On February 22nd 2018, large german insurance company BARMER's medical report was presented in Berlin, releasing comprehensive data on outpatient medical care in Germany. This year's report focused on young individuals between 18 and 25 years. This phase of life is often associated with many life-changing events, and academics play a major role. Many young people are on their own when they start their studies, and while a large part may enjoy their time at college, many students perceive their circumstances as very stressful.
Young and healthy - right?
So far, young people have largely been considered a healthy population group, yet the report reveals that today, more than one in six university students is affected by a mental disorder diagnosis. Looking at the entire group of 18- to 25-year-olds, even every fourth is affected. "In total, nearly 2 million young adults in Germany are suffering from mental health disorders", says PD Dr. med. habil David Ebert, Head of the E-Mental Health & Behavioral Health Promotion and Technology Lab at Friedrich-Alexander-University Erlangen-Nuremberg, who accompanied BARMER in preparing the doctor's report.
Even more so, one should take into account that these numbers only reflect a part of all individuals affected. "As epidemiological studies show that only a part of all young individuals with mental illness actually seek help at a doctor or psychotherapist, we should assume that there is a high number of unreported cases which do not appear in health insurance data" Ebert says, with less than half of all mental illness cases actually being treated. Data of the report also show that only a part of those who are treated actually receive help from a mental health specialist, about half of whom are treated exclusively by the family doctor. It is also frightening that there has been an enormous increase in diagnoses. Depression diagnoses alone have risen more than 70% since 2005.
Need for low-threshold digital support services
Facing these numbers, BARMER emphasizes the high demand for low-threshold offers. "Some affected individuals are very reluctant to seek help from a doctor. A much more important reason why students do not seek professional help, however, is that many simply want to solve their problems on their own" Ebert says. Current research results of the Friedrich-Alexander University Erlangen-Nuremberg and international findings of the WHO World Mental Health Group have corroborated this finding, Ebert emphasizes.
Internet and app-based services could be a solution: "They can help affected people to implement proven psychological strategies independently in everyday life and thus effectively reduce complaints and prevent future disorders. When properly designed one can reach comparable effects as traditional face-to-face psychotherapy". Ebert's research group, together with colleagues, has now conducted more than 30 randomized controlled trials showing that such services cover a wide range of areas, including stress management, coping with depression, reducing anxiety, managing sleep disorders or excessive drinking, and can be highly effective. CEO of BARMER, Prof. Christoph Staub added: "We therefore see great potential in online services, especially if they are anonymous and meet the usage habits of the smartphone generation". Currently, however, it is difficult for users of internet-based services to separate high quality offers from unprofessional ones.
In Germany, there is no quality control and even some offers provided by health insurance companies of questionable quality. A task force of the German Society for Psychology (DGPS) in cooperation with the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) is currently trying to change this by developing quality criteria that should help to ensure that only high-quality, effective programs that are not harmful for patients will find their way into routine care.
An innovative concept: StudiCare
BARMER also supports the StudiCare project, led by David Ebert, which is part of the WHO World Mental Health Group's Caring University project. Its mission is to promote the mental health of students worldwide. In Germany, this project is being carried out by the Friedrich-Alexander-University Erlangen-Nürnberg (FAU) in cooperation with the Prof. Dr. Harald Baumeister of the University of Ulm. As part of the project, several thousand students from all over Germany can make use of over 17 internet- and app-based training systems free of charge.
These focus, amongst others, on offers to overcome test anxiety, depressed mood, procrastination, sleep difficulties, stress management or the promotion of psychological resilience. The project aims to use study results to determine the effectiveness and cost-effectiveness of innovative digital prevention strategies for the promotion of mental health among students. From this, recommendations for action are to be derived on how the mental health of students in Germany can be effectively promoted nationwide.
The BARMER doctor's report shows that this is should be a clear priority.