[Implementation of a novel form of care for the early detection and prevention of emotional and behavioral problems in children in the pediatric setting: Qualitative interviews with pediatricians, practice staff and parents]

AIM OF THE STUDY

Evaluation of the implementation of a standardized screening using the Strengths and Difficulties Questionnaire (SDQ) as part of the routine pediatric health check-ups in the Dresden area (Germany) in order to detect emotional and behavioral problems (EBPs) in children early and allocate them to indicated preventive programs and/or to further counselling and treatment services.

METHODS

1.) Semi-structured interviews were performed with participating pediatricians (n=4), practice staff (n=4) and custodians of screened children (n=17) and subjected to content analysis regarding feasibility, advantages and disadvantages of the screening and the targeted allocation, as well as barriers and facilitators of using the screening and the preventive programs and further services. 2.) A self-developed questionnaire survey (descriptive analysis: means and frequencies) was conducted among pediatricians (n=34/99) to inquire about the implementation of the SDQ screening regarding feasibility, advantages, disadvantages and necessary conditions for a potential adoption of the screening to standard health services.

RESULTS

In the interviews, the pediatricians and practice staff reported that the SDQ screening embedded in routine pediatric health check-ups was simple and could be carried out in a few minutes. The screening helped to identify and address possible EBPs in children and to recommend a targeted service. Apart from the expenditure of time, no disadvantages were mentioned. As expected, parent-related (e.g. fears, attitudes and trust in the pediatrician), child-related (does not want to reveal any information about him- or herself , attitude and motivation), service provider-related (presentation of services), organizational (necessary signatures, financing, waiting time) and service-related (duration, costs, venue, designation) factors influenced the families' use of the screening and further services. Interviewed custodians whose child participated in an indicated preventive program within the project (n=11) would recommend the SDQ screening and preventive program to other families. In the questionnaire survey 28/31 pediatricians "completely" or "rather" agreed on a 5-point Likert scale that the SDQ screening and targeted allocation should be included in standard pediatric care.

DISCUSSION

The use of the SDQ, which is one of the most widely used and, despite its brevity, most valid screening instruments for the early detection of EBPs, in routine pediatric health check-ups and the targeted allocation of further health services represent a feasible approach to the early identification and clarification of EBPs in children as well as their allocation to indicated preventive services.

CONCLUSION

An adoption of the novel form of care (SDQ screening and targeted allocation to indicated preventive programs and further services) to standard pediatric care unfolds its benefits if preventive and care services for EBPs in children are made available nationwide.

Social Interactions in Everyday Life of Socially Anxious Adolescents: Effects on Mental State, Anxiety, and Depression

Unfavorable interpersonal behavior in social anxiety disorder (SAD) contributes to the maintenance of the disorder and may also be related to the development of secondary depression. Since there is limited research on daily life behavior in SAD, this study aimed to describe social interaction behavior and analyze the effect of positive interactions on depression, anxiety, and mental state. Data were obtained from the Behavior and Mind Health study (11/2015-12/2016), an epidemiological cohort study of adolescents and young adults (n = 1,180, aged 14-21 years) from Dresden, Germany. Interpersonal behavior, current mental state, anxiety, and depression were assessed eight times per day over four days using smartphone-based ecological momentary assessments. The analyzed subsample consisted of n = 723 participants, comparing 12-month SAD (n = 60) and healthy controls (HC; n = 663). The interaction behavior of participants with SAD did not differ substantially from that of HC in terms of frequency of social interactions, type of interaction partner, and time spent communicating, although they reported fewer real-life interaction partners (SAD: M = 2.49, SD = 4.78; HC: M = 3.18, SD = 6.43; F(17,044) = 23.92, p < 0.001). When comparing mental state, anxiety, and depression after interactions with familiar people to no interaction, no differences were found between SAD and HC. However, interactions with unfamiliar people negatively affected depressive symptoms in individuals with SAD (b = 0.53; SE = 0.25; 95%CI: 0.04-1.03; p = 0.036). In adolescents with SAD, social situations with unfamiliar people seem to be processed in a dysfunctional way, contributing to increased depressive mood in everyday life. This is particularly interesting given the high rate of secondary depression in SAD.

Addressing help-seeking, stigma and risk factors for suicidality in secondary schools: short-term and mid-term effects of the HEYLiFE suicide prevention program in a randomized controlled trial

BACKGROUND

Suicidal ideation and suicide attempts present a serious public health concern among adolescents and young adults. School-based suicide prevention programs are a key tool for addressing this problem. However, more research is necessary to assess their effectiveness, acceptability, and safety. In response, the HEYLiFE suicide prevention program was developed to enhance help-seeking, reduce stigma towards suicidal peers and diminish risk factors for suicidality. This article presents the evaluation findings of the HEYLiFE program in German secondary schools.

METHODS

We conducted a randomized-controlled trial measuring short-term pre-post within-group effects in the intervention group only and mid-term effects at 6-months-follow-up compared to a waitlist-control group. Schools were assigned randomly to the intervention or control group (no blinding). We recruited students ≥12 years of age. Primary outcomes were knowledge about suicidality, attitudes towards suicidality, stigma towards a suicidal peer, help-seeking intentions and behaviours, risk factors for suicidality. The data was analysed with linear mixed models and generalized linear mixed models.

RESULTS

A total of N = 745 students participated (n = 353 intervention group, n = 392 control group). We observed favourable short-term effects on knowledge, attitudes towards suicidality and fear towards a suicidal peer. Unexpectedly, the program also led to an increase in desire for social distance and a decrease in prosocial emotions towards a suicidal peer. The mid-term effects of the program were exclusively favourable, resulting in enhanced attitudes towards help-seeking while protecting from a sharper rise in risk-factors for suicidality and from an increase in social distance. The program had more favourable effects on females and on students aged >13 years. The program was well-received by the students, and no serious adverse events were reported.

CONCLUSIONS

These findings demonstrate the effectiveness of the HEYLiFE universal suicide prevention program in addressing variables associated with suicidal ideation and suicide attempts among adolescents on the mid-term. The short-term negative effects on stigma and more negative effects on males should be addressed in the future. Future evaluation studies should examine its effects on suicidality and its effectiveness within populations at high risk.

TRIAL REGISTRATION

The study was preregistered in the German Clinical Trials Register (registration number: DRKS00017045; registration date: 02/04/2019).

[Indicative prevention programs for mental health promotion in preschool and primary school age: Willingness of pediatricians and families to participate in an innovative care chain]

BACKGROUND

Mental health problems usually have their onset in childhood. Undiagnosed, they may progress into mental disorders. Despite their effectiveness, existing preventive programs have been rarely used. We aimed to examine to what extent the establishment of a care chain can identify children at high risk at an early stage and assign them to preventive interventions. In addition, prevention program participation was assessed.

METHODS

In a prospective implementation study, the Strengths and Difficulties Questionnaire was administered as a screening instrument to families during regular pediatric health examinations (U9-U11, child age 5-10 years). Families received feedback directly from the pediatrician, and in the case of borderline abnormal emotional or behavioral problems, a recommendation for an indicative prevention program. Program indication was additionally determined in an entry examination prior to program participation.

RESULTS

In the area of Dresden (Germany), n = 46 (38.7%) pediatricians participated in the project. In n = 28 pediatric practices, n = 3231 (86.4%) families participated in the screening and n = 864 (26.7%) children received a prevention recommendation. Of the families, n = 118/864 (13.7%) self-registered for the prevention programs, n = 215/624 (35.5%) showed interest after being contacted by the study teamn. Through other pathways, n = 139 families requested participation. Clinical evaluation interviews to assess prevention indication were conducted in n = 337 children (n = 461; via all entry pathways). Finally, n = 237 (n = 337) children participated in an indicated prevention program.

CONCLUSION

Expanding screening to mental health problems during regular health checkups is feasible, useful, and widely accepted. In order to implement a care chain, a supply structure should be established to enable referral to and uptake of preventive interventions.

[How good are teachers at recognising mental health issues and assistance needs in adolescents? A vignette-based study]

INTRODUCTION

Teachers can help identify mental health issues in adolescents and act as gateway-providers by referring adolescents at risk to a mental health professional. Studies have so far investigated awareness concerning mental health issues among primary school teachers in the USA. The present study uses case vignettes to examine whether secondary school teachers in Germany can detect and assess the presence and severity of mental disorders in adolescents, and which factors predict referral to professional support services.

METHODS

N=136 secondary school teachers completed an online questionnaire with case vignettes depicting students with moderate or severe internalizing and externalizing disorders. We assessed the ability to recognize mental health issues and evaluate the level of severity, worry and perceived prevalence of the problem as well as the helping behaviour among teachers.

RESULTS

66 and 75% of the teachers were able to identify mental health issues in case vignettes of externalizing and internalizing disorders, respectively. 60% and 61%, respectively, designated the mental disorder correctly as externalizing or internalizing, and the true positive rates did not differ between externalizing vs. internalizing disorders. However, moderate and externalizing disorders were identified with less precision, and recommendations to seek professional mental help were more seldom made for these disorders.

DISCUSSION

The results indicate that teachers can validly and probably intuitively identify (at least severe cases of) mental disorders in their students. Given the uncertainty expressed and the substantial interest of teachers, further education and training on mental health conditions disorders in adolescents is recommended.

The impact of mode of delivery on parent-infant-bonding and the mediating role of birth experience: a comparison of mothers and fathers within the longitudinal cohort study DREAM

BACKGROUND

The association between mode of delivery (MOD) and parent-infant-bonding has only been studied in mothers and findings have been inconclusive. The aim of this study was to prospectively investigate how MOD relates to postpartum parent-infant-bonding in both mothers and fathers and whether these associations are mediated by birth experience.

METHODS

This study is part of the prospective cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Our sample comprised N = 1,780 participants who completed quantitative questionnaires during pregnancy as well as 8 weeks and 14 months postpartum. MOD was dummy coded, contrasting spontaneous vaginal delivery against vaginal delivery induced by drugs, operative vaginal delivery, planned, and unplanned cesarean section. Parent-infant bonding and birth experience were assessed using validated scales. A moderated mediation analysis based on ordinary least square (OLS) regression and bootstrapped estimates was conducted, considering relevant confounding variables.

RESULTS

Compared to spontaneous vaginal delivery, all categories of MOD predicted more negative birth experiences in both parents. A more positive birth experience predicted stronger parent-infant-bonding at 8 weeks, but not at 14 months postpartum. Mothers who delivered via cesarean section (planned or unplanned) reported stronger parent-infant-bonding at 8 weeks and 14 months postpartum. In fathers, only unplanned cesarean section was associated with stronger parent-infant-bonding at 8 weeks postpartum. At 8 weeks postpartum, birth experience mediated the association between a vaginal delivery induced by drugs and a planned cesarean section and mother-infant-bonding and between a vaginal delivery induced by drugs, an operative vaginal delivery, and planned cesarean section and father-infant-bonding. At 14 months postpartum, birth experience mediated the association between a vaginal delivery induced by drugs, operative vaginal delivery, and planned cesarean section and parent-infant-bonding in both parents.

CONCLUSIONS

The results emphasize the importance of the birth experience for parent-infant-bonding in both mothers and fathers. Further research should address the mechanisms by which parents with an unplanned cesarean section establish stronger parent-infant-bonding compared to parents whose baby was delivered via spontaneous vaginal delivery, despite their overall more negative birth experiences.

Suizidalität

Ursachen Die Entwicklung eines standardisierten (der jeweiligen Abteilung angepassten) Vorgehens ist für die Risikobeurteilung vorteilhaft. Hierzu gehören beispielsweise die Erfassung von Risiko- und Schutzfaktoren als Basis für die Ableitung konkreter Handlungsempfehlungen.

Suizidprävention Im Hinblick auf Präventionsmaßnahmen konnte insbesondere für die Methodenrestriktion als Public-Health-Ansatz sowie die Verbesserung der Behandlung psychischer Erkrankungen (v. a. der Depression) als gesundheitspolitischer Ansatz eine profunde Evidenz gezeigt werden. Die Etablierung regelmäßiger Schulungen/Weiterbildungen in den helfenden Berufen (schichtenübergreifend) ist essenziell zur differenzierten Einschätzung des Suizidrisikos notwendig.

Suizidalität in Klinik und Praxis Die systematische und wiederholte Erfassung von Risikofaktoren (gemäß psychometrisch validierter Skalen) sagt im Einzelfall nichts über das tatsächliche Suizidrisiko eines Individuums aus. Der Wert eines standardisierten Prozesses liegt also nicht in der Vorhersagemöglichkeit eines einzelnen Suizids, sondern in der Einschätzung verschiedener Faktoren, die die Grundlage bilden, Suizidalität zu erkennen und damit gezielte besser zugeschnittene Interventionen zu ermöglichen. Unabhängig von der eigenen Haltung des Arztes/Therapeuten ist das Wissen über die Einschätzung von Suizidalität (inkl. Risiko- und Schutzfaktoren) sowie die daraus resultierenden Konsequenzen die Grundlage für den Umgang mit suizidalen Patienten.

Merkmale eines Gesprächs zur Einschätzung des Suizidrisikos Krisenhafte Zustände mit akuter Suizidalität sind in den meisten Fällen von vorübergehender (und eher kürzerer) Dauer. Schaffen wir es, den Menschen durch diese Zeit zu begleiten, ist mit zunehmendem Zeitabstand oft eine Neubewertung und (erneute) Lebensorientierung möglich.

Psychotherapeutische/pharmakologische Möglichkeiten Zur Behandlung der unterschiedlichen Facetten von Suizidalität steht eine Anzahl von allgemeinen, z. B. pflegerischen sowie speziellen Maßnahmen (psychotherapeutische Begleitung, medikamentöse Therapie, Soziotherapie) in verschiedenen Settings zur Verfügung. Diese sollten auf die individuellen Bedürfnisse des Patienten abgestimmt sein.

Die Bedeutung peripartaler mütterlicher Angst- und depressiver Störungen für die frühkindliche Entwicklung

Zusammenfassung. Theoretischer Hintergrund: Aktuelle Studien zeigen spezifische Zusammenhänge von peripartalen psychischen Störungen und kindlichen Entwicklungsauffälligkeiten. Fragestellung: Haben Kinder von Müttern mit einer peripartalen Angst- oder depressiven Störung ein erhöhtes Risiko für (visuo–)‌motorische, sprachliche und kognitive Entwicklungsauffälligkeiten? Methode: In der prospektiven MARI-Studie ( N = 306) wurden peripartale psychische Störungen mit dem CIDI-V in jedem Schwangerschaftstrimester sowie 2, 4 und 16 Monate nach der Geburt erhoben. Die kindliche Entwicklung wurde mit dem Neuropsychologischen Entwicklungs-Screening im Alter von 4 ( N = 263) und 16 Monaten ( N = 241) erfasst. Ergebnisse: Maternale depressive Störungen vor der Schwangerschaft waren negativ mit der visuellen Entwicklung (4 Monate; OR = 3.3) und der Haltungs- und Bewegungssteuerung (16 Monate; OR = 4.4) des Kindes assoziiert. Diskussion: Entwicklungsauffälligkeiten könnten u. a. durch ein verändertes Interaktionsverhalten (z. B. weniger Blickkontakt/Ermutigung) betroffener Mütter begründet sein.

Physical and mental health changes in the five years before and five years after childbirth: A population-based panel study in first-time mothers and fathers from Germany

BACKGROUND

The transition to parenthood is characterized by far-reaching changes in life. However, little prospective-longitudinal evidence from general population samples exists on changes of general physical and mental health in the years around the birth of a child among mothers and fathers.

METHODS

Using data from the German Socio-Economic Panel Study (SOEP), this study examined continuous and discontinuous short- and long-term changes of general physical and mental health from five years before until five years after the birth of the first child in women (N = 1,912) and men (N = 1,742). Whether a child was born was assessed annually throughout the study. Physical and mental health was assessed biannually from 2002 to 2018 with the SF-12v2.

RESULTS

Multilevel analyses revealed that women experienced a considerable decrease of physical health during pregnancy, which remitted after delivery. On average, women's mental health increased in the last year before and first year after delivery. These mental health improvements were stronger in older vs. younger mothers and remained largely stable in the years after childbirth. In contrast, little evidence for changes of general physical or mental health in (expectant) fathers was found.

LIMITATIONS

Physical and mental health was assessed with a short questionnaire only (SF-12v2).

CONCLUSIONS

On average, women's mental health tends to improve before and after the birth of the first child. Men seem to be much less affected by the birth of a child than many previous studies suggest.

Progression of externalizing disorders into anxiety disorders: Longitudinal transitions in the first three decades of life

BACKGROUND

There is a notable comorbidity between externalizing disorders and anxiety disorders, which may be explained by the co-occurrence of two prevalent early-onset disorders, by shared vulnerability and risk factors, or as evidence that one disorder group might be causally related to the other.

AIM

To investigate the longitudinal trajectories of externalizing disorders, their interplay with anxiety disorders, and putative predictors for symptom progression in youth.

METHODS

1053 adolescents (14-17 years) from the general population were assessed at baseline and prospectively at 2, 4, and 10-year follow-up using a standardized interview of mental disorders (DIA-X/M-CIDI) to assess "early" (oppositional-defiant disorder, conduct disorder, ADHD) and "late" (antisocial behavior, substance use disorders) externalizing disorders as well as anxiety disorders. Longitudinal associations and predictors for symptom progression were examined using Kaplan-Meier-analyses.

RESULTS

Lifetime prevalence of early externalizing disorders were 9.1% and 6.4% among those with and without any anxiety disorder. A late externalizing disorder was reported by 50.3% of those with an early externalizing disorder and in 26.6% of those with any anxiety disorder. Both early (HR: 1.5, 95%CI: 1.0-2.3) and late externalizing disorders (HR: 2.1, 95%CI: 1.7-2.6) were associated with incident anxiety disorders. Higher parental rejection, lower volitional inhibition, and higher volitional avoidance predicted incident anxiety disorders among those with early externalizing disorders.

DISCUSSION

Early externalizing disorders likely follow a homotypic continuity (to late externalizing disorders) and/or a heterotypic continuity to anxiety disorders, and thus appear as a useful target for prevention and early intervention.

Wie gelingt die Prävention psychischer Beschwerden?

Hintergrund

Emotionale und Verhaltensprobleme in der Kindheit haben oft weitreichende Folgen für die soziale, emotionale und kognitive Entwicklung, sodass ihrer Prävention ein hoher Stellenwert zukommt. Dennoch ist die Inanspruchnahme von Präventionsmaßnahmen im Kindesalter gering.

Ziel

In einer versorgungsepidemiologischen Implementationsstudie wird untersucht, inwiefern durch ein systematisches Screening eingebettet in U‑Untersuchungen die Identifikation von Risikokindern und die Zuweisung zu Präventionsprogrammen gelingt.

Methoden

Dazu ist ein Screening mittels „Strengths and Difficulties Questionnaire“ während der regulären Gesundheitsuntersuchungen (U9–U11) von ca. 3500 Kindern im Alter von 5 bis 10 Jahren in ca. 53 Arztpraxen in Dresden und 20 km Umkreis geplant. Die Eltern erhalten von der Fachkraft für Kinderheilkunde eine Rückmeldung zu den Ergebnissen und im Falle von grenzwertigen Werten auf den Subskalen „Emotionale Probleme“ und/oder „Verhaltensprobleme“ eine Empfehlung für ein indikatives Präventionsprogramm. Zu vier Messzeitpunkten werden Familien mittels standardisierter und projektspezifischer Fragebogen befragt. Zusätzlich erfolgen leitfadengestützte Interviews mit Leistungserbringern und Familien.

Ergebnisse und Schlussfolgerung

Es werden die Machbarkeit, Nützlichkeit und Akzeptanz eines Screenings für emotionale und Verhaltensauffälligkeiten bei Kindern und Präventionsempfehlungen in Kinderarztpraxen im Prä‑/Post-Vergleich und nach 12 Monaten evaluiert. Förderliche und hemmende Faktoren für die Inanspruchnahme werden bestimmt, um Empfehlungen für die Implementation von Präventionsangeboten in die Regelversorgung abzuleiten, um emotionale und Verhaltensauffälligkeiten frühzeitig zu erkennen und der Entwicklung psychischer Störungen vorzubeugen.

Prospective Associations of Lifetime Post-traumatic Stress Disorder and Birth-Related Traumatization With Maternal and Infant Outcomes

OBJECTIVE

Many women experience traumatic events already prior to or during pregnancy, and delivery of a child may also be perceived as a traumatic event, especially in women with prior post-traumatic stress disorder (PTSD). Birth-related PTSD might be unique in several ways, and it seems important to distinguish between lifetime PTSD and birth-related traumatization in order to examine specific consequences for mother and child. This post-hoc analysis aims to prospectively examine the relation of both, lifetime PTSD (with/without interpersonal trauma) and birth-related traumatization (with/without postpartum depression) with specific maternal and infant outcomes.

METHODS

In the prospective-longitudinal Maternal in Relation to Infants' Development (MARI) study, N = 306 women were repeatedly assessed across the peripartum period. Maternal lifetime PTSD and birth-related traumatization were assessed with the Composite International Diagnostic Interview for women. Maternal health during the peripartum period (incl. birth experience, breastfeeding, anxiety, and depression) and infant outcomes (e.g., gestational age, birth weight, neuropsychological development, and regulatory disorders) were assessed via standardized diagnostic interviews, questionnaires, medical records, and standardized observations.

RESULTS

A history of lifetime PTSD prior to or during pregnancy was reported by 25 women who indicated a less favorable psycho-social situation (lower educational level, less social support, a higher rate of nicotine consumption during pregnancy). Lifetime PTSD was associated with pregnancy-related anxieties, traumatic birth experience, and anxiety and depressive disorders after delivery (and in case of interpersonal trauma additionally associated with infant feeding disorder). Compared to the reference group, women with birth-related traumatization (N = 35) indicated numerous adverse maternal and infant outcomes (e.g., child-related fears, sexual problems, impaired bonding). Birth-related traumatization and postpartum depression was additionally associated with infant feeding and sleeping problems.

CONCLUSION

Findings suggest that both lifetime PTSD and birth-related traumatization are important for maternal and infant health outcomes across the peripartum period. Larger prospective studies are warranted.

IMPLICATIONS

Women with lifetime PTSD and/or birth related traumatization should be closely monitored and supported. They may benefit from early targeted interventions to prevent traumatic birth experience, an escalation of psychopathology during the peripartum period, and adverse infant outcomes, which in turn may prevent transgenerational transmission of trauma in the long term.

Personalized Assessment of Anxiety and Avoidance in Children and Their Parents-Development and Evaluation of the Anxiety and Avoidance Scale for Children

In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.

Help-Seeking Behavior and Treatment Barriers in Anxiety Disorders: Results from a Representative German Community Survey

Although effective therapies exist, treatment rates of anxiety disorders (AD) are low, raising the question why affected individuals do not receive treatment. We provide data from the nationally representative German Health Interview and Examination Survey-2011 (DEGS1) on the help-seeking behavior and perceived treatment barriers of 650 subjects with Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV AD). Only 26% of all cases with AD in the community reported having had contact with mental health services because of their anxiety problems in their lifetime. 16% were currently receiving professional help, most frequently by psychotherapists (8%), psychiatrists (5%) and general practitioners (5%). 40% of all cases never even considered seeking help and 31% reported barriers to treatment, such as self-reliance (18%) or beliefs that treatments were ineffective (9%), unavailable (8%) or too stigmatizing (7%). Measures to increase treatment rates should thus target individual as well as public attitudes and health literacy to increase awareness of and access to evidence-based interventions.

Dos and Don'ts in Designing School-Based Awareness Programs for Suicide Prevention

Abstract.Background: Despite the promising evidence for the effectiveness of school-based awareness programs in decreasing the rates of suicidal thoughts and suicide attempts in young people, no guidelines on the targets and methods of safe and effective awareness programs exist. Aims: This study intends to distill recommendations for school-based suicide awareness and prevention programs from experts. Method: A three-stage Delphi survey was administered to an expert panel between November 2018 and March 2019. A total of 214 items obtained from open-ended questions and the literature were rated in two rounds. Consensus and stability were used as assessment criteria. Results: The panel consisted of 19 participants in the first and 13 in the third stage. Recommended targets included the reduction of suicide attempts, the enhancement of help-seeking and peer support, as well as the promotion of mental health literacy and life skills. Program evaluation, facilitating access to healthcare, and long-term action plans across multiple levels were among the best strategies for the prevention of adverse effects. Limitations: The study is based on opinions of a rather small number of experts. Conclusion: The promotion of help-seeking and peer support as well as facilitating access to mental health-care utilities appear pivotal for the success of school-based awareness programs.

“Mutig werden kann ich lernen”: Kognitive Verhaltenstherapie bei ausgeprägter Angstsymptomatik, Entwicklungsstörung und Intelligenzminderung

<b><i>Hintergrund:</i></b> Die psychotherapeutische Behandlung von Kindern und Jugendlichen mit geistiger Behinderung unterliegt einer Vielzahl von Barrieren. <b><i>Fallbericht:</i></b> Der hier vorgestellte Behandlungsfall illustriert die erfolgreiche Anwendung kognitiver Verhaltenstherapie bei einem 10-jährigen Mädchen bei Entwicklungsstörung und Intelligenzminderung. Nach einer medizinisch notwendigen Untersuchung entstanden ausgeprägte Angstsymptome und Verhaltensprobleme. Infolge einer bekannten Epilepsie war der Einsatz expositionsbasierter Techniken fraglich. Die kognitive Verhaltenstherapie umfasste 64 Behandlungseinheiten. Das Vorgehen zur Selbstbeobachtung, Rationalvermittlung und Angstbewältigung war stark handlungsbezogen und wenig kognitiv orientiert und fand im häuslichen Setting mit Einbezug der Familienmitglieder statt. Nachfolgend wurden – auch aufgrund der zunehmenden Reifung des Kindes – kognitiv anspruchsvollere Techniken eingesetzt. Zur 38. Behandlungseinheit wurden zuvor angstbesetzte Situationen dem Entwicklungsstand angemessen und selbstständig bewältigt. Eine nachfolgende medizinische Untersuchung ähnlich der Auslösesituation wurde therapeutisch vorbereitet und sicher bewältigt. Zu Behandlungsende waren die Alltagskompetenzen maßgeblich erweitert. <b><i>Schlussfolgerungen:</i></b> Entgegen der Vorannahmen bedurfte es nur weniger Anpassungen an das Setting und die Behandlungstechniken im Vergleich zum Vorgehen bei ähnlicher Symptomatik ohne geistige Behinderung. Durch die psychotherapeutische Behandlung konnte kurz- und langfristig eine Manifestation (Eskalation) von weiterem Problemverhalten verhindert werden. Das Erkennen und die Auseinandersetzung mit dem “Anderssein” infolge der geistigen Behinderung und verfügbarer Alltagskompetenzen bergen Entwicklungsrisiken und -chancen, die durch eine psychotherapeutische Begleitung gut bewältigt werden können.

"Doctor, my back hurts and I cannot sleep." Depression in primary care patients: Reasons for consultation and perceived depression stigma

Background

General practitioners (GPs) play a significant role in depression care. Recognition of depression is crucial for adequate treatment but is impeded by a high portion of depressed patients only reporting physical symptoms to their GP. Among the many reasons for this phenomenon is mental health stigma. We investigated how patients with depression differed from patients without depression regarding the types and number of complaints presented to their GP, as well as their depression stigma. For the subgroup of patients with depression, potential associations between perceived depression stigma and number and types of presented complaints were investigated to see if these might reflect the patient’s intention to conceal mental health symptoms due to fear of being stigmatized by others. Further, we investigated if perceived depression stigma is related to depression treatment.

Methods

Data on depressive symptoms (assessed by the Depression Screening Questionnaire; DSQ), depression stigma (assessed by the Depressions Stigma Scale; DSS), type of complaints reported to the GP and treatment-related factors were collected from 3,563 unselected primary care patients of 253 GPs in a cross-sectional epidemiological study (“VERA study”) in six different German regions. Data of a total of 3,069 patients was used for analysis on complaints reported to the GP (subsample of the VERA study), and for 2,682 out of 3,069 patients data on a stigma questionnaire was available.

Results

Nearly half of the primary care patients with depression (42.2%) reported only physical complaints to their GP. Compared to patients without a depression diagnosis, patients with depression reported twice as many complaints to their GP with a mean of 2.02 (1.33) vs. 1.2 (0.69), including a more frequent combination of physical and mental symptoms (28.8% vs. 3.5%). Patients with depression showed higher total stigma compared to patients without depression, Mdn = 48 (IQR 40–54) vs. Mdn = 46.3 (IQR 29–53), due to higher perceived stigma, Mdn = 27 (IQR 21–32) vs. Mdn = 25.9 (IQR 20–29). Perceived stigma was associated with male gender (beta -.14, p = .005) and a lack of pharmacological treatment (beta -.14, p = .021) in patients with a depression diagnosis.

Conclusion

The number of complaints presented to the GP might function as a marker to actively explore depression in primary care patients, in particular when both physical and mental symptoms are reported. Perceived depression stigma should also be addressed especially in male patients. Further research should clarify the role of perceived stigma as a potential inhibitor of pharmacological treatment of depression in primary care.

Associations of Partnership Quality and Father-to-Child Attachment During the Peripartum Period. A Prospective-Longitudinal Study in Expectant Fathers

Background: During the transition to parenthood, a complex network of relationships unfolds between father, mother and the child. Expectant parents begin bonding with their unborn child, with this antenatal process supposedly being predictive for later postnatal attachment and child mental health. At the same time, couples may experience a change in partnership quality. While the majority of previous studies focused on associations between psychopathology, partnership quality and attachment from the perspective of mothers, the changes in partnership quality and attachment from the perspective of fathers has gained far less attention. Methods: Data were derived from the Maternal Anxiety and it's Relation to Infants' Development (MARI) study. N = 109 expectant fathers were recruited during mid-pregnancy (22 to 26 week of gestation). Lifetime anxiety and depressive disorders (DSM-IV) were assessed with a standardized diagnostic interview (CIDI). Paternal partnership characteristics and father-to-child attachments were assessed using standardized questionnaires at the second trimester, 10 days after delivery and 4 months after delivery in N = 76 fathers. Analyses were based on bivariate, robust and multivariate regression analyses. Results: Fathers did not report an overall decrease in partnership quality during the peripartum period. However, fathers with comorbid anxiety and depressive disorders reported lower partnership satisfaction at postpartum, as compared to unaffected fathers. Fathers with pure depressive disorders reported lower intensity of antenatal attachment. Paternal antenatal partnership quality was positively associated with antenatal father-to-child attachment. Furthermore, antenatal father-to-child attachment, as well as ante- and postnatal partnership quality in fathers, were positively related to postnatal father-to-child attachment. Conclusions: Antenatal father-to-child-attachment and paternal partnership quality appear to be promising targets for the prevention of postnatal attachment problems in fathers. The associations between partnership quality and attachment to the child further support an interpersonal approach in perinatal research, treatment and intervention, and may also feed into awareness programs that encourage expectant fathers to actively engage in relationships as early as during pregnancy-both with the mother and the unborn child.

Birth Experience Mediates the Association Between Fear of Childbirth and Mother-Child-Bonding Up to 14 Months Postpartum: Findings From the Prospective Cohort Study DREAM

OBJECTIVE

To explore the longitudinal associations between prepartum fear of childbirth (FOC), birth experience, and postpartum mother-child-bonding, and the potential mediator role of the birth experience.

DESIGN

Women from the prospective cohort study DREAM completed questionnaires during pregnancy, 8 weeks, and 14 months after the birth.

PARTICIPANTS

A community sample of n = 645 pregnant women from a large city in Eastern Germany participated in the study.

RESULTS

In a regression analysis, FOC predicted negative birth experience (β = 0.208, p < 0.001) which in turn predicted poorer mother-child-bonding both at 8 weeks (β = 0.312, p < 0.001) and 14 months postpartum (β = 0.200, p < 0.001). FOC also predicted mother-child-bonding at 14 months postpartum (β = 0.098, p < 0.05). Of note, this association was mediated by birth experience both at 8 weeks, indirect effect ab = 0.065, 95% CI [0.036, 0.098], and 14 months postpartum, indirect effect ab = 0.043, 95% CI [0.023, 0.067]. These effects remained stable even when adjusting for potential confounders.

KEY CONCLUSIONS

This study suggests that the association between FOC and mother-child-bonding is mediated by birth experience, pointing to the importance of a woman's positive subjective experience.

IMPLICATIONS FOR PRACTICE

Findings reveal two targets for peripartum interventions for women at risk for poor mother-child-bonding, namely the implementation of FOC screenings during pregnancy, and birth experience as mediating factor between FOC and mother-child-bonding. Focusing on the mother's subjective birth experience could aid to identify women at risk for impaired bonding who might need additional support.

Corrigendum: Associations of Partnership Quality and Father-to-Child Attachment During the Peripartum Period. A Prospective-Longitudinal Study in Expectant Fathers

[This corrects the article DOI: 10.3389/fpsyt.2021.572755.].

The state of the art in European research on reducing social exclusion and stigma related to mental health: A systematic mapping of the literature

Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.

Parental Cognitions About Sleep Problems in Infants: A Systematic Review

Introduction: Parental cognitions may directly and indirectly contribute to infant sleep outcomes. This review provides a systematic up-to-date overview of the associations between parental cognitions and infant sleep problems with special emphasis on temporal relationships and the content of parental cognitions. Methods: A systematic literature research in PubMed and Web of Science Core Collection sensu Liberati and PRISMA guidelines was carried out in March 2020 using the search terms (parent^* AND infant^* AND sleep^* problem^*), including studies with correlational or control group designs investigating associations between parental cognitions and sleep problems in children aged 1-6 years. Results: Twenty-three studies (published from 1985 to 2016) met inclusion criteria, of which 14 reported group differences or associations between parental sleep-related cognitions and child sleep outcomes. Nine papers additionally reported on the role of general parental child-related cognitions not directly pertaining to sleep. Findings from longitudinal studies suggest that parental cognitions often preceded child sleep problems. Cognitions pertaining to difficulties with limit-setting were especially prevalent in parents of poor sleepers and were positively associated with both subjective and objective measures of child sleep outcomes. Conclusions: Parental cognitions appear to play a pivotal role for the development and maintenance of sleep problems in young children, arguing that parents' attitudes and beliefs regarding child sleep inadvertently prompts parental behavior toward adverse sleep in offspring. Associations are however based on maternal reports and small to moderate effect sizes. Thus, additional parental factors such as mental health or self-efficacy, as well as additional offspring factors including temperamental dispositions and regulatory abilities, require consideration in further studies.

European mental health research resources: Picture and recommendations of the ROAMER project

As part of the Roamer project, we sought to have a picture of the available mental health research (MHR) funding, capacity-building and infrastructures resources and to establish consensus-based recommendations that would allow an increase of European MHR resources and enable better use and accessibility to them. The methods fell into three sections (i) a review of the literature, (ii) a mental health-related keywords search within the Cordis^®, On-Course^® and Meril^® databases which contain information on European research funding, training and infrastructures. These reviews provided an overview that was presented to (iii) two experts workshops with 28 participants drawn from academic which identified gaps and produced recommendations. The literature review illustrates the debates in the scientific community on funding, training and infrastructures. The database searches estimated the fraction of health research resources available for mental health. Eight overarching goals for MHR resources were identified by the workshops; each of them was carried out with several practical recommendations. Resources for MHR are scarce considering the burden of mental disorders, the high rate of return of MHR and the under-investment of the field. The recommendations are urgently warranted to increase resources and their optimal access and use.

Characterization of noise sources in a microfabricated single-beam zero-field optically-pumped magnetometer

We present an experimental noise characterization of a miniature single-beam absorption-based optically-pumped magnetometer with a noise floor of 7 fT/Hz1/2 operating in the spin-exchange relaxation-free regime. We experimentally evaluate noise arising from the laser intensity, laser frequency, laser polarization, cell temperature, and magnetic field coils used for the phase-sensitive detection of the magnetometer signal. We find that noise in the range between DC and 30 Hz is a result of noise sources coupling to the atoms in a manner similar to a magnetic field, while the noise at frequencies above 30 Hz is mainly due to laser intensity noise. Our results place an upper limit on the noise sources for our system that matches well with the noise spectrum of the magnetometer at frequencies above 5 Hz.

[How frequently are depressive disorders recognized in primary care patients? : A cross-sectional epidemiological study in Germany]

BACKGROUND

Primary care physicians (PCPs) play a crucial role for guideline-oriented intervention in patients with depression.

OBJECTIVES

Based on a diagnostic screening questionnaire, this study investigates the sensitivity of PCPs to recognize patients with depression as well as the factors facilitating recognition and concordant diagnostic decisions.

METHOD

In a cross-sectional epidemiological study in six regions of Germany, 3563 unselected patients filled in questionnaires on mental and physical complaints and were diagnostically evaluated by their PCP (N = 253). The patient reports on an established Depression-Screening-Questionnaire (DSQ), which allows the approximate derivation of an ICD-10 depression diagnosis, were compared with the physician diagnosis (N = 3211). In a subsample of discordant cases a comprehensive standardized clinical-diagnostic interview (DIA-X/CIDI) was applied.

RESULTS

On the study day, the prevalence of ICD-10 depression was 14.3% according to the DSQ and 10.7% according to the physician diagnosis. Half of the patients identified by DSQ were diagnosed with depression by their physician and two thirds were recognized as mental disorder cases. More severe depression symptomatology and the persistent presence of main depression symptoms were related to better recognition and concordant diagnostic decisions. Diagnostic validation interviews confirmed the DSQ diagnosis in the majority of the false-negative cases. Indications for at least a previous history of depression were found in up to 70% of false-positive cases.

CONCLUSION

Given the high prevalence of depression in primary care patients, there is continued need to improve the recognition and diagnosis of these patients to assure guideline-oriented treatment.

Infant, maternal, and familial predictors and correlates of regulatory problems in early infancy: The differential role of infant temperament and maternal anxiety and depression

BACKGROUND

Excessive infant crying, feeding and sleeping problems are likely to emerge from the complex interplay of various factors.

AIMS

To investigate the role of infant (e.g., temperament), maternal (e.g., anxiety and depressive disorders), and familial (e.g., social support) factors as potential precursors of infant regulatory problems.

STUDY DESIGN

Prospective-longitudinal study.

SUBJECTS

286 mother-infant dyads were investigated from early pregnancy until 16 months postpartum via questionnaires and interviews.

OUTCOME MEASURES

Regulatory problems at 2, 4 and 16 months postpartum assessed by standardized diagnostic interviews.

RESULTS

Fussy infant temperament and maternal anxiety disorders were associated with excessive infant crying (OR=1.16, 95%CI:1.05-1.29, OR=3.28, 95%CI:1.16-9.26) and feeding problems (OR=1.05, 95%CI:1.01-1.11, OR=2.27, 95%CI:1.36-3.80) whereas maternal depressive disorders were associated with infant sleeping problems (OR=2.55, 95%CI:1.06-6.11). Moreover, high maternal age (OR=0.86, 95%CI:0.75-0.98) was associated with a lower risk for excessive crying and being a single mother (OR=0.16, 95%CI:0.03-0.73) and cognitive reappraisal to regulate emotions (OR: 0.59, 95%CI:0.36-0.96) was associated with a lower risk for sleeping problems.

CONCLUSION

Excessive infant crying and feeding problems may be related to interactional deficits of anxious mothers who perceive their infants as "difficult" during soothing or feeding situations. Sleeping problems may be transmitted already during pregnancy by an altered sleep-wake-rhythm of mothers with a history of depression or by a genetic predisposition. Therapeutic interventions should focus on maternal anxiety and depression, behavior management techniques to cope with difficult situations with "fussy" infants and potential protective factors (e.g. favorable maternal emotion regulation) to address crying, feeding and sleeping problems.

A microfabricated optically-pumped magnetic gradiometer

We report on the development of a microfabricated atomic magnetic gradiometer based on optical spectroscopy of alkali atoms in the vapor phase. The gradiometer, which operates in the spin-exchange relaxation free regime, has a length of 60 mm and cross sectional diameter of 12 mm, and consists of two chip-scale atomic magnetometers which are interrogated by a common laser light. The sensor can measure differences in magnetic fields, over a 20 mm baseline, of 10 fT/[Formula: see text] at frequencies above 20 Hz. The maximum rejection of magnetic field noise is 1000 at 10 Hz. By use of a set of compensation coils wrapped around the sensor, we also measure the sensor sensitivity at several external bias field strengths up to 150 mG. This device is useful for applications that require both sensitive gradient field information and high common-mode noise cancellation.

Unterschiede in der Mutter-Kind-Bindung bei Frauen mit und ohne Soziale Phobie

Zusammenfassung. Fragestellung: Untersuchung der Bedeutung von mütterlicher Sozialer Phobie für die Entwicklung der Mutter-Kind-Beziehung in einer prospektiv-longitudinalen Studie. Methodik: Eine Teilstichprobe von 46 Frauen mit vs. ohne Lebenszeitdiagnose einer Sozialen Phobie und deren Kindern wurde analysiert. Soziale Phobien der Mütter wurden mit dem Composite International Diagnostic Interview für Frauen (CIDI-V) erhoben. Die Mütter wurden zum ante- und postnatalen Bonding befragt (MAAS, MPAS) und die Kinder wurden 16 Monate nach der Geburt mit dem Fremde-Situations-Test beobachtet. Ergebnisse: Kinder von sozialphobischen Müttern waren in der Verhaltensbeobachtung prozentual häufiger unsicher gebunden (45.4 % vs. 33.3 %) und brauchten signifikant länger, um den Kontakt zur Mutter in der Wiedervereinigungsphase wiederherzustellen (U = 160.0, p = .019). In Bezug auf das ante- (t = -.151, p = .881) und postnatale (t = .408, p = .685) Bonding der Mutter an das Kind sowie im widerstehenden (U = 262.5, p = .969), vermeidenden (U = 311.5, p = .258) und kontakterhaltenden (U = 224.0, p = .373) Verhalten des Kindes in der Fremden Situation zeigten beide Gruppen vergleichbare Werte. Schlussfolgerungen: Möglicherweise haben Mütter mit Sozialer Phobie eine gehemmte Verhaltensdisposition weitergegeben oder ihre Kinder weniger zur sozialen Interaktion ermutigt als Mütter ohne Soziale Phobie. Wenn Kinder von sozialphobischen Müttern Interaktionsängste zeigen, sollte eine Aufklärung über verschiedene Therapiemöglichkeiten sowie über mögliche Konsequenzen des eigenen (Vermeidungs-)Verhaltens für die kindliche Entwicklung erfolgen.

Family functioning mediates the association between parental depression and low self-esteem in adolescents

BACKGROUND

The negative impact of parental depression on offsprings' development has been repeatedly documented. There is however little research on the potential pathways contributing to this association. The present study examined the relationship between parental depressive disorders, family functioning and adolescents' self-esteem.

METHODS

A community-based sample of 1040 participants aged 14-17 years and their parents was assessed including direct and indirect information on parental psychopathology based on the Munich-Composite International Diagnostic Interview (M-CIDI). Family functioning and youth self-esteem were assessed by self-report questionnaires using the McMaster Family Assessment Device (FAD) in parents and the "Aussagen-Liste zum Selbstwertgefühl" in adolescents.

RESULTS

Findings from multiple regression analyses indicated positive associations between parental depressive disorders and dimensions of dysfunctional family functioning as well as between dysfunctional familial affective involvement and youth's positive self-esteem. The relationship between parental depression and self-esteem was partly mediated by familial affective involvement.

LIMITATIONS

Associations may be underestimated, since incidence for depressive disorders spans to the third decade of life. Consensus diagnoses for parental depressive disorders were based on direct and indirect information for maximum use of available data, neglecting familial load, chronicity of parental depressive disorders or comorbid conditions. Thus, specificity of the findings for the family transmission of depressive disorders remains yet to be determined.

CONCLUSIONS

Findings contribute to understanding of the pathways on how parental depression impairs offsprings' view of themselves, and to consider family functioning as a possible target for preventive interventions.

Oral but not written test anxiety is related to social anxiety

AIM

To examine the associations of test anxiety (TA) in written vs oral exam situations with social anxiety (SA).

METHODS

A convenience sample of 204 students was recruited at the Technische Universität Dresden (TU Dresden, Germany) and contacted via e-mail asking to complete a cross-sectional online survey based on established questionnaires. The study protocol was approved by the ethics committee of the TU Dresden. Full data of n = 96 students were available for dependent t-tests and correlation analyses on the associations of SA and TA respectively with trigger events, cognitions, safety behaviors, physical symptoms and depersonalization. Analyses were run using SPSS.

RESULTS

Levels of TA were higher for fear in oral exams than for fear in written exams (M = 48.1, SD = 11.5 vs M = 43.7, SD = 10.1 P < 0.001). Oral TA and SA were positively correlated (Spearman’s r = 0.343, P < 0.001; Pearson’s r = 0.38, P < 0.001) contrasting written TA and SA (Spearman’s r = 0.17, P > 0.05; Pearson’s r = 0.223, P > 0.05). Compared to written TA, trigger events were more often reported for oral TA (18.2% vs 30.3%, P = 0.007); which was also accompanied more often by test-anxious cognitions (7.9% vs 8.5%, P = 0.001), safety behavior (8.9% vs 10.3%, P < 0.001) and physical symptoms (for all, P < 0.001).

CONCLUSION

Written, but not oral TA emerged being unrelated to SA and may rather not be considered as a typical facet of SA disorder.

[Mental disorders in women: Natural course during premenstrual phases, peripartum period and perimenopause]

Epidemiological studies indicate sex-specific differences in prevalence rates and the natural course of mental disorders. Affective, anxiety, somatoform and eating disorders are more prevalent in women than men, whereas substance use disorders occur more commonly in men, and some disorders are equally distributed in both sexes (e. g. psychotic disorders). The aim of this review is to depict the natural course of mental disorders during the reproductive stages (premenstrual phases, peripartum period, perimenopause) in women, including also neuroendocrine features associated with the menstrual cycle, pregnancy, puerperium and perimenopause. Recommendations for sex-specific diagnostic and therapeutic procedures are provided.

Mental health research priorities for Europe

Mental and brain disorders represent the greatest health burden to Europe-not only for directly affected individuals, but also for their caregivers and the wider society. They incur substantial economic costs through direct (and indirect) health-care and welfare spending, and via productivity losses, all of which substantially affect European development. Funding for research to mitigate these effects lags far behind the cost of mental and brain disorders to society. Here, we describe a comprehensive, coordinated mental health research agenda for Europe and worldwide. This agenda was based on systematic reviews of published work and consensus decision making by multidisciplinary scientific experts and affected stakeholders (more than 1000 in total): individuals with mental health problems and their families, health-care workers, policy makers, and funders. We generated six priorities that will, over the next 5-10 years, help to close the biggest gaps in mental health research in Europe, and in turn overcome the substantial challenges caused by mental disorders.

The 'Early Developmental Stages of Psychopathology (EDSP) study': a 20-year review of methods and findings

PURPOSE

The "Early Developmental Stages of Psychopathology (EDSP)" study is a prospective-longitudinal study program in a community sample (Munich, Germany) of adolescents and young adults. The program was launched in 1994 to study the prevalence and incidence of psychopathological syndromes and mental disorders, to describe the natural course and to identify vulnerability and risk factors for onset and progression as well as psychosocial consequences. This paper reviews methods and core outcomes of this study program.

METHODS

The EDSP is based on an age-stratified random community sample of originally N = 3021 subjects aged 14-24 years at baseline, followed up over 10 years with up to 3 follow-up waves. The program includes a family genetic supplement and nested cohorts with lab assessments including blood samples for genetic analyses. Psychopathology was assessed with the DSM-IV/M-CIDI; embedded dimensional scales and instruments assessed vulnerability and risk factors.

RESULTS

Beyond the provision of age-specific prevalence and incidence rates for a wide range of mental disorders, analyses of their patterns of onset, course and interrelationships, the program identified common and diagnosis-specific distal and proximal vulnerability and risk factors including critical interactions.

CONCLUSIONS

The EDSP study advanced our knowledge on the developmental pathways and trajectories, symptom progression and unfolding of disorder comorbidity, highlighting the dynamic nature of many disorders and their determinants. The results have been instrumental for defining more appropriate diagnostic thresholds, led to the derivation of symptom progression models and were helpful to identify promising targets for prevention and intervention.

Schlafprobleme bei Soldaten und die Rolle traumatischer Ereignisse bei Auslandseinsätzen

Zusammenfassung. Fragestellung: Schlafprobleme, ihre Auswirkungen und Implikationen sind besonders im Kontext militärischer Missionen ein bedeutsames, jedoch wenig untersuchtes Thema. Methoden: Eine repräsentative Stichprobe von 1478 deutschen Bundeswehrsoldaten wurde 12 Monate nach Ende ihres Auslandseinsatzes mittels des Pittsburgh Sleep Quality Index (PSQI) sowie zu psychischen Störungen (DSM-IV-TR) und traumatischen Ereignissen persönlich untersucht und mit N = 880 Soldaten ohne Auslandseinsatz verglichen. Ergebnisse: 41 % der Soldaten mit und 38 % der Soldaten ohne Auslandseinsatz erfüllten die PSQI-Kriterien für Schlafprobleme. Traumatische Einsatzereignisse waren mit mehr Schlafproblemen assoziiert (β: 0.7, 95 % KI: 0.4 – 1.0, p < .001). In Abhängigkeit der Anzahl traumatischer Einsatzereignisse wurde ein höherer PSQI-Gesamtwert bei inzidenten psychischen Störungen (β: 1.2, 95 % KI: 0.3 – 2.1, p = .011), aber auch bei Soldaten ohne psychische Störungen (β: 0.7, 95 % KI: 0.3 – 1.1, p = .001) berichtet. Schlussfolgerung: Auslandseinsätze scheinen in Abhängigkeit traumatischer Ereignisse das Ausmaß von Schlafproblemen bei Soldaten sowohl innerhalb als auch außerhalb des Kontextes psychischer Störungen zu erhöhen.

Towards Horizon 2020: challenges and advances for clinical mental health research - outcome of an expert survey

BACKGROUND

The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders.

METHODS

The research was conducted as an expert survey and expert panel discussion during a scientific workshop.

RESULTS

Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The "subjectivity gap" between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required.

CONCLUSION

Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs.

An optically modulated zero-field atomic magnetometer with suppressed spin-exchange broadening

We demonstrate an optically pumped (87)Rb magnetometer in a microfabricated vapor cell based on a zero-field dispersive resonance generated by optical modulation of the (87)Rb ground state energy levels. The magnetometer is operated in the spin-exchange relaxation-free regime where high magnetic field sensitivities can be achieved. This device can be useful in applications requiring array-based magnetometers where radio frequency magnetic fields can induce cross-talk among adjacent sensors or affect the source of the magnetic field being measured.

Structure-activity relationship of the pro- and anticoagulant effects of Fucus vesiculosus fucoidan

Fucoidan is a highly complex sulfated polysaccharide commonly extracted from brown seaweed. In addition to their many biological activities, fucoidans have recently been demonstrated to inhibit or increase coagulation at different concentration ranges. Their structural features, i.e. molecular weight (Mw), Mw distribution, degree of sulfation, monosaccharide composition, and different linkages, are known to affect these activities. Therefore, structure-activity relationship (SAR) analysis of fucoidan is crucial for its potential use as a procoagulant. In this study, Fucus vesiculosus (F.v.) fucoidan was fractionated by charge and size as well as over- and desulfated to different degrees to yield preparations with various structural properties. The fractions' pro- and anticoagulant activities were assessed by calibrated automated thrombography (CAT) and activated partial thromboplastin time(aPTT) assays. Binding to and inhibition of the anticoagulant protein tissue factor pathway inhibitor (TFPI) and the ability to activate coagulation via the contact pathway were also investigated. This paper discusses the impact of charge density, size, and sugar composition on fucoidan's pro- and anticoagulant activities. Fucoidan requires a minimal charge density of 0.5 sulfates per sugar unit and a size of 70 sugar units to demonstrate desired procoagulant activities for improvement of haemostasis in factor VIII/factor IX-deficient plasma.

The psychological perspective on mental health and mental disorder research: introduction to the ROAMER work package 5 consensus document

This paper provides an overview of the theoretical framework of the Psychological Sciences' reviews and describes how improved psychological research can foster our understanding of mental health and mental disorders in a complementary way to biomedical research. Core definitions of the field and of psychological interventions and treatment in particular are provided. The work group's consensus regarding strength and weaknesses of European Union (EU) research in critical areas is summarized, highlighting the potential of a broader comprehensive "Behaviour Science programme" in forthcoming programmatic EU funding programmes.

ROAMER: roadmap for mental health research in Europe

Despite the high impact of mental disorders in society, European mental health research is at a critical situation with a relatively low level of funding, and few advances been achieved during the last decade. The development of coordinated research policies and integrated research networks in mental health is lagging behind other disciplines in Europe, resulting in lower degree of cooperation and scientific impact. To reduce more efficiently the burden of mental disorders in Europe, a concerted new research agenda is necessary. The ROAMER (Roadmap for Mental Health Research in Europe) project, funded under the European Commission's Seventh Framework Programme, aims to develop a comprehensive and integrated mental health research agenda within the perspective of the European Union (EU) Horizon 2020 programme, with a translational goal, covering basic, clinical and public health research. ROAMER covers six major domains: infrastructures and capacity building, biomedicine, psychological research and treatments, social and economic issues, public health and well-being. Within each of them, state-of-the-art and strength, weakness and gap analyses were conducted before building consensus on future research priorities. The process is inclusive and participatory, incorporating a wide diversity of European expert researchers as well as the views of service users, carers, professionals and policy and funding institutions.

Advancing psychotherapy and evidence-based psychological interventions

Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, "component analyses" aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support "real time" clinical decision-making to prevent treatment failure or relapse) might be one promising way forward.

The need for a behavioural science focus in research on mental health and mental disorders

Psychology as a science offers an enormous diversity of theories, principles, and methodological approaches to understand mental health, abnormal functions and behaviours and mental disorders. A selected overview of the scope, current topics as well as strength and gaps in Psychological Science may help to depict the advances needed to inform future research agendas specifically on mental health and mental disorders. From an integrative psychological perspective, most maladaptive health behaviours and mental disorders can be conceptualized as the result of developmental dysfunctions of psychological functions and processes as well as neurobiological and genetic processes that interact with the environment. The paper presents and discusses an integrative translational model, linking basic and experimental research with clinical research as well as population-based prospective-longitudinal studies. This model provides a conceptual framework to identify how individual vulnerabilities interact with environment over time, and promote critical behaviours that might act as proximal risk factors for ill-health and mental disorders. Within the models framework, such improved knowledge is also expected to better delineate targeted preventive and therapeutic interventions that prevent further escalation in early stages before the full disorder and further complications thereof develop. In contrast to conventional "personalized medicine" that typically targets individual (genetic) variation of patients who already have developed a disease to improve medical treatment, the proposed framework model, linked to a concerted funding programme of the "Science of Behaviour Change", carries the promise of improved diagnosis, treatment and prevention of health-risk behaviour constellations as well as mental disorders.

Dimensional anxiety scales for DSM-5: sensitivity to clinical severity

PURPOSE

Psychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels.

METHODS

The dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n=83) and threshold anxiety disorders (n=49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder).

RESULTS

Individuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders.

CONCLUSION

The self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.