Testing an integrated model of population mental health: an incidence and inception cohort study

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Monitoring of population mental health is now considered to play a vital role in health, risk factor and demographic surveillance systems across the globe. Adopting a public mental health perspective on monitoring and surveillance requires us to consider the entire spectrum of mental-ill health, which broadly ranges from severe mental disorders via at-risk populations to positive mental health and well-being. This population mental health approach has become the mainstay of public mental health provision in many European countries, but there has been a dearth of research on this issue in Germany in the past 20 years, and fundamental conceptual and methodological issues remain to be addressed in relation to this approach at both the national and international level. The research aims to establish and delineate the basic epidemiology of population mental health by testing key aspects (i.e., treated incidence, clinical stage transitions, transdiagnostic dimensions, digital momentary phenotypes, population mean) of an integrated transdiagnostic model encompassing the entire continuum of mental ill-health. To achieve this, we will establish a highly innovative, two-arm population-based incidence and inception cohort study, in two tightly defined catchment areas (Mannheim, Rhine-Neckar-Region) in Germany using cutting-edge statistical approaches and digital technology. In the incidence arm, incident cases will be identified using rigorous case ascertainment procedures (including a leakage study) from around 853,816 persons at risk in the two catchment areas over a two-year case ascertainment period, which will provide an equivalent of 1,707,632 person-years at risk. In the inception cohort-arm, we will recruit, at baseline (t0), a population-based, epidemiologically characterized cohort of individuals, who meet criteria for a clinical high-risk state for severe mental disorder (CHARMS, stage 1b) or non-specific psychological distress (stage 1a), as well as individuals, who do not meet these criteria (stage 0), by selecting a stratified random sample from the same catchment areas as incident cases. This cohort will be recruited over a period of 18 months and followed every 6 months, with a minimum follow-up time of 12 months for all participants, corresponding to a total duration for recruitment and assessment of 2.5 years. This will ensure that all participants will be followed at 6 months (t1) and 12 months (t2), whilst allowing us to collect data, where possible, at 18 months (t3) and 24 months (t4), thereby making optimal use of time to event (survival) data. This two-arm design will allow us to calibrate the entire mental ill-health continuum, examine fundamental conceptual and methodological issues, establish nationwide feasibility of design and methods for more comprehensive monitoring of population mental health, and, thereby, provide the basis for assessing the impact of novel public mental health services at the population level.