodgson G, Ross L, Tiffin P et al. Outcomes post-discharge from an early intervention in psychosis service. Early intervention in psychiatry 2012; 6: 465-468
65 Lambert M, Bock T, Schottle D et al. Assertive community treatment as part of integrated care versus standard care: a 12-month trial in patients with first- and multiple-episode schizophrenia spectrum disorders treated with quetiapine immediate release (ACCESS Trial). The Journal of clinical psychiatry 2010; 71: 1313-1323
66 Petersen L, Jeppesen P, Thorup A et al. A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. Bmj 2005; 331: 602
67 Hegelstad WT, Larsen TK, Auestad B et al. Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome. The American journal of psychiatry 2012; 169: 374-380
68 Lambert M, Conus P, Lubman DI et al. The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta psychiatrica Scandinavica 2005; 112: 141-148
69 Ballageer T, Malla A, Manchanda R et al. Is adolescent-onset first-episode psychosis different from adult onset?. Journal of the American Academy of Child and Adolescent Psychiatry 2005; 44: 782-789
70 Schimmelmann BG, Conus P, Cotton S et al. Pre-treatment, baseline, and outcome differences between early-onset and adult-onset psychosis in an epidemiological cohort of 636 first-episode patients. Schizophrenia research 2007; 95: 1-8
71 Karow A, Reimer J, Konig HH et al. Cost-effectiveness of 12-month therapeutic assertive community treatment as part of integrated care versus standard care in patients with schizophrenia treated with quetiapine immediate release (ACCESS trial). The Journal of clinical psychiatry 2012; 73: e402-e408
72 Goldberg K, Norman R, Hoch JS et al. Impact of a specialized early intervention service for psychotic disorders on patient characteristics, service use, and hospital costs in a defined catchment area. Canadian journal of psychiatry 2006; 51: 895-903
73 McCrone P, Killaspy H, Bebbington P et al. The REACT study: cost-effectiveness analysis of assertive community treatment in north London. Psychiatric services. Psychiatric services Washington, DC 2009; 60: 908-913
74 McCrone P, Knapp M, Dhanasiri S. Economic impact of services for first-episode psychosis: a decision model approach. Early intervention in psychiatry 2009; 3: 266-273
75 Cocchi A, Mapelli V, Meneghelli A et al. Cost-effectiveness of treating first-episode psychosis: five-year follow-up results from an Italian early intervention programme. Early intervention in psychiatry 2011; 5: 203-211
76 Wong KK, Chan SK, Lam MM et al. Cost-effectiveness of an early assessment service for young people with early psychosis in Hong Kong. The Australian and New Zealand journal of psychiatry 2011; 45: 673-680
77 Mihalopoulos C, Harris M, Henry L et al. Is early intervention in psychosis cost-effective over the long term?. Schizophr Bull 2009; 35: 909-918
78 Nordentoft M, Ohlenschlaeger J, Thorup A et al. Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders. Psychological medicine 2010; 40: 1619-1626
79 McCrone P, Craig TK, Power P et al. Cost-effectiveness of an early intervention service for people with psychosis. Br J Psychiatry 2010; 196: 377-382
80 Hastrup LH, Kronborg C, Bertelsen M et al. Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study). Br J Psychiatry 2012; 202 (1) 35-41
81 Zechmeister I, Kilian R, McDaid D. Is it worth investing in mental health promotion and prevention of mental illness? A systematic review of the evidence from economic evaluations. BMC public health 2008; 8: 20
82 Mihalopoulos C, Vos T, Pirkis J et al. The economic analysis of prevention in mental health programs. Annual review of clinical psychology 2011; 7: 169-201
83 Mihalopoulos C, Vos T, Pirkis J et al. The population cost-effectiveness of interventions designed to prevent childhood depression. Pediatrics 2012; 129: e723-e730
84 Lynch FL, Hornbrook M, Clarke GN et al. Cost-effectiveness of an intervention to prevent depression in at-risk teens. Archives of general psychiatry 2005; 62: 1241-1248