Project

With us in balance

Goal: The nationwide model project “Mit uns im Gleichgewicht” (With Us In Balance) aims to prevent depression among farmers, forest owners and horticulturists. The project is funded by the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG) and is evaluated by the Friedrich-Alexander University Erlangen-Nürnberg and the University of Ulm.
Farmers are a vulnerable population for developing depression or other mental health disorders due to a variety of risk factors in their work context (e.g. high workload, family conflicts, seasonal work). In order to maintain mental health of farmers, forester owners and horticulturists, the SVLFG offers on-site preventive measures such as workshops on stress management to the insured persons. Within the model project, these offers will be expanded to internet and tele-based interventions (guided internet interventions of the GET.ON Institute and personalized telebased coaching by IVPNetworks). It is evaluated in parallel running, randomised controlled trials whether the internet- and tele-based interventions are (cost-)effective in reducing depressive symptoms and other mental health concerns as well as in preventing the onset of clinical depression in this specific target group of farmers, gardeners and foresters. In addition, the implementation study aims to evaluate the implementation of tailored IMIs and a personalised telebased coaching in the routine care. If the clinical effectiveness of the internet- and tele-based services can be shown and the implementation succeeds, these services may be feasible in the long-term and health care in rural areas could be sustainably improved.
The Department of Clinical Psychology and Psychotherapy of the FAU and the Department of Clinical Psychology and Psychotherapy University of Ulm, on behalf of SVLFG, are investigating in partly overlapping sub-projects the implementation and (cost-)effectiveness of the preventive interventions among farmers, forest owners and gardeners.
Target group of the project: Insured individuals at the SVLFG, their co-insured partners and family members
Project duration: 01.06.2017 – 30.05.2021

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Project log

Johanna Freund
added a research item
Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters, and gardeners (SVLFG) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual. Methods: In a two-armed, pragmatic randomized controlled trial (N = 312) with follow-ups at post-treatment (6 months), 12 and 18 months, insured farmers, foresters, and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or enhanced treatment as usual. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25–50 min delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress, and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-)effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level. Clinical Trial Registration: German Clinical Trial Registration: DRKS00015655.
Johanna Freund
added a research item
Background: People in green professions are exposed to a variety of risk factors, which could possibly enhance the development of depression. Amongst possible prevention approaches, internet- and mobile-based interventions (IMIs) have been shown to be effective and scalable. However, little is known about the effectiveness in green professions. The aim of the present study is to examine the (cost-)effectiveness of a tailored IMI program for reducing depressive symptoms and preventing the onset of clinical depression compared to enhanced treatment as usual (TAU+). Methods: A pragmatic randomized controlled trial (RCT) will be conducted to evaluate a tailored and therapeutically guided preventive IMI program in comparison to TAU+ with follow-ups at post-treatment (9 weeks), 6-, 12-, 24-, and 36-months. Entrepreneurs in green professions, collaborating spouses, family members and pensioners (N = 360) with sufficient insurance status and at least subthreshold depression (PHQ-9 ≥ 5) are eligible for inclusion. Primary outcome is depressive symptom severity (QIDS-SR16). Secondary outcomes include incidence of depression (QIDS-SR16), quality of life (AQoL-8D) and negative treatment effects (INEP). A health-economic evaluation will be conducted from a societal perspective. The IMI program is provided by psychologists of an external service company and consists of six guided IMIs (6-8 modules, duration: 6-8 weeks) targeting different symptoms (depressive mood, depressive mood with comorbid diabetes, perceived stress, insomnia, panic and agoraphobic symptoms or harmful alcohol use). Intervention choice depends on a screening of participants' symptoms and individual preferences. The intervention phase is followed by a 12-months consolidating phase with monthly contact to the e-coach. Discussion: This is the first pragmatic RCT investigating long-term effectiveness of a tailored guided IMI program for depression prevention in green professions. The present trial builds on a large-scale strategy for depression prevention in green professions. The intended implementation of the IMI program with a nationwide rollout has the potential to reduce overall depression burden and associated health care costs in case of given effectiveness. Trial registration: German Clinical Trial Registration: DRKS00014000 . Registered on 09 April 2018.
Johanna Freund
added 2 research items
Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters and gardeners (SVLFG ) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual (TAU+ ).Methods: In a two-armed, pragmatic randomized controlled trial (N=312) with follow-ups at post-treatment (6 months), 12 months and 18 months, insured farmers, foresters and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or TAU+. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25 to 50 minutes delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-) effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level.
Johanna Freund
added a project goal
The nationwide model project “Mit uns im Gleichgewicht” (With Us In Balance) aims to prevent depression among farmers, forest owners and horticulturists. The project is funded by the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG) and is evaluated by the Friedrich-Alexander University Erlangen-Nürnberg and the University of Ulm.
Farmers are a vulnerable population for developing depression or other mental health disorders due to a variety of risk factors in their work context (e.g. high workload, family conflicts, seasonal work). In order to maintain mental health of farmers, forester owners and horticulturists, the SVLFG offers on-site preventive measures such as workshops on stress management to the insured persons. Within the model project, these offers will be expanded to internet and tele-based interventions (guided internet interventions of the GET.ON Institute and personalized telebased coaching by IVPNetworks). It is evaluated in parallel running, randomised controlled trials whether the internet- and tele-based interventions are (cost-)effective in reducing depressive symptoms and other mental health concerns as well as in preventing the onset of clinical depression in this specific target group of farmers, gardeners and foresters. In addition, the implementation study aims to evaluate the implementation of tailored IMIs and a personalised telebased coaching in the routine care. If the clinical effectiveness of the internet- and tele-based services can be shown and the implementation succeeds, these services may be feasible in the long-term and health care in rural areas could be sustainably improved.
The Department of Clinical Psychology and Psychotherapy of the FAU and the Department of Clinical Psychology and Psychotherapy University of Ulm, on behalf of SVLFG, are investigating in partly overlapping sub-projects the implementation and (cost-)effectiveness of the preventive interventions among farmers, forest owners and gardeners.
Target group of the project: Insured individuals at the SVLFG, their co-insured partners and family members
Project duration: 01.06.2017 – 30.05.2021