Matthias C Angermeyer

Università degli studi di Cagliari, Cagliari, Sardinia, Italy

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Publications (619)1583.53 Total impact

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    ABSTRACT: Media coverage of the Germanwings plane crash intensely focused on the co-pilot's mental illness and was criticized for potentially increasing depression stigma. We explored whether stigma beliefs towards persons with depression changed in April 2015 (about one month after the crash) compared to 2014. Telephone surveys among the adult population were conducted in Munich, Germany (N=650 in 2014 and N=601 in 2015). In both surveys, four components of stigma were assessed: (1) characteristics ascribed to persons with a depression, (2) belief in a continuum of symptoms from mental health to mental illness, (3) emotional reactions to people afflicted by depression (fear, anger, and pro-social reactions), and (4) desire for social distance. Some stigmatizing attitudes have increased after the crash. More specifically, we found more pronounced changes in the attributes ascribed (stereotypes) and in the perceived separation from persons afflicted (continuum beliefs) than in the emotional reactions and the desire for social distance. However, overall increase in depression stigma was smaller than expected as changes were not statistically significant in the majority of the analyzed items. Due to the study design no causal interpretation of results is possible. Moreover, evidence presented is confined to a regional German sample. A single devastating event and related media coverage seem to have a limited impact on public stigmatizing attitudes. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 07/2015; 186:261-265. DOI:10.1016/j.jad.2015.07.029 · 3.71 Impact Factor
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    ABSTRACT: Public knowledge about and attitudes towards mental illness were analyzed. Furthermore, changes in knowledge and attitudes after an information and awareness campaign were examined. The basis were two telephone surveys in 2011 (t0) and 2014 (t1) in Hamburg (intervention) and Munich (control). In 2011, the public was relatively well informed about mental disorders. Regarding the level of information of the public before the campaign and inconsistent results of previous evaluation studies the anticipated impact of the awareness campaign at t1 are moderate. © Georg Thieme Verlag KG Stuttgart · New York.
    Psychiatrische Praxis 07/2015; 42(S 01):S20-S24. DOI:10.1055/s-0034-1387649 · 1.64 Impact Factor
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    ABSTRACT: The aim of the present study was to investigate how different mentally demanding work conditions during the professional life-i.e., enriched environments at work-might influence the rate of cognitive decline in old age. Individuals (n = 1,054) of the Leipzig Longitudinal Study of the Aged, a representative population-based cohort study of individuals aged 75 years and older, underwent cognitive testing via the Mini-Mental State Examination (MMSE) in up to 6 measurement waves. Type and level of mentally demanding work conditions in the participants' former professional life were classified based on the O*NET job descriptor database. In multivariate mixed-model analyses (controlling for sociodemographic and health-related factors), a high level of mentally demanding work tasks stimulating verbal intelligence was significantly associated with a better cognitive functioning at baseline (on average 5 MMSE points higher) as well as a lower rate of cognitive decline (on average 2 MMSE points less) over the 8-year follow-up period compared with a low level. The rate of cognitive decline in old age was also significantly lower (on average 3 MMSE points less) in individuals who had a high level of mentally demanding work tasks stimulating executive functions than those who had a low level. The results suggest that a professional life enriched with work tasks stimulating verbal intelligence and executive functions may help to sustain a good cognitive functioning in old age (75+ years). The findings thus emphasize that today's challenging work conditions may also promote positive health effects. © 2015 American Academy of Neurology.
    Neurology 04/2015; 84(21). DOI:10.1212/WNL.0000000000001605 · 8.30 Impact Factor
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    ABSTRACT: The desire for social distance towards individuals with obesity as part of the stigmatization process has not been investigated. The aims of this study include: (a) determining the prevalence of social distance and its domains in a population-based sample; (b) reporting levels of emotional response; and (c) investigating the association of BMI, emotional response and social distance. The data were derived from a large population based telephone survey in Germany (total n = 3,003, this sub-sample n = 1008). Emotional response to individuals with obesity was assessed for the emotions discomfort, pity, insecurity, amusement, sympathy, help and incomprehension (5-point Likert scale). Social distance was measured on a 5-point Likert scale covering different areas of social interaction. This served as the dependent variable for a linear regression model and mediation models that included BMI and emotional response. Social distance was highest for job recommendation, introduction to a friend, someone with obesity marrying into the family and renting out a room. Means of emotional responses were highest for pity (Mean = 2.58), sympathy (Mean = 2.87) and wanting to help (M = 2.76). In regression analyses, incomprehension (b = 1.095, p < 0.001) and sympathy (b = −0.833, p < 0.001) and the respondents' own BMI (b = −0.145, p < 0.001) were significantly associated to the overall amount of social distance. Mediation models revealed a significant mediation effect of BMI through sympathy (b = −0.229, % of total effect through mediation = 10.3%) and through incomprehension (b = −0.057, % of total effect through mediation = 27.5%) on social distance.
    Social Science & Medicine 03/2015; 128. DOI:10.1016/j.socscimed.2015.01.002 · 2.56 Impact Factor
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    ABSTRACT: Background: Alcohol use in adolescents constitutes a major public health concern. Europe is the heaviest drinking region of the world. Several school-based alcohol prevention programs have been developed but it is not clear whether they are really effective. The present study was aimed at identifying the typology with the best evidence of effectiveness in European studies. Methods: A systematic search of meta-analyses and/or randomized controlled trials (RCTs) on interventions school-based prevention programs aimed at preventing alcohol consumption or changing the attitudes to consume alcohol. Results: A meta-analysis published in 2011 and 12 RCTs more recently published were identified. The meta-analysis evaluated 53 RCTs but only 11.3% of them were conducted in Europe. Globally, 23 RCTs (43.4%) showed some evidence of effectiveness, and 30 RCTs (56.6%) did not find significant difference between the groups. According to the conclusions of the meta-analysis, the Unplugged program should be considered as a practice option in Europe. Among the other 12 RCTs, 42% were conducted in Europe. Globally, 7 studies (58.3%) achieved positive results, and 5 studies (41.7%) did not find significant differences or produced a mixed pattern of results. Three of the 5 European trials (60%) used the Unplugged program with positive results. Conclusion: Even if further studies should be conducted to confirm these results, Unplugged appears to be the prevention project with the best evidence of effectiveness in European studies.
    Clinical Practice and Epidemiology in Mental Health 03/2015; 11((Suppl 1: M6)):102-112. DOI:10.2174/1745017901511010102
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    ABSTRACT: The acquisition of social and emotional skills is associated with positive youth development, character education, healthy lifestyle behaviours, reduction in depression and anxiety, conduct disorders, violence, bullying, conflict, and anger. School-based interventions aimed to enhance these skills go beyond a problem-focused approach to embrace a more positive view of health; they could also improve the youth's wellbeing. To describe the main features and to establish the effectiveness of universal school-based RCTs for children and the youth, aimed to promote their psychosocial wellbeing, positive development, healthy lifestyle behaviours and/or academic performance by improving their emotional and social skills. Systematic review by searching for relevant papers in PubMed/Medline with the following key words: "mental health" OR "wellbeing" OR "health promotion" OR "emotional learning" OR "social learning" OR "emotional and social learning" OR "positive youth development" OR "life skills" OR "life skills training" AND "school". Interval was set from January 2000 to April 2014. 1,984 papers were identified through the search. Out of them 22 RCTs were included. While most interventions were characterized by a whole-school approach and SAFE practices, few studies only used standardized measures to assess outcomes, or had collected follow-up data after ≥ 6 months. The results of all these trials were examined and discussed. Universal school-based RCTs to enhance emotional and social skills showed controversial findings, due to some methodological issues mainly. Nevertheless they show promising outcomes that are relatively far-reaching for children and youth wellbeing and therefore are important in the real world.
    Clinical Practice and Epidemiology in Mental Health 03/2015; 11((Suppl 1: M2)):21-40. DOI:10.2174/1745017901511010021
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    ABSTRACT: Cross-sectional studies frequently find higher age associated with negative attitudes towards persons with mental illness. We explore whether attitudes worsen over the life span, or follow a cohort pattern. Using data from three identical population surveys in Germany from 1990, 2001 and 2011 (combined sample n = 7835), we performed age-period-cohort analyses determining the association of age, time period and birth-cohort with social distance from a person with either depression (n = 3910) or schizophrenia (n = 3925), using linear and nonlinear partial least squares regression models. Social distance increases with age, independent from cohort and period effects, cumulating to an increase of 2.4 (schizophrenia) and 2.3 (depression) on the 28 point social distance scale over the life span (youngest to oldest participant). We found a cohort effect in depression, but not schizophrenia, with decreasing social distance until 1970 and a slight increase in younger cohorts. Period effects were visible particularly in schizophrenia, with growing social distance over time. Considering demographic change and the vulnerability of older persons to severe outcomes of mental illness such as suicide, the observed increase of negative attitudes over the life span seems highly relevant. We discuss the role of conservatism and preferences for agreeable social contacts in older age. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Acta Psychiatrica Scandinavica 02/2015; DOI:10.1111/acps.12401 · 5.55 Impact Factor
  • Johannes Bahlmann · Georg Schomerus · Matthias C Angermeyer
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    ABSTRACT: Objective: This study examined illness beliefs of the lay public associated with the diagnostic labels burnout and depression. Methods: Representative population survey in Germany 2011, using unlabelled case vignettes of a person suffering from depression. Following presentation of the vignette, respondents were asked openly how they would call the problem described. Agreement with various illness beliefs was elicited with Likert-scaled items. Results: Seeing the problem as inherited predicted use of the label depression (OR 1.29, p < 0.001), while stress at work as a perceived cause was associated with use of the label burnout (OR 1.56, p < 0.001). Belief that the problem described resembled everyday experiences (belief in a symptom continuum) also predicted using the label burnout instead of depression (OR 1.31, p < 0.05). Conclusion: Although overlapping with beliefs about depression, the diagnostic label burnout is also associated with specific illness beliefs among the general public. © Georg Thieme Verlag KG Stuttgart · New York.
    Psychiatrische Praxis 12/2014; DOI:10.1055/s-0034-1387365 · 1.64 Impact Factor
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    ABSTRACT: Regardless of the respondents’ sex, age emerges as significant predictor of desire for social distance from individuals with either anorexia nervosa (AN) or bulimia nervosa (BN)•Women’s desire for social distance from individuals with BN is significantly predicted by the attribution of weak will (emphasizing a blame-based stigma)•Men’s desire for social distance from individuals with BN is significantly predicted by the attribution of brain disease•The contact theory, which proposes that stigma can be reduced via personal contact to individuals afflicted, only holds true for female respondents in our sample
    Eating Behaviors 11/2014; 16. DOI:10.1016/j.eatbeh.2014.10.017 · 1.58 Impact Factor
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    ABSTRACT: Purpose of the study is to investigate helpseeking preferences of the Sardinian public in case of depression. A telephone survey was conducted among the adult population, using quota sampling (N = 1,200). Respondents were presented with a vignette depicting a person with symptoms of major depressive disorder, followed by a fully structured interview. Psychologists were most frequently selected as source of professional help, followed by psychiatrists and G.P.s. Residents of small towns more frequently recommended mental health professionals than city residents. Public help-seeking preferences reflect the availability of services, beliefs about the appropriate treatment of depression and attitudes towards those providing it.
    Administration and Policy in Mental Health and Mental Health Services Research 10/2014; DOI:10.1007/s10488-014-0604-y · 3.44 Impact Factor
  • Mauro G Carta · Matthias C Angermeyer
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    ABSTRACT: In the current classifications of mental illnesses (World Health Organization 1990, American Psychiatric Association 1994, American Psychiatric Association 2013), diagnoses are made by describing the symptoms of a clinical picture regardless of potential causes of the disease. Such a “descriptive approach” was introduced more than 40 years ago to overcome inconsistencies due to divergent causal interpretations of the same disorder in the different psychiatric schools. In fact, in the 1970s the famous UK/USA study had shown that the high frequency of schizophrenia and low frequency of affective disorders among mental hospital admissions in New York compared to those in London were largely due to the different psychiatric background influencing the practice of diagnosis (Cooper et al. 1971). What an American psychiatrist with a psychoanalytic education called schizophrenia was likely to be defined by a British psychiatrist as a manic-depressive psychosis (Gurland et al. 1972). ...
    Culture Medicine and Psychiatry 10/2014; 39(1). DOI:10.1007/s11013-014-9411-x · 1.29 Impact Factor
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    Georg Schomerus · Herbert Matschinger · Matthias C Angermeyer
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    ABSTRACT: Background: Alcohol dependence is among the most severely stigmatized mental disorders. We examine whether negative stereotypes and illness beliefs related to alcohol dependence have changed between 1990 and 2011. Methods: We used data from two population surveys with identical methodology that were conducted among German citizens aged ≥18 years, living in the 'old' German states. They were conducted in 1990 and 2011, respectively. In random subsamples (1990: n = 1,022, and 2011: n = 1,167), identical questions elicited agreement with statements regarding alcohol dependence, particularly with regard to the illness definition of alcohol dependence and blame. Results: Overall, agreement with negative stereotypes did not change in the course of 2 decades. About 55% of the respondents agreed that alcohol dependence is an illness like any other, >40% stated that it was a weakness of character and 30% endorsed that those affected are themselves to blame for their problems. Conclusions: It is apparent that promoting an illness concept of alcohol dependence has not been an easy solution to the problem of stigma. We discuss how the normative functions of alcohol dependence stigma might have prevented a reduction of negative stereotypes. © 2014 S. Karger AG, Basel.
    European Addiction Research 10/2014; 20(6):293-299. DOI:10.1159/000362407 · 2.07 Impact Factor
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    World psychiatry: official journal of the World Psychiatric Association (WPA) 10/2014; 13(3). DOI:10.1002/wps.20169 · 12.85 Impact Factor
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    ABSTRACT: Post-traumatic stress disorder (PTSD) should be one of the most preventable mental disorders, since many people exposed to traumatic experiences (TEs) could be targeted in first response settings in the immediate aftermath of exposure for preventive intervention. However, these interventions are costly and the proportion of TE-exposed people who develop PTSD is small. To be cost-effective, risk prediction rules are needed to target high-risk people in the immediate aftermath of a TE. Although a number of studies have been carried out to examine prospective predictors of PTSD among people recently exposed to TEs, most were either small or focused on a narrow sample, making it unclear how well PTSD can be predicted in the total population of people exposed to TEs. The current report investigates this issue in a large sample based on the World Health Organization (WHO)'s World Mental Health Surveys. Retrospective reports were obtained on the predictors of PTSD associated with 47,466 TE exposures in representative community surveys carried out in 24 countries. Machine learning methods (random forests, penalized regression, super learner) were used to develop a model predicting PTSD from information about TE type, socio-demographics, and prior histories of cumulative TE exposure and DSM-IV disorders. DSM-IV PTSD prevalence was 4.0% across the 47,466 TE exposures. 95.6% of these PTSD cases were associated with the 10.0% of exposures (i.e., 4,747) classified by machine learning algorithm as having highest predicted PTSD risk. The 47,466 exposures were divided into 20 ventiles (20 groups of equal size) ranked by predicted PTSD risk. PTSD occurred after 56.3% of the TEs in the highest-risk ventile, 20.0% of the TEs in the second highest ventile, and 0.0-1.3% of the TEs in the 18 remaining ventiles. These patterns of differential risk were quite stable across demographic-geographic sub-samples. These results demonstrate that a sensitive risk algorithm can be created using data collected in the immediate aftermath of TE exposure to target people at highest risk of PTSD. However, validation of the algorithm is needed in prospective samples, and additional work is warranted to refine the algorithm both in terms of determining a minimum required predictor set and developing a practical administration and scoring protocol that can be used in routine clinical practice.
    World psychiatry: official journal of the World Psychiatric Association (WPA) 10/2014; 13(3-3):265-274. DOI:10.1002/wps.20150 · 12.85 Impact Factor
  • Sven Speerforck · Georg Schomerus · Susanne Pruess · Matthias C. Angermeyer
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    ABSTRACT: Objective It is unclear whether different biogenetic causal beliefs affect stigmatization of mentally-ill patients differently. It has been argued that in particular believing in a ‘chemical imbalance’ as a cause of mental disorder might be associated with more tolerant attitudes. Method In a representative population survey in Germany (n=3642), using unlabelled case vignettes of persons with depression, schizophrenia, or alcohol dependence, we elicited agreement with three different biogenetic explanations of the illness: ‘Chemical imbalance of the brain’, ‘brain disease’ and ‘heredity’. We further investigated emotional reactions as well as the desire for social distance. For each vignette condition we calculated linear regressions with each biogenetic explanation as independent and emotional reactions as well as social distance as dependent variable controlling for socio-demographic variables. Limitations Our cross-sectional study does not allow statements regarding causality and the explanatory power of our statistical models was low. Results ‘Chemical imbalance of the brain’ and ‘brain disease’ were both associated with a stronger desire for social distance in schizophrenia and depression, and with more social acceptance in alcohol dependence, whereas ‘heredity’ was not significantly associated with social distance in any of the investigated illnesses. All three biogenetic causal beliefs were associated with more fear in all three illnesses. Conclusion Our study corroborates findings that biogenetic explanations have different effects in different disorders, and seem to be harmful in depression and schizophrenia. A particular de-stigmatizing potential of the causal belief ‘chemical imbalance’ could not be found. Implications for useful anti-stigma messages are discussed.
    Journal of Affective Disorders 10/2014; 168:224–228. DOI:10.1016/j.jad.2014.06.013 · 3.71 Impact Factor
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    ABSTRACT: Abstract Background and objectives Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments. Methods During face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment. Results 1860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR = 1.8; 95%CI 1.3–2.5), panic (OR = 1.4; 95%CI 1.0–2.0), generalized anxiety (OR = 1.3; 95%CI 1.1–1.7), specific phobia (OR = 1.3; 95%CI 1.1–1.6); post-traumatic stress (OR = 1.5; 95%CI 1.1–1.9); binge eating (OR = 1.8; 95%CI 1.2–2.9) and alcohol abuse (OR = 1.5; 95%CI 1.1–2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21). Conclusions A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study. Keywords: Asthma, Mental disorders, Population, Epidemiology, Chronic disease, Comorbidity
    Journal of Psychiatric Research 09/2014; DOI:10.1016/j.jpsychires.2014.09.007 · 4.09 Impact Factor
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    T Luck · M Luppa · H Matschinger · F Jessen · M C Angermeyer · S G Riedel-Heller
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    ABSTRACT: Objective In this study, we aimed to analyze the association between new—incident—subjective memory complaints (SMC) and risk of subsequent dementia in a general population sample aged 75+ years.Method Data were derived from follow-up (FUP) waves I-V of the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). We used the Kaplan-Meier survival method to estimate dementia-free survival times of individuals with and without incident SMC and multivariable Cox proportional hazards regression to assess the association between incident SMC and risk of subsequent dementia, controlled for covariates.ResultsOf 443 non-demented individuals, 58 (13.1%) developed dementia during a subsequent 5.4-year follow-up period. Participants with incident SMC showed a significantly higher progression to dementia (18.5% vs. 10.0%; P = 0.010) and a significantly shorter mean dementia-free survival time than those without (6.2 vs. 6.8 years; P = 0.008). The association between incident SMC and risk of subsequent dementia remained significant in the multivariable Cox analysis (adjusted hazard ratio = 1.8; P = 0.028).Conclusion Our findings suggest higher progression to dementia and shorter dementia-free survival in older individuals with incident SMC. These findings support the notion that such subjective complaints should be taken seriously in clinical practice as possible early indicators of incipient dementia.
    Acta Psychiatrica Scandinavica 09/2014; 131(4). DOI:10.1111/acps.12328 · 5.55 Impact Factor
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    Georg Schomerus · Herbert Matschinger · Michael J Lucht · Matthias C Angermeyer
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    ABSTRACT: Alcohol dependence is a severely stigmatized disorder. Perceived stigma may deter help-seeking and is associated with higher co-morbidity and self-stigma in persons with alcohol dependence. We assess changes in the perception of alcohol-related stigma over 21 years in the general population.
    Drug and Alcohol Dependence 08/2014; DOI:10.1016/j.drugalcdep.2014.07.033 · 3.28 Impact Factor
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    ABSTRACT: Background There is not much known about the associations of beliefs about depression (depression literacy) with a history of depression and treatment experience. Methods Analyses were based on a telephone survey in two large German cities (Hamburg and Munich). Written vignettes with typical signs and symptoms suggestive of a depression were presented to 1293 respondents. Respondents were then asked about beliefs about causes, symptoms, prevalence, and treatment using a standardized questionnaire. For the analysis respondents were divided into three groups: (1) people who never had a depression, (2) people who had a depression but were not treated and (3) people with treatment experience. Results Respondents with experience in treatment for depression were more likely to correctly recognize the disorder, to positively evaluate treatability and to favor external factors (adverse conditions in childhood and psychosocial stress) as potential causes of depression compared to those who never were afflicted. There were no significant differences between these two groups regarding beliefs about the effectiveness of treatment options. There were only few significant differences in depression literacy between respondents who have a history of depression but have not sought help and those who never were afflicted. Limitations The three groups were constituted on the basis of respondents' self-reports, not medical diagnoses. Conclusions Our findings only partly support the general assumption that being afflicted and having sought help is associated with beliefs closer to those of professionals.
    Journal of Affective Disorders 08/2014; 164C:28-32. DOI:10.1016/j.jad.2014.04.001 · 3.71 Impact Factor
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    ABSTRACT: Using population-based data, the relationship between biogenetic causal beliefs and emotional reactions to persons with schizophrenia or depression was examined. Biogenetic attributions elicited either negative emotions alone or pro-social and negative emotions at the same time. Biogenetic attributions seem not helpful for improving emotional reactions to people with mental disorders.
    Psychiatry Research 07/2014; DOI:10.1016/j.psychres.2014.07.038 · 2.68 Impact Factor

Publication Stats

17k Citations
1,583.53 Total Impact Points

Institutions

  • 2010–2015
    • Università degli studi di Cagliari
      • Department of Public Health, Clinical and Molecular Medicine
      Cagliari, Sardinia, Italy
  • 2013
    • The London School of Economics and Political Science
      • Personal Social Services Research Unit
      London, ENG, United Kingdom
    • University of Greifswald
      • Department of Psychiatry and Psychotherapy
      Greifswald, Mecklenburg-Vorpommern, Germany
  • 2012
    • University of Toronto
      Toronto, Ontario, Canada
    • Illinois Institute of Technology
      Chicago, Illinois, United States
  • 2011
    • University of Otago
      • Department of Medicine (Dunedin)
      Taieri, Otago, New Zealand
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 2010–2011
    • Medical University of Vienna
      • Department of Psychiatry and Psychotherapy
      Wien, Vienna, Austria
  • 1996–2011
    • University of Leipzig
      • • Klinik und Poliklinik für Psychiatrie und Psychotherapie
      • • Institute of Legal Medicine
      Leipzig, Saxony, Germany
  • 2008
    • Fachhochschule Münster
      Muenster, North Rhine-Westphalia, Germany
    • University College London
      • Mental Health Sciences Unit
      London, ENG, United Kingdom
  • 2007
    • University of Groningen
      • Department of Psychiatry
      Groningen, Groningen, Netherlands
  • 2004–2007
    • Universität Ulm
      • Clinic of Psychiatry and Psychotherapy III (Ulm)
      Ulm, Baden-Württemberg, Germany
    • University of Applied Sciences
      Gieben, Hesse, Germany
  • 2003
    • University of Leicester
      Leiscester, England, United Kingdom
  • 1994–1995
    • Central Institute of Mental Health
      Mannheim, Baden-Württemberg, Germany