Originalbeiträge (Originals). Primäremotionen und Bindung bei psychischer Störung.

Primaryemotions and attachment in mental disorder Objectives: There is increasing evidence for associations between primary emotions and attachment with mental illness. This study illuminates the mediation relationship of these psychodynamic constructs in relation to psychiatric disorders. METHODS: 921 subjects (69.9 % female) were examined, who completed the questionnaires Brief Affective Neuroscience Personality Scales including a LUST Scale, Experiences in Close Relationships - Revised 8, and ICD-10 Symptom Rating online. A path analysis was conducted to evaluate the mediation effects of attachment anxiety. RESULTS: A disease-specific pattern of direct associations between primary emotions, attachment anxiety, and psychological impairment emerged (all p < .01). Attachment exerted mediating effects primarily for SADNESS (p < .01), and to a lesser extent for LUST and CARE (p > .01).The model provided variance resolution ranging from7%(eating disorders) to 47%(depression). CONCLUSION: The results demonstrate the relevance of affective explanations regarding the development of psychological symptoms, as well as therapeutic implications.

Eating Habits and Eating Disorder Associated Behavior in Bipolar Disorder.

ABSTRACT: A relevant comorbidity of bipolar disorder (BD) is eating disorders (EDs). Crossed vulnerability factors as eating disorder-specific symptoms (EDSSs) may trigger the onset of both disorders in either direction. The Structured Inventory for Anorexic and Bulimic Eating Disorders for Self-Report was used to examine the occurrence of EDs in euthymic/subsyndromal individuals with BD ( n = 86) and healthy controls ( n = 86) matched for age and sex. Furthermore, we explored EDSSs with the subscales "general psychopathology and social integration," "bulimic symptoms," "body image and slimness ideal," "sexuality and body weight," "counteract," and "atypical binge." Higher rates of all EDSSs were reported in BD. Younger individuals with BD showed higher expression in "bulimic symptoms," "body image and slimness ideal," and "atypical binge" subscales. No participants fulfilled ED diagnosis. The findings show a link between EDSS and BD. Clinicians should pay attention to a multimodal intervention, considering risk factors, investigating eating habits and ED associated behaviors.

[Questionnaire for Assessment of Mental Pain after Traumatic Events (FESSTE-30): Preliminary Standard Values and Factorial Structure]. / Erste Vergleichswerte und faktorielle Struktur des Fragebogens zur Erfassung von seelischem Schmerz nach traumatischen Ereignissen (FESSTE-30).

BACKGROUND: The questionnaire for the assessment of mental pain after traumatic experiences (FESSTE-30) is the first instrument in the German language which can be used for the standardized operationalization of mental pain in research and expert review process. The primary aim of the present study was to present quality criteria of the questionnaire and its preliminary gender-specific comparative values for the German-speaking general population. METHODS: The FESSTE-30 consists of five subscales ("Depression", "Somatization", "Dissociation", "Intrusive Memories" and "Fear"), and the total scale "Mental Pain". In addition, the attached trauma checklist enables a structured assessment of the extent of traumatic experiences. The questionnaire was investigated regarding reliability and validity based on a convenience sample of the German-speaking general population (n=1448; 86.2% female). RESULTS: The reliabilities of the subscales and the total scale ranged between Cronbach's alpha=0.81-0.94. The internal consistency of the scale "extent of traumatic experiences" showed a Cronbach's alpha=0.65. Regarding confirmatory factor analysis, a latent bifactor structure with a general factor and five residual factors showed the following model fit: RMSEA=0.05 (90% CI: 0.05, 0.06); TLI=0.93; CFI=0.94; NFI=0.92; χ²/df=4.94. DISCUSSION: The results indicate that FESSTE-30 is a reliable and valid self-assessment method for assessment of mental pain, suitable for application in research, treatment and expert review processes. The preliminary standard values can be used as a guideline for the evaluation of individual cases. Further investigations with clinical samples are planned.

A Bifactor Model of Personality Organization.

The aim of this study was to explore the viability of a bifactor model for the Inventory of Personality Organization (IPO), which is a self-report measure of personality functioning based on Kernberg's model of personality organization. A heterogeneous, predominantly clinical sample (N = 616) completed the German 83-item version of the IPO. Confirmatory and Exploratory Factor Analyses were applied to explore the factor structure of the IPO. We were able to establish a bifactor model with a general factor of personality functioning and three specific factors (Aggression, Reality Testing, Moral Values), which represent additional dimensions of personality organization. Virtually all items showed substantial positive loadings on the general factor, explaining roughly 66% of the common variance. Furthermore, we found support for convergent and discriminant validity of general and specific factors with regard to interview-based assessments of personality disorders and personality organization. The results lend support to a bifactor approach to Kernberg's model of personality organization. We also present a 30-item brief form of the IPO that efficiently implements the bifactor approach and may be further validated in future studies.

The supervisory relationship from an attachment perspective: Connections to burnout and sense of coherence in health professionals.

Supervision is an essential part of the training and work environment of health professionals, especially of psychotherapists and clinical/health psychologists. However, although the supervisory process is always a relational one and may therefore be influenced by attachment dynamics, the importance of the supervisory relationship for the professional's performance and the well-being of the supervisee has yet to be fully examined. In this cross-sectional observational study, the Experiences in Close Relationships-Revised (ECR-RD; avoidant and anxious attachment), the Supervisory Relationship Questionnaire (SRQ), the Maslach Burnout Inventory (MBI) and the Sense of Coherence Scale (SOC-13) were analysed for 346 (81.8% female) health professionals. Considering professional experience and number of supervision sessions as control variables, a better supervisory relationship negatively predicted burnout symptoms (ß = -.31) but positively predicted sense of coherence (ß = .31, both p < .01). The final model, including avoidant and anxious attachment as additional predictors, explained 30% of the variance in burnout symptoms and 41% of the variance in sense of coherence. The results underline the importance of the supervisory relationship for the well-being and the professional performance of health professionals. Interactions between the supervisory relationship and underlying attachment parameters should be further explored in future studies.

[The relationship between trauma, consequences of trauma and personality structure: A mediation analysis]. / Die Beziehung zwischen Trauma, Traumafolgen und Persönlichkeitsstruktur: Eine Mediationsanalyse.

The relationship between trauma, consequences of trauma and personality structure: A mediation analysis Background: This study deals with the hitherto scarcely explored relationship between the extent of traumatization, psychopathological consequences and personality structure. It is examined whether the structural integrity of the personality has a mediating influence on the relationship between trauma and symptoms of post-traumatic stress disorder (PTSD) and mental pain after traumatization. Methods: The investigated community sample consisted of 381 adults (89 % female) who reported at least one lifetime traumatic experience. The path analysis technique was applied to estimate associations between the degree of traumatization, PTSD symptoms, mental pain and the integrity of personality structure. Results: The extent of experienced traumatization is significantly associated with increased impairment of personality structure (ß = .40; p < .001), severity of the mental pain (ß = .21; p < .001) and PTSD symptoms (ß = .14; p < .01). Deficits in the personality structure were associated with increased mental pain (ß = .67; p < .001) and PTSD symptoms (ß = .73; p < .001). The mediation analysis showed an indirect effect of traumatization on mental pain (ß = .27; p < .001) and PTSD symptoms (ß = .29; p < .001), which is partially mediated by personality structure level. A detailed analysis showed that this mediation relationship can be attributed in particular to deficits in the ability to observe oneself. Discussion: The results of this study emphasize the significance of personality structure in the development of psychological consequences of traumatization. Regarding therapeutic practice, especially the ability to observe oneself seems to offer an important starting point for the treatment of mental pain and PTSD symptoms.

Relationship Between Skin Shame, Psychological Distress and Quality of Life in Patients with Psoriasis: a Pilot Study.

Shame has been registered as a part of psychosocial distress in patients with psoriasis. This study investigated 44 patients with psoriasis and 88 age- and sex-matched individuals without skin disease. Skin shame, multifarious expressions of shame, psychological symptoms, overall health, dermatological quality of life, disease burden and disease severity were measured. Higher levels of skin shame correlated with a greater disease burden (r=0.63; p < 0.01), higher Dermatology Life Quality Index (r=0.33; p < 0.05), and lower mental quality of life (r=-0.30; p <´ 0.05). Patients had a higher level of skin shame (F=74.03; eta2= 0.36; p < 0.01) and less physical quality of life on the SF-36 (F=5.14; eta2= 0.04; p < 0.05) than non-dermatological controls. General shame was not related to disease burden or quality of life. While self-rated skin shame appears to be related to quality of life in patients with psoriasis, no association was registered between expert-rated Psoriasis Area and Severity Index and quality of life.

[German version of the Skin Shame Scale (SSS-24) : Validation with dermatological patients and dermatologically healthy individuals]. / Deutsche Version der Skin Shame Scale (SSS-24) : Validierung anhand dermatologischer Patienten und dermatologisch gesunder Personen.

BACKGROUND: Skin shame plays an important role in the psychological distress of dermatological patients. However, it is rarely examined in research or clinical practice due to the lack of availability of a robust measure of skin shame. This study sought to adapt and validate the Skin Shame Scale (SSS-24) for use in the German-speaking population. METHODS: The SSS-24 questionnaire was completed by 488 dermatologically healthy (DH) individuals (66.6% women) and 339 dermatological patients (DP; 66.7% women). Participants also completed measures of general shame (SHAME) and of psychological distress (BSI[Brief Symptom Inventory]-18). RESULTS: The SSS-24 showed adequate psychometric properties and a high internal consistency in both samples (DH: α = 0.91; DP: α = 0.95). DP reported more skin shame than DH (p < 0.001) but in both samples more skin shame was associated with more general shame and more psychological distress (p < 0.001). CONCLUSIONS: Overall, the psychometric properties of the English original version were replicated in the German version of the SSS-24. Due to the strong associations with general shame and psychological distress, skin shame should be considered an important parameter in psychodermatology. The SSS-24 enables further research into the role of shame in skin conditions and provides a useful tool for identifying patients who might benefit from psychosocial interventions.

Sense of coherence is linked to post-traumatic growth after critical incidents in Austrian ambulance personnel.

BACKGROUND: Ambulance personnel, as well as other emergency services like fire-fighters or the police force, are regularly confronted with experiences of extreme psychological distress and potentially traumatizing events in the line of their daily duties. As a consequence, this occupational group is exposed to an elevated risk of developing symptoms of Post-Traumatic Stress (PTSS). Subsequently, symptoms of Post-Traumatic Stress have been observed as potentially co-occurring with Post-Traumatic Growth (PTG) in ambulance personnel as well. Therefore, in this study we hypothesized that Sense of Coherence (SOC) might play an important role as an underlying feature in enabling growth after stressful experiences in Austrian ambulance personnel. METHODS: In this study, voluntary and full-time ambulance personnel (n = 266) of the Austrian Red Cross ambulance service completed an online survey including the Sense of Coherence Scale (SOC-29), the Post-Traumatic Growth Inventory (PTGI) and the Impact of Event Scale Revised (IES-R) for the assessment of PTSS. In line with theoretical considerations, a two-step cluster analysis limited to four clusters and further ANOVAs were conducted. RESULTS: Four clusters were confirmed and labelled PTSS-low/PTG-low, PTSS-low/PTG-high, PTSS-high/PTG-high and PTSS-high/PTG-low. Further ANOVAs revealed substantial cluster differences in SOC, with higher SOC-levels in PTSS-high/PTG-high than in PTSS-high/PTG-low (p < .01), in PTSS-low/PTG-high than in PTSS-low/PTG-low (p < .01) and in PTSS-low/PTG-high than in PTSS-high/PTG-low (p < .01). CONCLUSIONS: Our findings point to a significant association between SOC and the development of PTG in ambulance personnel. Furthermore, the results suggest that growth and stress after critical incidents are independent from each other and can co-exist. Therefore, promoting SOC (e.g., meaningfulness) in ambulance personnel - e.g., through psychological interventions - might preserve and enhance psychological health after critical incidents.

[The role of eye movement desensitization and reprocessing (EMDR) in substance use disorders: A systematic review]. / Die Rolle des Eye Movement Desensitization and Reprocessing (EMDR) bei Substanzgebrauchsstörungen: Ein systematischer Überblick.

Eye Movement Desensitization and Reprocessing (EMDR) is a therapeutic method that has been shown to be especially effective in traumatic disorders. Since the concept of an addiction memory has become widely accepted, the use of EMDR also in substance use disorders (SUD) treatment might count as a separate field. This review summarizes the current state of research on treatment effects EMDR in SUD. The literature search included the databases of PubMed and PsychInfo; four studies met the inclusion criteria. EMDR was found to be related to a decreased amount of craving, fear and depression and to an improvement of emotion regulation and management and self-esteem. Initial findings indicate a high therapeutic potential of EMDR in SUD treatment.

Insecure Attachment Styles and Increased Borderline Personality Organization in Substance Use Disorders.

BACKGROUND: Previous research has linked insecure attachment styles and borderline personality organization to substance use disorder (SUD). However, it still remains unclear whether those impairments apply to different kinds of SUDs to the same extent. Therefore, in this study we sought to investigate potential differences regarding attachment deficits and borderline personality organization in two different SUD inpatient groups and furthermore in comparison to healthy controls. SAMPLING AND METHODS: A total of 66 (24 female) inpatients diagnosed with alcohol use disorder (AUD), 57 (10 female) inpatients diagnosed with polydrug use disorder (PUD), and 114 (51 female) healthy controls completed the Borderline Personality Inventory and the Attachment Style Questionnaire. RESULTS: Compared to healthy controls, AUD and PUD inpatients showed significant deficits in all attachment parameters (p < 0.01) as well as a significantly increased amount of borderline personality organization (p < 0.01). No differences between AUD and PUD inpatients were observed (p > 0.05). CONCLUSIONS: Our results indicate that the drug(s) of choice cannot be regarded as an indicator for the extent of attachment deficits or personality pathology. These initial findings are mainly limited by the rather small sample size as well as just a single point of measurement. Future research might also consider further covariates such as comorbidity or psychotropic medication.

Vulnerable Dark Triad Personality Facets Are Associated with Religious Fundamentalist Tendencies.

BACKGROUND: This study explores the possibility that religious fundamentalism (RF) may be linked to deficits in personality structure, which is in contrast to the general assumption that religiosity and spirituality are positively related to mature personality development. SAMPLING AND METHODS: To test this hypothesis, 327 (232 female) college students completed the Multidimensional Inventory for Religious/Spiritual Well-Being together with the Innsbrucker Religious Fundamentalism Scale. In addition, the 'vulnerable dark triad' of personality ('vulnerable narcissism', subscale of the Pathological Narcissism Inventory; 'secondary psychopathy', subscale of Levenson's Self-Report Psychopathy Scale; 'borderline personality', of the Borderline Personality Inventory) was assessed. RESULTS: In general, the relation between spirituality and healthy personality functioning was confirmed. In addition to greatly overlapping with 'general religiosity' (p < 0.001), RF was also relevantly predicted by narcissistic ('hiding the self') and borderline ('primitive defenses') personality facets (p < 0.05 for both). CONCLUSIONS: Based on these preliminary data, we conclude that specific structural deficits in personality might lead to more rigorous variants of religious/spiritual beliefs such as RF. Further research in clinical surroundings as well as in religious extremist groups is recommended.

Spiritual well-being and coping in scleroderma, lupus erythematosus, and melanoma.

BACKGROUND AND OBJECTIVES: Religious/spiritual (R-S) well-being is associated with greater vitality and lower depression scores. In this study, we investigated strategies for coping with disease and the role of religiosity/spirituality with respect to improving subjective well-being. PATIENTS AND METHODS: One hundred and forty-nine patients (107 women), 44 of whom with systemic sclerosis (SSc), 48 with lupus erythematosus (LE), and 57 with stage I or II malignant melanoma (MM) were surveyed using a self-designed questionnaire, which addressed subjective well-being and disease-related circumstances, as well as the Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB). RESULTS: At the time of diagnosis, disease burden is greater in LE patients than in patients with SSc and MM. Only after several years are SSc and LE patients able to accept their disease. Compared with healthy individuals, the overall score of R-S well-being is significantly lower in LE patients. In LE, photosensitivity and joint pain are inversely correlated with the ability to forgive. SSc patients with facial lesions and pulmonary involvement show greater religiosity. MM patients display significantly higher values for transcendental hope. CONCLUSION: Talks about the disease and psychological support are the most important needs of patients with SSc, LE, and MM. At present, programs aimed at improving R-S coping skills do not seem to play a significant role, but could be an important resource that should be addressed in the future.

Spirituelles Wohlbefinden und Coping bei Sklerodermie, Lupus erythematodes und malignem Melanom.

HINTERGRUND UND ZIELE: Religiös-spirituelles Wohlbefinden ist verbunden mit höherer Vitalität und verminderter Depressionsneigung. In unserer Studie untersuchten wir die Strategien zur Krankheitsbewältigung und die Rolle von Religiosität-Spiritualität (R-S) zur Verbesserung des subjektiven Wohlbefindens. PATIENTEN UND METHODIK: 149 Patienten (107 Frauen), 44 mit systemischer Sklerodermie (SKL), 48 mit Lupus erythematodes (LE) und 57 mit malignem Melanom (MM), Stadium I-II, wurden mittels eines selbstentwickelten Fragebogens zum subjektiven Wohlbefinden, zu den mit der Erkrankung einhergehenden Umständen sowie mit dem Multidimensionalen Inventar (MI-RSB) zu R-S befragt. ERGEBNISSE: LE-Patienten sind zum Zeitpunkt der Diagnosestellung stärker belastet als SKL- und MM-Patienten. SKL- und LE-Patienten können erst nach Jahren die Erkrankung akzeptieren. Der Gesamtscore des religiös-spirituellen Befindens liegt bei LE-Patienten signifikant unter dem Wert der Normalbevölkerung. Fotosensitivität und Gelenksschmerzen sind bei LE-Patienten negativ assoziiert mit der Fähigkeit Vergeben zu können. SKL-Patienten mit Gesichtsveränderungen und Lungenbeteiligung zeigen höhere allgemeine Religiosität. MM-Patienten haben höhere Werte für transzendente Hoffnung. SCHLUSSFOLGERUNGEN: Vorträge über die Krankheit und psychologische Betreuung sind die wichtigsten Bedürfnisse von Patienten mit SKL, LE und MM an ihre Betreuer. Religiös-spirituelle Angebote zur Krankheitsverarbeitung scheinen derzeit eine untergeordnete Rolle zu spielen, könnten aber eine wichtige Ressource sein, der man in Zukunft mehr Aufmerksamkeit schenken sollte.

EEG neurofeedback effects in the treatment of adolescent anorexia nervosa.

A pre-post design including 22 females was used to evaluate the effectiveness of neurofeedback in the treatment of adolescent anorexia nervosa. Resting EEG measures and a psychological test-battery assessing eating behavior traits, clinical symptoms, emotionality, and mood were obtained. While both the experimental (n = 10) and control group (n = 12) received their usual maintenance treatment, the experimental group received 10 sessions of individual alpha frequency training over a period of 5 weeks as additional treatment. Significant training effects were shown in eating behavior traits, emotion regulation, and in relative theta power in the eyes closed condition. Although the results are limited due to the small sample size, these are the first empirical data demonstrating the benefits of neurofeedback as a treatment adjunct in individuals with anorexia nervosa.

[The relationship between Yoga Immersion, psychological well-being and psychiatric symptoms]. / Die Beziehung zwischen Yoga Immersion, psychologischem Wohlbefinden und psychiatrischer Symptomatik.

BACKGROUND: In recent years positive effects of Yoga (as a kind of spiritual exercise) in regards to subjective well-being and physical health can be found as well documented in the literature. METHOD: Based on a construct-psychological approach a newly developed scale for the assessment of Yoga involvement (immersion) was validated on a sample of 233 non-clinical subjects (210 females) by means of socio-demographic and well established psychometric parameters of psychological well-being and psychiatric symptoms. Furthermore, the group of yoga practitioners was compared with a control group consisting of 93 gymnastics practitioners (83 women) with respect to these parameters. RESULTS: The amount of Yoga Immersion (YI) can be reliably assessed by means of the one-dimensional YI-scale (10 items) and shows to be strongly correlated with Mindfulness (r = .56; p < .01), Inner Correspondence (r = .61; p < .01) and Religious/Spiritual Well-being (r = .68; p < .01). Furthermore highly yoga-immersive practitioners exhibited a significant higher amount of psychological well-being (p < .01) compared to marginally/moderately yoga-immersive and gymnastics practitioners. The Yoga-group also showed a lower amount of psychiatric symptoms (e.g. depression; p < .01). CONCLUSIONS: The globally postulated positive relationship between Yoga-practicing and mental health could be confirmed; thereby the impact of YI can be assumed as central. Further randomized controlled trial research focusing on the health/disease-related aspects of YI might be conducted especially in clinical groups.

Dimensions of religious/spiritual well-being and the dark triad of personality.

BACKGROUND: In general, religious/spiritual dimensions are found to be negatively correlated with all kinds of psychiatric disorders such as depression, suicidal ideation and substance abuse. Contrary to these findings, the goal of this study was to investigate the relationship between dimensions of religious/spiritual well-being (RSWB) and less favorable aspects of personality - the so-called 'dark triad' of personality traits, i.e. narcissism, machiavellianism and psychopathy - together with general deficits in personality structure. SAMPLING AND METHODS: A total of 312 college students (220 females) completed the Multidimensional Inventory for RSWB, the revised Narcissistic Personality Inventory, the Machiavellianism Inventory and the Levenson Self-Report Psychopathy Scale along with the 16-item Inventory of Personality Organization. RESULTS: RSWB was confirmed to be negatively correlated with these negative aspects of personality, in particular with subclinical psychopathy. More specifically, there were several notable overlaps; narcissism, for instance, was found to be significantly positively associated with some RSWB subdimensions such as 'hope' or 'connectedness'. CONCLUSIONS: First deductions can be made from these data concerning an ambivalent role of spirituality in impaired personality structure. These associations might be further investigated especially in psychiatric patients diagnosed with personality disorders in order to describe potential psychopathological facets of religion and spirituality more adequately.

Motivational processing of food cues in anorexia nervosa: a pilot study.

Current literature suggests an increased attentional bias toward food stimuli in eating-disordered individuals compared to healthy controls. In line with these research efforts, the present study aims to investigate the processing of food stimuli (enriched by emotional stimuli) between patients diagnosed for anorexia nervosa (AN) and healthy controls by means of electroencephalography. Twenty-two female adolescents (eleven AN patients vs. eleven healthy controls) were investigated. Positive event-related potentials "P300" and "late positive potential" (LPP) reflecting attentional processing (caused by motivationally relevant stimuli) were investigated during passive viewing of the food cue picture stream. This method was used for the first time in a sample of individuals with AN. As a main result, AN patients exhibited a higher amount of attentional bias in P300 and LPP, while watching food stimuli. Moreover, AN patients rated food stimuli as less pleasant. For a conclusion, there is substantial evidence pointing to an abnormal attentional brain reactivity to food pictures in AN. Therefore, food stimuli seem to be more motivationally relevant for AN patients than for healthy controls. By broadening existing knowledge, these findings might bear some implications for the treatment for AN. However, further research is recommended in order to confirm the results coming from rather limited data.

[Religious/spiritual well-being in mentally ill persons II: the development of a short scale and comparison scores for clinical psychiatric groups and healthy controls]. / Religiös/Spirituelles Befinden bei psychisch Kranken II: Die Entwicklung einer Kurzskala und Vergleichswerte von klinisch-psychiatrischen Gruppen und gesunden Kontrollpersonen.

OBJECTIVE: The Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB) was successfully applied in several clinical as well as non-clinical studies. However, the original version of the scale often showed to be as too comprehensive especially for clinical surroundings. There for the aim of this study is to develop a short version of the scale comprising 12 items. METHOD: Based on a sample representative of the Austrian general population (N = 1,500), a first MI-RSWB short version is developed by means of factor- and reliability analysis. Furthermore the new short version of the scale is initially validated through several indicators of mental illness. RESULTS: The MI-RSWB short version shows convincing psychometric properties. The total scale as well as the sub scales exhibit at least a sufficient internal consistency. A significant negative association with several indicators of psychiatric illness is also confirmed for the short version of the scale. CONCLUSIONS: The MI-RWSB 12 scale is especially recommended for further research focusing on the clinical relevance of religiosity and spirituality.

Anxious and depressive symptoms mediate the influence of sleep quality on suicidality in young adults.

This study investigated how sleep quality affects the global severity of psychiatric symptoms, including suicidality, in young adults. Poor sleep quality has a significant impact on mental health and should therefore be given special attention in suicidal treatment. 1,214 participants (914 females; age: M = 25.81, SD = 6.35) completed the Brief Symptom Inventory (BSI-18), the Scale for Suicidal Experience and Behavior (SSEV), and the Pittsburgh Sleep Quality Index (PSQI) via an online survey. Correlation statistics and path analysis were conducted for data evaluation. Thereby, anxiety and depression but not somatization mediated the relationship between sleep quality and suicidality. Our findings confirm the putative link between diminished sleep quality and increased suicidality and may lead to an early detection of suicidal behavior.