Cutoff scores of the Eating Disorder Examination-Questionnaire for the German population.

OBJECTIVE: The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report measures for the assessment of eating disorder (ED) symptomatology. However, proposed cutoff scores that may indicate the presence of an ED have been heterogeneous. Therefore, the current study derived cutoff scores from two large samples: one representative for the German population and one composed of persons with EDs at admission to inpatient treatment. METHOD: Receiver operating characteristic analysis was used with the EDE-Q global score as independent variable and group (controls: n = 2519, patients: n = 2038) as dependent variable. These analyses were also conducted separately with the patient group divided into persons with anorexia nervosa (AN; n = 1456), bulimia nervosa (BN; n = 370), and other EDs (n = 212) and after matching groups for age and sex distribution. RESULTS: The EDE-Q global score discriminated well between controls and patients (AUC >91%, sensitivity >.84, specificity >.79). A score of 1.6 discriminated best between controls and patients in general and persons with AN in particular. Optimal thresholds for discriminating between controls and persons with BN and other EDs ranged between scores of 1.8 and 2.4. DISCUSSION: In the German population, cutoff scores between 1.6 and 2.4 may be used to screen for the presence or absence of an ED or evaluate treatment outcome, with slightly higher cutoff scores for persons with BN and other EDs than for persons with AN. PUBLIC SIGNIFICANCE: Questionnaire scores have little value when it is unclear which scores indicate the likely presence of an ED, as such scores can be used to estimate the prevalence of or screen for EDs in the general population and evaluate outcome at the end of ED treatment. The current study indicates a score around 2 on the EDE-Q as an optimal threshold for this.

Dealing with the challenges of the pandemic - results of a population-based survey during the second year of the COVID-19 pandemic contrasting benefits and burden.

BACKGROUND: The pandemic and the associated consequences have been ongoing stressors with severe impacts on the population and particularly on families. Research focusing on groups dealing well with the challenges of the pandemic is scarce. Here, we aimed to identify groups being well-adjusted during the pandemic and associated predictors. METHODS: A representative sample of the German population (N = 2,515, 51.6% women, 50.09 years), and a subsample of persons with children or adolescents under the age of 18 (N = 453, 60.3% women, 40.08 years) was assessed from July to October 2021. As huge differences in coping with the pandemic are seen, cluster analysis was performed. RESULTS: Persons in the "well-adjusted cluster" were characterized by higher quality of life, better coping with the pandemic and lower burden of the pandemic. The family subsample well-adjusted cluster was characterized by lower pandemic-associated burden, lower parental stress compared to before the pandemic and a better relationship with the child. Fewer mental health symptoms and less pandemic-associated negative impact on career predicted membership of the well-adjusted cluster in both samples. An interaction between mental health symptoms and the negative impact of COVID-19 on the career was found. CONCLUSIONS: Our results underscore the importance of mental health and work-related factors for coping with the pandemic.

Attachment styles and healthcare utilization: exploring the role of the patient-doctor relationship.

BACKGROUND: With the purpose of improving healthcare, past research has examined the link between healthcare utilization and attachment. It is suggested that an individual's attachment style influences both the quality of their patient-physician relationship and healthcare utilization patterns. Nevertheless, most studies concentrate on the individual aspect, overlooking the dyadic dimension; specifically, the investigation of how insecure attachment relates to health behavior within patient-physician relationships. This gap leaves the role of the patient-doctor relationship in this process unclear. Therefore, to elucidate this complex interplay, we hypothesized that the correlation between attachment and healthcare utilization is mediated by the quality of the patient-physician-relationship. METHOD: Participant selection was based on electoral districts, a random-route procedure, and the Kish selection grid. The participants were visited by a trained interviewer who collected psychometric and sociodemographic information. Participants answered the Experiences in Close Relationships-Revised questionnaire (ECR-RD8) and the Patient-Doctor Relationship Questionnaire (PDRQ-9). Additionally, participants were asked about their healthcare utilization. The final sample consisted of N = 2.275 participants. RESULTS: In average the participants reported consulting their primary health care practitioner M(SD) = 4.44 (4.76) times in the past 12 months. Generally, the participants rated the quality of the relationship with their primary health care practitioner close to "totally appropriate" (M = 4.12 ± .69). The degree of insecure attachment manifested towards the lower extremity of the scale. The total effect of the mediation analyses was significant. Regardless, the indirect effect indicated a trend result with minimal effect sizes. CONCLUSION: The findings of the current study bridged the gap between attachment styles and healthcare utilization. Nonetheless, our results suggested insufficient support for the mediating role of the primary care physician in the relationship between attachment style and healthcare utilization. Considering the characteristics of the sample, this outcome may not apply in a clinical context. However, further research is needed to shed light in the revealed trends and indicate implications.

Psychometric properties of the German version of the Pre-loss Grief Questionnaire (PG-12-R).

This study aimed to develop a German version of the revised Pre-loss Grief Questionnaire (PG-12-R) and examine its factor structure, reliability and validity. The PG-12-R was assessed in a representative German sample (N = 2,515). Of these, 362 (14.4%) reported to have a loved one suffering from an incurable disease and 352 provided full data sets. Principal component factor analysis, scree-plot and parallel analysis were conducted. Results supported a one-factor model of PG-12-R with high internal consistency. Convergent validity was confirmed by negative correlations with psychological well-being and time since diagnosis and positive correlations with a more difficult perception of circumstances surrounding the illness and unpreparedness. The German version of the PG-12-R represents a reliable and valid measurement tool of pre-loss grief. It may be used as a screening measure for high levels of pre-loss grief to identify individuals who may need additional support.

A powerful safety net: Social support moderates the association of quality of life deficits with suicidal ideation in long-term childhood cancer survivors.

OBJECTIVES: Cancer survivors are at risk for suicidality. We aimed to expand the knowledge about protective factors and their interplay with risk factors by testing social support as a modifier of the association of Quality of Life (QoL) deficits with suicidal ideation. RESEARCH APPROACH: We surveyed N = 633 childhood cancer survivors (CCS) using validated questionnaires (EORTC Core Quality of Life questionnaire QLQ-C30, Patient Health Questionnaire PHQ-9). The interaction of QoL and social support was investigated using multiple linear regression analysis. FINDINGS: CCS reporting suicide attempts and current suicidal ideation (SI) had lower QoL. CCS with SI reported less social support. QoL and social support were independently associated with SI and interacted: among CCS with less social support, low QoL was more strongly associated with SI. CONCLUSION: The results highlight the need for interdisciplinary survivorship care, and to focus on risk and protective factors to strengthen suicide prevention.

[Assessing Relationship Satisfaction with Four Items? Psychometric Evaluation of the Ultra-short German Version of the Dyadic Adjustment Scale (DAS-4)]. / Erfassung der Partnerschaftszufriedenheit mit vier Items? Psychometrische Evaluation der deutschen Version einer Kurzform der Dyadic Adjustment Scale (DAS-4).

The quality of an individual's relationship plays a central role in their personal well-being as well as their mental and physical health. Despite its great importance, there are only a few ultra-short self-report measures for the assessment of relationship quality. An exception is the four-item version of the Dyadic Adjustment Scale (DAS-4), which is gaining increasing popularity internationally. In this study, the German version of the DAS-4 was evaluated for the first time with regard to its psychometric properties in a general population sample of individuals in a romantic relationship (N=1296). In addition to satisfactory item characteristics, the unidimensional measurement model showed sufficient goodness of fit and the internal consistency was satisfactory (ω=0.80). Measurement invariance was shown for men and women based on the latent construct of the DAS-4. In line with the hypothesis, associations of the DAS-4 with gender, general life satisfaction, psychopathology and attachment styles were found, which suggests construct validity. Despite the lack of application experiences and pending psychometric analyses of the DAS-4 in relevant target groups, such as individuals in couples counselling or therapy, the four-item version can be recommended for assessing relationship satisfaction.

[Aspects of Utilization of Psychotherapy in Germany in Times of the GDR and Later]. / Aspekte der Inanspruchnahme von Psychotherapie in Deutschland zu Zeiten der DDR und danach.

Objective The aim of the study was to examine real differences in the use of psychotherapy in the New Federal States during the GDR era and today. In addition, differences according to the willingness seeking psychotherapy as well as barriers in opinions and contact to the mentally ill between people from the New Federal States, the Old Federal States and people who moved from the New Federal States to the Old Federal States (internal migrants) should be recorded, taking into account generational effects (experience of the Cold War - birth before / after January 1st, 1980). Methods To investigate these questions, the data from a representative survey in the New Federal States of N=2729 people as well as the data from a second online based survey of people from the New and Old Federal States as well as internal migrants with a total of N=4789 participants were evaluated.Results There was a prevalence of 1% for the use of psychotherapy during the GDR era. Overall, the prevalence of therapy experiences among people who experienced the GDR and were born before January 1st in 1980 was almost 13%. They also reported greater willingness seeking help for mental suffering since the end of the Cold War. The prevalence among younger people was about 12%. In the second survey, there were significant differences, among the older respondents. East Germans today and even during the GDR era were less willing to seek psychotherapy for mental suffering, they also have less contact to mentally ill people. Differences according to desires for distance from mentally ill people, self stigmatization in the presence of a mental illness and discrimination against mentally ill people emerged between East Germans, West Germans and internal migrants depending on generational affiliation.Discussion Barriers that prevent the use of psychotherapy should be taken into account on a generational and socialization specific basis. Socialization as a relevant factor might explain a lack of willingness to utilize psychotherapy amongst people that experienced the GDR era and still live in the new Federal States.

Prolonged grief disorder in ICD-11 and DSM-5-TR: differences in prevalence and diagnostic criteria.

Background: Prolonged grief disorder (PGD) was recently included as a disorder in the ICD-11 and DSM-5-TR. Although both classification systems use the same name, the criteria content, and diagnostic approach vary. This study aimed to estimate the respective prevalence of PGDICD-11 and PGDDSM-5-TR and examine the diagnostic agreement while varying the diagnostic algorithm of PGDICD-11 (bereavement vs. symptom period; varying number of accessory symptoms). Methods: A representative sample of the German general population (N = 2,509) was investigated, of which n=1,071 reported the loss of a close person. PGD symptoms were assessed with the Traumatic Grief Inventory - Self Report Plus (TGI-SR+). Results: The point prevalence of PGD among the bereaved varied between 4.7%-6.8%, depending on the criteria and diagnostic algorithm. The prevalence of PGDDSM-5-TR was significantly lower than the prevalence of PGDICD-11. The diagnostic agreement between both criteria sets was substantial and increased after the number of accessory symptoms for PGDICD-11 was increased from one to three. The most common symptoms were intrusive thoughts/images related to the deceased person, longing for the deceased person, and difficulty accepting the loss. Conclusion: The results demonstrate that the prevalence of PGD significantly varies depending on the application of the diagnostic algorithm and criteria. PGD affects a substantial proportion of the general population and should be addressed by healthcare providers. However, applying the minimum ICD-11 criteria could lead overestimating the prevalence. Therefore, further harmonizing the ICD-11 and DSM-5-TR criteria and diagnostic algorithm for PGD seems appropriate.

Further Evidence for a Dimensional Latent Structure of Health Anxiety: Taxometric Analyses of the Whiteley Index Based on Two German Representative Samples.

Health anxiety is an intricate part of illness anxiety and somatic symptom disorder. Based on convenience samples, two out of three available studies indicate that it is a dimensional rather than a categorical construct. Using two representative datasets, this study investigates whether previous results can be clarified. Conventional taxometric analyses as well as comparison curve fit indices (CCFI) profile analyses (MAMBAC and MAXSLOPE procedures) were calculated with two datasets of the German adult population assessing the Whiteley Index (WI-14, N = 2,072; WI-7, N = 2,498). Mean CCFIs indicated a dimensional structure for both the WI-7 (mean CCFI = 0.42, mean CCFI profile = 0.40) and the WI-14 (mean CCFI = 0.44, mean CCFI profile = 0.32). The results support and extend previous findings by strongly suggesting a dimensional distribution of health anxiety in the general population. Implications for research and practice comprise the adoption of a dimensional description of psychopathology as well as transdiagnostic treatment approaches.

Abusive head trauma: The body of the iceberg - A population-based survey on prevalence and perpetrators.

BACKGROUND: Research on abusive head trauma (AHT) is usually research on clinically identified cases, while population-based studies, having the potential to identify cases of shaking that did not end with hospital admission, are missing to date. OBJECTIVE: Thus, we aimed to assess the prevalence of AHT and associated risk factors in a representative sample of the German population. PARTICIPANTS AND SETTING: We conducted a cross-sectional, observational study in Germany from July to October 2021. Using different sampling steps including a random route procedure, a probability sample of the German population was generated. The final sample consisted of 2503 persons (50.2 % female, mean age: 49.5 years). METHODS: Participants were asked about sociodemographic information in a face-to-face interview and whether they had been ever responsible for the care of an infant and whether they had ever performed potential harmful methods including shaking to calm it, intimate partner violence (IPV) and adverse childhood experiences (ACEs) using a questionnaire. RESULTS: In total, 1.4 % of women (N = 18) and 1.1 % of men (N = 13) reported to have at least once shaken an infant to calm it. Ever having used a potential harmful parenting method in calming an infant was reported by 4.9 % of women (N = 61) and 3.1 % (N = 39) of men. No gender differences were seen. A low income, living with someone under 16 in the household and victimization and perpetration of IPV and ACEs are associated with increased risks of shaking and other potential harmful methods to calm an infant. CONCLUSIONS: Our data suggest that despite better knowledge on the dangers of shaking, the percentage of women that shake infants might be higher than previously thought. Also, intimate partner violence and ACEs are key risk factor for shaking and harmful parenting behaviors in general. This has important implications for future prevention programs.

Social support in older adults: Validation and norm values of a brief form of the Perceived Social Support Questionnaire (F-SozU K-6).

BACKGROUND: Social relations are crucial for maintaining physical and mental health across the life span. As social roles, networks and needs change with age a valid assessment of social support in older adults and age-specific norms are necessary. The present work aims to [1) assess the level of social support in individuals > 60 years of the general German population, [2) evaluate the brief six-item form of the Perceived Social Support Questionnaire (F-SozU K-6) in this age group and to [3) provide age-specific norm values. METHODS: We analyze data of N = 706 people representative for the German population collected in 2021. To assess social support, we used the F-SozU K-6. We tested for selectivity, item difficulty, internal consistency, construct and factor validity, as well as factorial invariance. Additionally, we assessed correlations and associations with depression, loneliness, and sociodemographic factors. Furthermore, we reported norm values for respondents > 60 years. RESULTS: Participants > 60 years reported a mean level of 23.97 (SD = 4.82) of social support. Results of the CFA confirmed a very good model fit. Measurement invariance across sex and age was shown. Associations with ADS and LS-S supported construct validity. Multiple regression analysis showed that female sex, increasing age, having a partner, and a higher equivalized household income were associated with higher levels of social support. CONCLUSION: The F-SozU K-6 is a reliable and economical tool to assess perceived social support in older adults. Norm values for individual > 60 years are provided.

Psychometric evaluation of the patient health questionnaire stress scale.

The "Patient Health Questionnaire (PHQ)" is a screening instrument, designed for time-efficient detection and severity assessment of depression, anxiety, and other syndromes in medical settings. Besides the questions on psychological symptoms, there are items on psychosocial functioning, on stressors and critical life events. However, for the stress items there are no psychometric properties available until now. The present study is thought to investigate item characteristics, internal consistency as well as factorial and construct validity of the stress scale of the PHQ. A representative sample of the general population of Germany was collected by a demography consulting company (USUMA, Berlin). Per random-route procedure, households and members of the households were selected. The sample was representative for the German community regarding age, gender, and education. In this investigation the following questionnaires were administered: PHQ-Stress, Questions on Life Satisfaction Modules (FLZ-M), Type-D Scale-14 (DS14). The sample included N = 2396 participants with mean age of 48.50 (SD = 17.75; range = 14 to 92) and 55.2 % being female. Reliability of the PHQ stress scale was acceptable (ω = 0.776), but some factor loadings were comparatively low. Model fit indices showed mixed results, some indicating unacceptable and some indicating acceptable fit of the 10-item stress scale of the PHQ. Correlations with related constructs demonstrated the scale's convergent validity. The results of this validation study indicate that the PHQ stress scale, which provides a one-dimensional total stress score, is a valid, good practical and reliable self-report instrument for assessing the severity of psychosocial stress.

Depression, anxiety, and health-related quality of life in normal weight, overweight and obese individuals with diabetes: a representative study in Germany.

OBJECTIVE: Diabetes in the course of lifetime is related to a higher risk for mental disorders. The present study addresses the comparison of individuals with diabetes and non-diabetic individuals in depressive symptoms, generalized anxiety symptoms, and health-related quality of life. Furthermore, mediator effect of BMI and health-related quality of life (HRQOL) on the association between diabetes, depression, and generalized anxiety was analyzed. METHODS: In this cross-sectional study, the three questionnaires PHQ-9, GAD-7, EQ-5D-5L were measured in a representative sample of the German population (N = 2386). In addition, the presence of diabetes and BMI were assessed via self-report. RESULTS: There were higher values in depressive and anxiety symptoms as well as lower score in HRQOL in individuals with diabetes compared to non-diabetic individuals. Obese individuals with diabetes showed the highest rates in depressive symptoms and generalized anxiety as well as lowest score in HRQOL. With regard to the mediator analyses, association between diabetes, depressive symptoms, and anxiety symptoms is partially mediated by the BMI and fully mediated by the HRQOL. CONCLUSIONS: In conclusion, individuals with diabetes have an increased risk in the development of depressive and anxiety symptoms as well as lower health-related quality of life. Future research and strategies in the public health policies among individuals with diabetes should take into account that the association between diabetes, depression, and anxiety is mediated by BMI and HRQOL.

The effects of effort-reward imbalance on the job, overcommitment, and income on life satisfaction in Germany from a longitudinal perspective.

BACKGROUND: The effort-reward imbalance at work model offers a theoretical and analytical framework to estimate the subjective perception of work-related stress. High demands and low rewards in return can harm mental and physical health, well-being, and life satisfaction. According to the theory, overcommitment partially explains why employees endure such straining jobs. In Germany, cultural and economic aspects of labor differ between East and West. Incomes are lower in the East, while work centrality there is higher. In this article, the effects of effort-reward imbalance, overcommitment, and income on life satisfaction as well as their interactions with region were analyzed to gain a clearer picture of regional disparities regarding life satisfaction and the generality of this work stress model in Germany. METHODS: Data from 3848 participants from 2006 to 2011 of the German Socio-Economic Panel were analyzed. Within-between models were estimated, including fixed and random effects of the continuous form of effort-reward imbalance to predict subjective life satisfaction. Time-variant covariates - e.g., overcommitment or income - as well as time-constant variables - e.g., region, sex, education - were integrated. Differences in regional labor markets between East and West Germany were considered. RESULTS: Easterners exhibited higher imbalances and overcommitment than Westerners, indicating worse working conditions. Higher imbalances and overcommitment were associated with lower life satisfaction within and between participants, whereas for income only random effects were supported. While region did not moderate the effect of work stress, East Germans' life satisfaction benefitted more from a higher income. CONCLUSION: The importance of internal work structures in terms of recognition, adequate pay, advancement opportunities, or time pressure were underlined. As compared to the West, Easterners' life satisfaction benefitted more from higher income but not more from a lower imbalance or lower overcommitment. The interplay between materialistic and nonmaterialistic rewards at work should be focused on in the future.

Socially isolated, but not lonely in lockdown: Exploring the role of reflective functioning as a protective factor in the early days of the COVID-19 pandemic in Germany.

INTRODUCTION: Loneliness is a pressing public mental health issue. So far, there has been a paucity of investigations focused on the individual differences modulating this subjective feeling in the face of difficult circumstances, e.g., the COVID-19 pandemic. As such, the present study aimed to investigate the role of mentalization; given that the construct comprises reflection abilities that might be particularly relevant to the pandemic's interpersonal challenges. METHODS: A survey representative of the German population was conducted from May to June 2020 (N = 2503). We examined mentalization, operationalized as reflective functioning (RF) and measured using the Mentalization Questionnaire (MZQ), both as a protective factor against loneliness on its own and as a moderator of the association of social isolation with loneliness. RESULTS: Of the overall sample, 822 (32.8 %) individuals reported social isolation. Worse RF was moderately associated with higher levels of loneliness (r = 0.433, p < .001). A linear regression model (controlling for sociodemographic characteristics and general personality pathology) confirmed this positive association, but also indicated an interaction effect of RF and social isolation in the statistical prediction of loneliness. Stratified models showed that RF was a comparatively weaker statistical predictor of loneliness among the socially isolated. DISCUSSION: This representative population study expanded our knowledge about the factors shaping loneliness in the population. RF emerged as a potentially modifiable protective influence. Further research needs to clarify the mechanisms through which it mitigates loneliness. LIMITATIONS: The cross-sectional design does not give insight into the temporal association of RF and loneliness.

Early Childhood Care in the Former East Germany and Mental Stress in Adulthood.

BACKGROUND: It is still debated in Germany whether early childhood care outside the family might cause mental stress in adulthood. In the German Democratic Republic (GDR-the former East Germany before unification), children were often cared for outside the family from a very early age. METHODS: To determine the relation between early childhood care outside the family and mental stress in adulthood, we carried out a survey among 1575 persons who were born and socialized in the GDR. They were classified into four care groups according to the age at which they were first cared for outside the family. Associations with depressiveness, somatization disorders, and anxiety disorders in adulthood were tested with logistic regression analysis. Care group-specific prevalences of experiences of abuse and neglect in childhood were estimated with analysis of variance. RESULTS: Comparisons of persons cared for outside the family before the age of three, or from the age of three onward, with persons cared for within the family in their preschool years did not reveal any difference with respect to depressiveness (odds ratio [OR] = 0.95; 95% confidence interval [0.58; 1.55]; OR = 1.05 [0.63; 1.74]), somatization disorders (OR = 1.11 [0.74; 1.67]; OR = 1.09 [0.71; 1.66]), or anxiety disorders (OR = 0.87 [0.46; 1.64]; OR = 1.12 [0.59; 2.10]). Nor were there any intergroup differences with respect to experiences of abuse and neglect. Certain features of the very small group of children who had long-term care outside the family are discussed in the article. CONCLUSION: No relation was found between earlychildhood care in day-care centers in the GDR and mental stress in adulthood. The data were too sparse for any conclusions about specific aspects of care outside the home (e.g., quality or child-rearing norms).

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

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

Suicidal ideation in patients with diabetes and childhood abuse - The mediating role of personality functioning: Results of a German representative population-based study.

AIMS: Suicidal ideation (SID) in patients with diabetes mellitus is increasingly acknowledged. Still, the underlying mechanisms are unclear. We examined SID prevalences in patients with diabetes, its association with different types of abuse, and a mediating effect of personality functioning. METHODS: In a representative population sample (N = 2,515), diabetes, SID, abuse (ICAST-R), personality functioning (OPD-SQS), and depression/anxiety (PHQ-4) were assessed by self-report. Statistical analyses comprised Chi2-Tests, logistic regression and mediation analyses. RESULTS: The prevalence of SID (21.8 %) was three fold higher in patients with diabetes compared to the general population. Abuse further increased the likelihood to report SID in diabetes patients (sexual: 48.1 % vs. 18.2 %; χ2(1) = 12.233, p <.001; emotional: 35.7 % vs. 15.7 %; χ2(1) = 10.892, p <.001). A dose-response relationship between the number of abuse experiences and SID was observed (one abuse experience: OR = 1.138, 95 %-CI [0.433, 2.990], p =.793, >2 abuse experiences: OR = 2.693, 95 %-CI [1.278, 5.675], p =.009). Impaired personality functioning had an indirect effect on the association between emotional abuse and SID (b = 0.25, 95 %-CI [0.037, 0.551]). CONCLUSIONS: Diabetes patients experience increased SID prevalences, especially those with emotional or sexual abuse. In individuals with a history of emotional abuse, impaired personality functioning partly explained SID and should therefore be considered and addressed in this patient group.

Health behavior and psychological treatment utilization in adults with avoidant/restrictive food intake disorder symptoms.

BACKGROUND: Avoidant/restrictive food intake disorder (ARFID), an eating disorder not associated with weight and shape concerns, results in nutrient or energy deficiencies related with further health consequences and a pronounced need for specialized treatment. These interventions need to be tailored to individual health behavior. However, research about health behavior and treatment utilization in ARFID is scarce, particularly in adults, as ARFID is more common in children despite occurring across the lifespan. One important aspect of health behavior is the individual's health regulatory focus (i.e., health prevention and health promotion). Additionally, symptoms of eating disorders have generally been associated with various health risk behaviors, such as smoking, drinking, or unhealthy physical (in)activity. Therefore, the present study aimed to investigate health behavior and psychological treatment utilization in adults with symptoms of ARFID. METHODS: A representative adult population sample (N = 2415) completed several self-report questionnaires assessing symptoms of eating disorders and health behavior. Differences between groups (symptoms of ARFID vs. no symptoms of ARFID) were tested with analysis of variance, Mann-Whitney-U-tests, and binary logistic regression. RESULTS: Individuals with symptoms of ARFID (n = 20) did not differ in their health regulatory focus, smoking status, physical activity or psychological treatment utilization from individuals without symptoms of ARFID (n = 2395). However, they reported higher alcohol misuse than individuals without symptoms of ARFID. CONCLUSION: The findings suggest a relevance of further exploration of the relationship between alcohol misuse and ARFID, given the preliminary nature of these results. This exploration could inform treatment strategies for addressing potential comorbid substance misuse. Furthermore, the low psychological treatment utilization in adults with symptoms of ARFID suggest a need for more specialized psychological treatment services, public education about ARFID being an indication for psychological treatment, and further research about treatment barriers.

Avoidant/restrictive food intake disorder (ARFID), an eating disorder not associated with body image or weight concerns, results in nutrient or energy deficiencies related with further health consequences. It is most common in children, but can occur across the lifespan, although there is little research in adults. Therefore, the study investigated if adults with symptoms of ARFID differ from adults without symptoms of ARFID in health behaviors. A total of 2415 adults from a German national population sample completed questionnaires assessing symptoms of ARFID, health regulatory focus (health promotion focus with the aim of improving one's health and health prevention focus aiming to avoid any deterioration in health), alcohol misuse, smoking behavior, physical activity and psychological treatment utilization. Adults with symptoms of ARFID did not differ from those without symptoms of ARFID in treatment utilization or any of the assessed health behaviors except reporting higher alcohol misuse. We, therefore, suggest to further explore potential alcohol misuse in individuals with ARFID. Furthermore, more research about treatment barriers in ARFID and more specialized psychological treatment services as well as public education about ARFID being an indication for psychological treatment, are needed to address the low psychological treatment utilization.

To what extent are psychological variables considered in the study of risk and protective factors for suicidal thoughts and behaviours in individuals with cancer? A systematic review of 70 years of research.

Psychological variables substantially shape the risk of suicidal thoughts and behaviours (STBs). However, it is unclear to what extent they are considered in individuals with cancer. We synthesized the quantitative research landscape concerning psychological risk/protective factors of STBs in the (psycho-) oncological context. This pre-registered review (PROSPERO-ID CRD42022331484) systematically searched the databases PubMed/Medline, CINAHL, PsycInfo, Cochrane Library, and Web of Science (as well as the grey literature and preprints). Risk of bias (RoB) was estimated using the ROBINS-I tool. Of 11,159 retrieved records, 319 studies were eligible for inclusion. Of those, 163 (51.1%) had investigated psychological factors (affective: n = 155; social: n = 65; cognitive: n = 63; personality/individual differences: n = 37; life events: n = 6), in a combined 3,561,741 participants. The most common STBs were suicidal ideation (n = 107) or death wishes (n = 20) rather than behaviour (suicide deaths: n = 26; attempts: n = 14). Most studies had a serious RoB. Thus, a large body of research investigated STBs in cancer patients/survivors, but it rarely aligned with the theoretical or clinical developments in suicide research. We propose a conceptual model of STBs in cancer delineating moderation and mediation effects to advance the integration of the fields, and to inform future research and practice.