Calibrating Independence Goals and Partner Support: Couples Adjust to Functional Limitations after Tumor Surgery

BACKGROUND

When patients recover from disease-related functional limitations, support received from partners may not always match patients' changing independence goals. The lines of defense (LoD) model proposes a hierarchy of independence goals (LoDs), ranging from minimising discomfort by disengagement (lowest LoD) to protection of self-reliance (highest LoD). Prostate cancer patients' LoDs were examined as moderators of the association between partner support and patients' and partners' affect during patients' recovery from postsurgical functional limitations.

METHODS

Data from 169 couples were assessed four times within 7 months following patients' surgery. Patients reported on post-surgery functional limitations (i.e. incontinence), LoDs, affect, and received partner support. Partners reported on affect and support provided to patients.

RESULTS

In patients endorsing lower LoDs, more received support was associated with less negative affect. Also, not endorsing high LoDs while receiving strong partner support was related to patients' lower negative and higher positive affect. Partners' support provision to patients tended to be associated with increases in partners' negative affect when patients had endorsed higher LoDs and with increases in positive affect when patients had endorsed lower LoDs.

CONCLUSIONS

Matching patients' independence goals or LoDs with partners' support may be beneficial for patients' and partners' affect.

Anxiety and depression in the general population in Colombia: reference values of the Hospital Anxiety and Depression Scale (HADS)

PURPOSE

The objective of this study was to generate normative values and to test psychometric properties of the Hospital Anxiety and Depression Scale (HADS) for the general population of Colombia. While there are several normative studies in Europe, Latin American normative values are missing. The identification of people with mental distress requires norms obtained for the specific country.

METHODS

A representative face-to-face household study (n = 1,500) was conducted in 2012. The survey questionnaire contained the HADS, several other questionnaires, and sociodemographic variables.

RESULTS

HADS mean values (anxiety: M = 4.61 ± 3.64, depression: M = 4.30 ± 3.91) were similar to those reported from European studies. Females were more anxious and depressed than males. The depression scale showed a nearly linear age dependency with increasing scores for old people. Mean scores and percentiles (75 and 90%) are presented for each age decade for both genders. Both anxiety and depression correlated significantly with the total score of the multidimensional fatigue inventory and with the mental component summary score of the quality of life questionnaire SF-8. Internal consistency coefficients of both scales were satisfying, but confirmatory factorial analysis results only partially supported the two-dimensional structure of the questionnaire.

CONCLUSION

This study supports the reliability of the HADS in one Latin American country. The normative scores can be used to compare a patient's score with those derived from a reference group. However, the generalizability to other Latin American regions requires further research.

[Are urban dwellers more depressed and anxious than the rural population? Results of a representative survey]

This study investigates the association between urbanicity and mental health in the general population. We conducted a representative survey (N = 5,036) measuring depression (PHQ-2), anxiety (GAD-2) as well as life satisfaction (FLZM). Results support the assumption that the prevalence rate for pathological scores of depression and anxiety are higher in urban than in rural areas. But, there is no clear linear association between urbanicity and mental health. Urbanicity seems to be a distal factor for higher rates in anxiety and depression. Urban-rural differences in other studies can not be transferred to the German population that easily. Future studies have to take variables on an individual and community level into account to analyse the relationship between urbanicity and mental health.

[Prevalence of personal exhaustion in the general population in Germany and its coherences towards further psychosomatic disorders]

The delineated mental and somatic symptoms in the context of burnout have to be seen as serious health complaints. Exhaustion is one of the symptoms in this context. The present study focuses the prevalence of exhaustion symptoms (assessed with a screeninger for mental wellbeing) in the German general population and the correlation with anxiety and depression as well as further symptoms that co-occur. For this purpose, data of 2 433 persons from a population-based representative sample were analysed. After setting a cut-off point the results reveal that 6% of the population show serious mental impairments, which can be interpreted as a exhaustion prevalence rate. Moreover, the results imply clear relationships of exhaustion and other symptoms as well as mental and somatic impairments and the intake of pharmaceuticals.

Dopamine-modulated aversive emotion processing fails in alcohol-dependent patients

Negative mood states after alcohol detoxification may enhance the relapse risk. As recently shown in healthy volunteers, dopamine storage capacity (V d) in the left amygdala was positively correlated with functional activation in the left amygdala and anterior cingulate cortex (ACC) during an emotional task; high functional connectivity between the amygdala and the ACC, a region important for emotion regulation, was associated with low trait anxiety. Based on these findings, we now tested whether detoxified alcohol-dependent patients have a disrupted modulation of the anterior cingulate cortex activation in response to aversive stimuli by amygdala dopamine. Furthermore, we asked whether disrupted functional coupling between amygdala and ACC during aversive processing is related to trait anxiety.We used combined 6-[18F]-fluoro-l-DOPA positron emission tomography (PET), functional magnetic resonance imaging (fMRI) and Spielberger's state-trait anxiety questionnaire (STAI) in 11 male detoxified alcohol-dependent patients compared to 13 matched healthy controls.Unlike healthy controls, patients showed no significant correlation between our PET metric for dopamine storage capacity (FDOPA V d), in left amygdala and activation in left ACC. Moreover, the functional connectivity between amygdala and ACC during processing of aversive emotional stimuli was reduced in patients. Voxel-based morphometry did not reveal any discernible group differences in amygdala volume.These results suggest that dopamine-modulated corticolimbic circuit function is important for responding to emotional information such that apparent functional deficits in this neuromodulatory circuitry may contribute to trait anxiety in alcohol-dependent patients.

Psychometric Properties of the German Narcissism Inventory 90 (NI-90) in a clinical and non-clinical sample of adolescents: a comparative study

BACKGROUND

The Narcissism Inventory (NI) is a frequently used German inventory for measuring narcissism in clinical settings; an additional short version (NI-90) also exists. Psychometric properties of the NI-90 scales were examined in clinical and non-clinical adolescent samples.

METHODS

Two adolescent samples were assessed with the NI-90: a non-clinical sample (n = 439, mean age ± SD = 15.05 ± 1.77 years) and a clinical sample (n = 235, 18.26 ± 0.77 years). Confirmatory factor analysis and principle component analysis were used to scrutinize the structure of the scales. Multiple regression analysis was used to predict the scores on two scales (helpless self; negative body self).

RESULTS

This study revealed heterogeneity in the NI-90 scales, which in turn explains the wide range seen in Cronbach's α (from 0.53 to 0.93). The postulated 4-factor structure could not be replicated in both samples. Multiple regression analysis revealed that personality disorder did not significantly predict negative body self or helpless self scores, whereas eating, mood, as well as somatoform and conversion disorders did. One NI-90 scale (greedy for praise and reassurance) showed sufficient psychometric quality for the measurement of narcissism in both samples.

CONCLUSION

Based on the results, the authors recommend revising the NI-90. Items that may be useful for measuring aspects related to affective and body image complaints are presented. The greedy for praise and reassurance scale may be valuable for measuring features of 'overt' narcissism.

Alters- und geschlechtspezifische Neunormierung der Fragen zur Lebenszufriedenheit (FLZM) für die Altersspanne von 14 bis 64 Jahre

Zusammenfassung. Theoretischer Hintergrund: Der FLZM-Fragebogen (Fragen zur Lebenszufriedenheit) ist ein ökonomisches, reliables Verfahren zur Erfassung der allgemeinen Lebenszufriedenheit. Fragestellung: Die vorhandenen Normwerte sind über 10 Jahre alt, zudem fehlen bislang Angaben über Prozentränge. Methode: Die vorliegende Studie stellt eine alters- und geschlechtsspezifische Neunormierung anhand einer bevölkerungsrepräsentativen Stichprobe aus Deutschland für den Altersbereich 14 bis 64 Jahre vor (N = 3877). Ergebnisse: Mittelwerte, Standardabweichungen, Trennschärfeindices und Prozentränge werden für Alter und Geschlecht getrennt berichtet. Die Ergebnisse zeigen gute interne Konsistenzen für die gewichtete (Cronbachs Alpha = 0,83) wie auch für die ungewichtete Lebenszufriedenheit (Cronbachs Alpha = 0,82). Schlussfolgerungen: Für die FLZM liegen aktualisierte Normdaten vor. Für einen Einsatz des Messinstruments können nun aktuelle Vergleichsdaten der gesamtdeutschen Bevölkerung zwischen 14–64 Jahren herangezogen werden.

Subjective underchallenge at work and its impact on mental health

PURPOSE

To investigate the relation between subjective underchallenge at work and the degree of depressiveness and life satisfaction.

METHODS

A representative sample of the German general population of N = 1,178 (52.5% men; age: M = 40.4 years, SD = 11.3) was included in this study. Measurements contain Satisfaction with Life Scalè (SWLS) and the Patient Health Questionnairè (PHQ-D). To assess subjective underchallenge at work, a ten-item scale was developed for the purpose of this study. The association between subjective underchallenge at work, life satisfaction and depressiveness was examined by means of path analyses.

RESULTS

A significant positive association was found between subjective underchallenge at work and depressiveness, mediated by life satisfaction. This association was not moderated by income but by level of education. Participants with a medium educational level displayed a weaker association than participants with either a high or a low educational level.

CONCLUSION

Not only work overload but also feeling underchallenged at work can have a negative impact on mental health and well-being. This is not an issue for blue-collar workers only and deserves more attention in future research.

Anxiety and depression in cardiac patients: age differences and comparisons with the general population

BACKGROUND

Anxiety and depression are often found in cardiac patients, but also in the general population. Therefore, evaluation of these symptoms in patients requires a comparison with norm values. The purpose of this study was to explore differences between cardiac patients and the general population in age dependency of anxiety and depression, and to discuss possible reasons for these differences.

METHODS

A sample of German cardiac patients (n = 2,696) and a sample of the German general population (n = 2,037) were tested using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

While we confirmed a linear age trend of anxiety and depression in the general population, we observed an inverted U-shaped age dependency in the patient sample. Young patients are especially affected by anxiety and depression. Five items of the HADS that mainly contributed to the age differences were identified. Formal characteristics of these 5 items could not explain the age differences. Concerning the meaning of the items, however, most of the items refer to worrying about the future.

CONCLUSIONS

The relatively low rates of anxiety and depression in older patients (compared with the general population) indicate that adaptation processes took place, which should be taken into account in studies concerning the psychological status of patients. Young patients need special attention when dealing with mental distress.

Low effective organizational strategies in visual memory performance of unmedicated alcoholics during early abstinence

OBJECTIVE

Alcohol-dependent patients in early abstinence show an impairment of cognitive functions which can be seen in poor implementation of newly learned skills for avoiding relapse. Executive dysfunction may persist during abstinence in alcohol-dependent persons, thus mitigating long-term abstinence. This study assessed visual memory function and choice of organizational strategies in alcoholics, as these are major factors necessary to implement ongoing behavior changes which are required for maintaining abstinence.

METHODS

We investigated 25 severely alcohol-dependent male patients between days 7 to 10 of abstinence, immediately after clinical withdrawal symptoms have ceased, compared to 15 healthy age, sex, and education matched controls. Pharmacological therapy had been terminated at least four half-lifes before inclusion into the study. Visual perceptual learning and organizational strategies were assessed with the Rey-Osterrieth Complex Figure Test (R-OCF).

RESULTS

There were no group differences in copying or recalling the figure, but time differences occurred. Alcoholics and healthy controls performed worse in recalling than in copying. But, alcoholics used less effective organizational strategies.

CONCLUSIONS

There was a deficit in choice of organizational strategy in newly abstinent and unmedicated alcohol-dependent patients. Due to the imperfect organizational strategies, alcoholics might need auxiliary therapeutic care to strengthen their cognitive ability.

Zusammenhang zwischen körperdysmorphen Beschwerden, Körperbild und Selbstaufmerksamkeit an einer repräsentativen Stichprobe

This study investigates the association between body image and body dysmorphic symptoms in the population by taking different kinds of self-consciousness into account. Body dysmorphic symptoms are characterized by a distressing and impairing preoccupation with an imagined or slight defect in appearance. A representative sample of 1621 persons in Germany was examined with screening instruments for body image, body dysmorphic symptoms and self-consciousness. Women reported more body dysmorphic symptoms and higher self-consciousness than men. People with body dysmorphic symptoms reported a more negative body image and higher self-consciousness. Different aspects of self-consciousness moderated the association between body dysmorphic symptoms and negative body image. Results were discussed towards hypotheses of affect modulation and depression tendency of patients with body dysmorphic symptoms.

[Discrepancy between ideal and real body image: does it affect body-dysmorphic disorder symptoms?]

Body dysmorphic symptoms are characterized by a distressing and impairing preoccupation with an imagined or slight defect in appearance. It is assumed that a discrepancy between ideal and real body image is associated with body dysmorphic disorder symptoms. On the basis of a nationwide survey participants were analysed in terms of their body dysmorphic symptoms and specific aspects of their body image. The ideal and real body image differed significantly in both sexes and in age groups. On closer examination it was apparent that there were different factors for men and women which predicted the occurrence of body dysmorphic symptoms. The results are discussed against the background of existing body ideals and in terms of their gender specific relevance.

The Aging Males' Symptoms (AMS) scale: review of its methodological characteristics

Background

The current paper reviews data from different sources to get a closer impression on the psychometric and other methodological characteristics of the Aging Males' Symptoms (AMS) scale gathered recently. The scale was designed and standardized as self-administered scale to (a) to assess symptoms of aging (independent from those which are disease-related) between groups of males under different conditions, (b) to evaluate the severity of symptoms over time, and (c) to measure changes pre- and post androgen replacement therapy. The scale is in widespread use (14 languages).

Method

Original data from different studies in many countries were centrally analysed to evaluate reliability and validity of the AMS.

Results

Reliability measures (consistency and test-retest stability) were found to be good across countries, although the sample size was sometimes small.

Validity: The internal structure of the AMS in healthy and androgen deficient males, and across countries was sufficiently similar to conclude that the scale really measures the same phenomenon. The sub-scores and total score correlations were high (0.8–0.9) but lower among the sub-scales (0.5–0.7). This however suggests that the subscales are not fully independent.

The comparison with other scales for aging males or screening instruments for androgen deficiency showed sufficiently good correlations, illustrating a good criterion-oriented validity. The same is true for the comparison with the generic quality-of-life scale SF36 where also high correlation coefficients have been shown.

Methodological analyses of a treatment study of symptomatic males with testosterone demonstrated the ability of the AMS scale to measure treatment effect, irrespective of the severity of complaints before therapy. It was also shown that the AMS result can predict the independently generated (physician's) opinion about the individual treatment effect.

Conclusion

The currently available methodological evidence points towards a high quality of the AMS scale to measure and to compare HRQoL of aging males over time or before/after treatment, it suggests a high reliability and high validity as far as the process of construct validation could be pressed ahead yet. But certainly more data will become available, particularly from ongoing clinical studies.