Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment

BACKGROUND

Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy.

METHODS

A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II.

RESULTS

Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation.

LIMITATION

Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II.

CONCLUSION

Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

Pathological network changes in patients with social anxiety disorder before and after an Internet-based CBT

A network perspective may shed light on the understanding of Internet-based CBT efficacy for social anxiety disorder. Previous cross-sectional evidence revealed a densely interconnected network for individuals with social anxiety. Yet, longitudinal network changes before and after ICBT are lacking. This study aimed to investigate pathological network changes with Graphical Gaussian Model among patients with social anxiety disorder (n = 249). Social phobia scale (SPS) and Social interaction anxiety scale (SIAS) were measured before and after 8 weeks Internet-based CBT. Results revealed the connection between symptom tension when speaking and symptom awkward when being watched was the most robust edges during ICBT interventions. The pathological network benefited from ICBT and exhibited modification in several prominent interconnections. The overall network connectivity continues to exhibit comparable strength after ICBT. This study represents the first examination of social anxiety network changes after patients with SAD completed a systematic ICBT. Changes in critical edges and nodes provide valuable insights for the design and efficacy assessment of ICBT interventions.

The relationship among psychological distress, well-being and excessive social media use during the outbreak of Covid-19: A longitudinal investigation

INTRODUCTION

The corona pandemic has been a life event causing negative consequences on mental health. Mental health consists of positive and negative dimensions. The present longitudinal study investigated how positive and negative dimensions changed over 15 months after the Covid-19 outbreak. Potential changes of excessive social media use (SMU) and its relationship with mental health were also investigated.

METHOD

Data (N = 189) on distress (measured overall and as depression, anxiety, and stress), well-being and excessive SMU were collected at three time points (baseline, BL; 3-month follow-up, FU1; 15-month follow-up, FU2) via online surveys in Italy. Repeated analyses of variance were used to test differences among the three measurement time points. Mediational models were applied.

RESULTS

Distress did not change over time, well-being decreased and excessive SMU increased significantly. The relationship between distress at BL and excessive SMU at FU2 was significant (total effect, c: p < .001). The relationship between distress at BL and well-being at FU1 (a: p < .001), and between well-being at FU1and excessive SMU at FU2 (b: p = .004) was significant. Including FU1 well-being in the model, the relationship between distress at BL and excessive SMU at FU2 was not significant (direct effect, c': p = .078). The indirect effect (ab) was significant.

CONCLUSION

Well-being mediated the relationship between baseline stress and excessive SMU. Enhanced stress may reduce well-being which, in turn, increases the risk of excessive SMU. This emphasizes the urgency of programmes that foster well-being, especially during stressful events such as a pandemic.

Depressive primary care patients' assessment of received collaborative care

The "Patient Assessment of Chronic Illness Care" (PACIC) is a tool for evaluating outpatient health service for patients with chronic diseases. Our aim was to analyze the association between PACIC scores of primary care patients with depression and patients' or patients' general practitioners' (GPs) characteristics. In a data set including depressive primary care patients (N = 280) the association of patient characteristics (sex, age, depressive symptom severity, suicidal ideation) with PACIC scores were assessed by linear regression models. The association between GPs' characteristics (type, location of practice; age, qualification of practitioner) and PACIC scores was assessed by linear mixed models with individual practices as random effects. Patient Health Questionnaire (PHQ-9) scores at 12 months follow up and changes in PHQ-9 scores from baseline to follow up were significantly positive associated with higher PACIC scores (beta = 0.67, 95%-CI [0.02, 1.34]). PACIC scores were not associated with patients' sex (p = 0.473) or age (p = 0.531). GP's age was negatively associated with PACIC scores (p = 0.03). In conclusion, in patients with depression, the PACIC is independent from patients' and GPs' characteristics. The PACIC may be appropriate to assess patient-perspective on depression services in primary care.

Relationship between sense of control, psychological burden, sources of information and adherence to anti-COVID-19 rules

BACKGROUND

Adherence to anti-COVID-19 rules is important to slow down the pandemic spread. The present study investigated potential predictors of the adherence.

METHODS

Data of 1.247 participants from Germany (age: M (SD) = 22.99 (6.18)) were assessed via online surveys in autumn and winter 2020. The focus of the data collection was on adherence to anti-COVID-19 rules, sense of control, psychological burden, and sources of COVID-19 information.

RESULTS

In moderated mediation analyses, the positive relationship between sense of control and adherence to anti-COVID-19 rules was significantly mediated by the level of psychological burden experienced by the COVID-19 situation. The source of COVID-19 information significantly moderated the negative association between burden and adherence. Specifically, the higher the use of social media (e.g., Facebook, Twitter) and the lower the use of official governmental sites and of television reports, the closer the link between high burden and low adherence.

LIMITATIONS

Due to the cross-sectional study design, the present findings allow only hypothetical assumptions of causality.

CONCLUSIONS

The present results disclose potential mechanisms that could contribute to the adherence to anti-COVID-19 rules. They emphasize the role of the COVID-19 information source for the adherence level. Potential ways of how the level of adherence could be enhanced are discussed.

The Benefits of Physical Activity and Positive Mental Health for Reducing the Burden of COVID-19: Validation from a Cross-sectional and Longitudinal Investigation in China and Germany

Many people experience high burden by the outbreak of the coronavirus disease (COVID-19) and its consequences for health and everyday life. The present cross-national study investigated potential factors that can reduce the burden by COVID-19 in China and Germany. Cross-sectional and longitudinal (China: N = 474, baseline, BL: 2015, follow-up, FU: 2020; Germany: N = 359, BL: 2019, FU: 2020) data on physical activity (e.g., jogging) (BL/FU), positive mental health (PMH) (BL/FU), and burden by COVID-19 (FU) were collected via online surveys. In both countries, physical activity was positively associated with PMH, and both variables were negatively related to burden by COVID-19. Furthermore, PMH mediated the link between physical activity and burden. The mediation model was significant when physical activity and PMH were assessed at the BL, while burden was measured at the FU; and it was also significant when all variables were assessed at the FU. The present findings reveal that physical activity in combination with PMH can reduce the experience of burden by COVID-19. Conscious fostering of physical activity and PMH is supported as an effective strategy to reduce the negative impact of the pandemic outbreak on mental and physical health. Additional benefits such as increased adherence to governmental measures around COVID-19 are discussed.

Human perceptual learning is delayed by the N-methyl-D-aspartate receptor partial agonist D-cycloserine

BACKGROUND

The optimisation of learning has long been a focus of scientific research, particularly in relation to improving psychological treatment and recovery of brain function. Previously, partial N-methyl-D-aspartate agonists have been shown to augment reward learning, procedural learning and psychological therapy, but many studies also report no impact of these compounds on the same processes.

AIMS

Here we investigate whether administration of an N-methyl-D-aspartate partial agonist (D-cycloserine) modulates a previously unexplored process - tactile perceptual learning. Further, we use a longitudinal design to investigate whether N-methyl-D-aspartate-related learning effects vary with time, thereby providing a potentially simple explanation for apparent mixed effects in previous research.

METHODS

Thirty-four volunteers were randomised to receive one dose of 250 mg D-cycloserine or placebo 2 h before tactile sensitivity training. Tactile perception was measured using psychophysical methods before and after training, and 24/48 h later.

RESULTS

The placebo group showed immediate within-day tactile perception gains, but no further improvements between-days. In contrast, tactile perception remained at baseline on day one in the D-cycloserine group (no within-day learning), but showed significant overnight gains on day two. Both groups were equivalent in tactile perception by the final testing - indicating N-methyl-D-aspartate effects changed the timing, but not the overall amount of tactile learning.

CONCLUSIONS

In sum, we provide first evidence for modulation of perceptual learning by administration of a partial N-methyl-D-aspartate agonist. Resolving how the effects of such compounds become apparent over time will assist the optimisation of testing schedules, and may help resolve discrepancies across the learning and cognition domains.

The relationship between burden caused by coronavirus (Covid-19), addictive social media use, sense of control and anxiety

The outbreak of Covid-19 has significantly restricted people's everyday life and contributed to enhanced social media use (SMU). The present study investigated the relationship of burden caused by Covid-19 and addictive SMU. Data were assessed in a sample of 550 users of social media (age: M (SD) = 27.08 (6.74)) from Germany via online surveys in spring 2020. In a moderated mediation analysis, the positive association between burden and addictive SMU was significantly mediated by the level of perceived sense of control. Anxiety symptoms significantly moderated the relationship between sense of control and addictive SMU. Specifically, the link between both variables was significant only for medium and high levels of anxiety symptoms. The present findings disclose the mechanisms that can contribute to the development of addictive tendencies during the pandemic outbreak. Potential practical implications and ways of how the negative consequences of burden caused by Covid-19 might be prevented are discussed.

The relationship between social media use, stress symptoms and burden caused by coronavirus (Covid-19) in Germany and Italy: A cross-sectional and longitudinal investigation

Introduction

The need for “social distancing” to reduce the spread of Covid-19 is accompanied by an increase of social media use (SMU). Many people engage in intensive online activity to find information about the current Covid-19 situation and to interact about it with other users. The present study investigated the extent of SMU as Covid-19 information source and its relationship with stress symptoms and burden caused by the pandemic in Germany and Italy.

Methods

Cross-national longitudinal (Germany, N = 501; 3-months period) and cross-sectional (Italy, N = 951) data on Covid-19 information sources, stress symptoms and burden caused by Covid-19 were collected via online surveys.

Results

About 50% of the German sample and about 60% of the Italian sample frequently used SM as Covid-19 information source. Cross-sectional analyses in both countries revealed that SMU is positively associated with stress symptoms and experienced burden. Moreover, stress symptoms mediated the link between SMU and burden. This was also confirmed by longitudinal analyses in Germany (burden assessed three months after SMU and stress symptoms).

Limitations

The mostly female and relatively young sample composition limits the generalizability of present findings. Only two European countries were investigated.

Conclusions

The present findings reveal a potential negative impact of enhanced SMU on individual mental health state and behavior. Additionally, they emphasize the significance of a conscious and cautious use of SM as information source specifically during the pandemic.

Validating the use of a smartphone app for remote administration of a fear conditioning paradigm

Fear conditioning models key processes related to the development, maintenance and treatment of anxiety disorders and is associated with group differences in anxiety. However, laboratory administration of tasks is time and cost intensive, precluding assessment in large samplesnecessary for the analysis of individual differences. This study introduces a newly developed smartphone app that delivers a fear conditioning paradigm remotely using a loud human scream as an aversive stimulus. Three groups of participants (total n = 152) took part in three studies involving a differential fear conditioning experiment to assess the reliability and validity of a smartphone administered fear conditioning paradigm. This comprised of fear acquisition, generalisation, extinction, and renewal phases during which online US-expectancy ratings were collected during every trial with evaluative ratings of negative affect at three time points. We show that smartphone app delivery of a fear conditioning paradigm results in a pattern of fear learning comparable to traditional laboratory delivery and is able to detect individual differences in performance that show comparable associations with anxiety to the prior group differences literature.

Education and mental health: Do psychosocial resources matter?

Prevalence rates for mental health problems are higher when an individual's socioeconomic status (SES) is low, but the underlying mechanisms are not clearly understood. We investigated associations between education as indicator for SES and depressive symptoms as well as positive mental health (PMH). Moreover, we hypothesized that low education is associated with a lack of psychosocial resources and more daily hassles, which in turn mediate the relationships between education and mental health. In a German representative sample (N = 7937), we cross-sectionally first examined whether a person's educational level was associated with depressive symptoms and PMH. Educational level was defined as the highest academic qualification achieved. Second, we investigated whether also sense of control, resilience, delay of gratification, cultural activity and daily hassles followed gradients along the educational level. Third, we investigated whether they mediated the relationship between education and mental health. Results showed that depressive symptoms measured by items from the DASS-42 depression subscale were more prevalent for persons with a low educational level, PMH operationalized by the Positive Mental Health Scale was equally distributed, and all psychosocial characteristics followed the gradient of educational level. In addition, the group with a high school diploma was particularly burdened. Structural equation modeling indicated that the associations between education and mental health were mediated by all psychosocial characteristics and daily hassles, apart from the delay of gratification. In the group with the lowest educational level the model fit indices for depressive symptoms and PMH were acceptable (χ2 = 10007.243 (627), CFI = 0.869, RMSEA = 0.04 (90% CI [0.04, 0.04], SRMR = 0.05; and χ2 = 12779.968 (741), CFI = 0.86, RMSEA = 0.05 (90% CI [0.05, 0.05], SRMR = 0.05), respectively). The effect size Pm refers to the proportion of the total effect that is mediated by one or more variables ("M"), and the effect size of all indirect effects in the model for depressive symptoms was Pm = .80 and for PMH it was Pm = .68. The results support our hypotheses that low education is associated with less psychosocial resources, which in turn serve together with daily hassles as pathways between education and depressive symptoms as well as PMH. Building on these findings, longitudinal studies are necessary to investigate causality.

Genome-wide expression and response to exposure-based psychological therapy for anxiety disorders

Exposure-based psychological treatments for anxiety have high efficacy. However, a substantial proportion of patients do not respond to therapy. Research examining the potential biological underpinnings of therapy response is still in its infancy, and most studies have focussed on candidate genes. To our knowledge, this study represents the first investigation of genome-wide expression profiles with respect to treatment outcome. Participants (n=102) with panic disorder or specific phobia received exposure-based cognitive behavioural therapy. Treatment outcome was defined as percentage reduction from baseline in clinician-rated severity of their primary anxiety diagnosis at post treatment and 6 month follow-up. Gene expression was determined from whole blood samples at three time points using the Illumina HT-12v4 BeadChip microarray. Linear regression models tested the association between treatment outcome and changes in gene expression from pre-treatment to post treatment, and pre-treatment to follow-up. Network analysis was conducted using weighted gene co-expression network analysis, and change in the detected modules from pre-treatment to post treatment and follow-up was tested for association with treatment outcome. No changes in gene expression were significantly associated with treatment outcomes when correcting for multiple testing (q<0.05), although a small number of genes showed a suggestive association with treatment outcome (q<0.5, n=20). Network analysis showed no association between treatment outcome and change in gene expression for any module. We report suggestive evidence for the role of a small number of genes in treatment outcome. Although preliminary, these findings contribute to a growing body of research suggesting that response to psychological therapies may be associated with changes at a biological level.

Students’ Value Orientations in Contemporary China: Analysis of Measurement Invariance and Latent Mean Differences in Comparison With Students From Germany and Russia

The present study examined Chinese students’ personal value orientations according to the Schwartz value theory in comparison with students from Germany and Russia. The theory postulates 10 value orientations grouped into four higher-order factors: conservation versus openness to change and self-transcendence versus self-enhancement. Schwartz’ value orientations have been extensively investigated in Europe but less in East Asian countries such as China. We hypothesized that Chinese students would score higher on conservation and self-enhancement than German and Russian students, but lower on self-transcendence. Regarding openness to change, a null hypothesis was formulated. Students from China ( n = 9,601), Germany ( n = 1,118), and Russia ( n = 3,890) completed the Portrait Values Questionnaire (PVQ-21). To ensure methodological preconditions for cross-cultural comparison, measurement invariance of the PVQ-21 was tested. In a first step, confirmatory Factor Analysis (CFA) was conducted separately for each country. Due to the high correlation between the 10 values, the four higher-order dimensions were studied separately. Configural, metric, and scalar invariance models were tested using multigroup CFA. Full metric and partial scalar invariance models held for all higher-order factors. Thereafter, latent means of values were compared across samples. As a result, Chinese students scored highest on the four higher-order dimensions when compared with Russian and German samples, thus the hypotheses were only partly confirmed. Results of this study could reflect the value conflicts emerging from various cultural influences in contemporary China: Young people are confronted with daily negotiation between Confucian tradition and the rapid economic development.

The circular structure of values: The case of China

This study examined the circular structure of values in China. The circular structure is a central element of Schwartz value theory and visualises the idea that some values are similar while others conflict with one another. Whereas numerous studies addressed the question whether the circular structure of values can be generalised cross-culturally, results for China are inconclusive. In this paper, we argue that taking a closer look at China provides a challenge to the circular structure and allows for drawing conclusions regarding the limits versus generalizability of Schwartz' theory. For this purpose, we first conduct a re-analysis of Chinese data from a former meta-analysis (Study 1) and second, present results from a large study of 10,652 Chinese college students (Study 2). Results of Study 1 revealed that graphical representation of the circular structure matched theoretical expectations but five out of six samples showed relatively bad fit to the theorised structure. By contrast, data in Study 2 showed a good model fit. As an overall conclusion, the circular structure is well supported in the Chinese context, and small sample sizes in previous studies might have caused the imperfect match to the prototypical circular structure.

Sleep enhances exposure therapy

BACKGROUND

Sleep benefits memory consolidation. Here, we tested the beneficial effect of sleep on memory consolidation following exposure psychotherapy of phobic anxiety.

METHOD

A total of 40 individuals afflicted with spider phobia according to DSM-IV underwent a one-session virtual reality exposure treatment and either slept for 90 min or stayed awake afterwards.

RESULTS

Sleep following exposure therapy compared with wakefulness led to better reductions in self-reported fear (p = 0.045, d = 0.47) and catastrophic spider-related cognitions (p = 0.026, d = 0.53) during approaching a live spider, both tested after 1 week. Both reductions were associated with greater percentages of stage 2 sleep.

CONCLUSIONS

Our results indicate that sleep following successful psychotherapy, such as exposure therapy, improves therapeutic effectiveness, possibly by strengthening new non-fearful memory traces established during therapy. These findings offer an important non-invasive alternative to recent attempts to facilitate therapeutic memory extinction and consolidation processes with pharmacological or behavioral interventions.

Ecological momentary assessment to evaluate cognitive-behavioral treatment for binge eating disorder

OBJECTIVE

Cognitive-behavioral treatment (CBT) for binge eating disorder (BED) is traditionally evaluated using clinical interviews and questionnaires. These retrospective assessment methods are discussed to be problematic due to memory recall error. Ecological momentary assessment (EMA) might be promising for gathering ecologically valid and reliable data.

METHOD

We assessed the feasibility of and reactivity to EMA and compared the treatment efficacy measured by traditional vs. EMA-based instruments in 28 BED individuals participating in short-term CBT.

RESULTS

Patients were highly compliant and we found no reactivity to EMA. Estimated treatment effects for binge eating based on EMA were comparable to questionnaire-based methods. The overall concordance between methods was moderate.

DISCUSSION

Results suggest that binge eating over 1 week can be equally accurately assessed by EMA or by self-report questionnaires in BED treatment trials. EMA contributes to a detailed knowledge of binge eating in daily live and helps to advance treatment options.

Increasing the motivation for physical activity in obese patients

OBJECTIVE

In this randomized controlled study, a standardized motivation intervention was compared with a relaxation intervention with regard to its effectiveness in decreasing dropout rates and increasing physical activity in a sample of obese patients.

METHOD

Thirty-eight obese participants were randomly assigned to a one-session motivation or relaxation intervention. Thereafter, both groups participated in an 8-week aerobic program. Adherence, physical activity, motivational stage of change, and body mass index (BMI) were assessed during intervention and at 3- and 6-month follow-ups.

RESULTS

During the aerobic program, the motivation group showed significantly fewer dropouts but comparable adherence if only completers were considered. Moreover, their weekly minutes of physical activity increased over time before leveling off, whereas steady decreases were observed in the relaxation group. For motivational stage of change and BMI, no significant group differences were observed.

DISCUSSION

The importance and efficacy of motivational interventions in enhancing the high dropout rates in obesity treatment is underlined.

Negative mood induction and unbalanced nutrition style as possible triggers of binges in binge eating disorder (BED)

OBJECTIVE

To investigate whether negative mood and unbalanced nutrition style (fat rich/carbohydrate low) synergistically trigger binge eating in overweight and obese binge eating disorder (BED) patients.

METHODS

Subsequently to following an unbalanced or a balanced nutrition plan for three days, participants' food intake in a taste test was measured. During the taste test, participants were either in a negative or a neutral mood that was induced through a guided imagery task.

PARTICIPANTS

Sixty-nine overweight and obese women with BED (mean age: 36.7 years, mean body mass index: 32.8 kg/m2).

MEASUREMENTS

Eating behavior was assessed by measuring the amount of eaten food during the taste test. Visual analog scales were used to assess negative affect, tension, urge to eat, and hunger before and after the mood induction and after the taste test.

RESULTS

Negative mood and unbalanced nutrition had neither a combined synergistic effect nor separate additive effects on the amount of food intake. Negative affect and tension decreased after the taste test in the negative mood group.

CONCLUSIONS

Negative mood does not invariably enhance the risk of binge-eating behavior. Fat-rich, carbohydrate-low nutrition style did not influence food intake during a taste test. This finding questions the role of this specific nutrition style as a crucial factor in promoting binge eating. If replicated, these findings are important, since they could guide development of treatment protocols.

A randomized comparison of cognitive behavioral therapy and behavioral weight loss treatment for overweight individuals with binge eating disorder

OBJECTIVES

The aim of this study was to determine the efficacy of cognitive-behavioral therapy (CBT) and behavioral weight loss treatment (BWLT) for overweight patients with binge eating disorder (BED).

METHOD

Eighty obese patients meeting criteria of BED according to DSM-IV-TR were randomly assigned to either CBT or BWLT consisting of 16 weekly treatments and 6 monthly follow-up sessions. Binge eating, general psychopathology, and body mass index (BMI) were assessed before, during, and after treatment, and at 12-month follow-up.

RESULTS

At posttreatment results favored CBT as the more effective treatment. Analysis of the course of treatments pointed to a faster improvement of binge eating in CBT based on the number of self-reported weekly binges, but faster reduction of BMI in BWLT. At 12-month follow-up, no substantial differences between the two treatment conditions existed.

CONCLUSION

CBT was somewhat more efficacious than BWLT in treating binge eating but this superior effect was barely maintained in the long term. Further research into cost effectiveness is needed to assess which treatment should be considered the treatment of choice.

Restrained eating in overweight children: Does eating style run in families?

Overweight children show abnormalities in eating style, such as restrained eating and tendency toward overeating (comprising both emotional and external eating). Family surroundings play a major role in developing eating behaviors in children. We tested whether restrained eating and tendency toward overeating predicted the amount of food intake in 41 overweight children (23 girls and 18 boys) and their parents (40 mothers and 11 fathers) after receiving a preload. We further investigated with questionnaires whether there were associations between the parents' and their children's eating behavior and whether mothers' food intake predicted the amount of food consumed by children in an experimental trial. We found that neither children with restrained eating nor their mothers ate more after a preload, but children with a high tendency toward overeating ate somewhat more after receiving a preload. Further analyses showed that children's food intake in the preload paradigm was predicted by mothers' food intake. Our findings point to a familial transmission of eating styles: children eat as their primary caregivers do, even when the caregivers are not present in the laboratory.

[Validity of diagnoses of mental disorders by primary care physicians]

BACKGROUND AND OBJECTIVE

Even in young adult age, psychological disorders are highly prevalent. Family doctors and gynaecologists are the physicians most often consulted by young women. Hence, they have a special responsibility to diagnose psychiatric disorders and--if necessary--to refer to a specialist.

PATIENTS AND METHODS

In a prospective epidemiological study, 342 young women (between 18 and 25 years of age) were questioned two times with a structured interview (F-DIPS) designed for mental disorders. In the time period (1997 and 1998), we also investigated, by analysing personal health insurance data, primary-care physicians' diagnoses and payments for services rendered. The diagnoses were compared.

RESULTS

There was only a small accordance between F-DIPS and claimcards. Ambulant treating doctors diagnosed somatoform disorders in 28 % of the young women (F-DIPS: 3, 8 %). The F- DIPS found mostly phobic disorders (29 %) (claimcards: 6,1 %). A disorder-specific therapy was only rarely initiated. The treatment (psychotherapy and/or drug therapy) of women with psychiatric disorders appeared to be insufficient.

CONCLUSION

The study indicates that primary-care physicians should be urgently trained in psychiatric diagnostics und therapy.

Impact of carbohydrate and fat intake on weight-reducing efficacy of orlistat

BACKGROUND

Orlistat treatment of obesity results in a poor long-term weight loss (< 5%) in about 30% of patients.

AIM

Total energy and macronutrient intake were examined to assess the effect of a change in eating habits on weight loss.

METHODS

Sixty-two patients consumed a hypocaloric diet, together with orlistat (3 x 120 mg/day), for 72 weeks, with a maximal fat allowance of 30% of the energy intake. At regular intervals, food diaries were recorded.

RESULTS

Fifty-six patients completed the study and lost 8.5 +/- 0.88 kg (P < 0.001). Energy intake was approximately 1500 kcal/day during the entire study period. In three sub-groups established according to weight loss (1, < 5%; 2, > 5% and < 10%; 3, > 10%), fat intake was within the recommended range in all groups during the first 6 months, but thereafter only in group 3. All groups increased their carbohydrate consumption, with the greatest increase in group 1, which could account for the rapid regain of initially lost body weight in this group.

CONCLUSION

At the beginning of a weight management programme in conjunction with orlistat, a low fat intake is advised for an efficient reduction in body weight. Subsequently, in patients with poor long-term weight loss, dietary recommendations must also consider carbohydrate restriction to ensure an adequate hypocaloric diet.

Generalized anxiety disorder and clinical worry episodes in young women

BACKGROUND

This article presents epidemiological data on the prevalence of DSM-IV generalized anxiety disorder (GAD) and sub-threshold GAD (fulfilling three out of four GAD criteria) in young women together with data on co-morbidity and psychosocial functioning. The prevalence of clinically relevant worry and its predictive validity for the diagnosis of GAD were also examined.

METHOD

Young women (N = 2064), aged between 18 and 25, from a representative German community sample were diagnosed with a structured clinical interview (ADIS-L, German research version). An additional interview questioned all the participants about the frequency/intensity and uncontrollability of diverse worry topics.

RESULTS

Thirty-seven participants (1.8%) fulfilled the criteria of current GAD (1 week point prevalence) and 56 received a lifetime diagnosis (2.7%); a further 50 participants (2.3%) were diagnosed with sub-threshold GAD. Co-morbidity between GAD and other disorders was high for current (68%) and lifetime GAD (91%). GAD, as well as sub-threshold GAD, showed clearly reduced levels of psychosocial functioning. Whereas worries of low intensity and high controllability were ubiquitous in all subsamples, clinically defined worrying was rarely present in healthy subjects (0.89%) and of adequate predictive accuracy for GAD.

CONCLUSIONS

Full GAD and sub-threshold GAD were moderately frequent in young women. Although DSM-IV worry criteria proved to be highly useful, the strictness of the complete GAD-criteria should not lead to absence of attention from subclinical generalized anxiety states in research and practice.

Thought suppression: specificity in agoraphobia versus broad impairment in social phobia?

The paradoxical effects of intended thought suppression have been linked to psychological disorders, specifically anxiety disorders. So far, the evidence for thought suppression playing a major role in the disorder is mixed. One important issue is whether thought suppression is impaired only for thoughts related to the disorder, or if the ability for mental control is generally impaired in anxiety patients. This study compared groups of agoraphobics and social phobics with a healthy control group. All subjects were asked to suppress two topics related to the respective central fear of the two disorders and one nonspecific topic. We found a rather specific deficit in thought suppression for the agoraphobics; that is, when compared with the control group, we found the biggest differences for the agoraphobic fear. The social phobics seem to be characterized by a general impairment of mental control, affecting specific and nonspecific stimuli. In addition, among several psychopathological variables, social anxiety proved to be the strongest predictor for problems with thought suppression. Taken together, there are several indicators that generally impaired thought suppression may be an important feature of social phobia.

Anxious and depressive symptoms in adolescents: epidemiological data of a large scale study in Dresden

OBJECTIVES

The present large scale epidemiological study was designed to assess the prevalence of mental disorders in adolescents.

METHODS

Two cross-sectional studies have been performed in adolescents in Dresden and the results of the examination of 627 high school and 485 secondary school students (mean age 15.5 years) are presented. Self rating procedures like the Beck Depression inventory (BDI) and clinical interviews have been used to enhance validity.

RESULTS

The results underline the high prevalence rates of anxiety and depression in adolescents. Up to 30% of the 9th and 10th grades students suffer from mental disorders or are at risk for the development of mental disorders.

CONCLUSIONS

Therefore primary prevention of mental disorders is desirable.

The emotional Stroop effect in anxiety disorders: general emotional or disorder specificity?

Selective attentional biases, often documented with a modified Stroop task, are considered to play an important role in the etiology and maintenance of anxiety. Two competing explanations for these effects are selectivity for highly emotional words in general vs. selectivity for disorder-specific words. We tested these explanations in 32 patients with generalized anxiety disorder (GAD), 29 patients with social phobia (SP), and 31 non-anxious controls. Stimuli were of four kinds: GAD-related words, SP-related words, words with a neutral valence, and words with a positive valence. Different attentional biases were observed: GAD patients were slowed by all types of emotional words, while SP patients were distracted specifically by speech-related words.

Obesity and mental illness in a representative sample of young women

OBJECTIVE

To investigate the relation between mental disorders and weight, especially obesity.

DESIGN

Epidemiological study of mental disorders with a representative sample of young women.

SUBJECTS

A total of 2064 women, age 18-25 y, living in Dresden, Germany.

MEASUREMENTS

Verbal reports of body mass index, structured clinical interview for psychological disorders.

RESULTS

We found an association between psychological disorders and weight. Obese women had the highest rate of mental disorders overall, and they had higher rates of all subgroups of mental disorders, although many differences were not statistically significant. Most importantly, obese women suffered from an anxiety disorder significantly more often than women who were not obese. The observed differences were independent of socioeconomic status.

CONCLUSIONS

In young women, obesity is related to increased rates of mental disorders, most notably anxiety disorders. Future longitudinal research will have to determine the causal relationships behind this correlation.

[Anxiety and depression in students. A study in Dresden middle schools and high schools]

OBJECTIVES

Recent investigations by the WHO have shown once again the high prevalence of mental disorders in European countries. Mainly in the field of mental disorders considerable deficits exist particularly with regard to primary prevention.

METHODS

Although there is no doubt as to the importance of primary prevention within the scope of Public Health, there are deficits in this branch in Germany. This is unfortunate, considering that the proof of successful interventions is evidence for causal risk models. The current investigation is part of a study focusing upon the development, implementation and evaluation of a prevention program for anxiety and depression in adolescents and young adults.

RESULTS

Presented here are the prevalence rates of anxiety disorders and depression ascertained in the first cross-sectional study carried out in secondary schools and high schools. A total of 627 high school students and 485 secondary school students in grades nine and ten in Dresden were examined.

Angst und Depression bei Schülern

Zusammenfassung Fragestellung: Neueste Untersuchungen der WHO haben europaweit erneut Belege für die hohe Prävalenz psychischer Erkrankungen erbracht. Vor allem bei psychischen Störungen bestehen erhebliche Defizite im Bereich der primären Prävention.Methodik: Obwohl Einigkeit darüber besteht, dass der primären Prävention im Rahmen der Public Health ganz besondere Bedeutung zukommt, ist dieser Forschungszweig in Deutschland bisher defizitär. Dies ist umso bedauerlicher, als gerade der Nachweis erfolgreicher Interventionen einen Beweis für kausale Risikomodelle liefert. Die hier vorgestellte Untersuchung ist Teil einer Studie, deren Hauptziel die Entwicklung, Implementation und Evaluation eines Programms zur Prävention von Depressionen und Angststörungen bei Jugendlichen und jungen Erwachsenen ist.Ergebnisse: Die vorliegende Arbeit präsentiert die im Rahmen der ersten Querschnittstudie an Gymnasien und Mittelschulen in Dresden ermittelten Prävalenzraten für Angststörungen und Depressionen. Insgesamt wurden 627 Gymnasiasten und 485 Mittelschüler der Klassenstufen 9 und 10 in Dresden untersucht.

[Are eight-year olds already suffering from panic disorder? Investigation of prevalence with focus on panic disorder and agoraphobia]

A representative sample of 826 eight-year-old second-graders in Dresden was examined in a two-stage procedure to ascertain the 6-month prevalence of DSM-IV anxiety disorders. Particular care was taken to assess panic disorder. The eight-year-olds had already been interviewed personally in a screening session and in 230 children an individual diagnostic examination with a structured diagnostic interview was carried out. The total prevalence of anxiety disorder was 9.5%. No case of either panic disorder or agoraphobia was found. For the diagnosis of agoraphobia the DSM-IV diagnostic criterion was lacking in which situations typical to agoraphobia are feared or avoided because escape would be difficult or it would be difficult to reach help. Eight-year-olds do not forge this cognitive link. In agoraphobic situations 2.5% of the children (almost exclusively, girls) suffer from a specific phobia. The prevalence of anxiety disorders is markedly higher among girls than in boys.

[Are eight-year olds already suffering from panic disorder? Investigation of prevalence with focus on panic disorder and agoraphobia]

A representative sample of 826 eight-year-old second-graders in Dresden was examined in a two-stage procedure to ascertain the 6-month prevalence of DSM-IV anxiety disorders. Particular care was taken to assess panic disorder. The eight-year-olds had already been interviewed personally in a screening session and in 230 children an individual diagnostic examination with a structured diagnostic interview was carried out. The total prevalence of anxiety disorder was 9.5%. No case of either panic disorder or agoraphobia was found. For the diagnosis of agoraphobia the DSM-IV diagnostic criterion was lacking in which situations typical to agoraphobia are feared or avoided because escape would be difficult or it would be difficult to reach help. Eight-year-olds do not forge this cognitive link. In agoraphobic situations 2.5% of the children (almost exclusively, girls) suffer from a specific phobia. The prevalence of anxiety disorders is markedly higher among girls than in boys.

[Separation anxiety and agoraphobia in 8-year-old children]

In the literature on the aetiology of panic disorder, the separation-anxiety-hypothesis is discussed, in which separation anxiety disorder is conceived as a precursor of panic disorder. Using the representative sample of the Dresden Child Anxiety Study (DKAS) we examined weather agoraphobic and separation anxiety symptoms do already co-occur systematically in eight-year-olds. After N = 826 children had been screened, N = 230 took part in an individual diagnostic interview. With a total prevalence of 9.5% for all anxiety disorders, the prevalence rate for separation anxiety amounted to 2.8%. Another 2.5% of the children (almost exclusively girls) received a diagnosis of specific phobia in agoraphobic situations. Separation anxiety, social anxiety, agoraphobic anxiety and panic anxiety were assessed on a dimensional level, as well. However, no specific pattern of co-morbidity could be found in terms of an increased frequency of agoraphobic fears and separation anxiety occurring simultaneously. The symptom profiles of children with separation anxiety and those with agoraphobic anxieties differed considerably. Children currently living in a separation situation do not exhibit separation anxiety or agoraphobia more frequently than the rest of the children.

Explicit memory in anxiety disorders

Two experiments were conducted to study selective memory bias favoring anxiety-relevant materials in patients with anxiety disorders. In the 1st experiment, 32 patients with generalized anxiety disorder (GAD), 30 with social phobia (speaking anxiety), and 31 control participants incidentally learned GAD-relevant words, speech anxiety-relevant words, strongly pleasant words, and words with a neutral valence. Participants did not show any explicit memory bias for threatening materials. Thirty patients suffering from panic disorder (PD) with agoraphobia and 30 controls took part in the 2nd experiment. The design was similar to the 1st experiment. This time a highly specific selective memory bias for threatening words was found. Words describing symptoms of anxiety were better recalled by PD patients. Results are consistent with previous findings but are inexplicable by existing theories.

Explicit memory in anxiety disorders

Two experiments were conducted to study selective memory bias favoring anxiety-relevant materials in patients with anxiety disorders. In the 1st experiment, 32 patients with generalized anxiety disorder (GAD), 30 with social phobia (speaking anxiety), and 31 control participants incidentally learned GAD-relevant words, speech anxiety-relevant words, strongly pleasant words, and words with a neutral valence. Participants did not show any explicit memory bias for threatening materials. Thirty patients suffering from panic disorder (PD) with agoraphobia and 30 controls took part in the 2nd experiment. The design was similar to the 1st experiment. This time a highly specific selective memory bias for threatening words was found. Words describing symptoms of anxiety were better recalled by PD patients. Results are consistent with previous findings but are inexplicable by existing theories.

Cognitive aspects of hypochondriasis and the somatization syndrome

The aim of this study was to evaluate whether specific cognitive aspects are present in patients suffering from somatoform disorders. With a sample of 493 patients from a center for behavioral medicine, the authors evaluated a questionnaire assessing typical cognitions concerning body perception, illness behavior, and health. The authors further examined 225 participants, including patients with a somatization syndrome, patients with somatization syndrome and additional hypochondriasis, patients with hypochondriasis, patients with other mental disorders (clinical control group), and nonclinical controls. The results showed that not only patients with hypochondriasis but also patients with somatization syndrome had cognitive concerns and assumptions that were specific for the disorder. These patients had a self-concept of being weak and unable to tolerate stress. A catastrophizing interpretation of minor bodily complaints found in hypochondriacal patients in earlier studies was also found for patients with multiple somatization symptoms.

Cognitive aspects of hypochondriasis and the somatization syndrome

The aim of this study was to evaluate whether specific cognitive aspects are present in patients suffering from somatoform disorders. With a sample of 493 patients from a center for behavioral medicine, the authors evaluated a questionnaire assessing typical cognitions concerning body perception, illness behavior, and health. The authors further examined 225 participants, including patients with a somatization syndrome, patients with somatization syndrome and additional hypochondriasis, patients with hypochondriasis, patients with other mental disorders (clinical control group), and nonclinical controls. The results showed that not only patients with hypochondriasis but also patients with somatization syndrome had cognitive concerns and assumptions that were specific for the disorder. These patients had a self-concept of being weak and unable to tolerate stress. A catastrophizing interpretation of minor bodily complaints found in hypochondriacal patients in earlier studies was also found for patients with multiple somatization symptoms.

Don't worry and beware of white bears: thought suppression in anxiety patients

The ability to suppress unwanted thoughts was investigated in patients with Generalized Anxiety Disorder (GAD; n = 29), Speech Phobics (n = 25), and nonanxious controls (n = 28). All participants spent 5 minutes thinking aloud about anything that came to mind while trying not to think of white bears. In another task, they thought aloud for 5 minutes while trying not to think of their main worry. Intrusions of unwanted thoughts were signaled by button presses and recorded on tape. In accordance with the disorder's definition and complaints of the GAD patients, they showed more intrusions of their main worry than of white bears. The opposite was true for other participants. Compared to a baseline measure, all participant groups were unable to reduce duration of main worry thoughts when trying to suppress them.

Psychopathology in children of patients with panic disorder or animal phobia

Several studies reveal a heightened risk for anxiety and other mental disorders in the offspring of patients with panic disorder and other anxiety disorders. Data on the specific type of transmitted disorders, however, are inconsistent. We investigated the specificity of the relationship between parents' and children's psychopathology. We assessed current and past mental disorders in 5- to 15-year-old children of patients with panic disorder (CPAN, n = 34), children of parents with no diagnosis of a mental disorder (CCON, n = 30) and children of animal phobics (CPHOB, n = 23) using a structured diagnostic interview according to DSM-III-R criteria. Diagnoses are based on parent as well as child information. CPAN and CPHOB had significantly more often at least one current mental disorder than children of the healthy control parents. Compared to CPHOB and CCON, children of panic patients had significantly more severe diagnoses and more often multiple diagnoses. Furthermore, a higher rate of internalizing anxiety disorders, particularly separation anxiety disorder, was found in CPAN. In contrast, children of animal phobics showed a higher rate of externalizing anxiety disorders. Our results suggest a specific transmission of such disorders that share common features of parental symptomatology.

[Panic disorder and its psychological treatment]

Over the past decade, panic disorder has become a major research focus in psychopathology and treatment. Initial interest in the causes of the disorder was triggered by biological theories and investigators. More recently, however, research on newly developed psychological approaches has advanced our understanding of panic disorder and has led to the development of specific treatment programs. This review describes symptomatology and course, the psychophysiological model of panic and a psychological treatment that directly targets panic attacks and the fears and behaviors associated with them.