Maintaining Mental Health Through Positive Writing: Effects of a Resource Diary on Depression and Emotion Regulation.

OBJECTIVE: The present study investigated the beneficial effects of the resource-oriented positive writing intervention resource diary (RD) on mental health variables among patients recently discharged from psychiatric inpatient treatment. METHOD: Eighty-nine patients were randomly assigned to either an intervention group completing RD over the course of 4 weeks (n = 45) or a control group receiving no intervention (n = 44). To measure changes in mental health, patients filled out a number of self-report questionnaires on depression, emotion regulation, and resource activation before and after the intervention.  RESULTS: Participants completing RD had significantly lower depression scores than controls and reported an increased use of the functional emotion regulation strategy "reappraisal" 5 weeks after discharge. A decreased use of the dysfunctional strategy "expressive suppression" was found in the female subsample. No differences were found for resource activation. CONCLUSION: These findings suggest that a resource-oriented positive writing intervention has potential for stabilizing mental health after psychiatric discharge and could therefore present an economical alternative or addition to established aftercare programs.

[Psychotherapy with older caregivers]. / Psychotherapie mit älteren pflegenden Angehörigen.

Nursing and caring for a relative can be regarded as an important developmental task, which mainly affects elderly people who provide care for their very old parents or their (spouse) partners. Being responsible for the care of someone can be associated with a severe caregiver burden and experienced as a crisis. Possible psychological consequences are pronounced depressive symptoms or maladaptive stress reactions. For these caregivers, psychotherapeutic counselling can be sensible and helpful in addition to other resources of caregiver support. This applies in particular to improving coping with problematic everyday situations, stressful emotions, and strengthening resources. Multimodal interventions that address methods of cognitive behavioral therapy and acceptance as well as commitment therapy could show good evidence for this target group but have so far received little attention in healthcare programs. Because it is often difficult for caregivers to organize regular visits to the psychotherapist's practice, psychotherapeutic offers would be desirable in more flexible settings (e. g. by telephone or internet-based). The extent to which such supplementary interventions can be embedded and financed in the context of chronic care models is still unclear.

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.

[Involving family members of chronically ill patients in physician-patient communication]. / Einbezug von Familienangehörigen chronisch Kranker in die Arzt-Patient-Kommunikation.

Involving family members in the patient's treatment is central for coping with chronic diseases. The family's functioning and their involvement in the treatment process have a significant influence on compliance as well as on the patient's coping and quality of life. This article illustrates this broad topic through selected aspects. First, the importance of the family for the patient's coping and quality of life is highlighted in certain examples. Criteria for the family's involvement and important topics for the doctor's encounter with family members are introduced. Second, the necessities, problems, and consequences of doctor-family communication are illustrated for the examples of stroke and dementia. Overall, there is only limited time to include the family in in-patient as well as out-patient care. As a result, physician-family communication is not integrated sufficiently in general care, even for chronic diseases.

[Carer burden in dementia: origins and intervention]. / Die Belastung pflegender Angehöriger bei Demenz : Enstehungsbedingungen und Interventionsmöglichkeiten.

Caring for a demented elderly indiviudal in the home is associated with a high burden on care-providing family members. Factors contributing to this burden include invariable context conditions such as gender, type of relationship and severity of symptoms as well as role change, coping style, available support and appraisal of the caring role. Most interventions for family carers have focused on providing dementia-related information and problem solving skills but have placed less emphasis on the emotional facets of the burden. Controlled studies evaluating the efficacy of support programs for family carers suggest that the greatest benefits can be achieved by interventions which are intensive, long-term, individually tailored and targeted to the everyday context. From these findings and experiences the outline of a psychologically based behavioral intervention for family carers of dementia patients is derived.

[Self-determined but with professional leadership? On the effectiveness and definition of self-help groups]. / Selbstbestimmt aber professionell geleitet? Zur Effektivität und Definition von Selbsthilfegruppen.

PURPOSE: Because the effectiveness of self-help groups (SHGs) has not been proven yet and also since multi-focus reviews on SHGs are rare, the present article offers an overview of the current state of research. Possible reasons for the conflicting results in the literature are also investigated. METHODS: An extensive literature search was done to review studies which used longitudinal design and control groups to measure the effectiveness of SHGs and so-called "support groups". RESULTS: Positive effects in comparison to the control groups were proven in four out of seven of the studies. In the remaining three studies the outcomes between the groups were the same. CONCLUSION: Considering the naturalistic designs of the studies, these results clearly indicate that SHGs are indeed effective. An insufficient consideration of the heterogeneity of the groups is held responsible for the difficulties associated with previous research on the topic, especially as far as the differentiation between SHGs and professionally led groups is concerned. The definition excludes professional leadership but, in fact, professional involvement in SHGs up to their leadership is the rule. The following suggestions have been derived from this literature analysis: uniform classifications for SHGs and professionally-led support groups should be established in order to make it possible to provide a clear distinction between these types of groups as well as to indicate the extent of professional involvement in them. A plea is made for a generally stronger consideration of organisational differences in the research of SHGs.

[Side effects of psychotherapeutic intervention for caregivers of stroke patients: do patients also benefit?]. / Nebeneffekte eines therapeutischen Gruppenprogramms für Ehepartner von Schlaganfallpatienten: Profitieren auch die Patienten?

AIM: The present study aimed at investigating whether stroke patients benefit from their spouses attending a psychotherapeutic group intervention, in terms of improved functioning level and quality of life. METHOD: Within the scope of a panel study with control group design, n = 124, stroke patients were interviewed using standardized questionnaires, regarding competences of daily life (PCRS) and quality of life (WHOQoL). In the intervention group, the patients' spouses attended a psychotherapeutic group intervention; the spouses of two control groups merely received illness-related information. Data was evaluated statistically by means of multiple regression analysis. RESULTS: No statistically significant effects of the caregiver intervention on the patients were found. However, patients of the intervention group tended to report improved quality of life in the course of the study period, whereas subjective quality of life worsened for patients of the control groups. In all groups, impairments of everyday-life competences increased. DISCUSSION: The results of this study suggest that psychotherapeutic group intervention for caregivers also has positive side effects on the patients. Further research is necessary in order to provide a better understanding of the mechanisms at work behind these positive side effects. Assistance concepts for spouses of stroke patients should utilize such intermediary effects more systematically.

[Gender- and age-specific aspects of assistance need in caregivers of stroke patients: results from a qualitative panel study]. / Geschlechts- und altersspezifische Aspekte des Hilfebedarfs bei Angehörigen von Schlaganfallpatienten - Ergebnisse einer qualitativen Längsschnittstudie.

AIM: The present study aimed at investigating the need for professional assistance in carers of stroke patients who do not require a therapeutic group intervention; and furthermore, how this need for assistance is changing in the course of rehabilitation. METHOD: Ten highly burdened spouses of stroke survivors were interviewed twice in the framework of a qualitative panel study. In-depth interviews concerning subjective burden and assistance requirements were carried out and analyzed using Grounded Theory coding procedures. RESULTS: The evaluation of the interview data showed that the relatives' needs for assistance change in the course of rehabilitation, and feature gender- and age-specific differences. Assistance needs persist in the medium and long term, with qualitative diversifications: During the in-patient rehabilitation period, carers request mainly illness-related information, whereas emotional assistance is rarely desired. This is different during the out-patient rehabilitation period: While the desire for further information decreases, the need for emotional assistance (e. g.disburdening counselling) increasingly comes to the fore. Women much more often desire professional assistance than men. DISCUSSION: When designing and offering professional assistance for caregivers of stroke patients, gender- and age-specific aspects should be taken into account, as well as the medium- and long-term changes in assistance need.

["I never feel free"--women care for the demented husband, father or mother]. / "Frei fühle ich mich nie"--Frauen pflegen ihren an Demenz erkrankten Ehemann, Vater oder Mutter.

The care of elderly relatives with dementia is not any longer a job exclusively done by women nevertheless the care for three quarters of patients is mainly provided by women. This study comprises 70 persons consulting the "Alzheimer Advice Centre" in Leipzig. The aim was to examine the difference between nursing men and women with regard to the way they experience their situation. Independent of sex nursing persons experience their job as a strain. Especially spouses suffer from depressive disorders, states of exhaustion and pain in arms and legs. Nursing spouses differ in their ways of coping with regard to their sex. Wives experience the symptoms of dementia and the limitation of personal freedom as stressing whereas husbands pick out as a central theme the worries about their wives. Men use instrumental support in the nursing situation more often than wives. Altogether mainly women provide care. Sometimes they even take care of several persons. Therefore the resulting strains and limitations are to be regarded as special problems of women.

[Influence of dispositional coping strategies on physical complaints and life satisfaction in the elderly]. / Zum Einfluss dispositioneller Bewältigungs-strategien auf Körperbeschwerden und Lebenszufriedenheit im Alter.

Well-being and mental and physical health in old age are influenced in a significant way by the fact that it is possible to cope successfully with ongoing hazards, threats and problems. In recent years coping research has shown increasing interest in coping processes in the elderly. Most of the studies are focused on age-related differences in coping processes and on the issue of change or stability of coping in old age. However, the goal of our study was to examine the impact of dispositional coping strategies, conceptualized as consistent personality characteristics, on physical complaints and life satisfaction among the elderly. We recurred on the model of coping modes by Krohne, which postulates two statistically independent person-specific coping dimensions named "vigilance" and "cognitive avoidance". Based on this model it is possible to identify the "classical" coping styles of "sensitization" (high vigilance and low cognitive avoidance) and "repression" (low vigilance and high cognitive avoidance). In our study, including 766 subjects older than 60 years, we found a higher frequency of "repressors" than of "sensitizers". Results show that dispositional coping strategies are significant moderator variables of both physical complaints and life satisfaction: Older people who prefer a cognitive-avoidant coping strategy ("repressors") are more satisfied with their life and have less complaints than "sensitizers".

[Psychological diagnosis of pain and pain treatment in the elderly]. / Psychologische Schmerzdiagnostik und Schmerzbehandlung im Alter.

Chronic pain is one of the most common complaints in the elderly, associated with much impairment of quality of life. Up to now clinical research has focused little attention on pain in old age. Pain is often classified as an inevitable epiphenomena in the elderly. But present studies show that differences between older and younger patients appear less important than similarities. The studies also make evident that proved psychological pain management is transferable to elderly patients. The knowledge of effective psychological treatment in case of chronic pain in the elderly has been seldom realized in clinical practice.

[Long-term life changes and stress sequelae for spouses of stroke patients]. / Langfristige Lebensveränderungen und Belastungsfolgen bei Ehepartnern von Schlaganfallpatienten.

OBJECTIVE: This study investigates the long-term effect of stroke on the quality of life and health of patients' spouses. METHOD: Twenty-six spouses of stroke patients were interviewed by means of standardized questionnaires and qualitative interviews. The study participants had been living with the consequences of stroke for 3 years on average when the interviews were carried out. RESULTS: A stroke is often followed by considerable changes in everyday life and by role shifts within the relationship. In particular, depressive and aggressive changes in the patient's behaviour are experienced as burdensome. In addition to impairments in quality of life, psychological and psychosomatic troubles can also from the burden experienced. Depressive symptoms are the main factor in these negative consequences: the more a patient is assessed as depressive, the more his/her spouse reports health problems and poor quality of life. DISCUSSION: Long-term changes in everyday life and partnership can bring about significant chronic burden for the spouses of stroke patients. Hence, offers of support and counseling are required not only in the acute and post-acute stages of stroke, but also after inpatient rehabilitation has ended.

[The Antonovsky Sense of Coherence Scale. Test statistical evaluation of a representative population sample and construction of a brief scale]. / Die Sense of Coherence Scale von Antonovsky. Teststatistische Uberprüfung in einer repräsentativen Bevölkerungsstichprobe und Konstruktion einer Kurzskala.

In this article we will describe the evaluation of Antonovsky's 29-items Sense of Coherence Scale (SOC-29) in a large community sample (n = 2.005) of the German population and the development of the Leipzig Short Scale (SOC-L9), which consists of only 9 items. The SOC-29 has a high internal consistency (alpha = 0.92), however, the SOC-subscales (comprehensibility, manageability, meaningfulness) were correlated with each other. A principal component factor analysis did not identify the 3-factor structure of the SOC-Scale. It appears that the best solution consists of one global factor. The newly developed SOC-L9, conceptualized as an unidimensional scale, is a reliable and valid instrument, which allows to assess the SOC economically. In our study the Sense of Coherence depended on age and gender. Women and older people reported a lower SOC. Furthermore we found significant associations between SOC and different subjective health measures. A high SOC was associated with both a lower extent of subjective body complaints and somatoform symptoms and with minor health-related problems in daily living.

[The emotional burden in caregiving relatives of stroke patients]. / Psychische Belastungen bei Angehörigen von Schlaganfallpatienten.

Sustained psychosocial burdens as a consequence of stroke not only affect the stroke victim but frequently their spouses and significant others as well. The present study analyses the extent of emotional burden in spouses of stroke patients (Beck Depression Inventory, BDI and Beck Anxiety Inventory, BAI), examining the relationships of emotional burden in spouses with the medical assessment regarding stroke severity (Barthel Index, BI) and with the spouses' own perceptions of the stroke patients' impairment (Patient Competency Rating, PCR) as well as determining the factors that were independently associated with emotional burden in spouses. 82 spouses of stroke patients are examined in our study. The questioning was realised on admission into inpatient or partially inpatient rehabilitation centres. Initial results indicated that relatives of stroke victims have higher scores for anxiety compared to the general population. The assessment of disability in the stroke victims by their spouses correlates directly with the psychosocial burden of the spouses. By using this methodology, a high-risk group of spouses could be identified. The predictors of emotional burden in spouses (Anxiety and Depression) are gender of spouse and the spouse's subjective perception of disability in the stroke victim. The age of spouses and medical assessment of the severity of stroke on the other hand have no predictive value for the extent of emotional burden in spouses.

[Effects of chronic stress on physical or psychological health - an analysis of family caregivers of dementia patients]. / Auswirkungen chronischer Belastungen auf die physische und psychische Befindlichkeit - eine Prozessanalyse bei Pflegenden Angehörigen von Demenzkranken.

The effects of chronical strains on physical or psychological health are subject of this paper. Stress-related symptoms of family caregivers of dementia patients have been proven in various studies. For this group of people an analysis of the health risk factors is regarded as to be especially important. Diary investigations allow to identify the individual assessment (by the caring person) of factors related to the care situation and to recognize the health and quality of sleep have been used as indicators regarding the state of health. In this study strong differences in the individual view of stress factors and their effects on psychological an physical state of the caring person are shown.

[Perception of stress by caregiving relatives of dementia patients]. / Belastungserleben pflegender Angehöriger von Demenzpatienten.

The increasing interest in research on burden and health risks of family caregivers was furthered by the increasing prevalence rate of dementias in the elderly and by the fact that 80-90% of the demented are cared for by near family members. The present paper presents some results of a study investigating stress-related symptoms of family caregivers. From a clinical perspective these results point to needed interventions for supporting the caregivers. Specific burden components, depression, and body complaints were assessed in n = 70 family caregivers of dementia patients. A substantial degree of social isolation, depressive disorders, and physical complaints could be found. The level of burden experienced was not directly related to severity of dementia and to impairment of the demented or to structural conditions of the care (degree and length of care). Differences were observed between spouse caregivers and other relatives; spouses suffer more psychosomatic complaints and depression.