Trial document




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  DRKS00011561

Trial Description

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Title

Social-support-Networks of persons with mental illnesses

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Trial Acronym

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URL of the Trial

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Brief Summary in Lay Language

Despite the fact that informal social support networks (ISSN) embody an important coping ressource in mental disorders, ISSN are underestimated respectively inadequately considered regarding their influence on the course of disease as well as on the access and the coordination of health care. In this respect, inclusion of ISSN in provision of health care for strengthening social contexts, potential social support and coping cometencies is an important component of psychosocial care for persons with mental disorders. Especially for persons with depressive disorders, whose social retreat is closely associated with the disease, and people with borderline personality disorders, who tend to have unstable social relationships as core criterion of their diagnosis, ISSN seem to be a relevant factor. However, to date there are no systematic findings on ISSN characteristics in persons with depressive disorders and persons with borderline personality disorder.Still, corresponding findings would be needed urgently to assist affected people and their ISSN within psychosocial care.Thus, the research project’s goal is the systematic examination of ISSN of persons with depressive disorders or borderline personality disorder, describing their social structure, and, if possible, analyzing different types of ISSN and their connection to potentials of social support.The study is designed as an exploratory cross-sectional study using standardized telephone inter-views in former patients of the Department of Psychiatry and Psychotherapy of the Medical Center University of Freiburg.

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Brief Summary in Scientific Language

Informal social networks (ISNs) are relationship networks that emerge from communication and exchange processes between different agents of a social structure (Aderhold, 2004). In 2012 a JAMA statement already criticized that the influence of ISSN on the course of disease and on the access to and the coordination of health care is underestimated or inadequately considered (Wolff, 2012), although ISSN probably represent an important nodal point especially for persons with mental disorders that influences their motivation to utilize health care services and preventive services (Wolff, 2012, Loos et al., 2013). In addition, ISSN is an important coping resource for mental disorders (Klauer et al., 2001), and also own research shows that ISSN provides a variety of social support (Frank et al., 2015, Hoffmann, 2015). In this respect, inclusion of ISSN into health care delivery to strengthen social contexts, potential social support and coping competencies is an important factor of the psychosocial care of persons with mental disorders. Especially for persons with depressive disorders and people with borderline personality disorder ISSN seem to be peculiarly relevant. For example, relapses in depressive disorders (DGPPN et al., 2015) and rehospitalizations after in-patient treatment (Bitzer et al., 2011) are frequent and approximately 20% of the affected develop a chronic progression (Spijker et al., 2002; Gilmer et al ., 2005). At this, aspects potentially related to ISSN like low social integration, low social support or negative social interactions are risk factors for such negative or chronic disease progressions (Hölzel et al., 2011). At the same time, individuals with depressive disorders often withdraw from social relationships or get left behind (DGPPN et al., 2015), which has negative effects on the state of ISSN and the aspects mentioned before. Regarding borderline personality disorders the tendency towards unstable social relationship is a core criterion of the diagnosis (Agrawal et al., 2004). In particular family ISSN are characterized by split alliance patterns, inadequate communication, or a lack of family ties, and thus often fail in its function as holding-environment (Ruiz-Sancho & Gunderson, 2000), which has been appreciated etiologically in Linehan’s (2008) concept of invalidating environments. An initial systematic network analysis analyzing ISSN in persons with borderline personality disorders revealed that their social relationships are characterized by significantly frequent contact terminations and that central figures of their ISSN are of little importance for maintaining positive contacts (Clifton et al., 2007). Within an own study essential results and network structures of ISSN of persons with borderline personality disorder were quantified more precisely (Hoffmann, 2015) using a multicentric occasional sampling approach (N = 59). Moreover, four network types with different effects on coping and social support were identified.Systematic findings concerning the nature of ISSN in persons with depressive disorders, further validation of the existing findings for people with borderline personality disorder and differentiation of ISSN constitution between persons with different psychiatric diagnosis groups are still missing. However, such findings are urgently needed to support affected people as well as their ISSN in coping within psychosocial care. Thus, this research project’s goal is systematically recording ISSN of persons with depressive disor-ders or borderline personality, describing their social structure, and, if possible, analyzing different types of ISSN as well as their potentials of social support. The study is designed as an exploratory cross-sectional study using standardized telephone inter-views with former patients of the Department for Psychiatry and Psychotherapy University Medical Center Freiburg.

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Organizational Data

  •   DRKS00011561
  •   2017/03/10
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  •   yes
  •   Approved
  •   574/16, Ethik-Kommission der Albert-Ludwigs-Universität Freiburg
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Secondary IDs

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Health Condition or Problem studied

  •   F32 -  Depressive episode
  •   F33 -  Recurrent depressive disorder
  •   F60.31 -  [generalization F60.3: Emotionally unstable personality disorder]
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Interventions/Observational Groups

  •   Patients with depressive disorders (F32.xx / F33.xx) or borderline personality disorder (F60.31) will be interviewed about their social network’s structure onetime using standardized telephone interview. Therein, sociodemographic and clinical parameters will be assessed based on the recommendations for epidemiological studies (Jöckel et al., 2012), the German Health Interview and Examina-tion Survey for Adults (Gößwald et al., 2012) and with self-constructed items. In addition, dysfunctional patterns of family interaction are measured with Hooley’s and Teasdale’s (1989) Perceived Criticism Scale and Fydrich’s et al. (2009) short form of the social support question-naire is used to assess perceived social support. Furthermore, the use of health care services will be captured based on the Client Sociodemographic and Service Receipt Inventory (Roick et al., 2001), the questionnaire for acquisition of health care in old age (Seidl et al., 2015) and German Health Interview and Examination Survey for Adults (Gößwald et al., 2012).
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Characteristics

  •   Non-interventional
  •   Observational study
  •   Single arm study
  •   Open (masking not used)
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  •   Uncontrolled/Single arm
  •   Other
  •   Single (group)
  •   N/A
  •   N/A
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Primary Outcome

It is an exploratory pilot study and therefore, no primary and secondary outcomes, but primary and secondary objectives are defined. As primary objective, informal social support networks (ISSN) of persons with depressive disorders (ICD-10 F32.xx and F33.xx) and / or borderline personality disorder (ICD-10 F60.31) will be assessed systematically and their social structure will be described formally. The ISSN structure will be collected with a standardized telephone interview, which is based on instruments of general network analyses (Wellmann 1979, Burt 1984, Fischer 1991) as well as psychiatric network analyses (Stosberg 1999, Clifton et al 2007, Hoffmann 2015). In particular, generators for the anonymized collection of network persons, their sociodemographic measures (e.g. age, sex), aspects regarding the relationship to the interviewed person (e.g. role, accessibility) and the connection between the persons relevant to the network will be assessed. In respect of the formal description of ISSN, relational parameters will summarize global features of the network (e.g. density, multiplexity). Characteristics of network partners (so-called Alteri) will be included in aggregated form for ISSN further description (e.g. homogeneity or heterogeneity of ISSN).

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Secondary Outcome

Starting from the described primary objectives, the aim is to examine whether there are diagnosis-specific differences in ISSN or whether different types of ISSN can be differentiated within or possibly across diagnosis groups. In addition to that, identified ISSN types shall be analyzed with regard to their potential for social support measured by the standardized short form of the questionnaire for social support (Fydrich et al., 2009) or their current dysfunctional interaction patterns measured via the Perceived Criticism Scale by Hooley and Teasdale (1989).

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Countries of Recruitment

  •   Germany
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Locations of Recruitment

  • University Medical Center 
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Recruitment

  •   Actual
  •   2017/04/01
  •   150
  •   Monocenter trial
  •   National
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Inclusion Criteria

  •   Both, male and female
  •   18   Years
  •   no maximum age
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Additional Inclusion Criteria

Paitents (older 18 years) with a primary diagnosis of a depressive disorder (F32.xx or F33.xx) or borderline personality disorder (F60.31) discharged from inpatient treatment at the Department of Psychiatry and Psychotherapy Medical Center University of Freiburg between 01.07.2012 and 30.06.2016 will be included. At least one stationary stay must have had a minimum duration of seven days in the given period. On the one hand, this minimum duration is required because the planned study is intended to refer to patients with regular inpatient treatment. Shorter stationary admissions are usually crisis interventions, which often indicate an involuntary special situation that will not be included in this study. On the other hand, the minimum period of stay is required to ensure that all included patients un-derwent an adequate diagnostic process to ensure the correctness of the given primary diagnosis. Another prerequisite for patients to participate is the completion of a discharge questionnaire after their last inpatient stay in the Department for Psychiatry and Psychotherapy Medical Center University of Freiburg and the agreement to be contacted for research purposes. In addition, patients must have sufficient knowledge of German language to carry out the standardized telephone interviews and they must be able to give informed consent.

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Exclusion Criteria

Patients younger than 18 years of age and those with a primary diagnosis that differs from the listed target diagnoses will be excluded from the study. Furthermore, patients will be excluded, who did not complete the discharge questionnaire during their last inpatient stay at the Department of Psychiatry and Psychotherapy Medical Center University of Freiburg or who denied to be contacted for research purposes. Lastly, patients will also be excluded, if their longest inpatient stay has not lasted at least seven days or more during any of their stays in the reference period. Further criteria for exclusion are not intended.

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Addresses

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    • Universitätsklinikum FreiburgKlinik für Psychiatrie und PsychotherapieAG Psychotherapie- und Versorgungsforschung
    • Mr.  Dr. phil.  Fabian  Frank 
    • Hauptstraße 5
    • 79104  Freiburg
    • Germany
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    • Evangelische Hochschule FreiburgFachbereich Soziale Arbeit
    • Mr.  Prof. Dr. phil.  Heiko  Löwenstein 
    • Bugginger Straße 38
    • 79114  Freiburg
    • Germany
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    • Universitätsklinikum FreiburgKlinik für Psychiatrie und PsychotherapieAG Psychotherapie- und Versorgungsforschung
    • Mr.  Dr. phil.  Fabian  Frank 
    • Hauptstraße 5
    • 79104  Freiburg
    • Germany
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    • Universitätsklinikum FreiburgKlinik für Psychiatrie und PsychotherapieAG Psychotherapie- und Versorgungsforschung
    • Mr.  Dr. phil.  Fabian  Frank 
    • Hauptstraße 5
    • 79104  Freiburg
    • Germany
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Sources of Monetary or Material Support

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    • Universitätsklinikum FreiburgKlinik für Psychiatrie und PsychotherapieAG Psychotherapie- und Versorgungsforschung
    • Mr.  Dr. phil.  Fabian  Frank 
    • Hauptstraße 5
    • 79104  Freiburg
    • Germany
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Status

  •   Recruiting complete, follow-up complete
  •   2017/07/21
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Trial Publications, Results and other Documents

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