Impact of Home-Based Work during the COVID-19 Pandemic on Mental and Physical Health in a German Population-Based Sample

Background: The COVID-19 outbreak necessitated physical distancing, as part of secondary prevention, at a personal and professional level. Working from home (WFH) became increasingly important. In this study, the impact of the COVID-19 pandemic restrictions on physical and mental health is investigated, compared with pre-pandemic data, and with employees who WFH and are on-site. Methods: Data from the German Saxon longitudinal study population were used. Attitudes towards WFH as well as mental and physical health assessments during the COVID-19 pandemic were examined. Comparisons were made with corresponding pre-pandemic scores and between employees WFH and on-site in 2022. Results: In total, 319 participants with equal gender distribution were included. Of those, 86 worked from home stating better organizability of their work, more time for partnership, less stress, and greater work satisfaction. Compared to pre-pandemic data, the D-score, PHQ-4, G-Score, and PHQ-SSS-8 showed a significant increase. No difference in physical or mental health between employees WFH and on-site was observed. Conclusion: In general, COVID-19 restrictions had a negative impact on mental and physical health. Although WFH is well accepted, it did not show significant health benefits.

[Anxiety, Depression, Psychological Strain and Physical Complaints before and after the Covid-19 Pandemic in a German Longitudinal Study with Adults from Saxony]

OBJECTIVE

The objective of the study was to investigate whether psychological distress increased in a German community sample from Saxony during the course of the Corona pandemic.

METHODS

In 2017/2018 and 2022, N=289 participants (54.7% female) of the Saxon Longitudinal Study were interviewed about their psychological well-being using questionnaires (PHQ-4, SSS-8).

RESULTS

There is a significant increase in complaints (anxiety, depression, psychological distress, physical complaints) compared to 2017/2018 to 2022 with effect sizes in the small and medium range (Cohens d=0.26-0.62).

CONCLUSION

Data collection was not due to the pandemic but was routine as part of an ongoing long-term study. The Covid-19 pandemic led to an increase in psychological distress and physical complaints in a Saxonian, age-homogeneous population sample.

Variables associated with oral health-related self-efficacy - results of a cross-sectional study

BACKGROUND

Oral health-related self-efficacy (OH-SE) is pivotal for oral health and is associated with other oral-health related variables, such as dental fear and anxiety (DF/A) and dental hygiene behaviors (DHB). This study attempts to analyze associations between OH-SE and oral healthrelated variables in a German population to extend previous research by analyzing whether OH-SE can be predicted by these variables, as this might contribute to the development of treatment interventions.

METHODS

OH-SE, DF/A, oral health-related quality of life (OHRQoL), self-perceived dental condition, satisfaction with general health, DHB, and socioeconomic status were assessed as a part of the Saxon Longitudinal Study in an adult sample (n = 309, 56.3% female, all Saxon secondary school 8th graders in 1987). The associations of OH-SE with these variables were examined by means of correlation, multiple linear regression analyses, and group comparisons. Significance (p), standardized regression coefficients (β), and effect size (Cohen's d) were calculated.

RESULTS

The correlation analyses revealed increased OH-SE to be accompanied by low levels of DF/A, high levels of OHRQoL, high levels of self-perceived dental condition, increased satisfaction with general health and socioeconomic status (all r ≥ 0.142; all p ≤ 0.013). In the regression analysis, OH-SE was mainly predicted by self-perceived dental condition and satisfaction with general health (R2 = 0.157) as well as by daily frequency of toothbrushing, OHRQoL, and socioeconomic status on a trend-level basis. In the group comparisons OH-SE was lower in participants with moderate for manifest DF/A and higher in individuals with higher OHRQoL, better self-perceived dental condition, increased satisfaction with general health, increased daily frequency of toothbrushing, more dental appointments, and above-average socioeconomic status (trend level; all t ≥ 1.57; p ≤ 0.059).

CONCLUSIONS

In this cross-sectional study, high levels of OH-SE were mainly predicted by general health as well as self-perceived dental condition. It was also associated with decreased DF/A, increased DHB, higher OHRQoL, and higher socioeconomic status. Future research should analyze these associations in longitudinal designs to address whether interventions focusing on adherence to good DHB improve (dental) health and thus OH-SE. This might be a promising approach, particularly in relation to the treatment of DF/A.

Insomnia symptoms in adulthood. Prevalence and incidence over 25 years

OBJECTIVE/BACKGROUND

Despite its high prevalence, little information is available about the course of insomnia symptoms over the life span. In this study, we analyzed the self-reported insomnia symptoms of the general population over more than 20 years, covering young up to middle adulthood.

PATIENTS/METHODS

Data from waves 12 to 32 of the Saxon Longitudinal Study (1996-2021), were analyzed. Based on data from the 12th wave, n = 115 adults (48 men (41.7%), 67 women (58.3%), Mage = 23.59, SD = 0.59) completed the G-Score Item #3 in the following 18 waves, thus forming the basis for our analyses. The G-Score Item #3 reads "In the last 12 months, have you had the following complaints? Please indicate how often they occurred - Insomnia". The G-Score Item #3 was dichotomized using a cut-off score of 2, and prevalence and incidence rates were calculated by gender.

RESULTS

The minimum prevalence rate was 23.48% (Mage = 32.11, SD = 0.40), and the maximum was 47.83% (Mage = 48.43, SD = 0.64), indicating an increase in insomnia symptoms with age. In most cases, no evidence was found for gender differences in prevalence rates. The incidence rates were 10.43% for the 1st year of follow-up and 8.7% for the 5th year and 6th year of follow-up, respectively.

CONCLUSIONS

This study provides further evidence for the high prevalence rates of insomnia symptoms in the general population. As this study is the first epidemiological study of insomnia symptoms based on a single-item (screening) instrument, it should be rather seen as an extension than a replication of previous study findings.

[Psychometric Evaluation of a Single-Item-Screener for Sleep Disturbances]

OBJECTIVE

Sleep disturbances are one of the most prevalent health complaints in the general population. Thus, the need for validated screening instruments and prevention measures is high. The aim of the current study is to evaluate a potential single-item screening instrument and therefore, contribute to an improved early detection.

METHODS

Data from Saxony Longitudinal Study (SLS) is being analyzed. Based on data of 32nd wave (n=321, 172 women, 149 men, M age=48.42, SD=0.64), the G-Score Item #3 ("Have you had the following complaints in the last 12 months? Please indicate how often they occurred. - sleeplessness"), a potential screening instrument, is psychometrically evaluated. A Receiver Operating Characteristic (ROC)-Analysis is calculated to assess the predictive validity of the G-Score Item #3.

RESULTS

Retestreliability for the G-Score Item #3 is 0.70 (p<0.001). Correlation with the Jenkins Sleep Scale (JSS) was r=0.79 (p<0.01). The area under the curve (AUC) is 0.92, providing evidence for a very good predictive validity.

DISCUSSION AND CONCLUSION

This study provides evidence for the use of the G-Score Item #3 as a screening instrument for sleep disturbances by showing good psychometric properties and brevity.

Are Attitudes towards COVID-19 Pandemic Related to Subjective Physical and Mental Health?

In this paper, we investigate the relationship between a person's psychological distress, subjective physical health and their attitudes towards the COVID-19 pandemic. The evaluation was performed on the basis of data from two waves of the Saxon Longitudinal Study, carried out in 2019 (pre-pandemic) and 2021. The number of study participants in both waves was 291. We tested in autoregressive cross-lagged models the stability of the respondents' health status before and during the pandemic and reviewed their influence on attitudes towards COVID-19. Our results show that COVID-19-related concerns are controlled by subjective physical health, while pandemic denial is linked to psychological distress. In an unknown and critical situation, with limited control over the situation, the strategy of avoidance or suppression may be used by individuals for protection by psychologically downplaying the stressor and danger.

[Internal Migration and Mental Health - Relevant Factors 20 and 30 years after Unification: Results of a Longitudinal Study in German]

Aim The aim of the present study was to determine the relevant factors in the mental health of people who experienced internal migration in comparison with people who did not. Methods Data from a longitudinal study in Saxony were used to compare the psychological distress of individuals who migrated internally with that of those who did not in 2010 and 2020. Bootstrapping-based mediation analysis was applied to examine possible mediators between internal migration and mental health.Results Individuals who experienced internal migration reported less mental distress compared to those who did not in 2010, but not in 2020, but these effects disappeared after including covariates and mediators. Important mediators in 2010 were life situation, political solidarity with FRG, winner of German Unification and job security; in 2020, these were threat of old-age poverty and experiences with system.Discussion Internal migration influences mental distress through different factors. Especially the current life circumstances play a crucial role.

Psychological and Socio-Economical Determinants of Health: The Case of Inner German Migration

A substantial body of research has shown worse health conditions for East- vs. West-Germany in the wake of reunification. In the present study, we investigate how these differences between the two formerly divided regions developed and what maintains them. Specifically, we consider the associations between health status, income satisfaction, and health-related locus of control. In a quasi-experimental and longitudinal study design, we are particularly interested in the differences between individuals who stayed in East-Germany and those who were born in the East but migrated to West-Germany. To this end, we examined data from seven waves of the Saxony Longitudinal Study (2003-2009). Specifically, we tested a cross-lagged panel model with random effects, which evinced very good model fit. Most parameters and processes were equivalent between individuals who stayed in East-Germany vs. moved to West-Germany. Crucially, there was the expected pattern of positive correlations between health, income, and locus of control. In addition, we found substantially lower values for all three of these variables for the individuals who stayed in East-Germany (vs. moved to West-Germany). A possible explanation is the increase in socio-economic status that the internal migrants experienced. These findings present an important contribution of research in order to foster a better understanding on the social dynamics in Germany related to internal/domestic migrants and implications in the context of health outcomes (e.g., significantly more unemployment in East vs. West-Germany), especially since almost 20-25% of East-German citizens migrated to West-Germany. Until now, there are no similar studies to the Saxony longitudinal project, since the data collection started in 1987 and almost every year an identical panel has been surveyed; which can be particularly useful for health authorities. The study mainly focuses on social science research and deals with the phenomenon of reunification, approaching several subjects such as mental and physical health, quality of life and the evaluation of the political system. Yet even though many people have experienced such a migration process, there has been little research on the subjects we approach. With our research we deepen the understanding of the health consequences of internal migration.

Psychosocial aftercare of adolescent and young adult cancer survivors in Germany: Awareness, utilisation, satisfaction and associated factors

AIM

This study systematically assesses the awareness of, utilisation of and satisfaction with psychosocial care for adolescents and young adult (AYA) cancer survivors in aftercare.

METHODS

Survivors between 18 and 39 years were surveyed in aftercare. Awareness of, utilisation of and satisfaction with psychological counselling (PC), social-legal counselling (SLC) and other psychosocial care (OPC) were measured using self-developed questionnaires. Multivariate analyses were conducted to determine factors correlated with awareness and use of psychosocial care.

RESULTS

Five hundred and fourteen survivors participated; the mean age at diagnosis was 29.6 years (SD = 6.14). 54% of cancer survivors were aware of PC, 45% of SLC and 24% of OPC. Those who possessed knowledge about these services used it to a considerable extent (63%-74%), and the majority (66%-75%) was highly satisfied. No common factors could be found that increase the likelihood of being aware of these three services (R²  = 0.028-0.138). Female gender (OR = 2.08-2.18) and high anxiety (OR = 1.19-1.38) were identified as common factors that increase the likelihood of utilising psychosocial services (R²  = 0.160-0.395).

CONCLUSION

AYA who are aware of psychosocial services in aftercare are motivated to use them and express high satisfaction with use. For the utilisation of psychosocial services, anxiety and female gender can be identified as common factors. The visibility of psychosocial services for aftercare should be increased given the high number of unaware AYA survivors. The active and repeated addressing of psychosocial issues and regular provision of information (e.g., written guides on survivorship) by caregivers should be made a standard of care for AYA cancer survivors.

The long-lasting impact of unemployment on life satisfaction: results of a longitudinal study over 20 years in East Germany

BACKGROUND

Economic disruption in East Germany at the time of reunification (1990) resulted in a noticeable increase in unemployment. The present study provides data from a German cohort for over 20 years. The aim was to examine how the frequency of experiencing unemployment affects life satisfaction and whether their relationship changes over time.

METHODS

In the Saxon Longitudinal Study, an age-homogeneous sample was surveyed annually from 1987 to 2016. Since 1996, 355 people (54% female) have been examined for issues related to unemployment. Life satisfaction was measured with both the Global Satisfaction with Life Scale and the Questions on Life SatisfactionModules questionnaire.

RESULTS

In 1996, the participants were 23 years old and 50% of the sample was affected by unemployment. At all 16 different measuring points, participants who were never unemployed indicated higher life satisfaction than those who were once unemployed. The repeatedly unemployed consistently reported the lowest values of life satisfaction. In each year, there were significant differences with small to medium effect sizes.

CONCLUSION

Our results support the notion that the adverse effects of unemployment on life satisfaction increase with the time spent unemployed. In 2016, only 2% of the cohort were currently unemployed, but differences between people with and without unemployment experience still exist. This indicates that the negative effect of the unemployment experience will last for a very long time. To the best of our knowledge, this is the first study that demonstrates the effect so persistently at so many measurement points for over 20 years.

Perceived social support and associations with health-related quality of life in young versus older adult patients with haematological malignancies

Background

This study compared the perceived social support of young and older adult cancer patients, examining possible influencing factors as well as associations with health-related quality of life.

Methods

A total of 179 young patients (18–39 years) and 200 older adult patients (> 70 years) with haematological malignancies completed questionnaires on their perceived social support (ISSS-8, scales: Positive Support and Detrimental Interactions, range 0–16) and health-related quality of life (EORTC QLQ-C30). Tests for mean differences, correlations and regression analyses to determine associated variables of social support were performed.

Results

No difference was reported between young (M = 13.40, SD = 2.81) and older adult patients (M = 13.04, SD = 3.82; p = .313) for Positive Support. However, young patients (M = 4.16, SD = 3.10) reported having had more Detrimental Interactions than older patients did (M = 1.63, SD = 2.42; p < .001, Cohen’s d = .910). Comparison of the EORTC QLQ-C30 Function scales showed poorer outcomes for young patients on Emotional, Cognitive and Social Functions and a higher outcome on Physical Function compared with older adult patients. Regression analyses indicated that age (young vs. older adult patients) significantly explained proportions of variance in all models, with young age having a negative impact on Emotional, Cognitive and Social Functions and a positive impact on Physical and Role Functions compared with old age. Significant associations between Detrimental Interactions and all the scales examined except Cognitive Function were found.

Conclusions

The difference in negative perceptions of social support in young vs. older adult patients and its impact on health-related quality of life emphasises the necessity of differentiating between positive and negative social support. Negative interactions should be addressed through psychosocial care, particularly with young cancer patients.

Sexuality and cancer in adolescents and young adults - a comparison between reproductive cancer patients and patients with non-reproductive cancer

BACKGROUND

Sexuality is an important aspect of quality of life for adolescent and young adults that remains understudied in cancer patients. Most current knowledge about how cancer and cancer treatments can affect patients' sexuality pertains to reproductive cancer patients (breast, gynecological, male reproductive organs), whereas only little is known about how the disease affects the sex lives of patients with other types of cancer. This study examined sexual satisfaction and sexual supportive care needs among adolescent and young adult cancer patients, with a particular focus on how the type of cancer a person has is associated with these issues differently.

METHODS

Five hundred seventy-seven (n = 424 females, 73.5%) patients between 18 and 39 years of age at diagnosis and representing all major tumor entities completed the standardized questionnaire. The analysis addressed the following topics: sexual satisfaction (Life Satisfaction Questionnaire), sexual supportive care needs (Supportive Care Needs Survey), and changes in sexuality (Questions on Life Satisfaction Modules). These topics were tested by mean differences between reproductive and non-reproductive cancer, equivalence testing and regression analyses.

RESULTS

About one third of the patients reported being dissatisfied with their sexuality and having supportive care needs in this area. Changes in sexuality were significantly more common in women with reproductive cancers than in those who had other types of cancer (t = - 2.693, p = .007), while both groups had equivalence in scores for sexual satisfaction and sexual supportive care needs. Reproductive cancers are not more associated with deterioration of sexual satisfaction (R2 = .002, p = .243), changes in sexuality (R2 = .006, p = .070) or increased sexual supportive care needs than non-reproductive cancers (R2 = .004, p = .131).

CONCLUSIONS

The results indicate that about a third of adolescents and young adults with both reproductive but also with non-reproductive cancer experience sexual dissatisfaction in similar measure. An equal percentage of these patients also express a desire to receive supportive care in this area. Consequently, health care professionals should address issues of sexuality and cancer as a matter of routine when caring for young adults even when patients have a non-reproductive cancer.

Anxiety and depression in young adult German cancer patients: Time course and associated factors

OBJECTIVE

Cancer in young adulthood is a nonnormative and critical life event. The experience of having cancer can have a strong impact on the mental health of young adults. This study investigated anxiety and depression in young adult cancer patients, examining changes over time and determining associated factors.

METHODS

Young cancer patients (18-39 years at time of diagnosis, diagnosis less than 4 years) were examined. Anxiety and depression were measured at two time points (t2 = 12 months after t1) using the Hospital Anxiety and Depression Scale (HADS). Regression analyses were conducted to determine whether sociodemographic, medical, and/or psychosocial factors (social support, adjustment to the illness, unmet supportive care needs) were associated with patients' anxiety and depression.

RESULTS

Five hundred fourteen young cancer patients (mean age 29.6 years, 75.1% women) completed both questionnaires. A higher proportion showed elevated levels of anxiety (t1: 42.2%; t2: 45.3%) than of depression (t1: 16.9%; t2: 17.7%), and no significant changes in anxiety and depression levels over time were observed. Psychosocial factors explained a major proportion of the variances for anxiety and depression levels at both time points (adjusted R² between.50 and.59). Furthermore, significant associations were found for anxiety (t1) with gender (women↑); anxiety (t2) and depression (t2) with sick leave (sick leave yes↑); depression (t2) with time since diagnosis (longer time↑).

CONCLUSION

Psychological distress among adolescents and young adults (AYA) manifests particularly as anxiety. Strong associations between anxiety/depression and psychosocial factors, as well as the stability of psychological distress over time, clearly illustrate the need for psycho-oncological care in this patient group.

Unmet supportive care needs in young adult cancer patients: associations and changes over time. Results from the AYA-Leipzig study

PURPOSE

Coping with cancer at a young adult age (AYA) is a challenge for many patients and raises support needs. We aim to examine unmet supportive care needs and to investigate predictors of and changes in unmet needs over time.

METHODS

We surveyed AYAs (18-39 years at time of diagnosis, diagnosis < 4 years) at two time points (t2 = 12 months after t1) using the Supportive Care Needs Survey (SCNS-SF34) among other validated measures. We conducted multiple hierarchical regressions to identify sociodemographic, medical and psychosocial predictors of unmet needs.

RESULTS

A total of 514 AYAs (386 women) with a mean age of 29.6 years participated at both times. Psychological needs (M_t1 = 35.7; M_t2 = 32.09; p = 0.001) and informational needs (M_t1 = 32.18; M_t2 = 29.04; p = 0.021) were the most often reported unmet needs at both measurements and decreased slightly at t2. All other SCNS domains, except for patient care, remained stable over time. Higher supportive needs were associated with greater levels of effort to cope with the disease at both times in all domains. Older age and female gender were significantly associated with two and one of six domains, respectively, at t1 and t2.

CONCLUSIONS

AYAs reported primarily unmet psychological and informational needs, which were stable over time and indicated that AYAs do not have sufficient access to the support they need. The degree of effort to cope with cancer plays a key role in terms of unmet support needs.

IMPLICATIONS FOR CANCER SURVIVORS

Regular screening for this variable in acute and especially follow-up care settings could pave the way for clinicians to offer more targeted support.

Cancer-Related Fatigue and Associated Factors in Young Adult Cancer Patients

Purpose: Cancer-related fatigue (CRF) is a highly burdensome and long-lasting symptom of cancer and its therapy. This study aims to examine the severity of CRF in its different dimensions and to assess medical and sociodemographic factors associated with CRF in young adults with cancer (adolescents and young adults [AYAs]). Methods: Patients with malignant cancer (diagnosed within the last 4 years) aged 18-39 years at diagnosis were assessed. CRF was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Fatigue Module (EORTC QLQ-FA12) Questionnaire. Sociodemographic and medical data were collected with self-report questionnaires. Descriptive analyses, cluster analysis, and multiple regression analysis were used to examine CRF in AYAs. Results: In total, n = 577 patients were included. Respondents' fatigue scores were highest for the physical subscale (mean = 45.6; standard deviation [SD] = 28.2), followed by the emotional (mean = 26.7; SD = 28.8) and cognitive dimensions (mean = 19.7; SD = 22.7). Female participants, patients with an additional disease, and patients with financial problems resulting from having cancer reported significantly higher fatigue scores for all three of the subscales (R² range: 0.10-0.22). Testicular cancer patients had the lowest CRF scores for every dimension. Breast and gynecological cancer patients had the highest emotional and cognitive fatigue scores. Conclusion: Medical variables such as cancer site and therapy scheme seem to have little influence. Caregivers should assess CRF in AYAs independent of their medical characteristics. Reducing additional burdens may represent a way of reducing CRF in AYA cancer patients.

Psychometric properties of the fatigue questionnaire EORTC QLQ-FA12 and proposal of a cut-off value for young adults with cancer

BACKGROUND

Young adult patients with cancer have to deal with their disease in an eventful phase of life. A common side effect of cancer and its treatment is cancer-related fatigue (CRF), a phenomenon which can thwart successful coping with developmental tasks. The aims of this study were to assess the psychometric properties of the EORTC QLQ-FA12, a new instrument for assessing physical, emotional and cognitive fatigue, in young adults with cancer, and to propose a cut-off value that indicates a need for further more specific diagnostics.

METHODS

In a sample of young adults who were first diagnosed with cancer between the ages of 18 and 39 years old, we assess the composite and item reliabilities as well as discriminant validity of the subscales for the EORTC QLQ-FA12. We also discuss two possible ways to calculate a summarizing score when conducting a receiver operating characteristic (ROC) analysis to find the cut-off value.

RESULTS

The EORTC QLQ-FA12 fit the sample (CFI = 0.96, SRMR = 0.04), had discriminant validity regarding its subscales and every subscale showed convergent validity (composite reliabilities were 0.92 for physical, 0.89 for emotional and 0.74 for cognitive fatigue). The sum of the first ten items with a range of 0 to 30 revealed a cut-off value of twelve or more with 91% sensitivity and 77% specificity.

CONCLUSION

The new instrument EORTC QLQ-FA12 is able to distinguish between physical, emotional, and cognitive fatigue in young adult patients. It enables us to study different concepts of general fatigue without the need for additional items, and can be used as a screening instrument for young adults. Future research should investigate the multidimensional character of CRF.

[Are We Really as Happy as We Think We are? A Critical Examination of Work Satisfaction in a University Pediatric Hospital]

GOALS

Despite numerous reported deficits and an increasingly tense working environment in German hospitals, employees themselves often assess their job satisfaction as being high to very high. Hence, the board of directors does not have important arguments for sustainable improvement of working conditions. This discrepancy between working conditions and subjective satisfaction was the motivation for this work.

METHODS

Data were acquired via an attitude survey at the University Hospital for Children and Adolescents Leipzig, with employees sub-divided into medical, nursing and administrative/technical staff. The subjective satisfaction was examined by means of classical global ratings almost exclusively used by companies vs. the much more modern cognitive-emotional concept of the 'Schweizer Modell' describing qualitative job satisfaction. In addition, working hours, work-related effects on mental health, willingness to quit the job and actual dropout rate were compared.

RESULTS

A rather high level of job satisfaction was revealed while interpreting the classical global ratings. In contrast, the qualitative analysis showed that only 1 in 4 employees was really satisfied with his or her job, amongst doctors even only 1 in 10. Altogether there are four categories of satisfaction. Significant differences between occupational categories were seen when stratifying the data according to age profiles and the evaluation of the consequences of psychological job strain. These differences were not seen in willingness to quit the job.

CONCLUSION

Reports of high job satisfaction in hospitals in numerous publications can be mostly explained by employees who are resignedly satisfied. This is the psychodynamic outcome of strain compensating. This is not measurable with the concept of classical global ratings. Furthermore, the constructively dissatisfied employees, who are an often-underestimated resource for companies, are neglected. The reduction of strain in these people then mostly results in job changes.

[The G-Score - a Short Questionnaire for the Measurement of Subjective Physical Health]

AIM

The measurement of subjective physical health is important in clinical settings as well as for research purposes. In the present paper, the psychometric properties of the G-Score, a 4 item screening questionnaire for the self-assessment of one's physical health, is explored.

METHODS

The Objectivity, validity and reliability were estimated. Moreover, an item analysis and a suitable cut-off-value for the differentiation between healthy and presumably ill subjects were conducted. Data from the Saxony Longitudinal Study ("Sächsische Längsschnittstudie") 1998-2013 were analysed (N=324-417 healthy individuals).

RESULTS

The objectivity of the G-Score is estimated as very good. As a cut off for the differentiation between healthy and presumably ill subjects, a G-Score of 4 is suggested. The content validity is slightly lacking. Correlations with associated and non-associated constructs hint an interaction of physical with psychological discomfort. A good predictive validity of the instrument is assessed. Reliability estimates show acceptably good results. This indicates a high sensitivity for changes in the measured construct.

CONCLUSION

Putting all results into consideration, a use of the G-Score as a screening questionnaire in research is recommended. However, more psychometric investigations with representative samples and objective comparative data should be carried out.

Cancer-related fatigue in adolescents and young adults: A systematic review of the literature

Adolescents and young adults with cancer (AYA) represent a specific age cohort dealing with the disease in a stage of life characterized by development, upheavals, and establishment. The aim of this study was to point out the state of research on how AYA are affected by cancer-related fatigue (CRF).

RESULTS

Twelve articles were included. CRF was found to be higher in AYA than in either of the comparison groups, healthy peers and older cancer patients. Most included studies did not measure CRF with multidimensional, fatigue-specific instruments.

CONCLUSION

We found a gap in research concerning CRF in AYA. The existing findings suggest that CRF is a significant issue for AYA cancer patients. However, less is known about the prevalence, severity, and impact of CRF in AYA, and their treatment. This should be considered in future research, and risk and prevention factors should be ascertained. Multidimensional and fatigue-specific measuring tools should be used to do this.

[Development of a Short Version of the Bielefeld Partnership Expectations Questionnaire (BFPE)]

The Bielefeld Partnership Expectations Questionnaire (BFPE) is a self-rating instrument of partner related attachment. Besides the assessment of the dimensions fear of rejection, readiness for self-disclosure, and conscious need for care, individuals can be classified according to 5 different attachment patterns. Using data from a representative German survey (N=1768), an explorative factor analysis revealed a short version comprising 12 items. Confirmatory factor analysis using two datasets (N=1768 and N=801) supported the 3-factor-structure (RMSEA<0.08, CFI>0.93). Subscales of the short version were highly correlated with the corresponding scales of the long version (r=0,799-0,914). Furthermore, the classifications of 5 attachment patterns strongly converged (κ=0,659). The short version can be recommended as a substitute of the long version in clinical and non-clinical studies.

Prevalence and determinants of online-sex use in the German population

Introduction

The unlimited access to sexual features in the World Wide Web has raised concerns about excessive and problematic online-sex use. However, little is known about antecedents of internet-sex use of different intensity. Based on a representative German sample of 2,522 participants between the ages of 14 and 97 years, the aims of the present study were (1) to determine the prevalence rates of online-sex users with the short version (ISST_GSV) of the Internet Sex Screening Test and (2) to associate online-sex use with anxious vs. avoidant partner attachment patterns and “Big Five” personality traits as potential antecedents.

Results

The ISST is a brief, one-dimensional and reliable measure of online-sex activities (r_tt = .69). Overall, 14.7% of respondents reported occasional and 4.2% intensive online-sex use. In multivariate analysis, online-sex use was significantly positively associated with male sex, younger age, unemployment and an anxious partner attachment pattern and negatively with conscientiousness and agreeableness.

Conclusions

Arousal and satisfaction by virtual enactment of sexual phantasies may be attractive for anxiously attached persons who find it difficult to commit to a real life relationship due to fear of rejection or low self-esteem. More knowledge about the individual antecedents of intensive online-sex use may also be helpful for the development of consultation and treatment strategies for excessive and addictive online-sex use.

[Cancer and Career? - A Qualitative Study of Job Status of Young Adult Cancer Survivors]

Purpose: To examine the impact of cancer on work and education for AYA. Collect information about AYA's return to work/return to study. Methods: 18 AYA (10 female) aged 18 to 39 (m=27 years) at time of diagnosis completed a semi-structured interview. Qualitative content analysis was used to generate results. Results: 11 of 18 AYA had already returned to work/study. Flexible structures and emotional support of colleagues and managers were reported being helpful. 10 AYA planed or had already reduced job tasks, hours of work or further education. This was mostly compelled by physical disabilities due to cancer or treatment. Most AYA asked for more support within the social insurance system. Conclusions: Cancer often leads to changes in work or education. More social and vocational counseling to support AYA's rehabilitation process seems to be necessary.

How do young adults with cancer perceive social support? A qualitative study

The social support of adolescents and young adults (AYA) has been studied very little. 18 interviews were conducted and evaluated with content analysis (inter-rater reliability = 0.87). All of the young adult cancer patients interviewed reported having received social support from at least two people (family, friends, and/or partner). Forms of emotional and instrumental support were more often reported than informational support. 12 participants described having received nonhelpful support, especially in areas of dealing with their situation, limited social participation, and distancing of friends. The participants considered social exchanges with other young adult cancer patients an important source of social support. AYA cancer patient networking should be improved.

Life situation and psychosocial care of adolescent and young adult (AYA) cancer patients - study protocol of a 12-month prospective longitudinal study

BACKGROUND

In recent years, there has been an increased research focus on adolescent and young adult (AYA) cancer patients. Few longitudinal studies have taken into consideration the specifics of their life situation and the status of psychosocial care services for this population. Our ongoing study aims to determine the psychosocial life and supportive care situation of AYA cancer patients, to describe risk groups, and to develop recommendations for their psycho-oncological care and support.

METHODS

The AYA-Leipzig study (AYA-LE) is a German prospective, longitudinal, study examining AYAs´ life situation (e.g. psychological distress, quality of life) and psychosocial care (e.g. evaluation and preferences, support needs) using two measurement points, namely, upon acute treatment completion (baseline) and 12 months later. N = 577 AYA cancer patients aged between 18 and 39 years at diagnosis, and representing all major tumor entities fill out a standardized questionnaire (online or by post), mainly based on validated instruments. AYA-specific concerns (e.g. family planning, sexual and reproductive health, social support, health behavior) will explicitly be considered. Participants are recruited in 16 German acute care hospitals, four rehabilitation clinics, and from two German state tumor registries.

DISCUSSION

In summary, our longitudinal study will create a large database encompassing all malignant tumor entities and including detailed information about the distress and quality of life, specific problems, and specific support needs of AYA cancer patients at two different points in time post-diagnosis. The information we gather about existing psychosocial care and patient preferences and desires concerning psycho-oncological care will be used to develop recommendations for psycho-oncological care providers.

[Effectively communicate active listening : Comparison of two concepts]

Communication between physicians and patients has a great influence on patient adherence, patient satisfaction and the success of treatment. In this context, patient centered care and emotional support have a high positive impact; however, it is unclear how physicians can be motivated to communicate with patients in an appreciative and empathetic way. The implementation of such behavior requires a multitude of communicative skills. One of them is active listening, which is very important in two respects. On the one hand active listening provides the basis for several conversational contexts as a special communication technique and on the other hand active listening is presented in current textbooks in different ways: as an attitude or as a technique. In light of this, the question arises how active listening should be taught in order to be not only applicable in concrete conversations but also to lead to the highest possible level of patient satisfaction. The aim of this pilot study was to examine some variations in simulated doctor-patient conversations, which are the result of the different approaches to active listening. For this purpose three groups of first semester medical students were recruited, two of which were schooled in active listening in different ways (two groups of six students), i.e. attitude versus technique oriented. The third group (seven students) acted as the control group. In a pre-post design interviews with standardized simulation patients were conducted and subsequently evaluated. The analysis of these interviews was considered from the perspectives of participants and observers as well as the quantitative aspects. This study revealed some interesting tendencies despite its status as a pilot study: in general, the two interventional groups performed significantly better than the control group in which no relevant changes occurred. In a direct comparison, the group in which active listening was taught from an attitude approach achieved better results than the group in which the focus was on the technical aspects of active listening. In the group with active listening schooled as an attitude, the response to the feelings of the standardized simulation patients was significantly better from the perspectives of both participants and observers.

Is It Attachment Style or Socio-Demography: Singlehood in a Representative Sample

Since the percentage of single adults is steadily increasing, the reasons for this development have become a matter of growing interest. Hereby, an individual’s attachment style may have a connection to the partnership status. In the following analysis, attachment style, gender, age, education, and income were compared in regard to the partnership status. Furthermore, an analysis of variance was computed to compare the attachment style within different groups. In 2012, a sample of 1,676 representative participants was used. The participants were aged 18 to 60 (M = 41.0, SD = 12.3); 54% of the sample were female, and 40% were single. Attachment-related attitudes were assessed with the German version of the adult attachment scale (AAS). Single adult males did not show a more anxious attachment style than single adult females or females in relationships. Younger, i.e., 18 to 30 years old, paired individuals showed greater attachment anxiety than single individuals, whereby single individuals between the ages of 31 to 45 showed greater attachment anxiety than individuals in relationships. In addition, single individuals more frequently had obtained their high school diploma in contrast to individuals in relationships. Concerning attachment style, the individuals who had not completed their high school diploma showed less faith in others independent of singlehood or being in a relationship. Concerning age, older single individuals, i.e., 46 to 60 years, felt less comfortable in respect to closeness and showed less faith in others compared to paired individuals. Logistic regression showed that individuals were not single if they did not mind depending on others, showed high attachment anxiety, were older, and had lower education. An income below € 2000/month was linked to a nearly 13-fold increase of likelihood of being single. In sum, the attachment style had a differential age-dependent association to singlehood versus being in a relationship. Education played also a role, exclusively concerning faith in others.

Medical consultations about fertility preservation with haematological patients of childbearing age: A qualitative study

PURPOSE

Oncological treatments can cause serious long-term consequences, including effects on patients' fertility. Communication about possible fertility impairment is essential for cancer patients who want to have children. When oncologists initiate this discussion in a timely manner, patients can be referred to fertility specialists and avail themselves of fertility preservation methods. The oncologist plays a key role in this context.

METHODS

30 cancer patients of childbearing age (21-43 years) took part in semi-structured interviews between March 2011 and April 2012 about fertility and their desire to have children. Interview transcripts were thematically analyzed.

RESULTS

Physician-patient consultations broached the issue as a central theme in almost all patients. A few consultations were patient initiated, and the majority took place before the beginning of treatment. Almost half of the patients were satisfied with their consultations and were referred to a fertility specialist. The ideal setting for these conversations is in the presence of the patient's partner, in a private space, before the beginning of treatment.

CONCLUSIONS

All patients should be informed about the possibility of their fertility being impaired due to treatments, even if they have not explicitly expressed wanting children. The oncologist is the first and most important contact for the patient and, hence, should bring up the issue of family planning and fertility. An interdisciplinary communication and collaboration between oncologists and fertility specialists can improve patient care.

The LIFE-Adult-Study: objectives and design of a population-based cohort study with 10,000 deeply phenotyped adults in Germany

Background

The LIFE-Adult-Study is a population-based cohort study, which has recently completed the baseline examination of 10,000 randomly selected participants from Leipzig, a major city with 550,000 inhabitants in the east of Germany. It is the first study of this kind and size in an urban population in the eastern part of Germany. The study is conducted by the Leipzig Research Centre for Civilization Diseases (LIFE). Our objective is to investigate prevalences, early onset markers, genetic predispositions, and the role of lifestyle factors of major civilization diseases, with primary focus on metabolic and vascular diseases, heart function, cognitive impairment, brain function, depression, sleep disorders and vigilance dysregulation, retinal and optic nerve degeneration, and allergies.

Methods/design

The study covers a main age range from 40-79 years with particular deep phenotyping in elderly participants above the age of 60. The baseline examination was conducted from August 2011 to November 2014. All participants underwent an extensive core assessment programme (5-6 h) including structured interviews, questionnaires, physical examinations, and biospecimen collection. Participants over 60 underwent two additional assessment programmes (3-4 h each) on two separate visits including deeper cognitive testing, brain magnetic resonance imaging, diagnostic interviews for depression, and electroencephalography.

Discussion

The participation rate was 33 %. The assessment programme was accepted well and completely passed by almost all participants. Biomarker analyses have already been performed in all participants. Genotype, transcriptome and metabolome analyses have been conducted in subgroups. The first follow-up examination will commence in 2016.

[The extension of the Leipzig questionnaire of motives to have a child (LKM) for use in oncology--test construction and psychometric review]

Many young cancer patients had not completed family planning at the time of diagnosis. A cancer disease may change procreative attitudes and the development of specific motivations of having a child (for and against) is possible. This paper addresses the extension of the Leipzig questionnaire on motives for wanting children (LKM) in the context of cancer. Specific motivations of cancer patients are presented and test-statistically verified. Based on previous findings and a qualitative questioning (patients, professionals) items for specific motivations were developed and pre-tested. The revised version (20 items) was tested on a sample of 175 young cancer patients. Good to adequate item discrimination parameter and reliability (α=0.86) were shown. The factor analysis revealed the 2 scales "PRO - motivations for having children after cancer" and "CON - motivations against having children after cancer". These additional scales of specific motivations allow for a reliable and economical measure of motivations to have a child in young cancer patients. In the future the scales can be also used for other serious physical disease in young adulthood.

The core self-evaluation scale: psychometric properties of the german version in a representative sample

The Core Self-Evaluation Scale (CSES) is an economical self-reporting instrument that assesses fundamental evaluations of self-worthiness and capabilities. The broad aims of this study were to test the CSES's psychometric properties. The study is based on a representative survey of the German general population. Confirmatory factor analyses were conducted for different models with 1, 2, and 4 latent factors. The CSES was found to be reliable and valid, as it correlated as expected with measures of depression, anxiety, quality of life, self-report health status, and pain. A 2-factor model with 2 related factors (r = -.62) showed the best model fit. Furthermore, the CSES was measurement invariant across gender and age. In general, males had higher values of positive self-evaluations and lower negative self-evaluations than females. It is concluded that the CSES is a useful tool for assessing resource-oriented personality constructs.

The desire for children and fertility issues among young German cancer survivors

PURPOSE

For young cancer patients, family planning is not always completed at the time of cancer diagnosis. This study investigated young cancer patients' desire to have children, its intensity, and their discussion with oncologists and fertility specialists about fertility. Furthermore, gender differences, differences between childless patients and patients with children, and correlations with psychological distress were analyzed.

METHODS

A total of 149 cancer patients (range, 18-45 years of age) answered a self-developed questionnaire. Psychological distress was measured with the Patient Health Questionnaire.

RESULTS

Seventy-four percent of patients had a desire to have children at the time of diagnosis. Whereas the intensity of the desire for children increased pre- to post-treatment in childless patients, it decreased in patients who already had children. A total of 55 patients who wanted a child (50%) needed supportive care concerning this issue; 60% of the total sample had discussed fertility aspects with their oncologists and 20% with fertility specialists. Patients reported higher levels of satisfaction with their discussions with fertility specialists than with their discussions with oncologists. Men (56%) underwent fertility preservation more often than did women (31%). Female sex was the only variable predicting psychological distress, whereas parenthood, fertility preservation, and desire for children had no significant impact.

CONCLUSIONS

The desire to have children and the fertility issues involved are important for young cancer patients. Reasons for not discussing fertility aspects with oncologists and the cause of low referral rates to fertility specialists should be explored in future studies. The implementation of structured psychosocial supportive care might address the needs of highly fertility-distressed patients.

How is emotional awareness related to emotion regulation strategies and self-reported negative affect in the general population?

Objective

The Levels of Emotional Awareness Scale (LEAS) as a performance task discriminates between implicit or subconscious and explicit or conscious levels of emotional awareness. An impaired awareness of one's feeling states may influence emotion regulation strategies and self-reports of negative emotions. To determine this influence, we applied the LEAS and self-report measures for emotion regulation strategies and negative affect in a representative sample of the German general population.

Sample and Methods

A short version of the LEAS, the Hospital Anxiety and Depression Scale (HADS) and the Emotion Regulation Questionnaire (ERQ), assessing reappraisal and suppression as emotion regulation strategies, were presented to N = 2524 participants of a representative German community study. The questionnaire data were analyzed with regard to the level of emotional awareness.

Results

LEAS scores were independent from depression, but related to self-reported anxiety. Although of small or medium effect size, different correlational patters between emotion regulation strategies and negative affectivity were related to implict and explict levels of emotional awareness. In participants with implicit emotional awareness, suppression was related to higher anxiety and depression, whereas in participants with explicit emotional awareness, in addition to a positive relationship of suppression and depression, we found a negative relationship of reappraisal to depression. These findings were independent of age. In women high use of suppression and little use of reappraisal were more strongly related to negative affect than in men.

Discussion

Our first findings suggest that conscious awareness of emotions may be a precondition for the use of reappraisal as an adaptive emotion regulation strategy. They encourage further research in the relation between subconsious and conscious emotional awareness and the prefarance of adaptive or maladaptive emotion regulation strategies The correlational trends found in a representative sample of the general population may become more pronounced in clinical samples.

Motives and decisions for and against having children among nonheterosexuals and the impact of experiences of discrimination, internalized stigma, and social acceptance

Same-sex parents are increasingly a topic of public discourse. A growing number of homosexuals openly speak about their desire to have children or are already living together in different family constellations. The current study examined the decisions for or against having children and the motivations behind those decisions among nonheterosexuals living in Germany. A sample of 1,283 nonheterosexuals participated by means of an online survey. As some nonheterosexual individuals do not identify themselves with a male or female gender identity, a third category, "gender different," was generated. Motives for (not) having children, perceptions of social acceptance, experiences of discrimination in relation to one's sexual orientation, and levels of internalized stigma were taken into account regarding their influence on the decision about parenthood. Most respondents (80%) reported that they did not have children. However, among this group, 43% stated that they had decided to have children later in their lives, 24% were undecided, and 11% had already decided against having children. The most important influences on the decision of whether to have children were respondents' age and their desire for emotional stabilization. Negative experiences as a result of sexual orientation and internalized stigma had no impact on the decisions regarding parenthood.

[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.

[Health and quality of life within the context of unemployment and job worries]

Unemployment is associated with mental and physical complaints. The aim of this study is to examine the impact of frequency and duration of unemployment experiences in a representative sample of the German general population. In total, 2426 persons were interviewed about their employment biography and they answered the following questionnaires: Patient Health Questionnaire (PHQ-4), Questionnaire of life satisfaction (FLZ) and Zerssen-Complaints-List (B-LR). Unemployed persons reported significantly more anxiety, depression, health complaints and reduced life. The operationalisation of unemployment about the frequency or the duration did not matter. Severe worries about one's job have a similar impact as the experience of unemployment. Especially persons with a longer duration or frequent experiences of unemployment are at risk for higher burden, whereas a single or short time experience of unemployment can rather be compensated.

Ethical attitudes of German specialists in reproductive medicine and legal regulation of preimplantation sex selection in Germany

BACKGROUND

Because of its ethical and social implications, preimplantation sex selection is frequently the subject of debates.

METHODS

In 2006, we surveyed specialists in reproductive medicine in Germany using an anonymous questionnaire, including sociodemographic data and questions regarding ethical problems occurring in the practice of reproductive medicine. Most questions focused on preimplantation sex selection, including 10 case vignettes, since these enabled us to describe the most difficult and ethically controversial situations. This is the first survey among specialists in reproductive medicine regarding this topic in Germany.

RESULTS

114 specialists in reproductive medicine participated, 72 males (63%) and 42 females (37%), average age was 48 years (age range 29-67 years). The majority of respondents (79%) favoured a regulation that limits the use of preimplantation sex selection only for medical reasons, such as X-linked diseases (including 18%: summoning an ethics commission for every case). A minority of 18% approved of the use of sex selection for non-medical reasons (4% generally and further 14% for family balancing). 90% had received obvious requests from patients. The highest approval (46%) got the counselling guideline against a preimplantation sex selection and advising a normal pregnancy, if preimplantation sex selection would be allowed in Germany. The majority (67%) was opposed the personal use of preimplantation sex selection for non-medical reasons, but would think about it in medical cases. In opposite to woman, 14% of the men were in favour of personal use for non-medical reasons (p=0,043). 25% of specialists in reproductive medicine feared that an allowance of preimplantation sex selection would cause a shift in the sex ratio.

CONCLUSIONS

The majority of German specialists in reproductive medicine opposes preimplantation sex selection for non-medical reasons while recommending preimplantation sex selection for medical reasons, e.g. X-linked diseases like haemophilia.

[Protective factors for postpartum depression]

OBJECTIVES

This article examines the associations between protective factors und the occurrence of postpartum depressive symptoms.

METHODS

Using a prospective-longitudinal design 303 pregnant women were examined at 3 points in time (T1: 1st trimester, T2: 3rd trimester, T3: 3-5 months postpartum). The analyses are based on T1 and T3.

RESULTS

Sense of coherence (SOC-L9, Schumacher et al. 2000) at 1st trimester was on average 51.7 (SD = 7.2) - significantly above the mean of a comparison sample. 37 women (15.4 %) had a score of 10 or more on the Edinburgh Postnatal Depression Scale (EPDS, Cox et al. 1987) 3 to 5 months postpartum. Pregnant women who stated that their pregnancy had been planned and desired, with a higher marital and overall life satisfaction as well as a higher sense of coherence, had a significantly lower risk for the development of postpartum depression. Using multiple regression it was found that only sense of coherence significantly predicted postpartum depression.

CONCLUSIONS

The results suggest that a higher sense of coherence at first trimester is an important protective factor for the occurrence of postpartum depression.