Regional differences in the assessment of depressive symptoms in the former German Democratic Republic and Federal Republic of Germany.

AIM: The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health. SUBJECT AND METHODS: To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802). RESULTS: Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning-with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude. CONCLUSION: We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded.

[Authoritarianism becomes respectable in Germany: A risk factor for condoning physical violence toward children?] / Autoritarismus wird salonfähig in Deutschland: Ein Risikofaktor für körperliche Gewalt gegen Kinder?

Authoritarianism becomes respectable in Germany: A risk factor for condoning physical violence toward children? Abstract. Objective: Authoritarianism denotes aggressive behavior toward subordinates, submission to authorities, and conventionalism. Authoritarianism is assumed to be a central factor in the emergence of right-wing extremist ideology. Horkheimer described a close relationship between authoritarianism and the use of physical violence as a disciplinary method. Against the background of the current increase in right-wing extremist ideologies in Germany, which manifests itself in both social and political realms, this study examines the association between authoritarian and right-wing extremist ideology and the affirmation of corporal punishment as a disciplinary method. Method: We performed a cross-sectional study on a representative sample of the German population (N = 2,524). Results: 44.5 % of the participants supported corporal punishment. When respondents reported authoritarian and right-wing extremist attitudes, we discovered an increased affirmation of physical violence as a disciplinary method. Regarding party preference, participants who stated that they preferred the right-wing Alternative for Germany Party (AfD) showed the highest rate of supporting corporal punishment. Conclusions: The results presented indicate that the condoning of corporal punishment is still very widespread in Germany, and that the children of parents with authoritarian and right-wing extremist attitudes comprise a risk group for physical violence. Increased social awareness of these risks is necessary in light of the current increase of right-wing ideologies.

Attachment Style and Internet Addiction: An Online Survey.

BACKGROUND: One of the clinically relevant problems of Internet use is the phenomenon of Internet addiction. Considering the fact that there is ample evidence for the relationship between attachment style and substance abuse, it stands to reason that attachment theory can also make an important contribution to the understanding of the pathogenesis of Internet addiction. OBJECTIVE: The aim of this study was to examine people's tendency toward pathological Internet usage in relation to their attachment style. METHODS: An online survey was conducted. Sociodemographic data, attachment style (Bielefeld questionnaire partnership expectations), symptoms of Internet addiction (scale for online addiction for adults), used Web-based services, and online relationship motives (Cyber Relationship Motive Scale, CRMS-D) were assessed. In order to confirm the findings, a study using the Rorschach test was also conducted. RESULTS: In total, 245 subjects were recruited. Participants with insecure attachment style showed a higher tendency to pathological Internet usage compared with securely attached participants. An ambivalent attachment style was particularly associated with pathological Internet usage. Escapist and social-compensatory motives played an important role for insecurely attached subjects. However, there were no significant effects with respect to Web-based services and apps used. Results of the analysis of the Rorschach protocol with 16 subjects corroborated these results. Users with pathological Internet use frequently showed signs of infantile relationship structures in the context of social groups. This refers to the results of the Web-based survey, in which interpersonal relationships were the result of an insecure attachment style. CONCLUSIONS: Pathological Internet use was a function of insecure attachment and limited interpersonal relationships.

[Are urban dwellers more depressed and anxious than the rural population? Results of a representative survey]. / Sind Städter depressiver und ängstlicher im Vergleich zur Landbevölkerung? Ergebnisse einer repräsentativen Bevölkerungsumfrage.

This study investigates the association between urbanicity and mental health in the general population. We conducted a representative survey (N = 5,036) measuring depression (PHQ-2), anxiety (GAD-2) as well as life satisfaction (FLZM). Results support the assumption that the prevalence rate for pathological scores of depression and anxiety are higher in urban than in rural areas. But, there is no clear linear association between urbanicity and mental health. Urbanicity seems to be a distal factor for higher rates in anxiety and depression. Urban-rural differences in other studies can not be transferred to the German population that easily. Future studies have to take variables on an individual and community level into account to analyse the relationship between urbanicity and mental health.

What makes a violent mind? The interplay of parental rearing, dark triad personality traits and propensity for violence in a sample of German adolescents.

Machiavellianism, narcissism and psychopathy are socially aversive personality traits that are strongly linked to the propensity of violence. A central determinate of aggression and violence is parental rearing. Interestingly, while the origin of the development of Dark Triad is not yet entirely understood, next to genetic and environmental factors, literature points towards an influence of parenting styles to the development of dark traits. Therefore, in a sample of 1366 9th grade students (mean age 14.89,), we assessed the interplay between parental rearing, dark triad traits, observation of violence among peers and their propensity for violence. The sample has a good representativeness on school types. Results reveal a positive association between the experience of parental rejection by both parents and punishment as well as parental control and overprotection and Machiavellianism, narcissism and psychopathy. Parental emotional warmth was associated negatively with Machiavellianism and psychopathy while no significant association with narcissism was seen. In a path model, parental rearing, dark triad traits and observation of violence among peers significantly contributed to the propensity of violence. However, differences between the experienced parenting behaviour of mothers and fathers should be noted. Both rejection and overly harsh punishments by fathers and emotional warmth by mothers have no significant influence on the dark triad. It is interesting that the effects regarding maternal parenting behaviour are stronger overall than the effects regarding paternal parenting behaviour. These results underline the importance of parental rearing on the development of Machiavellianism, narcissism and psychopathy and suggest a significant role of parental rearing and the dark triad traits on propensity for violence in adolescents. Parenting trainings and family interventions may be a promising starting point to prevent antisocial behavior linked to the dark triad and to prevent violent behavior in future generations.

Mental health and life satisfaction in East and West Germany: Effects of generation and migration of citizens.

Objective: The reunification of Germany after the separation between 1949 and 1990 has offered a unique chance of studying the impact of socialization, political transformation, and migration on mental health. The purpose of this article was to compare mental distress, resources, and life satisfaction (1) between residents of East and West Germany and migrants who have fled from East to West Germany before reunification and (2) between three generations. Methods: We assessed anxiety, depression, resilience, self-esteem, and life satisfaction, comparing groups based on their residency and migration, as well as three different birth cohorts. Using a representative survey of 2006, analyses of variance show the differences between these groups. Based on a representative survey (N = 4,530), the effects of gender (53.6% women), residency/migration (74.4% grown up in the West, 20.4% in the East, 5.3% migrants from the East to the West) from three generations (32% born until 1945, 39% until 1967, and 29% to 1989), and positive and negative mental health indicators were analyzed. Results: Women reported higher distress and lower resilience. Residents of the Western states reported the lowest burden of distress (depressive and anxiety symptoms) and the highest overall life satisfaction, exceeding residents from the Eastern states and migrants from the Eastern to the Western states. Migrants from the Eastern to the Western states, however, reported the lowest resilience and self-esteem. They reported lower satisfaction with income, living conditions (compared to the Western residents), and the lowest levels of satisfaction with family (compared to East and West). Conclusion: Overall, our data point to inequalities between the Eastern and Western states regarding mental health 16 years after reunification favoring the residents of the Western states by lower distress and life satisfaction. Our data attest to the stresses and adjustments associated with migration from the Eastern to the Western states before reunification. A lower level of mental health and life satisfaction in the oldest generation may be related to the sequelae of World War II and also to aging.

Changes in authoritarianism before and during the COVID-19 pandemic: Comparisons of latent means across East and West Germany, gender, age, and education.

Modern theories of authoritarianism have stressed the importance of threat to the expression of authoritarian attitudes and intolerance. Arguably, authoritarian tendencies may have increased during COVID-19 pandemic, a major threat to life and security. One issue arising when comparing mean scores is that of measurement invariance. Meaningful comparisons are only possible, if latent constructs are similar between groups and/or across time. This prerequisite is rarely ever tested in research on authoritarianism. In this study, we aim to analyze the short scale for authoritarianism KSA-3 by investigating its measurement invariance on two levels (three first-order and one second-order factors) and latent mean changes using two German representative samples (N = 4,905). Specifically, we look at differences before and during the pandemic (2017 vs. 2020). While measurement invariance holds across both levels in all conditions, we find a decrease in latent means in 2020, contrary to expectations and established theories. Moreover, latent means differ with regard to gender, education, and east-west Germany. We conclude that analyses of latent means and measurement invariance instead of mean comparisons with composites should become the standard. Future studies should focus on threat as a moderator between authoritarianism and intolerance, and on possible interactions with context variables.

Examining air pollution (PM10), mental health and well-being in a representative German sample.

There is a growing debate on the role of the physical environment and what constitute risk and protective factors for mental health. Various forms of air pollution have shown links to physical and mental health concerns and considering that Germany does not meet the WHO air quality standards-poor air quality affects a large proportion of Germans and is more important now than ever. This study investigates the physical environmental factor, air pollution, measured by particulate matter of particles with an aerodynamic diameter smaller than 10 µm (PM10) and effects on determinants of mental health and well-being (life satisfaction, stress resilience, anxiety, depression, and self-esteem). A representative sample of N = 3020 German adults with 54% females (46% males) and an age range between 18 and 92 years (M = 49.04, S.D. ± 17.27) was used. Multivariate linear regression analyses show that higher life satisfaction, more self-esteem and higher stress resilience are predicted by less air pollution (PM10). Individual income, age, and gender were taken into account for each regression model. Gender specific sub-analyses revealed similar predictions for PM10 and stress resilience whereas PM10 and self-esteem were only significantly associated for females. Associations between mental health or well-being determinants and air pollution (PM10) are found in the representative German sample.

Influence of hydrocortisone dosage scheme on health-related quality of life in patients with adrenal insufficiency.

CONTEXT: Recent studies suggest that current glucocorticoid replacement therapies fail to completely restore well-being in patients with adrenal insufficiency (AI). OBJECTIVE: The objective of this study was to investigate health-related quality of life (QoL) in patients with AI depending on dose and frequency of daily intake of hydrocortisone (HC). DESIGN AND PATIENTS: In a cross-sectional study, primary and secondary AI patients were contacted and asked to complete three validated self-assessment questionnaires [Short Form-36 (SF-36), Giessen Complaint List (GBB-24), Hospital Anxiety and Depression Scale (HADS)]. HC doses were corrected for body surface area. Results were compared with sex- and age-matched controls drawn from the questionnaire-specific reference cohort. RESULTS: Completed questionnaire sets were available from 334 patients on HC (primary AI n = 194; secondary AI n = 140). Patients on higher doses of HC (>30 mg/day) showed significantly impaired subjective health status in two of eight SF-36 dimensions, and three of five GBB-24 scales compared with those on lower HC doses. No significant differences in QoL were found between lower HC doses (15-30 mg/day) or between primary or secondary AI. Patients on HC with thrice daily intake showed significantly impaired QoL in one of eight SF-36 dimensions (15-20 mg/day, 20-25 mg/day), in one of five GBB-24 scales (15-20 mg/day), as well as higher anxiety scores. CONCLUSIONS: Health-related QoL was impaired in patients with primary and secondary AI. HC doses above 30 mg/day were associated with a worse health status. Thrice daily intake of HC was not superior to twice daily intake. Our data support the perception that current replacement strategies are still insufficient to fully restore well-being and daily performance.

Authoritarianism and the transgenerational transmission of corporal punishment.

BACKGROUND: Authoritarianism, firstly described by Horkheimer in 1936, is characterized by submission to authorities, aggression against subordinates and conventionalism. Authoritarianism is discussed as major contributor for right-wing attitudes. Horkheimer hypothesized that authoritarianism has its origin in the experience of harsh parenting and exposure to corporal punishment (CP) by authoritarian parents. The other way around, literature points towards an association between conventionalism and support of CP as disciplinary method, suggesting a role of authoritarianism in the vicious cycle of transgenerational transmission of CP. OBJECTIVE: We aimed to assess the association of authoritarianism, right-wing attitudes and affirmation of CP, focusing particularly the role of authoritarianism and right-wing attitudes in the transgenerational transmission of CP. PARTICIPANTS AND SETTING: In a cross-sectional survey, a representative sample of the German population above the age of 14 (N = 2524) was selected in a random route approach. RESULTS: Authoritarian aggression, authoritarian submission and conventionalism (OR 1.40) such as right-wing self-assessment (OR 1.39) are associated with an increased support of different forms of CP. Moderation analyses reveal an increasing affirmation of CP by those with a history of CP holding authoritarian attitudes and right-wing positions. CONCLUSIONS: Our results suggest a significant role for sociopolitical attitudes in the affirmation of CP and its transgenerational transmission. Sociopolitical ideology may be an important factor to identify risk groups, but furthermore represents a promising target for preventive interventions that aim to stop the cycle of violence in families, and, subsequently, the dire consequences of CP.

Detecting Authoritarianism Efficiently: Psychometric Properties of the Screening Instrument Authoritarianism - Ultra Short (A-US) in a German Representative Sample.

With right-wing-extremist and -populist parties and movements on the rise throughout the world, the concept of authoritarianism has proven to be particularly valuable to explain the psychological underpinnings of these tendencies. Even though many scales to measure the different dimensions of authoritarianism exist, no short screening instrument has been tested and validated on a large scale so far. The present study examines the psychometric properties of the screening instrument Authoritarianism - Ultrashort (A-US) in three representative German samples (n = 2,524, n = 2,478, and n = 2,495). Using exploratory and confirmatory factor analysis, the A-US demonstrated acceptable internal consistency. Model fit was good and correlations with related constructs indicated convergent validity in both samples. Construct validity was demonstrated using the original version of the scale. The instrument proved to be invariant across sex, employment status, and education, but not across different age groups. Finally, the analyses showed that differences in the A-US are associated with sociodemographic variables. Potential causes and effects of these findings are discussed. Based on these results, the A-US proved to be a valuable and highly efficient tool to screen for authoritarian tendencies.

Gender and age differences in domain-specific life satisfaction and the impact of depressive and anxiety symptoms: a general population survey from Germany.

PURPOSE: Determine age and gender differences and interaction effects in domain-specific life satisfaction in the German population and examine to which degree depressive and anxiety symptoms are associated with life satisfaction in addition to sociodemographic variables, and which domains are affected. METHODS: Representative survey of the German population conducted 2006 with 5,036 participants (53.6% female). Mean age was 48.4 years (SD = 18.0). Measurements included domain-specific life satisfaction (FLZ(M)), anxiety (GAD-7), depressive symptoms (PHQ-2), and sociodemographic variables (e.g., marital status, income, employment, education, urbanity, part of Germany, religiousness, age and gender). RESULTS: Women were more satisfied with their family life, men showed greater satisfaction with their leisure activities. Age-group differences appeared in every life satisfaction domain. Age by gender interaction emerged in the field of satisfaction with health, income, and family life. Anxiety and depressive symptoms contributed significantly to the explained variance of domain-specific life satisfaction. CONCLUSIONS: Depressive and anxiety symptoms as two psychological variables have an additional impact on domain-specific life satisfaction. Further investigation is needed regarding the impact of psychological variables on domain-specific life satisfaction.

[Factor structure and reliability of the Toronto Alexithymia Scale (TAS-20) in the German population]. / Faktorstruktur und Reliabilität der Toronto-Alexithymie-Skala (TAS-20) in der deutschen Bevölkerung.

The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used instrument in alexithymia measurement. In the present study the original factor structure of the Canadian population is compared with two other factor structures extracted from a representative German population (n = 1859) with maximum likelihood confirmatory factor analysis (CFA). A three-factor-model with the factors "difficulties in identifying and describing feelings", "external oriented thinking" and "importance of emotional introspection" described the data best and most reliable, anyway none of the models met all criteria of CFA. This model is different from the Canadian original model, but describes alexithymia just as well.

Impaired subjective health status in 256 patients with adrenal insufficiency on standard therapy based on cross-sectional analysis.

BACKGROUND: There is mounting evidence that current replacement regimens fail to restore health-related subjective health status fully in patients with adrenal insufficiency (AI). Here we evaluated the subjective health status in primary and secondary AI and the effect of concomitant disease. METHODS: In a cross-sectional study, all AI patients registered with the University Hospital Wuerzburg (n = 148) or with the German Self-Help Network (n = 200) were contacted by mail. Underlying diagnoses and comorbidities were verified by review of medical records. Patients were asked to complete three validated self-assessment questionnaires [Short Form 36 (SF-36), Giessen Complaint List (GBB-24), Hospital Anxiety and Depression Scale (HADS)]. Results were compared to sex- and age-matched controls drawn from the questionnaire-specific reference cohorts. RESULTS: We identified 348 patients, and 256 agreed to participate. Completed questionnaire sets were available from 210 patients [primary AI (n = 132), secondary AI (n = 78)]. Seven of eight SF-36 dimensions, all five GBB-24 scales, and the HADS anxiety score reflected significant impairment of subjective health status in both AI cohorts (all P < 0.001). Even after exclusion of all patients with any concomitant disease, subjective health status remained significantly impaired in five SF-36 subscales and four GBB-24 subscales. Secondary AI patients were slightly more compromised than primary AI, significant with regard to two SF-36 scales (P < 0.05) and the HADS depression score (P < 0.001). A total of 18.3% of the AI patients were out of work, compared to 4.1% in the general population. CONCLUSION: Patients with AI on current standard replacement suffer from significantly impaired health-related subjective health status, irrespective of origin of disease or concomitant disease. Future studies will have to assess whether more physiological glucocorticoid replacement strategies in AI will ameliorate these impairments.

[Quality of life and distress among former refugees--a representative community survey of Germans born before 1946]. / Welche Auswirkungen haben Flucht und Vertreibung auf Lebensqualität und Befindlichkeit? Repräsentative Erhebung mit den vor 1946 Geborenen in Deutschland.

OBJECTIVES: By the end of Word War II, a substantial proportion of the German population was subjected to flight and expulsion. Severe strain and traumatization were described in individual reports. Preliminary studies based on selected samples indicated profound long-term consequences but no representative studies have been carried out to date. The purposes of the present study were to compare quality of life and well-being of former refugees and non-refugees and to identify risk factors for compromised well-being. METHODS: A representative sample of the German population (N = 2.043) was interviewed about experiences of flight and expulsion and their present quality of life. RESULTS: The refugees (18 % of the respective age group; N = 133) reported a reduced physical quality of life at the time of the study (SF-36). Furthermore, they suffered more often from panic attacks and were compromised in their health and well-being. In the regression analysis, the status as a former refugee was predictive for a reduced quality of life and anxiety, in addition to female gender, higher age and lower income. CONCLUSIONS: The study demonstrates the long-term consequences of flight and expulsion. Further studies are needed on individual coping with the aging process and biographical exposure to traumatic experiences.

[Does low resilience causes to greater psychological impairment?]. / Führt niedrige Resilienz zu einer stärkeren psychischen Belastung?

AIM: The purpose of this article is an analysis of the association between resilience, age and gender with psychological distress through anxiety and depression. METHODS: In a sample of 3784 individuals, the association of resilience with anxiety and depression was examined using a linear regression model. In addition to resilience, age and gender as well as the combination of these factors and their effects on resilience were analyzed. RESULTS: Low resilience predicts both anxiety and depression. Gender moderates this association. In male persons a stronger association between resilience and depression was found. CONCLUSION: In practice, these results should be considered in treatment.

Resilience in the General Population: Standardization of the Resilience Scale (RS-11).

BACKGROUND: The objectives of the study were to generate normative data for the RS-11 for different age groups for men and women and to further investigate the construct validity and factor structure in the general population. METHODS: Nationally representative face-to face household surveys were conducted in Germany in 2006 (n = 5,036). RESULTS: Normative data for the RS-11 were generated for men and women (53.7% female) and different age levels (mean age (SD) of 48.4 (18.0) years). Men had significantly higher mean scores compared with women (60.0 [SD = 10.2] vs. 59.3 [SD = 11.0]). Results of CFA supported a one-factor model of resilience. Self-esteem (standardized ß = .50) and life satisfaction (standardized ß =.20) were associated with resilience. CONCLUSIONS: The normative data provide a framework for the interpretation and comparisons of resilience with other populations. Results demonstrate a special importance of self-esteem in the understanding of resilience.

Deep impact--evaluation in the sciences.

The purpose of the paper is to evaluate the psychometric properties of the impact factor as an assessment procedure. Detailed criteria regarding theoretical underpinnings, test administration, scoring and interpretation are applied. The impact factor appears to be of limited use for deciding which journals to subscribe. It is not suitable for evaluating achievements of individual scientists and research groups. The impact factor contains serious sources of errors and flaws resulting in strong biases against culture- and language-bound medical subspecialties and non-Anglo-American countries. Possible alternatives are discussed.

Impact of forced displacement during World War II on the present-day mental health of the elderly: a population-based study.

BACKGROUND: The effects of traumatization among the elderly is a neglected topic in research and clinical settings. Forced displacement of civilians is one of the main traumatic features of modern armed conflict. Roughly 12 million German people were displaced in World War II (WWII) and to our knowledge there has been no representative study investigating the mental health outcomes of such trauma in the elderly population. The survey assessed whether current depression, anxiety, resilience and life satisfaction were significantly associated with forced displacement in WWII. METHODS: A nationwide representative face-to-face household survey was conducted in Germany. A representative sample of the German population aged 61 years or older (N = 1513 participants, N = 239 displaced in WWII) was approached using 258 sample points. Measurements included depressive symptoms (PHQ-2), anxiety (GAD-7), resilience (RS-11), general and domain-specific life satisfaction (FLZ(M)) and sociodemographic variables. RESULTS: Forced displacement in WWII is significantly associated with higher levels of anxiety and lower levels of resilience and life satisfaction 60 years later. In regression analyses, forced displacement in WWII significantly predicted current anxiety (beta 0.07; p < 0.01), life satisfaction (beta -0.06; p < 0.05) and resilience (beta -0.07; p < 0.01). CONCLUSION: To our knowledge this is the first nationwide representative survey to examine the late-life effects of forced displacement, particularly of persons displaced during WWII in Germany. Further research is needed to identify mediating variables and to evaluate psychotherapeutic interventions in elderly trauma survivors.

Life satisfaction, distress, and resiliency across the life span of women.

OBJECTIVE: This study aimed to determine (1) the relationship between life satisfaction, mental disorders, and aging in the female community and (2) to identify the impact of vulnerability factors, personal (resilience, self-esteem), and social resources on life satisfaction and distress. METHODS: A stratified random sample of the German female population (N = 2,540) was investigated using standardized questionnaires of life satisfaction (Questions on Life Satisfaction), depression, anxiety (Patient Health Questionnaire), resilience scale (RS-11), and self-esteem (Rosenberg Self-Esteem Scale). RESULTS: When participants were divided into six age groups (18-30, 31-40, 41-50, 51-60, 61-70, and >70 y), we found lower life satisfaction, satisfaction with partnership, and sexuality beyond the age of 50 years. Satisfaction with health was decreased already at early adulthood. Although the importance of partnership/sexuality was reduced around midlife, the importance of health increased. Depression was highest in the oldest group, whereas anxiety remained fairly stable across the cohorts. Life satisfaction was strongly associated with resilience, a good household income, the presence of a partnership, absence of anxiety and depression, lack of unemployment, positive self-esteem, religious affiliation, and-least-age. CONCLUSIONS: Personal and social resources and the absence of anxiety and depression are of crucial importance for the maintenance of life satisfaction in aging women.