Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment.

BACKGROUND: Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy. METHODS: A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II. RESULTS: Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation. LIMITATION: Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II. CONCLUSION: Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

Depressive primary care patients' assessment of received collaborative care.

The "Patient Assessment of Chronic Illness Care" (PACIC) is a tool for evaluating outpatient health service for patients with chronic diseases. Our aim was to analyze the association between PACIC scores of primary care patients with depression and patients' or patients' general practitioners' (GPs) characteristics. In a data set including depressive primary care patients (N = 280) the association of patient characteristics (sex, age, depressive symptom severity, suicidal ideation) with PACIC scores were assessed by linear regression models. The association between GPs' characteristics (type, location of practice; age, qualification of practitioner) and PACIC scores was assessed by linear mixed models with individual practices as random effects. Patient Health Questionnaire (PHQ-9) scores at 12 months follow up and changes in PHQ-9 scores from baseline to follow up were significantly positive associated with higher PACIC scores (beta = 0.67, 95%-CI [0.02, 1.34]). PACIC scores were not associated with patients' sex (p = 0.473) or age (p = 0.531). GP's age was negatively associated with PACIC scores (p = 0.03). In conclusion, in patients with depression, the PACIC is independent from patients' and GPs' characteristics. The PACIC may be appropriate to assess patient-perspective on depression services in primary care.

The Benefits of Physical Activity and Positive Mental Health for Reducing the Burden of COVID-19: Validation from a Cross-sectional and Longitudinal Investigation in China and Germany.

Many people experience high burden by the outbreak of the coronavirus disease (COVID-19) and its consequences for health and everyday life. The present cross-national study investigated potential factors that can reduce the burden by COVID-19 in China and Germany. Cross-sectional and longitudinal (China: N = 474, baseline, BL: 2015, follow-up, FU: 2020; Germany: N = 359, BL: 2019, FU: 2020) data on physical activity (e.g., jogging) (BL/FU), positive mental health (PMH) (BL/FU), and burden by COVID-19 (FU) were collected via online surveys. In both countries, physical activity was positively associated with PMH, and both variables were negatively related to burden by COVID-19. Furthermore, PMH mediated the link between physical activity and burden. The mediation model was significant when physical activity and PMH were assessed at the BL, while burden was measured at the FU; and it was also significant when all variables were assessed at the FU. The present findings reveal that physical activity in combination with PMH can reduce the experience of burden by COVID-19. Conscious fostering of physical activity and PMH is supported as an effective strategy to reduce the negative impact of the pandemic outbreak on mental and physical health. Additional benefits such as increased adherence to governmental measures around COVID-19 are discussed.

Relationship between sense of control, psychological burden, sources of information and adherence to anti-COVID-19 rules.

BACKGROUND: Adherence to anti-COVID-19 rules is important to slow down the pandemic spread. The present study investigated potential predictors of the adherence. METHODS: Data of 1.247 participants from Germany (age: M (SD) = 22.99 (6.18)) were assessed via online surveys in autumn and winter 2020. The focus of the data collection was on adherence to anti-COVID-19 rules, sense of control, psychological burden, and sources of COVID-19 information. RESULTS: In moderated mediation analyses, the positive relationship between sense of control and adherence to anti-COVID-19 rules was significantly mediated by the level of psychological burden experienced by the COVID-19 situation. The source of COVID-19 information significantly moderated the negative association between burden and adherence. Specifically, the higher the use of social media (e.g., Facebook, Twitter) and the lower the use of official governmental sites and of television reports, the closer the link between high burden and low adherence. LIMITATIONS: Due to the cross-sectional study design, the present findings allow only hypothetical assumptions of causality. CONCLUSIONS: The present results disclose potential mechanisms that could contribute to the adherence to anti-COVID-19 rules. They emphasize the role of the COVID-19 information source for the adherence level. Potential ways of how the level of adherence could be enhanced are discussed.

The relationship between burden caused by coronavirus (Covid-19), addictive social media use, sense of control and anxiety.

The outbreak of Covid-19 has significantly restricted people's everyday life and contributed to enhanced social media use (SMU). The present study investigated the relationship of burden caused by Covid-19 and addictive SMU. Data were assessed in a sample of 550 users of social media (age: M (SD) = 27.08 (6.74)) from Germany via online surveys in spring 2020. In a moderated mediation analysis, the positive association between burden and addictive SMU was significantly mediated by the level of perceived sense of control. Anxiety symptoms significantly moderated the relationship between sense of control and addictive SMU. Specifically, the link between both variables was significant only for medium and high levels of anxiety symptoms. The present findings disclose the mechanisms that can contribute to the development of addictive tendencies during the pandemic outbreak. Potential practical implications and ways of how the negative consequences of burden caused by Covid-19 might be prevented are discussed.

The relationship between social media use, stress symptoms and burden caused by coronavirus (Covid-19) in Germany and Italy: A cross-sectional and longitudinal investigation.

Introduction: The need for "social distancing" to reduce the spread of Covid-19 is accompanied by an increase of social media use (SMU). Many people engage in intensive online activity to find information about the current Covid-19 situation and to interact about it with other users. The present study investigated the extent of SMU as Covid-19 information source and its relationship with stress symptoms and burden caused by the pandemic in Germany and Italy. Methods: Cross-national longitudinal (Germany, N = 501; 3-months period) and cross-sectional (Italy, N = 951) data on Covid-19 information sources, stress symptoms and burden caused by Covid-19 were collected via online surveys. Results: About 50% of the German sample and about 60% of the Italian sample frequently used SM as Covid-19 information source. Cross-sectional analyses in both countries revealed that SMU is positively associated with stress symptoms and experienced burden. Moreover, stress symptoms mediated the link between SMU and burden. This was also confirmed by longitudinal analyses in Germany (burden assessed three months after SMU and stress symptoms). Limitations: The mostly female and relatively young sample composition limits the generalizability of present findings. Only two European countries were investigated. Conclusions: The present findings reveal a potential negative impact of enhanced SMU on individual mental health state and behavior. Additionally, they emphasize the significance of a conscious and cautious use of SM as information source specifically during the pandemic.

Validating the use of a smartphone app for remote administration of a fear conditioning paradigm.

Fear conditioning models key processes related to the development, maintenance and treatment of anxiety disorders and is associated with group differences in anxiety. However, laboratory administration of tasks is time and cost intensive, precluding assessment in large samplesnecessary for the analysis of individual differences. This study introduces a newly developed smartphone app that delivers a fear conditioning paradigm remotely using a loud human scream as an aversive stimulus. Three groups of participants (total n = 152) took part in three studies involving a differential fear conditioning experiment to assess the reliability and validity of a smartphone administered fear conditioning paradigm. This comprised of fear acquisition, generalisation, extinction, and renewal phases during which online US-expectancy ratings were collected during every trial with evaluative ratings of negative affect at three time points. We show that smartphone app delivery of a fear conditioning paradigm results in a pattern of fear learning comparable to traditional laboratory delivery and is able to detect individual differences in performance that show comparable associations with anxiety to the prior group differences literature.

Genome-wide expression and response to exposure-based psychological therapy for anxiety disorders.

Exposure-based psychological treatments for anxiety have high efficacy. However, a substantial proportion of patients do not respond to therapy. Research examining the potential biological underpinnings of therapy response is still in its infancy, and most studies have focussed on candidate genes. To our knowledge, this study represents the first investigation of genome-wide expression profiles with respect to treatment outcome. Participants (n=102) with panic disorder or specific phobia received exposure-based cognitive behavioural therapy. Treatment outcome was defined as percentage reduction from baseline in clinician-rated severity of their primary anxiety diagnosis at post treatment and 6 month follow-up. Gene expression was determined from whole blood samples at three time points using the Illumina HT-12v4 BeadChip microarray. Linear regression models tested the association between treatment outcome and changes in gene expression from pre-treatment to post treatment, and pre-treatment to follow-up. Network analysis was conducted using weighted gene co-expression network analysis, and change in the detected modules from pre-treatment to post treatment and follow-up was tested for association with treatment outcome. No changes in gene expression were significantly associated with treatment outcomes when correcting for multiple testing (q<0.05), although a small number of genes showed a suggestive association with treatment outcome (q<0.5, n=20). Network analysis showed no association between treatment outcome and change in gene expression for any module. We report suggestive evidence for the role of a small number of genes in treatment outcome. Although preliminary, these findings contribute to a growing body of research suggesting that response to psychological therapies may be associated with changes at a biological level.

Costs and benefits of self-efficacy: Differences of the stress response and clinical implications.

Encounters with stressors induce diverse idiosyncratic neuroendocrine, behavioral and psychological reactions across people. Perceived self-efficacy can alter autonomic responses and their effects on mental health. The beneficial effects of self-efficacy in buffering physiological arousal, enhancing performance, and diminishing psychopathological symptoms have been observed in diverse contexts. We show that the role of self-efficacy is not uniformly beneficial, and that higher levels of self-efficacy can sometimes lead to increases in neuroendocrine and psychological stress responses and decreases in performance, a phenomenon that has been widely neglected. We discuss specific conditions under which self-efficacy effects do not uniformly ameliorate or prevent the consequences of stress. These conditions suggest that therapeutic interventions need not always promote self-efficacy in principal. Simultaneously, they to do suggest that keeping self-efficacy high might be disadvantageous or detrimental.

Using carbon nanodots as inexpensive and environmentally friendly sensitizers in mesoscopic solar cells.

We discuss the use of carbon nanodots (CNDs) as sensitizers in mesoscopic solar cells. The CNDs are synthesized using a one-step, bottom-up microwave approach with citric acid, urea, and formic acid as precursors in aqueous media. Their light-harvesting capabilities can be tuned by adjusting the synthetic parameters. Comprehensive spectroscopic and theoretical studies allow us to rationalize the nature of their absorption features. Promising power conversion efficiencies (η) of 0.24% can be achieved from these cheap and eco-friendly sensitizers by optimizing the solar-cell assembly process. Interestingly, we found that extending the light absorption towards longer wavelengths does not necessarily improve the performance of the solar cells, since the longer-wavelength absorption features hardly contribute to the cells' photo-action spectra, so that the overall power conversion efficiency is actually worse. The origin of the lower performance is corroborated in transient absorption spectroscopy and photovoltage decay measurements. Our work points, on one hand, to the limits of as-synthesized CNDs as photosensitizers and, on the other hand, to possible improvements.

Thermochromic and solvatochromic properties of Lindqvist polyoxometalates.

The thermochromic and solvatochromic properties of Lindqvist metal oxide clusters [V(x)M(6-x)O19](n-) (x = 0, 1, 2, M = Mo, W) are reported. The cluster anions show pronounced changes of their electronic structure depending on their chemical environment (e.g. solvent polarity, temperature). These are rationalized using experimental and theoretical methods. A combined density functional theory and (51)V-NMR study suggests that temperature-dependent changes in the structural dynamics of the metal oxide framework are the underlying cause for the observed thermochromism. The results might open new avenues for the design of molecular optical sensors.

Molecular wires--impact of π-conjugation and implementation of molecular bottlenecks.

In this review we highlight recent progress in the field of photochemically and thermally induced electron transport through molecular bridges as integrative parts of electron donor-bridge-acceptor conjugates. The major emphasis is hereby on the design and the modular composition of the bridges. To this end, we will demonstrate that control over attenuation factors and reorganization energies, on one hand, as well as electronic and electron-vibration couplings, on the other hand, enables tuning electron transport over distances as short as 3.5 Å and as large as 50 Å by up to nine orders of magnitude. In terms of electron transport, the maximum extreme is given by carbon-bridged oligo-p-phenylenevinylenes of different lengths, while a zinc tetraphenylporphyrin free base tetraphenylporphyrin dyad constitutes the minimum extreme.

Sleep enhances exposure therapy.

BACKGROUND: Sleep benefits memory consolidation. Here, we tested the beneficial effect of sleep on memory consolidation following exposure psychotherapy of phobic anxiety. METHOD: A total of 40 individuals afflicted with spider phobia according to DSM-IV underwent a one-session virtual reality exposure treatment and either slept for 90 min or stayed awake afterwards. RESULTS: Sleep following exposure therapy compared with wakefulness led to better reductions in self-reported fear (p = 0.045, d = 0.47) and catastrophic spider-related cognitions (p = 0.026, d = 0.53) during approaching a live spider, both tested after 1 week. Both reductions were associated with greater percentages of stage 2 sleep. CONCLUSIONS: Our results indicate that sleep following successful psychotherapy, such as exposure therapy, improves therapeutic effectiveness, possibly by strengthening new non-fearful memory traces established during therapy. These findings offer an important non-invasive alternative to recent attempts to facilitate therapeutic memory extinction and consolidation processes with pharmacological or behavioral interventions.

Negative mood induction and unbalanced nutrition style as possible triggers of binges in binge eating disorder (BED).

OBJECTIVE: To investigate whether negative mood and unbalanced nutrition style (fat rich/carbohydrate low) synergistically trigger binge eating in overweight and obese binge eating disorder (BED) patients. METHODS: Subsequently to following an unbalanced or a balanced nutrition plan for three days, participants' food intake in a taste test was measured. During the taste test, participants were either in a negative or a neutral mood that was induced through a guided imagery task. PARTICIPANTS: Sixty-nine overweight and obese women with BED (mean age: 36.7 years, mean body mass index: 32.8 kg/m2). MEASUREMENTS: Eating behavior was assessed by measuring the amount of eaten food during the taste test. Visual analog scales were used to assess negative affect, tension, urge to eat, and hunger before and after the mood induction and after the taste test. RESULTS: Negative mood and unbalanced nutrition had neither a combined synergistic effect nor separate additive effects on the amount of food intake. Negative affect and tension decreased after the taste test in the negative mood group. CONCLUSIONS: Negative mood does not invariably enhance the risk of binge-eating behavior. Fat-rich, carbohydrate-low nutrition style did not influence food intake during a taste test. This finding questions the role of this specific nutrition style as a crucial factor in promoting binge eating. If replicated, these findings are important, since they could guide development of treatment protocols.

[Validity of diagnoses of mental disorders by primary care physicians]. / Validität von Krankenscheindiagnosen psychischer Störungen.

BACKGROUND AND OBJECTIVE: Even in young adult age, psychological disorders are highly prevalent. Family doctors and gynaecologists are the physicians most often consulted by young women. Hence, they have a special responsibility to diagnose psychiatric disorders and--if necessary--to refer to a specialist. PATIENTS AND METHODS: In a prospective epidemiological study, 342 young women (between 18 and 25 years of age) were questioned two times with a structured interview (F-DIPS) designed for mental disorders. In the time period (1997 and 1998), we also investigated, by analysing personal health insurance data, primary-care physicians' diagnoses and payments for services rendered. The diagnoses were compared. RESULTS: There was only a small accordance between F-DIPS and claimcards. Ambulant treating doctors diagnosed somatoform disorders in 28 % of the young women (F-DIPS: 3, 8 %). The F- DIPS found mostly phobic disorders (29 %) (claimcards: 6,1 %). A disorder-specific therapy was only rarely initiated. The treatment (psychotherapy and/or drug therapy) of women with psychiatric disorders appeared to be insufficient. CONCLUSION: The study indicates that primary-care physicians should be urgently trained in psychiatric diagnostics und therapy.

Impact of carbohydrate and fat intake on weight-reducing efficacy of orlistat.

BACKGROUND: Orlistat treatment of obesity results in a poor long-term weight loss (< 5%) in about 30% of patients. AIM: Total energy and macronutrient intake were examined to assess the effect of a change in eating habits on weight loss. METHODS: Sixty-two patients consumed a hypocaloric diet, together with orlistat (3 x 120 mg/day), for 72 weeks, with a maximal fat allowance of 30% of the energy intake. At regular intervals, food diaries were recorded. RESULTS: Fifty-six patients completed the study and lost 8.5 +/- 0.88 kg (P < 0.001). Energy intake was approximately 1500 kcal/day during the entire study period. In three sub-groups established according to weight loss (1, < 5%; 2, > 5% and < 10%; 3, > 10%), fat intake was within the recommended range in all groups during the first 6 months, but thereafter only in group 3. All groups increased their carbohydrate consumption, with the greatest increase in group 1, which could account for the rapid regain of initially lost body weight in this group. CONCLUSION: At the beginning of a weight management programme in conjunction with orlistat, a low fat intake is advised for an efficient reduction in body weight. Subsequently, in patients with poor long-term weight loss, dietary recommendations must also consider carbohydrate restriction to ensure an adequate hypocaloric diet.

Generalized anxiety disorder and clinical worry episodes in young women.

BACKGROUND: This article presents epidemiological data on the prevalence of DSM-IV generalized anxiety disorder (GAD) and sub-threshold GAD (fulfilling three out of four GAD criteria) in young women together with data on co-morbidity and psychosocial functioning. The prevalence of clinically relevant worry and its predictive validity for the diagnosis of GAD were also examined. METHOD: Young women (N = 2064), aged between 18 and 25, from a representative German community sample were diagnosed with a structured clinical interview (ADIS-L, German research version). An additional interview questioned all the participants about the frequency/intensity and uncontrollability of diverse worry topics. RESULTS: Thirty-seven participants (1.8%) fulfilled the criteria of current GAD (1 week point prevalence) and 56 received a lifetime diagnosis (2.7%); a further 50 participants (2.3%) were diagnosed with sub-threshold GAD. Co-morbidity between GAD and other disorders was high for current (68%) and lifetime GAD (91%). GAD, as well as sub-threshold GAD, showed clearly reduced levels of psychosocial functioning. Whereas worries of low intensity and high controllability were ubiquitous in all subsamples, clinically defined worrying was rarely present in healthy subjects (0.89%) and of adequate predictive accuracy for GAD. CONCLUSIONS: Full GAD and sub-threshold GAD were moderately frequent in young women. Although DSM-IV worry criteria proved to be highly useful, the strictness of the complete GAD-criteria should not lead to absence of attention from subclinical generalized anxiety states in research and practice.

The emotional Stroop effect in anxiety disorders: general emotional or disorder specificity?

Selective attentional biases, often documented with a modified Stroop task, are considered to play an important role in the etiology and maintenance of anxiety. Two competing explanations for these effects are selectivity for highly emotional words in general vs. selectivity for disorder-specific words. We tested these explanations in 32 patients with generalized anxiety disorder (GAD), 29 patients with social phobia (SP), and 31 non-anxious controls. Stimuli were of four kinds: GAD-related words, SP-related words, words with a neutral valence, and words with a positive valence. Different attentional biases were observed: GAD patients were slowed by all types of emotional words, while SP patients were distracted specifically by speech-related words.

Anxious and depressive symptoms in adolescents: epidemiological data of a large scale study in Dresden.

OBJECTIVES: The present large scale epidemiological study was designed to assess the prevalence of mental disorders in adolescents. METHODS: Two cross-sectional studies have been performed in adolescents in Dresden and the results of the examination of 627 high school and 485 secondary school students (mean age 15.5 years) are presented. Self rating procedures like the Beck Depression inventory (BDI) and clinical interviews have been used to enhance validity. RESULTS: The results underline the high prevalence rates of anxiety and depression in adolescents. Up to 30% of the 9th and 10th grades students suffer from mental disorders or are at risk for the development of mental disorders. CONCLUSIONS: Therefore primary prevention of mental disorders is desirable.