Public Mental Health – ongoing studies

Adopting a public mental health perspective on monitoring and surveillance requires us to consider the entire spectrum of mental-ill health, which broadly ranges from severe mental disorders via at-risk populations to positive mental health and well-being. This population mental health approach has become the mainstay of public mental health provision in many European countries, but there has been a dearth of research on this issue in Germany in the past 20 years, and fundamental conceptual and methodological issues remain to be addressed in relation to this approach at both the national and international level.

The MAKO study aims to establish and delineate the basic epidemiology of population mental health by testing key aspects (i.e., treated incidence, clinical stage transitions, transdiagnostic dimensions, digital momentary phenotypes, population mean) of an integrated transdiagnostic model encompassing the entire continuum of mental ill-health. To achieve this, we will establish a highly innovative, two-arm population-based incidence and inception cohort study, in a tightly defined catchment area (Mannheim ) in Germany using cutting-edge statistical approaches and digital technology. In the incidence arm, incident cases will be identified using rigorous case ascertainment procedures (including a leakage study) from around 326,000 persons at risk in the catchment area of Mannheim over a two-year case ascertainment period, which will provide an equivalent of 652,000person-years at risk. In the inception cohort-arm, we will recruit, at baseline (t0), a population-based, epidemiologically characterized cohort of individuals, who meet criteria for a clinical high-risk state for severe mental disorder (CHARMS, stage 1b) or non-specific psychological distress (stage 1a), as well as individuals, who do not meet these criteria (stage 0), by selecting a stratified random sample from the same catchment area as incident cases. This cohort will be recruited over a period of 18 months and followed every 6 months, with a minimum follow-up time of 12 months for all participants, corresponding to a total duration for recruitment and assessment of 2.5 years. This will ensure that all participants will be followed at 6 months (t1) and 12 months (t2), whilst allowing us to collect data, where possible, at 18 months (t3) and 24 months (t4), thereby making optimal use of time to event (survival) data.

This two-arm design will allow us to calibrate the entire mental ill-health continuum, examine fundamental conceptual and methodological issues, establish the nationwide feasibility of design and methods for more comprehensive monitoring of population mental health, and, thereby, provide the basis for assessing the impact of novel public mental health services at the population level.

This study is funded by the German Research Foundation.

You can participate in the MAKO study if you are

• living in Mannheim
• between 14 and 64 years of age
• feeling mentally well/healthy or
• feeling distressed; having difficulties in dealing with emotions or
• currently affected by a mental disorder

You can contact us via phone (+49 621 1703-1932) or e-mail (MAKO-StudieatZI-mannheim.de). In a first phone call, we will establish whether you are eligible for taking part in MAKO.

You can make an important contribution

The results of our research will contribute to a better understanding of development and occurrence of a first episode of untreated mental disorder. The aim is to improve the planning of,  and develop new  services to meet the needs of the population. This is what we are striving for and we can only achieve this with your help. It is of particular value to us that people from diverse cultural, ethnic and social backgrounds participate in the study.

For further information, please contact the study team at MAKO-StudieatZI-mannheim.de.

Youth are particularly affected by mental health problems, but  their use of, and access to, preventive interventions remains limited, as these are often not tailored to their personal needs and real-world settings. The recent rapid advances in Artificial Intelligence (AI) and digitization enable the development of novel digital interventions, which perfectly lend themselves to reach the generation of "digital natives" directly in their daily life and, thereby, improve access to interventions for mental health promotion and prevention. This applies in particular to digital ecological momentary interventions, which offer adaptive training components for mental health promotion and prevention via a smartphone app by real-time processing of ecological momentary assessment (EMA) and sensor data. Modern AI algorithms can significantly improve this process of personalizing training components by applying advanced prediction models (in particular, recurrent neural networks) to real-time multimodal EMA data and translating their findings back into personalized suggestions for mental health promotion and prevention.

To this end, we have recently launched the living lab “Artificial Intelligence for personalized digital mental health promotion and prevention in youth”. The overarching aim of this living lab is the exemplary and participatory investigation of the digital transformation (i.e., the processes underlying the rapid advances in digital technologies and AI) in public mental health provision based on the novel application of AI methods to a digital mHealth training for mental health promotion and prevention in adolescents and young adults that is tailored to person, moment and context in daily life. The living lab is carried out in transdisciplinary projects involving direct participation of relevant stakeholders, users from the target population and an interdisciplinary research group. Each of these projects includes one or more real-world experiments. These will be embedded in a transdisciplinary infrastructure, which will ensure ongoing quality assurance, sustainability assessment, public relations and networking.

The living lab is funded by the Ministry of Science, Research and Art of the State of Baden-Württemberg.

For further information and registration pleaste contact the study team Tel.: 0621 1703-1929 or via E-Mail christian.rauschenberg(at)zi-mannheim.de

The overarching aim of IMMERSE (Implementing Mobile MEntal health Recording Strategy for Europe) is to advance the transformation of mental health care in Europe into true person-centered care, focused on the needs of each individual seeking help for mental health problems, while giving them an active role in their treatment process and decision-making. In order to do so, IMMERSE has identified the Experience Sampling Methodology (ESM), a structured diary technique, as the methodology that puts the service user at the heart of their treatment. IMMERSE will integrate 20 years of research evidence on ESM into an innovative, clinical digital health tool, Digital Mobile Mental Health (DMMH), in close collaboration with stakeholders and extending it with mobile sensing data and innovative machine learning models. DMMH consists of an ESM app, assessing self-reports of mental state in daily life (ecological momentary assessment, EMA), a data-platform that allows the analysis of these data, and dashboard for visualization and feedback. IMMERSE will thoroughly evaluate strategies, processes and outcomes of DMMH implementation in a cluster Randomized Controlled Trial (cRCT) at 8 sites in 4 countries in Europe representing different contexts for implementation evaluation. At the same time, IMMERSE will identify and overcome key barriers and strengthen facilitators for implementation, transfer and scale-up of DMMH to routine mental health clinical practice by closely collaborating with relevant stakeholders, aligning the innovative DMMH tool to their needs. Similarly, the diverse ethical, legal and policy challenges and requirements will be identified and DMMH will be developed and implemented accordingly. Finally, IMMERSE is set out to do a cost-benefit analysis of the implementation and present a framework for future implementation of DMMH, including forecasting scenarios, aiming at a further scale-up of DMMH across 4 countries in Europe and beyond. IMMERSE thus offers a unique potential to significantly innovate mental health care in Europe.

For further information visit: https://www.immerse-project.eu/

Most mental disorders first emerge in youth and, as such, contribute substantially to global disease burden. In recent years, this has become particularly evident for psychotic disorders, for which risk manifests already at a developmentally earlier stage in the form of subclinical psychotic experiences. Contemporary research further suggests that subclinical psychotic experiences often co-occur with anxiety, depression and mania, reflecting a transdiagnostic phenotype associated with a range of subsequent psychopathological outcomes. Elevated stress sensitivity is one of the most widely studied psychological mechanism underlying psychotic and affective mental health problems. Thus, screening for, and targeting stress sensitivity as an underlying mechanism of, this transdiagnostic phenotype in youth is a promising indicated and translational strategy for preventing adverse outcomes later in life. Psychological help, however, remains difficult to access for youth and has limited efficacy under real-world conditions, calling for novel approaches. Compassion-Focused Interventions (CFIs) offer a wide range of innovative therapeutic techniques for targeting stress sensitivity and enhancing emotional resilience in psychosis, especially when co-occurring with affective disturbances. What is more, the recent rapid technological advances provide a unique opportunity to deliver youth-friendly, accessible, personalized, real-time, mobile health (mHealth) interventions, most prominently, ecological momentary interventions (EMIs) that enable youth to access interventions that are tailored to what a young person needs in a given moment and context in daily life.  EMIs further allow for investigating several causal criteria of candidate underlying psychological mechanisms, but robust, trial-based evidence on these interventions remains very limited.

The project aims to examine the clinical feasibility, candidate underlying mechanisms and initial signals of efficacy of a novel, accessible, transdiagnostic, ecological momentary, compassion-focused intervention for improving emotional resilience to stress (EMIcompass) in youth. In an exploratory randomized controlled trial, youth aged 14-25 with current distress, a broad Clinical High At-Risk Mental State (CHARMS) or a first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention in addition to treatment as usual (TAU) (experimental condition) or a control condition of TAU only. Stress sensitivity, emotional resilience, psychotic, depressive, anxiety and manic symptoms will be the primary outcomes obtained at baseline, post-intervention, and 4-week follow-up. Ecological interventionist causal models will be tested to improve our understanding of several causal criteria of underlying psychological mechanisms and contribute to enhancing efficacy of mHealth interventions for promoting resilience in youth, with the ultimate goal of preventing adverse outcomes later in life.

Targeting low self-esteem in youth exposed to childhood adversity is a promising selective strategy for preventing adult mental disorder, but psychological help remains difficult to access and accept for youth, calling for novel, youth-friendly approaches. Mobile Health (mHealth) and, most prominently, ecological momentary interventions (EMIs) provide a unique opportunity to deliver youth-friendly, personalized, real-time, guided self-help interventions. The aim of this study is to investigate the efficacy of a novel, accessible, transdiagnostic ecological momentary intervention for improving self-esteem (‘SELFIE’) in youth with prior exposure to childhood adversity.

In a parallel-group, assessor-blind, multi-centre randomized controlled trial, individuals aged 12–26 years with prior exposure to childhood adversity and low self-esteem will be randomly allocated to SELFIE in addition to treatment as usual (TAU) as the experimental condition or the control condition of TAU only, which will include access to all standard health care. SELFIE is a digital guided self-help intervention using a guided self-help approach administered through a smartphone-based App to allow for interactive, personalized, real-time and real-world transfer of intervention components in individuals’ daily lives, blended with three training sessions delivered by trained mental health professionals over a 6-week period. Outcomes will be assessed at baseline, post-intervention, and 6-month follow-up by blinded assessors.  

The SELFIE project is conducted in close collaboration with Maastricht University, Academic Medical Center Amsterdam, de Bascule Amsterdam and Parnassia Group.

Distress associated with psychotic experiences, social functioning and general psychopathology are important targets for early intervention in individuals with Ultra-High-Risk state (UHR) and a First-Episode Psychosis (FEP). Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets, but evidence on sustainable change and its underlying mechanisms in individuals’ daily lives remains limited. The aim of the current study is to investigate the efficacy of a novel ecological momentary intervention (EMI) based on methods of ACT.

Individuals with UHR or FEP will be randomly allocated to ACT-DL in addition to treatment as usual (TAU) as the experimental condition or a control condition of TAU only. Outcomes will be assessed at post-intervention, 6-month, and 12-month follow-up, and carried out by blinded assessors. The primary outcome will be distress associated with psychotic experiences, while secondary outcomes will include psychotic experiences, social functioning and general psychopathology. Process measures to assess putative mechanisms of change will include psychological flexibility, stress sensitivity and reward experiences. In addition, acceptability, treatment adherence and treatment fidelity of ACT-DL will be assessed.

This study is carried out jointly with the Center for Contextual Psychiatry at KU Leuven, Maastricht University, Academic Medical Center Amsterdam, Parnassia Group and other Dutch and Belgian academic and clinical partners.

Musculoskeletal pain conditions affect between 13.5% and 47% of the general population. Despite adequate medical treatment, these conditions tend to persist and become chronic. In addition to physical constraints, chronic musculoskeletal pain is associated with psychological and social impairments and can, therefore, contribute to a significant decrease in quality of life. This is why psychological mechanisms should be taken into account when treating chronic musculoskeletal pain. The overarching aim of the perPAIN-project is to develop and evaluate the efficacy of a mechanism-based personalized treatment approach in a feasibility trial, in order to improve treatment outcomes in patients with chronic musculoskeletal pain. This BMBF-funded project is carried out by a research consortium including the medical faculties Heidelberg and Mannheim as well as the Interdisciplinary Center for Clinical Trials, Mainz.

In order to develop a new personalized treatment approach, psychological factors that are relevant for pain to become chronic will be identified. For this purpose, momentary pain, mood and activities of adults (at least 18 years old) with primary chronic back pain, rheumatoid arthritis, osteoarthritis, or fibromyalgia syndrome will be measured in everyday life using app-based ecological momentary assessment (EMA) and by collecting activity and ECG sensor data. In a randomized controlled feasibility trial, participants will then receive a 12-week personalized therapy according to their individual symptoms and characteristics. In addition to psychological interventions for improving pain, this includes innovative  digital monitoring, feedback and personalized ecological momentary intervention (EMI) components that allow for real-time and real-world transfer of therapeutic principles based on common techniques in pain therapy aimed at positive refocusing and behavioral activation, tailored to their personal needs in their everyday life.

Ward-equivalent treatment (StäB), a form of crisis resolution and home treatment in Germany, has been introduced in 2018 as a new model of mental health service delivery for people with an indication for inpatient care. The rapid progress in the field of information and communication technology offers entirely new opportunities for innovative digital mental health care such as telemedicine, eHealth, or mHealth interventions. The aim of this research project is to model and initially evaluate novel digital forms of service delivery in the daily lives of help-seeking individuals for personalized delivery of StäB that may contribute to improving clinical and social outcomes as well as reducing direct and indirect costs. In this project, we focus on four digital forms of service delivery that can be used for personalized delivery of StäB:

1.  communication, continuity of care, and flexibility through online chat and video call;
2. monitoring of symptoms and behaviour in real-time through ecological momentary assessment (EMA);
3. use of multimodal EMA data to generate and offer personalized feedback on subjective experience and behavioural patterns as well as
4. adaptive ecological momentary interventions (EMIs) tailored to the person, moment, and context in daily life.

These new digital forms of service delivery have considerable potential to increase the effectiveness and cost-effectiveness of crisis resolution, home treatment, and assertive outreach. The project will model the application of these forms of care and carefully investigate their quality from the user perspective, safety, feasibility, initial process and outcome quality as well as barriers and facilitators of implementation.

For further information please contact the study team Tel.: 0621 1703-1929 or via E-Mail christian.rauschenberg(at)zi-mannheim.de.

The Corona EMIcompass app provides a digital training for strengthening your mental health from home by improving the way of coping with stress amid the current situation. The goal of the 6-week training is to manage an oftentimes changed everyday life and to treat yourself compassionately – as we would with a good friend. The training combines the use of the Corona EMIcompass app and 4 group training sessions. During the training sessions via video communication, our EMIcompass trainers will introduce various ways of coping with feelings and stress, and practice them together with the group. The app offers new content, supports with practicing previously learned strategies and provides support when it is needed.

As part of the EMIcompass study conducted by the department of Public Mental Health, the Corona EMIcompass app is scientifically monitored.

Our study team will provide further information by phone (0621 1703-1395) or via E-Mail. To participate in the mobile training using the Corona EMIcompass app, please click here.

Falls Sie an der DynAC-Studie teilnehmen möchten, wenden Sie sich an das Studienteam unter Tel.: 0621 1703-1932 oder per E-Mail dynac-studie(at)zi-mannheim.de. Weitere Informationen finden Sie auch hier. 

For further information or registration please contact the study team Tel.: 0621 1703-1932 oder via E-Mail mhfa-studie(at)zi-mannheim.de or click here. 

Registration for the MHFA course must be done separately.

For further information or registration please contact the study team Tel.: 0621 1703-1932 oder via E-Mail bee-studie(at)zi-mannheim.de.

For further information or registration please contact the study team Tel.: 0621 1703-1932 or via E-Mail bee-studie(at)zi-mannheim.de.