Psychosocial health and prevention of crisis in rural areas – Results of a pilot panel on psychosocial problems, subjective burden, and utilization of help in Germany

Abstract

Subject

Medical care, psychological help, and social support are often required in psychosocial problem situations and crises. Without an ICD-10-classification, psychosocial crises are not legally entitled to treatment with medical and psychotherapeutic care according to the German Social Code. However, untreated psychosocial crises often lead to mental disorders.

Methods

A pilot study was conducted among 399 participants using a mixed-methods approach in a rural district in North Germany, which led to the collection of epidemiological data on psychosocial problems and coping strategies among the population.

Results

The majority of respondents attributed high degrees of relevance to health; however, only a few were satisfied. Half of the respondents had somatic symptoms, and just under one third had mental disorder symptoms. Respondents also had family problems. Overall, women were more vulnerable than men. Respondents used more aid in the form of consultation from friends or partners than from professional social services.

Discussion

Regarding the utilization of help, it is striking that particularly the unemployed often did not seek help in the presence of psychosocial crises. Although there are many social services available in the rural study area, only a minimal number of respondents were aware of their existence. The lack of utilization of these services suggests a relatively low level of knowledge and acceptance of psychosocial professional groups’ competences as well as the general psychosocial self-help and self-care system among the population.

Conclusion

An interdisciplinary psychosocial care system could provide the population with adequate services and prevention approaches.

Introduction

Psychosocial health is characterized by individuals’ well-being, satisfaction, self-confidence, and ability to maintain interpersonal relationships (World Health Organization, 2015). Depending on their living conditions, individuals spend their entire lifespan completing different tasks and satisfying different requirements. Personal life crises triggered by adverse events or adverse social circumstances can cause a so-called "psychosocial crisis" (Filipp, 1990), for which successful management is important for maintaining psychosocial and mental health.

The term psychosocial crisis describes an excessive and overly burdensome demand (Caplan, 1964) and is divided into four stages: shock, reaction, adaptation, and re-orientation (Cullberg, 1978). In a value-neutral description psychosocial crisis is defined as a decision, turning point, climax or conflict in the broadest sense (Klauer & Greve, 2005). Psychosocial crises are those critical life events that, statistically, have occurred independent of the individuals' behavior and past symptoms of a disorder and are unpredictable and uncontrollable loss events (Klauer & Filipp, 1995). As a risk factor, the accumulation of critical life events must also be considered. Psychosocial crises are perceived, understood and evaluated in a subjective manner, meaning that subjective, personal and individual experience and behavior are the decisive factors for well-being (Ciompi, 2016).

A psychosocial crisis has an external origin, and affected individuals feel stress that goes beyond a maximum subjective burden. In addition, individuals suffering from psychosocial crises are at significantly higher risk of developing mental, psychiatric or psychosomatic disorders. Although psychosocial crises in all stages can limit individual performance and social functioning, systematic data about prevalence rates and diagnosis in alignment with the WHO's International Classification of Disorders, 10th Version (Dilling, Mombour, & Schmidt, 1991), are missing. Therefore, specific treatments for psychosocial crises are not outlined. The German health insurance system, based on the Fifth book of the German Social Code (SGB V; Sozialgesetzbuch V), does not cover the therapeutic costs of a psychosocial crisis.

Under the assumptions that psychosocial crises are considered to be a precursor to mental disorders, the described significant deficit in healthcare and health-related care systems is particularly noticeable in rural areas (Jacobi, 2009, Jacobi et al., 2014), where mental disorders are often occur because of social dynamics and demographic transformations (Glaesmer et al., 2008, Hessel, Gunzelmann, Geyer and Brähler, 2000).

Especially in rural areas, access to all types of potentially effective mental treatments is limited. The major barriers include a lack of care infrastructure (Wagenfeld, 2003), financial concerns such as insufficient coverage problems (Fox, Merwin, & Blank, 1995), and beliefs regarding the appropriateness of treatment, including the stigma surrounding mental health treatment (Jameson and Blank, 2007, Mukolo, Heflinger and Wallston, 2010).

The current research data on psychosocial crises and interventions are highly inconsistent due to different definitions and interpretations of the concept of psychosocial crisis and therefore are difficult to compare. In addition, to date, no systematic, interdisciplinary and integrated services exist for the care of people experiencing psychosocial crises in rural areas. At a national level, demand, care and effectiveness of prompt outpatient psychosocial counseling and interventions in research and development are increasingly being discussed. However, studies primarily focus on specific disease contexts that are intended to legitimize implementation and action demands (i.e., Diehl and Schneider, 2011, Grabe et al., 2005).

International studies often associate psychosocial crisis projects with specific target groups, such as HIV/AIDS sufferers (Rachlis et al., 2013), individuals with bipolar disorder (Beynon, Soares-Weiser, Woolacott, Duffy, & Geddes, 2008), students (Vonk, 1997), or referenced emergency situations in a pastoral context (Perren-Klingler, 2015). In addition, the "mismatch" of psychosocial needs and their care is discussed internationally (Vannieuwenborg, Buntinx, & De Lepeleire, 2015).

Overall, the available data do not explain (1) how people in rural areas manage psychosocial crisis situations, (2) how high their subjective burden is, and (3) what resources and help they provide and utilize in case of a psychosocial crisis.

The investigated district of Mecklenburgische Seenplatte (MSE), which is in the southeast part of the state of Mecklenburg-Vorpommern (M-V) in northern Germany, is the epitome of a rural area with a considerable lack of professional psychosocial aid for psychosocial crises. A total of 261,816 inhabitants live in the district, which has an area of 5470 square kilometers (48 inhabitants per square kilometer); 65,175 of the inhabitants live in the city of Neubrandenburg (NB), the regional center. The present pilot study examined epidemiological data on psychosocial crises caused by various psychosocial problems. In addition, the study examined which aids are utilized in situations of psychosocial crises. It did so by administering an online survey and conducting structured interviews in public places, asking participants about their experiences, needs and attitudes regarding psychosocial crises.