Psychological Consequences of Chronic Ethnic Discrimination in Male Turkish Immigrants Living in Austria: A 30-Day Ambulatory Assessment Study.

BACKGROUND: Chronic ethnic discrimination may be associated with negative psychological consequences in ethnic minority groups. However, little is known about the impact of acute discriminatory events on people who experience chronic ethnic discrimination. PURPOSE: We examined the impact of chronic and acute ethnic discrimination on the daily lives of Turkish immigrants in Austria, a population often overlooked in discrimination research. METHODS: Ninety male Turkish immigrants living in Austria (60 experiencing chronic and 30 infrequent ethnic discrimination) reported discriminatory events in real time for 30 days. Additionally, subjective stress, reactivity to daily hassles, affect, and maladaptive coping were assessed daily. RESULTS: Participants experiencing chronic ethnic discrimination indicated higher daily values for stress, negative affect, reactivity to daily hassles, and anticipation and avoidance coping. Negative psychological states increased for all participants on days when discriminatory events occurred, but participants with chronic ethnic discrimination showed significantly stronger increases in maladaptive coping and reactivity to daily hassles, with the latter effect persisting until the next day. CONCLUSIONS: Our study is the first to demonstrate interaction effects of chronic and acute ethnic discrimination on psychological factors in daily life. The results may advance the understanding of the mechanisms that lead to health disparities in ethnic minority populations and may inform the development of targeted interventions.

This study investigated the impact of chronic and acute ethnic discrimination on the daily lives of Turkish immigrants in Austria, a population often overlooked in discrimination research. While it is established that experiences of ethnic discrimination are related to worse mental and physical health, the "how," that is, the underlying psychological mechanisms, remain incompletely understood. Ninety male Turkish immigrants took part in this study, with 60 experiencing ethnic discrimination on a regular basis. Over a 30-day period, we tracked their experiences of discrimination and their daily stress, emotional reactions, and coping strategies. We found that the participants with regular experiences of ethnic discrimination had higher stress levels and more negative emotions than the participants with fewer experiences of discrimination. In addition, they more strongly reacted to acute discriminatory events in their daily lives and had more problems coping with such events. They even were more stressed by daily hassles, which continued into the following day. These findings advance the understanding of the negative impact of ethnic discrimination on health disparities in ethnic minority populations and may inform the development of targeted interventions.

Associations between sleep problems and posttraumatic stress symptoms, social functioning, and quality of life in refugees with posttraumatic stress disorder.

Many patients with posttraumatic stress disorder (PTSD) suffer from sleep problems, leading to impairments in social functioning and quality of life. Refugees are at high risk for sleep problems due to stressful life circumstances and a high PTSD prevalence. However, limited data on the frequency of sleep problems in refugees with diagnosed PTSD exist. This study examined the frequency of sleep problems in refugees with PTSD and their associations with symptoms of PTSD. Additionally, we investigated the contribution of sleep problems to social functioning and quality of life. Participants (N = 70) were refugees from different countries of origin currently living in Germany. All participants met the criteria for PTSD and completed measures of PTSD symptom severity, subjective sleep problems, social impairment, and quality of life. There was a very high frequency of sleep problems in the sample (100%), and sleep problems were significantly associated with both clinician-rated, r = .47, and self-rated, r = .30, PTSD symptom severity after controlling for overlapping items. Contrary to expectations, sleep problems did not predict social impairment, d = 0.16, nor quality of life, d = 0.13, beyond the effect of other PTSD symptoms. The findings highlight the widespread frequency of sleep problems among refugees. Future studies should assess the causal nature of the association between sleep problems and measures of psychosocial functioning in more detail and examine its dynamic change over time.

Psychobiological Mechanisms in Somatic Symptom Disorder and Depressive Disorders: An Ecological Momentary Assessment Approach.

OBJECTIVE: Persistent somatic symptoms cause strong impairment in persons with somatic symptom disorder (SSD) and depressive disorders (DDs). Specific negative psychological factors (NPFs), such as catastrophizing, negative affectivity, and behavioral avoidance, are assumed to contribute to this impairment and may maintain symptoms via dysregulations of biological stress systems. We examined the associations between NPF and somatic symptoms in the daily life of women with SSD or DD and investigated the mediating role of psychobiological stress responses. METHODS: Twenty-nine women with SSD and 29 women with DD participated in an ecological momentary assessment study. For 14 days, intensity of and impairment by somatic symptoms, NPF, and stress-related biological measures (cortisol, alpha-amylase) were assessed five times per day using an electronic device and saliva samples. Multilevel models were conducted. RESULTS: The greater the number of NPF, the higher the concurrent and time-lagged intensity of and impairment by somatic symptoms in both groups (12.0%-38.6% of variance explained; χ2(12) p < .001 for all models). NPFs were associated with higher cortisol levels in women with DD and with lower levels in women with SSD (interaction NPF by group: B = -0.04, p = .042 for concurrent; B = -0.06, p = .019 for time-lagged). In women with SSD, lower cortisol levels were associated with higher intensity at the next measurement time point (group by cortisol: B = -1.71, p = .020). No mediation effects were found. CONCLUSIONS: NPFs may be considered as transdiagnostic factors in the development and treatment of impairing somatic symptoms. Our findings will allow the development of new treatment strategies that use ecological momentary intervention approaches focusing on NPF.

Gay men's stress response to a general and a specific social stressor.

Gay men show altered psychobiological stress responses and exhibit a higher prevalence of mental disorders than their heterosexual counterparts. Both of these findings are likely due to gay-specific discrimination. Since it has not yet been determined whether gay-specific stress is more noxious than general stress, we tested whether gay men react more strongly to gay-specific socially stressful stimuli than to general socially stressful stimuli. N = 33 self-identified gay men (mean = 26.12 years of age, SD = 5.89), 63.6% of whom were in a relationship with a man, participated in an experimental within-group study, in which they were exposed to the Trier Social Stress Test (TSST) as well as a gay-specific TSST in a randomized order. Salivary cortisol and testosterone were assessed at five time points during the laboratory tests and perceived stress was assessed at four time points. According to psychobiological and perceived stress indices, the participants reacted similarly to a gay-specific and general social stressor. There were no significant differences in the outcomes, either when looking at pre-post-test differences or when comparing the overall stress responses. Given that the response to a gay-specific social stressor was equally pronounced as the one to a general social stressor, programs aiming to decrease minority stress but overlooking general stress are likely to yield only partial improvements in gay men's mental health. Instead, we suggest helping gay men cope with both forms of stress through building social support, assertiveness, and mindfulness skills, as well as decreasing emotional dysregulation.

Definition and Characteristics of Behavioral Medicine, and Main Tasks and Goals of the International Society of Behavioral Medicine-an International Delphi Study.

BACKGROUND: In the past decades, behavioral medicine has attained global recognition. Due to its global reach, a critical need has emerged to consider whether the original definition of behavioral medicine is still valid, comprehensive, and inclusive, and to reconsider the main tasks and goals of the International Society of Behavioral Medicine (ISBM), as the umbrella organization in the field. The purpose of the present study was to (i) update the definition and scope of behavioral medicine and its defining characteristics; and (ii) develop a proposal on ISBM's main tasks and goals. METHOD: Our study used the Delphi method. A core group prepared a discussion paper. An international Delphi panel rated questions and provided comments. The panel intended to reach an a priori defined level of consensus (i.e., 70%). RESULTS: The international panel reached consensus on an updated definition and scope of behavioral medicine as a field of research and practice that builds on collaboration among multiple disciplines. These disciplines are concerned with development and application of behavioral and biomedical evidence across the disease continuum in clinical and public health domains. Consensus was reached on a proposal for ISBM's main tasks and goals focused on supporting communication and collaboration across disciplines and participating organizations; stimulating research, education, and practice; and supporting individuals and organizations in the field. CONCLUSION: The consensus on definition and scope of behavioral medicine and ISBM's tasks and goals provides a foundational step toward achieving these goals.

Screening for DSM-5 Somatic Symptom Disorder: Diagnostic Accuracy of Self-Report Measures Within a Population Sample.

OBJECTIVE: The new DSM-5 somatic symptom disorder was introduced to improve the diagnosis of persons experiencing what used to be called somatoform disorders. So far, it is unclear whether existing self-report measures are useful to detect the new somatic symptom disorder. This study investigates the diagnostic accuracy of three self-report questionnaires that measure somatic complaints (15 item Patient Health Questionnaire [PHQ-15]) and psychological features (7-item Whiteley Index [WI-7]; Scale for Assessing Illness Behavior [SAIB]), in detecting somatic symptom disorder. METHODS: A nationally representative general population survey was performed resulting in 250 participants (minimum age = 14 years. 12.8% participation rate). Assessment took place at baseline and 12-month follow-up. Individual and combined diagnostic accuracy of the PHQ-15, WI-7, and SAIB in detecting somatic symptom disorder was evaluated using the area under the curve (AUC) of a receiver operating characteristic. RESULTS: Diagnostic accuracy was adequate to good for each individual questionnaire (PHQ-15: AUC = 0.79, p < .001, 95% confidence interval [CI] = 0.73-0.85; WI-7: AUC = 0.76, p < .001, 95% CI = 0.69-0.83; SAIB: AUC = 0.77, p < .001, 95% CI = 0.71-0.83). Combining the PHQ-15 and the WI-7 slightly improved diagnostic accuracy (AUC = 0.82, p < .001, 95% CI = 0.77-0.88), as did the combination of all three questionnaires (AUC = 0.85, p < .001, 95% CI = 0.79-0.90). CONCLUSIONS: The PHQ-15, WI-7, and SAIB are useful screening instruments to detect persons at risk for somatic symptom disorder, and a combination of these three instruments slightly improves diagnostic accuracy. Their use in routine care will lead to improved detection rates.

Psychobiological impact of ethnic discrimination in Turkish immigrants living in Germany.

Perceived ethnic discrimination has a negative impact on health. One of the key mechanisms may be a dysregulation of stress-responsive systems. Our aims were to investigate whether (1) acute face-to-face ethnic discrimination induces a stress response, and (2) to compare long-term endocrine functioning between immigrants and nonimmigrants. 30 male Turkish immigrants living in Germany underwent an ethnic discrimination condition and a control condition in the laboratory. Perceived ethnic discrimination, stress, salivary alpha-amylase and cortisol were measured four times. Heart rate and electrodermal activity were measured continuously. In addition, hair samples were collected from immigrants and 25 male nonimmigrants to determine long-term cortisol concentrations. Immigrants showed increases in perceived ethnic discrimination, stress, heart rate, alpha-amylase and cortisol during the ethnic discrimination condition. Immigrants had significantly lower hair cortisol concentrations than nonimmigrants. These findings suggest that acute ethnic discrimination elicits a psychobiological stress response. Abnormalities in long-term endocrine functioning in ethnic minorities may set the stage for the development of stress-related illnesses. Lay summary The present study found that racial discrimination of Turkish immigrants induced both psychological and physiological stress responses in the laboratory. Immigrants showed lower hair cortisol concentrations than nonimmigrants, indicating a dysregulated biological stress system.

Emotional distress and dysfunctional illness perception are associated with low mental and physical quality of life in Chinese breast cancer patients.

BACKGROUND: To evaluate the relationship between quality of life (QOL) and physical as well as psychological variables in Chinese breast cancer patients. METHODS: This multicenter cross-sectional study enrolled 254 Chinese breast cancer patients in different stages and treatment phases. They answered standard instruments assessing QOL (EORTC), somatic symptom severity (PHQ-15), depression (PHQ-9), anxiety (GAD-7), health-related anxiety (WI-7), illness perception (BIPQ), and sense of coherence (SOC-9). Canonical correlation was applied to identify the strongest correlates between the physical, emotional and social QOL scales and the physical and psychological variables. RESULTS: In our sample, a low global QOL was significantly associated with the following physical and psychological variables: symptom-related disability (Karnofsky Index) (r = .211, p < .01), somatic symptom severity (r = -.391, p < .001), depression (r = -.488, p < .001), anxiety (r = -.439, p < .001), health-related anxiety (r = -.398, p < .001), dysfunctional illness perception (r = -.411, p < .001), and sense of coherence (r = .371, p < .001). In the canonical correlation analysis, high somatic symptom severity, depression, anxiety, dysfunctional illness perception, and low sense of coherence showed the strongest correlations with low physical, emotional and social functioning. The first three significant canonical correlations between these two sets of variables were .78, .56, and .45. CONCLUSIONS: QOL in Chinese breast cancer patients is strongly associated with psychological factors. Our results suggest that Chinese physicians and nurses should incorporate these factors into their care for women with breast cancer to improve patients' QOL.

Operationalization of diagnostic criteria of DSM-5 somatic symptom disorders.

BACKGROUND: The aim of this study was to test the operationalization of DSM-5 somatic symptom disorder (SSD) psychological criteria among Chinese general hospital outpatients. METHODS: This multicenter, cross-sectional study enrolled 491 patients from 10 general hospital outpatient departments. The structured clinical "interview about cognitive, affective, and behavioral features associated with somatic complaints" was used to operationalize the SSD criteria B. For comparison, DSM-IV somatoform disorders were assessed with the Mini International Neuropsychiatric Interview plus. Cohen's к scores were given to illustrate the agreement of the diagnoses. RESULTS: A three-structure model of the interview, within which items were classified as respectively assessing the cognitive (B1), affective (B2), and behavioral (B3) features, was examined. According to percentages of screening-positive persons and the receiver operator characteristic (ROC) analysis, a cut-off point of 2 was recommended for each subscale of the interview. With the operationalization, the frequency of DSM-5 SSD was estimated as 36.5% in our sample, and that of DSM-IV somatoform disorders was 8.2%. The agreement between them was small (Cohen's к = 0.152). Comparisons of sociodemographic features of SSD patients with different severity levels (mild, moderate, severe) showed that mild SSD patients were better-off in terms of financial and employment status, and that the severity subtypes were congruent with the level of depression, anxiety, quality of life impairment, and the frequency of doctor visits. CONCLUSIONS: The operationalization of the diagnosis and severity specifications of SSD was valid, but the diagnostic agreement between DSM-5 SSD and DSM-IV somatoform disorders was small. The interpretation the SSD criteria should be made cautiously, so that the diagnosis would not became over-inclusive.

Classifying Fibromyalgia Syndrome as a Mental Disorder?-An Ambulatory Assessment Study.

PURPOSE: Fibromyalgia syndrome (FMS) is associated with psychological distress. The recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) raises the question of whether FMS is classifiable as "somatic symptom disorder" (SSD) and consequently as a mental disorder. To address this, the present ambulatory assessment study focuses on the everyday life occurrence of SSD symptoms in FMS and their predictive value concerning severity indicators of widespread pain. METHOD: Ambulatory data were assessed six times daily on 14 consecutive days via iPod. Twenty-eight women suffering from FMS indicated symptoms associated with SSD (somatic illness beliefs, health anxiety, time/energy devoted to pain, or health concerns) and momentary pain levels. Questionnaires regarding potential covariates (such as somatization, depression, health status) were completed at two additional sessions in the research laboratory. RESULTS: On average, SSD symptoms occurred three to four times daily and were mild to moderate in severity. Furthermore, these symptoms were both concurrently and prospectively associated with momentary pain intensity and subjective impairment by pain. Twenty percent of the variance in pain intensity and 28 % of the variance in subjective impairment were explained by momentary variables (SSD symptoms and intake of pain medication). Eighty-two percent of persons with FMS fulfilled the psychological SSD criterion when considering everyday occurring symptoms with at least mild severity. CONCLUSION: FMS might be diagnosed as a mental disorder according to DSM-5 in many cases. SSD symptoms proved to have predictive value for FMS severity and may thus have clinical relevance for diagnostic, prognostic, and intervention purposes.

[Obstacles and Opportunities for the Psychotherapeutic Treatment of Asylum Seekers]. / Barrieren und Chancen zur psychotherapeutischen Versorgung von Asylsuchenden ­ Eine Befragung niedergelassener Psychotherapeuten in Mittel- und Nordhessen.

Introduction: The number of refugees and asylum seekers in Germany is high. Presumably, the need for psychotherapeutic care is high in this group. However, this need stands in contrast to a lack of a specialized and widespread provision of such care. Registered psychotherapists could help to partially reduce this gap. The present study aimed at learning more about the expected or experienced obstacles and opportunities of registered psychotherapists in regard to the psychotherapeutic treatment of asylum seekers in Germany. Methods: 198 Hessian registered psychotherapists (40% of all contacted persons) from the administrative districts Marburg-Biedenkopf, Gießen, Lahn-Dill-Kreis, Schwalm-Eder-Kreis und Waldeck-Frankenberg completed a questionnaire. The questionnaire assessed their views of different possible obstacles and advantages regarding the psychotherapy of asylum seekers, as well as possibilities to improve one's own willingness to provide such a treatment. Results: The majority of the participating psychotherapists indicated a modest willingness to provide psychotherapy for asylum seekers. One third had already treated (on average 1-2) asylum seekers. The strongest obstacles were the application of translators, the high formal costs, and the insecurity regarding the reimbursement of therapy sessions. Possible cultural divergences, being afraid of difficult themes, or a potentially reduced adherence of asylum seekers were not seen as meaningful obstacles. Becoming familiar with another culture and new experiences were seen as main advantages of psychotherapy with an asylum seeker. Conclusion: The psychotherapeutic care of asylum seekers could possibly be improved through the exchange of information among psychotherapists and with the responsible local administrative organizations. Moreover, administrative districts could mainly improve the situation by providing help with finding adequate translators, facilitate the formal costs, and secure the reimbursement for psychotherapies with asylum seekers.

Perceived discrimination and impaired mental health in Turkish immigrants and their descendents in Germany.

OBJECTIVE: This study investigates the relationship between different forms of perceived ethnic discrimination, stress, and depressive and somatoform symptoms in Turkish immigrants and their descendents. Moreover, it was tested whether ethnic identification buffers the effect of discrimination on stress. METHODS: Variables were assessed via online and paper-pencil questionnaires (e.g., Behaviors from Intergroup Affect and Stereotype Treatment Scale, Patient Health Questionnaire, Perceived Stress Scale) in Turkish immigrants and their descendents (N=214) from the general population in Germany. Mediation and moderated mediation models were tested. RESULTS: Open aggression and discrimination in everyday situations showed large effects on depressive and somatoform symptoms. Also, paternalism showed a large indirect effect on impaired mental health via perceived stress, but only for persons lowly identified with being Turkish. CONCLUSION: This study reveals the large detrimental effects of different forms of discrimination on mental health in Turkish immigrants. However, a high ethnic identification can act as a buffer against stress.

Measurement invariance of the Illness Invalidation Inventory (3*I) across language, rheumatic disease and gender.

OBJECTIVES: The Illness Invalidation Inventory (3*I) assesses patients' perception of responses of others that are perceived as denying, lecturing, not supporting and not acknowledging the condition of the patient. It includes two factors: 'discounting' and 'lack of understanding'. In order to use the 3*I to compare and pool scores across groups and countries, the questionnaire must have measurement invariance; that is, it should measure identical concepts with the same factor structure across groups. The aim of this study was to examine measurement invariance of the 3*I across rheumatic diseases, gender and languages. METHODS: Participants with rheumatic disease from various countries completed an online study using the 3*I, which was presented in Dutch, English, French, German, Portuguese and Spanish; 6057 people with rheumatic diseases participated. Single and multiple group confirmatory factor analyses were used to test the factorial structure and measurement invariance of the 3*I with Mplus. RESULTS: The model with strong measurement invariance, that is, equal factor loadings and thresholds (distribution cut-points) across gender and rheumatic disease (fibromyalgia vs other rheumatic diseases) had the best fit estimates for the Dutch version, and good fit estimates across the six language versions. CONCLUSIONS: The 3*I showed measurement invariance across gender, rheumatic disease and language. Therefore, it is appropriate to compare and pool scores of the 3*I across groups. Future research may use the questionnaire to examine antecedents and consequences of invalidation as well as the effect of treatments targeting invalidation.

The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability.

Anxiety is frequently observed in persons with chronic obstructive pulmonary disease (COPD). Although anxiety in persons with COPD is multifaceted, it is mostly assessed as a general psychopathological condition. Consequently, the objectives of this study were to revise an existing questionnaire assessing relevant anxieties for use in clinical practice and research, to examine the association between COPD-related fears and disability, and finally to develop norms for COPD-related fears. Disease severity (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, use of long-term oxygen), sociodemographic characteristics, COPD-specific disability (COPD assessment test), and psychopathology (depression, general anxiety, somatoform symptoms, and disease-related fears) were obtained from a sample of 1025 individuals with COPD via the Internet. We used the COPD Anxiety Questionnaire (German: CAF) for the assessment of different fears that have been found to be relevant in COPD: fear of dyspnea, fear of physical activity, fear of progression, fear of social exclusion, and sleep-related worries. Mean COPD-specific disability was high (22.87). After explanatory and confirmatory factor analyses, a revised version of the CAF was constructed. The economical and user-friendly CAF-R showed adequate reliability and expected correlations with convergent and discriminant constructs. Gender-specific norms are provided for use in clinical practice and research. Even after controlling for GOLD stage, sociodemographic variables, and psychopathology, COPD-related fears contributed incrementally to disease-specific disability. The CAF-R is an economical and reliable tool to assess different specific fears in COPD. Results indicate that disease-specific fears have an impact on disability, supporting the assumption that detailed assessment of anxiety in COPD should be included in clinical practice.

The distinction between "medically unexplained" and "medically explained" in the context of somatoform disorders.

PURPOSE: Medically unexplained symptoms (MUS) currently constitute the main diagnostic criterion of somatoform disorders. It has been proposed that the required dichotomization of somatic complaints into MUS and medically explained symptoms (MES) should be abandoned in DSM-V. The present study investigated complaints in the general population in order to evaluate the relevance of a distinction between MUS and MES. METHODS: Three hundred twenty-one participants from a population-based sample were interviewed by telephone to assess symptoms present during the previous 12 months. Complaints were examined in terms of health care use, diagnoses made by the physician and degree of impairment. At the 1-year follow-up, 244 subjects were re-interviewed in order to explore the stability of symptoms. RESULTS: The complaints frequently prompted participants to seek medical health care (several pain and pseudoneurological symptoms led to a doctors' visit in >80 % of cases), although etiological findings rarely suggested a medical pathology (occasionally <30 %). MUS and MES proved, to an equal degree, to impair individuals and prompt a change in lifestyle. Pain caused the worst impairment compared with other symptoms. The most prevalent MUS and MES were characterized by a transient course (approximately 60 % remitted, 55 % newly emerged to follow-up), although various unexplained pain complaints tended to be persistent (e.g., back pain 67 %). Remarkably, the appraised etiology as explained or unexplained changed from baseline to follow-up in many persisting symptoms (20 % MUS → MES, 50 % MES → MUS). CONCLUSIONS: In principal, MUS and MES resulted in comparable impairment and stability. Due to conceptual and methodological difficulties, classification criteria for somatoform disorders should not be restricted to somatic aspects of the symptomatology.

Disagreement in doctor's and patient's rating about medically unexplained symptoms and health care use.

BACKGROUND: Medically unexplained (somatoform) symptoms (MUS) are highly prevalent in primary care. It remains unclear to what extent patients and their general practitioners (GPs) agree upon the etiology of physical symptoms as well as on the number of visits to the GP. PURPOSE: The purpose of this study is to determine patient-physician agreement on reported symptoms. METHOD: A sample of 103 persons provided information on MUS and health care utilization (HCU) during the previous 12 months. The persons' GPs (n = 103) were asked for the same information. By determining patient-physician agreement on reported symptoms, the sample was subdivided into a concordance group (high agreement: Pt = GP) and two discordance groups (substantial disagreement: Pt > GP, Pt < GP). RESULTS: Patients and their GPs showed substantial disagreement concerning physical symptom reports for the prior 12 months. On means, patients named 3.26 (SD = 3.23; range 0-21) physical complaints of which 71.6% were considered to be medically unexplained (MUS), whereas GPs only determined 1.77 (SD = 1.94; range 0-11) symptoms of which 57.5% were MUS. Substantial patient-physician agreement regarding the number of reported MUS was detected in 29.1% of the cases (Pt = GP). Patients of all groups underestimated their HCU. CONCLUSION: Since patients' and GPs' reports differ substantially concerning the etiology of symptoms and concerning HCU, both sources of data gathering should be treated carefully in primary care research.

[How do somatoform and depressive symptoms and syndromes affect life satisfaction? Results from a representative population survey in Germany]. / Wie wirken sich somatoforme und depressive Symptome und Syndrome auf die Lebenszufriedenheit aus? Ergebnisse einer bevölkerungsrepräsentativen Befragung in Deutschland.

OBJECTIVES: The aim of this study is to investigate the differential impact of somatoform and depressive symptoms/syndromes on life satisfaction. METHODS: In a representative population survey in Germany (N=2 510) depressive and somatic symptoms are screened with the Patient Health Questionnaire (PHQ), Life satisfaction is assessed with the Questions on Life Satisfaction (FLZM). RESULTS: Both subclinical depressive/somatic symptoms and clinically relevant depressive/somatoform syndromes are associated with decreased life satisfaction. Depressive symptoms/syndromes result in lower satisfaction in all areas of life, whereas somatic symptoms/somatoform syndromes only affect certain domains of life -satisfaction. CONCLUSIONS: Considering comorbid depressive symptoms/syndromes, somatic symptoms and somatoform syndromes show negative associations with only some of the subdimensions of life satisfaction. A dimensional approach is useful to consider the effects of subclinical symptoms on life satisfaction.

[Job insecurity versus unemployment: unequal in socioeconomic status but comparable detrimental effects on mental health and health care utilization]. / Arbeitsplatzunsicherheit vs. Arbeitslosigkeit: Trotz der Unterschiede im sozioökonomischen Status sind die Auswirkungen auf psychische Gesundheit und Inanspruchnahme von Gesundheitsleistungen ähnlich.

Knowledge about differential effects of unemployment and job insecurity on mental health and health care utilization are of high relevance. There are no studies which compare unemployed persons and persons with an insecure job in terms of different mental health indicators, and which investigate the mediating effect of mental health on health care utilization. Somatoform symptoms, anxiety, depression, physical health, and health care utilization were assessed in 161 unemployed persons, 218 persons with an insecure job, and 957 securely employed persons. Unemployed persons and persons with an insecure job showed equally worse mental health than securely employed persons on average. They also had significantly higher health care utilization. Mental health was a full mediator between job insecurity and unemployment on the one hand and health care utilization on the other hand. An adequate mental health care is necessary for unemployed persons as well as for persons with an insecure job.

How is music listening purpose related to stress recovery? - two preliminary studies in men and women.

Introduction: Studies have suggested that listening to music can reduce psychological and biological responses to a stressor. However, it is unclear whether music has the same effect on stress recovery. According to field studies, people commonly use music in daily life for the specific purpose of relaxation. We explored whether individuals who generally use music for relaxation purposes show improved recovery from an acute stressor. Methods: In two independent studies, twenty-seven healthy female participants (Mage = 24.07) (Study 1) and twenty-one healthy male participants (Mage = 23.52) (Study 2) were separated into two groups based on their frequency of using music for relaxation purposes (low vs. high). All participants underwent a lab-based psychosocial stress test. Subjective stress levels were measured using visual analogue scales. Salivary cortisol and salivary alpha-amylase were measured to assess endocrine and autonomic stress responses, respectively. Subjective stress levels and saliva samples were measured nine times throughout the stress induction and recovery procedure. Chronic stress levels were assessed using the Perceived Stress Scale and the Screening Scale of Chronic Stress. Results: No significant differences were observed in subjective stress levels, salivary alpha-amylase activity, or cortisol concentration between the two groups in either of the two studies. Further analyses revealed that among male participants, increased use of music for relaxation purposes was related to more chronic stress levels (t (10.46) = 2.45, p = 0.03, r = 0.60), whereas female participants exhibited a trend in the opposite direction (t (13.94) = -1.92, p = 0.07, r = 0.46). Discussion: Contrary to our expectations, the results indicate that habitual music listening for relaxation purposes is not associated with improved recovery from a stressor. However, due to the small sample size, future exploration is necessary to enhance the statistical power of the results of the study.

Recent developments on psychological factors in medically unexplained symptoms and somatoform disorders.

Somatic symptoms which are not fully explained by a medical condition (medically unexplained symptoms) have a high relevance for the public health. They are very common both in the general population and in patients in health care, and may develop into chronic impairing conditions such as somatoform disorders. In recent years, the relevance of specific negative psychological factors for the diagnosis and the stability of somatoform disorders and for the impairment by medically unexplained symptoms gained more and more attention. This resulted-among others- in core changes in the diagnostic classification criteria of somatoform disorders. Against this background, the present "Perspective" will outline recent developments and findings in the area of medically unexplained somatic symptoms and somatoform disorders. Moreover, it will lay a special focus on evidence on specific negative psychological factors that may influence the course of unexplained somatic symptoms and disorders and the impairment caused by these symptoms.