Relation of anxiety and other psychometric measures, balance deficits, impaired quality of life, and perceived state of health to dizziness handicap inventory scores for patients with dizziness.

BACKGROUND: An important question influencing therapy for dizziness is whether the strengths of the relationships of emotional and functional aspects of dizziness to 1) anxiety and other mental states, 2) perceived state of health (SoH) and quality of life (QoL) are different in patients with and without normal balance control. We attempted to answer this question by examining these dimensions' regression strengths with Dizziness Handicap Inventory (DHI) scores. METHODS: We divided 40 patients receiving group cognitive behavioural therapy (CBT) and vestibular rehabilitation for dizziness, into 2 groups: dizziness only (DO) and normal balance control; dizziness and a quantified balance deficit (QBD). Group-wise, we first performed stepwise multivariate regression analysis relating total DHI scores with Brief Symptom Inventory (BSI) sub-scores obtained pre- and post-therapy. Then, regression analysis was expanded to include SoH, QoL, and balance scores. Finally, we performed regressions with DHI sub-scores. RESULTS: In both groups, the BSI phobic anxiety state score was selected first in the multivariate regression analysis. In the DO group, obsessiveness/compulsiveness was also selected. The correlation coefficient, R, was 0.74 and 0.55 for the DO and QBD groups, respectively. When QoL and SoH scores were included, R values increased to 0.86 and 0.74, explaining in total 74, and 55% of the DHI variance for DO and QBD groups, respectively. Correlations with balance scores were not significant (R ≤ 0.21). The psychometric scores selected showed the strongest correlations with emotional DHI sub-scores, and perceived QoL and SoH scores with functional DHI sub-scores. CONCLUSIONS: Our findings suggest that reducing phobic anxiety and obsessiveness/compulsiveness during CBT may improve emotional aspects of dizziness and targeting perceived SoH and QoL may improve functional aspects of dizziness for those with and without normal balance control.

Focusing on cancer patients' intentions to use psychooncological support: A longitudinal, mixed-methods study.

OBJECTIVE: Distress screening programs aim to ensure appropriate psychooncological support for cancer patients, but many eligible patients do not use these services. To improve distress management, we need to better understand patients' supportive care needs. In this paper, we report the first key finding from a longitudinal study that focused on patients' intentions to use psychooncological support and its association with distress and uptake of the psychooncology service. METHODS: We conducted a prospective, observational study in an Oncology Outpatient Clinic and assessed distress, intention to use psychooncological support, and uptake of the psychooncology service by using the Distress Thermometer, a semistructured interview, and hospital records. We analyzed data with a mixed-methods approach. RESULTS: Of 333 patients (mean age 61 years; 55% male; 54% Distress Thermometer ≥ 5), 25% intended to use the psychooncology service (yes), 33% were ambivalent (maybe), and 42% reported no intention (no). Overall, 23% had attended the psychooncology service 4 months later. Ambivalent patients reported higher distress than patients with no intention (odds ratio = 1.18, 95% confidence interval [1.06-1.32]) but showed significantly lower uptake behavior than patients with an intention (odds ratio = 14.04, 95% confidence interval [6.74-29.24]). Qualitative analyses revealed that ambivalent patients (maybe) emphasized fears and uncertainties, while patients with clear intentions (yes/no) emphasized knowledge, attitudes, and coping concepts. CONCLUSIONS: We identified a vulnerable group of ambivalent patients with high distress levels and low uptake behavior. To optimize distress screening programs, we suggest addressing and discussing patients' supportive care needs in routine clinical practice.

[Influence of migration background on child development at school-enrolment - a multivariate model]. / Migrationshintergrund als Einflussfaktor auf die kindliche Entwicklung im Einschulungsalter - ein multivariates Modell.

BACKGROUND AND AIM: There is an increasing awareness for the role of a migration background regarding health over the past years in Germany. Descriptive data show that children from families with a migration background score significantly lower in developmental screening tests at school-enrolment compared to their peers of German origin. The analyses presented here examine the impact of a migration background on child development in the context of additional factors of influence. METHODS: Data are from the routine examina-tion at school-enrolment in Berlin in 2010 and 2011 (N=54 818). Because of the multicollinearity of migration background and the German language skills of the child and its parents these variables are combined to one variable. Multiple regression models are conducted with 'poor performance in 2 or more developmental domains' as the dependent variable and the migration variables as the independent variable controlled for sociodemographic and other relevant predictor variables. RESULT: The strongest predictor variable is the socioeconomic status of the family (OR 5.8). A migration background is only a predictor in combination with insufficient German language skills of child or parent (OR 1.6) and insufficient German language skills of child and parent (OR 5.3) respectively. Furthermore, very low birth weight children (birth weight < 1 500 g) are at risk for poor performance in 2 or more developmental domains (OR 4.2). Having spent not more than 2 years in day care (OR 1.6), living with a single parent and missing the preventive health check-up at the age of 4 (so called U8) have only a weak significant impact (OR 1.2 each). Electronic media exposure (television, computer) is no significant risk factor in our analyses. CONCLUSION: The analyses show that migration background is not a risk factor for poor performance in developmental tests per se, but is attributed to the higher proportion of families with a low socioeconomic status in this group and with insufficient German language skills. This emphasizes the importance of support for socially disadvantaged children in general and for comprehensive promotion of German language skills for children and their parents from foreign origin.

[SIPS--screening instrument for premenstrual symptoms. The German version of Premenstrual Symptoms Screening Tool to assess clinically relevant disturbances]. / SIPS--Screening-Instrument für prämenstruelle Symptome. Die deutsche Version des Premenstrual Symptoms Screening Tool zur Erfassung klinisch relevanter Beschwerden.

BACKGROUND: Premenstrual dysphoric disorder (PMDD) and severe premenstrual syndrome (PMS) are common, yet often remain unrecognized and not adequately treated. One reason for this is the lack of a valid German screening instrument. The aim of the present study was to create a German version of the English "Premenstrual Symptoms Screening Tool (PSST)" and to verify its applicability. MATERIAL AND METHODS: The German version of the PSST was created as "Screening-Instrument für prämenstruelle Symptome (SIPS)" and its reliability and validity determined based on data from 47 women with and without PMDD/severe PMS using Internet-based daily symptom ratings. RESULTS: The retest reliability of the SIPS was r=0.69, and Cronbach's alpha was 0.924. As an indicator of the convergent validity of the SIPS, there were significant differences between women with and without PMDD/severe PMS as identified by the SIPS with regard to prospectively assessed premenstrual symptomatology (F[2,44]=4.52, p<0.001) and symptom change (F[2,44]=25.23, p<0.001). CONCLUSIONS: The SIPS is reliable and valid and may help to improve the identification of women who require treatment for their premenstrual symptoms.

Depressive symptoms, but not anxiety, predict subsequent diagnosis of Coronavirus disease 19: a national cohort study.

AIMS: Several diseases are linked to increased risk of Coronavirus disease 19 (COVID-19). Our aim was to investigate whether depressive and anxiety symptoms predict subsequent risk of COVID-19, as has been shown for other respiratory infections. METHODS: We based our analysis on UK Biobank participants providing prospective data to estimate temporal association between depressive and anxiety symptoms and COVID-19. We estimated whether the magnitude of these symptoms predicts subsequent diagnosis of COVID-19 in this sample. Further, we evaluated whether depressive and anxiety symptoms predicted (i) being tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and (ii) COVID-19 in those tested. RESULTS: Based on data from N = 135 102 participants, depressive symptoms (odds ratio (OR) = 1.052; 95% confidence interval (CI) 1.017-1.086; absolute case risk: (moderately) severe depression: 493 per 100 000 v. minimal depression: 231 per 100 000) but not anxiety (OR = 1.009; 95% CI 0.97-1.047) predicted COVID-19. While depressive symptoms but not anxiety predicted (i) being tested for SARS-CoV-2 (OR = 1.039; 95% CI 1.029-1.05 and OR = 0.99; 95% CI 0.978-1.002), (ii) neither predicted COVID-19 in those tested (OR = 1.015; 95% CI 0.981-1.05 and OR = 1.021; 95% CI 0.981-1.061). Results remained stable after adjusting for sociodemographic characteristics, multimorbidity and behavioural factors. CONCLUSIONS: Depressive symptoms were associated with a higher risk of COVID-19 diagnosis, irrespective of multimorbidities. Potential underlying mechanisms to be elucidated include risk behaviour, symptom perception, healthcare use, testing likelihood, viral exposure, immune function and disease progress. Our findings highlight the relevance of mental processes in the context of COVID-19.

Effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychosocial stress in postpartum lactating women.

In several studies lactation has been shown to be associated with a hypothalamic-pituitary-adrenal axis hyporesponsiveness to physical and psychological stressors. As it is not known whether the marked blunting of endocrine stress reactivity in women can be ascribed to suckling as a short-term effect or to lactation in general, the acute effects of suckling on the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary system responses to mental stress were investigated in lactating women. Forty-three lactating women were randomly assigned either to breast-feed or to hold their infants for a 15-min period with the onset 30 min before they were exposed to a brief psychosocial stressor (Trier Social Stress Test). Both breast-feeding and holding the infant yielded significant decreases in ACTH, total plasma cortisol, and salivary free cortisol (all P < 0.01). There were no significant differences in baseline hormone levels between the groups 1 min before the stress test. In response to stress exposure, ACTH, total plasma cortisol, salivary free cortisol, norepinephrine, and epinephrine were significantly increased in all lactating women (all P < 0.001). However, total cortisol and free cortisol responses to stress were attenuated in breast-feeding women (P = 0.001 and P = 0.067, respectively), who also showed significantly decreasing PRL levels during the stress test (P = 0.005). In addition, there was no change in plasma oxytocin or vasopressin in response to the stressor. Breast-feeding as well as holding led to decreased anxiety (P < 0.05), whereas, in contrast, stress exposure worsened mood, calmness, and anxiety in the total group (all P < 0.001). From these data we conclude that lactation in women, in contrast to that in rats, does not result in a general restraint of the hypothalamic-pituitary-adrenal axis response to a psychosocial stressor. Rather, suckling is suggested to exert a short-term suppression of the cortisol response to mental stress.

Emotion and mood adaptations in the peripartum female:complementary contributions of GABA and oxytocin.

Peripartum hormones and sensory cues from young modify the maternal brain in ways that can render females either at risk for, or resilient to, elevated anxiety and depression. The neurochemical systems underlying these aspects of maternal emotional and mood states include the inhibitory neurotransmitter GABA and the neuropeptide oxytocin (OXT). Data from laboratory rodents indicate that increased activity at the GABA(A) receptor contributes to the postpartum suppression of anxiety-related behaviour that is mediated by physical contact with offspring, whereas dysregulation in GABAergic signalling results in deficits in maternal care, as well as anxiety- and depression-like behaviours during the postpartum period. Similarly, activation of the brain OXT system accompanied by increased OXT release within numerous brain sites in response to reproductive stimuli also reduces postpartum anxiety- and depression-like behaviours. Studies of peripartum women are consistent with these findings in rodents. Given the similar consequences of elevated central GABA and OXT activity on maternal anxiety and depression, balanced and partly reciprocal interactions between these two systems may be essential for their effects on maternal emotional and mood states, in addition to other aspects of postpartum behaviour and physiology.

Dynamic changes in DNA methylation of stress-associated genes (OXTR, BDNF ) after acute psychosocial stress.

Environmentally induced epigenetic alterations are related to mental health. We investigated quantitative DNA methylation status before and after an acute psychosocial stressor in two stress-related genes: oxytocin receptor (OXTR) and brain-derived neurotrophic factor (BDNF ). The cross sectional study took place at the Division of Theoretical and Clinical Psychobiology, University of Trier, Germany and was conducted from February to August 2009. We included 83 participants aged 61-67 years. Thereof, 76 participants completed the full study procedure consisting of blood sampling before (pre-stress), 10 min after (post-stress) and 90 min after (follow-up) the Trier social stress test. We assessed quantitative DNA methylation of whole-blood cells using Sequenom EpiTYPER. Methylation status differed between sampling times in one target sequence of OXTR (P<0.001): methylation increased from pre- to post-stress (P=0.009) and decreased from post-stress to follow-up (P<0.001). This decrease was also found in a second target sequence of OXTR (P=0.034), where it lost statistical significance when blood cell count was statistically controlled. We did not detect any time-associated differences in methylation status of the examined BDNF region. The results suggest a dynamic regulation of DNA methylation in OXTR-which may in part reflect changes in blood cell composition-but not BDNF after acute psychosocial stress. This may enhance the understanding of how psychosocial events alter DNA methylation and could provide new insights into the etiology of mental disorders.

[1995 Berlin social structure atlas--a planning instrument for health and social planning within the scope of administrative reform in Berlin]. / Sozialstrukturatlas Berlin 1995--ein Planungsinstrument für die Gesundheits- und Sozialplanung im Rahmen der Verwaltungsreform in Berlin.

Social unequality and social differences of a population can be defined as social structure. The objective of this study is the construction of indices with which an analysis of space-related social disparities from their spacious dimensions can be made. Each dimension has to be described with a multitude of space-related social indicators first, and then identified and calculated with a multivariate statistic procedure (Factor Analysis). With the existing analysis basic dates are provided. This information about the social situation of Berlin districts as well as the resulting political plannings shall contribute to the reduction of existing differences, in particular to the reduction of social disadvantages. In general, decisions regarding allocation on the private as well as on the public sector should be supported by the social structure analysis.