Feasibility, acceptability and adaption of dignity therapy: a mixed methods study achieving 360° feedback.

BACKGROUND: Dignity Therapy (DT) is a short-term intervention to reduce psychological suffering in end-of-life care. Its strength lies in evidenced-based development and investigation. The aim of the present study is to investigate the feasibility of DT at German palliative care units (PCU), as well as the acceptability and adaption of a German version of the DT question protocol (DTQP). METHOD: A clinical multicentre mixed methods study, whereby patients and relatives provided quantitative (feedback questionnaires) and qualitative (cognitive interviews) data on the DT intervention. Before using the DTQP on patients, healthcare professionals (HCP) were invited to participate in cognitive interviews to provide input on DT. Therefore 360° feedback was achieved. Finally, the conducted DT interviews were examined. The study took place at two German PCUs (Mainz and Würzburg). Participating HCPs were physicians, psychologists, nurses and chaplains. Patients admitted to the PCUs were eligible to participate if they had a terminal illness and a life expectancy ranging from 2 weeks to 12 months. RESULTS: Out of 410 admitted patients, 72 were eligible and 30 (7.3% of all patients and 41.7% of eligible patients) participated. On average, 9 questions from the DTQP were used per DT interview. Subsequent cognitive interviews with patients produced four main categories of feedback (on the title, the question protocol, wording, and the questions actually asked). Finally, of the 30 participants, 19 completed the feedback questionnaire, as did 26 relatives. Of those, 18 patients and 24 relatives evaluated DT as helpful. CONCLUSIONS: DT is feasible for German PCUs. Our research yielded a validated German translation of the DTQP following EORTC guidelines and findings were reported according to the COREQ checklist for qualitative design. TRIAL REGISTRATION: The study was registered retrospectively on the 22nd of December 2017 at the German Clinical Trials Register ( DRKS00013627 ).

Differentiating anxiety and depression: the State-Trait Anxiety-Depression Inventory.

The differentiation of trait anxiety and depression in nonclinical and clinical populations is addressed. Following the tripartite model, it is assumed that anxiety and depression share a large portion of negative affectivity (NA), but differ with respect to bodily hyperarousal (specific to anxiety) and anhedonia (lack of positive affect; specific to depression). In contrast to the tripartite model, NA is subdivided into worry (characteristic for anxiety) and dysthymia (characteristic for depression), which leads to a four-variable model of anxiety and depression encompassing emotionality, worry, dysthymia, and anhedonia. Item-level confirmatory factor analyses and latent class cluster analysis based on a large nation-wide representative German sample (N = 3150) substantiate the construct validity of the model. Further evidence concerning convergent and discriminant validity with respect to related constructs is obtained in two smaller nonclinical and clinical samples. Factors influencing the association between components of anxiety and depression are discussed.

Incidence of mental disorders in soldiers deployed to Afghanistan who have or have not experienced a life-threatening military incident-a quasi-experimental cohort study.

Introduction: There is very good international research on deployment-related mental disorders in military personnel. The incidence rates show a very wide range. A new strategy is therefore proposed in order to achieve better standardization and thus better comparability of the studies. In addition to a non-deployed comparison group, we propose to compare deployed soldiers with and without critical military incidents during the deployment. This additional distinction makes it possible to differentiate between the influencing variables of actual threat and general deployment stress. Methods: N = 358 male combat soldiers deployed to Afghanistan were included in the study. Clinical interviews were conducted several days before deployment and after deployment. Of them, n = 80 soldiers suffered a life-threatening military incident during deployment, whereas 278 soldiers did not. Odds ratios (OR) were calculated for the groups with and without critical military incidents and the new onset for PTSD, anxiety disorders and depressive disorders. Results: When comparing both groups, we found significantly higher 1-year incidence rates in the group with critical military incidents: 6.4% vs. 1.1% (OR 6.2) for post-traumatic stress disorder (PTSD); 7.0% vs. 1.1% (OR 6.5) for depression; and 15.9% vs. 2.8% (OR 6.6) for anxiety disorders. The 1-year incidence rate of mental multimorbidity (PTSD with anxiety or depression) was 4.8% vs. 0.4% (OR 12.0). Discussion: These results indicate that life-threatening military incidents during military deployment are important to mental health. As the different threat levels of the various missions are taken into account, additional predictors could be determined more precisely in further research.

Age and gender differences in narcissism: A comprehensive study across eight measures and over 250,000 participants.

Age and gender differences in narcissism have been studied often. However, considering the rich history of narcissism research accompanied by its diverging conceptualizations, little is known about age and gender differences across various narcissism measures. The present study investigated age and gender differences and their interactions across eight widely used narcissism instruments (i.e., Narcissistic Personality Inventory, Hypersensitive Narcissism Scale, Dirty Dozen, Psychological Entitlement Scale, Narcissistic Personality Disorder Symptoms from the Diagnostic and Statistical Manual of Mental Disorders, Version IV, Narcissistic Admiration and Rivalry Questionnaire-Short Form, Single-Item Narcissism Scale, and brief version of the Pathological Narcissism Inventory). The findings of Study 1 (N = 5,736) revealed heterogeneity in how strongly the measures are correlated. Some instruments loaded clearly on one of the three factors proposed by previous research (i.e., Neuroticism, Extraversion, Antagonism), while others cross-loaded across factors and in distinct ways. Cross-sectional analyses using each measure and meta-analytic results across all measures (Study 2) with a total sample of 270,029 participants suggest consistent linear age effects (random effects meta-analytic effect of r = -.104), with narcissism being highest in young adulthood. Consistent gender differences also emerged (random effects meta-analytic effect was -.079), such that men scored higher in narcissism than women. Quadratic age effects and Age × Gender effects were generally very small and inconsistent. We conclude that despite the various conceptualizations of narcissism, age and gender differences are generalizable across the eight measures used in the present study. However, their size varied based on the instrument used. We discuss the sources of this heterogeneity and the potential mechanisms for age and gender differences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Individual and Organizational Factors in Coping With COVID-19 in Soldier Students.

The COVID-19 pandemic has posed significant burden across different industrial sectors. Generally, an increase in psychological stress experiences has been reported, while the stress and coping responses of specific, potentially burdened populations have received less attention thus far. Thus, the present study investigated relations between individual (i.e., extraversion, neuroticism, conscientiousness) and organizational (i.e., organizational commitment and study satisfaction) factors, indicators of psychological health (i.e., loneliness, life satisfaction, COVID-19-related stress), and possible mediating effects of four broad coping dimensions (active coping, avoidant coping, social support, positive cognitive restructuring) in a specific sample of soldier students who engage in a double-role being military affiliates and students of non-military subjects. To this end, we assessed data of soldier students at two measurement points (N = 106 at t1 and N = 63 at t2) shortly after the second national lockdown in Germany (20. May 2021 to 11. July 2021) during the COVID-19 pandemic. Personality traits showed expected associations with indicators of psychological health, i.e., positive relations between neuroticism and social loneliness, between extraversion and COVID-19 stress, and negative relations between neuroticism and life satisfaction. Remarkably, organizational variables showed effects above and beyond personality traits on loneliness and life satisfaction. Neither individual, nor organizational factors could predict change in psychological health over time. We found evidence for mediation effects through active coping, avoidant coping, and the use of social support, but not through positive cognitive restructuring. Findings highlight the relative importance of organizational factors besides personality traits for psychological health in a military student sample, holding important implications for designing efficient support systems in the military.

Psychometric Properties of the Mindfulness Inventory for Sport (German Version).

Mindfulness-based training programs are highly established in competitive and recreational sports. One of the best-known approaches is the Mindfulness-Acceptance-Commitment Approach (MAC) by Gardner and Moore), which integrates mindfulness aspects of awareness, non-judgmental attitude, and focus. Based on these aspects, Thienot and colleagues developed and validated an English language sport-specific questionnaire, the so-called Mindfulness Inventory for Sport (MIS), for the assessment of mindfulness skills in athletes. The aim of this study is to psychometrically test a German language version of the MIS (MIS-D). To assess the psychometric properties, the MIS-D was examined in an online survey with an integrated test-retest design (n = 228) for reliability (internal consistency; test-retest reliability), validity (factorial; convergent), and measurement invariance (gender; competition type). The present results support the psychometric quality of the German language version of the MIS. Necessary replications should among others focus on checking the measurement invariance for further relevant subgroups.

Assessment of the histrionic self-presentation style: initial validation of the Polish version of the As-If-Scale.

BACKGROUND: The main research objective was to translate and evaluate the Polish version of the As-If-Scale (AIS) as well as to test the measurement invariance of the Polish and the original (German) versions of the tool, and to analyze the differences in histrionic self-presentation style among Poles and Germans. The AIS consists of 8 items for the subjective assessment of the histrionic self-presentation style which involves behaviors such as playing roles, imitating people or even engaging others in performing small role-plays, and is seen as an individual difference phenomenon. PARTICIPANTS AND PROCEDURE: The psychometric properties of the Polish version were tested in two samples with a total of 762 participants. RESULTS: The article presents the factor structure and reliability of the scale. In addition, the AIS was correlated with measures of the Big Five personality traits, pragmatism and gelotophobia to provide initial validation. Measurement invariance was tested using data collected in this study (Polish sample) and existing and previously published data (German sample). CONCLUSIONS: Overall, the results provide support for the reliability of the scale as its properties are similar to those of the German version. The findings also allow one to make broader cross-cultural comparisons of the histrionic self-presentation style, which includes various types of behavior and is often associated with humor.

Relations of Dispositions toward Ridicule and Histrionic Self-Presentation with Quantitative and Qualitative Humor Creation Abilities.

Previous research has shown that humor and self-presentation are linked in several ways. With regard to individual differences, it turned out that gelotophilia (the joy of being laughed at) and katagelasticism (the joy of laughing at others) are substantially associated with the histrionic self-presentation style that is characterized by performing explicit As-If-behaviors (e.g., irony, parodying others) in everyday interactions. By contrast, gelotophobia (the fear of being laughed at) shows a negative correlation with histrionic self-presentation. In order to further contribute to the nomological network, we have explored whether the three dispositions toward ridicule and laughter as well as histrionic self-presentation are related to humor creation abilities. In doing so, we have assessed the four constructs in a study with 337 participants that also completed the Cartoon Punch line Production Test (CPPT, Köhler and Ruch, 1993, unpublished). In the CPPT, subjects were asked to generate as many funny punch lines as possible for six caption-removed cartoons. The created punch lines were then analyzed with regard to quantitative (e.g., number of punch lines) and qualitative (e.g., wittiness of the punch lines and overall wittiness of the person as evaluated by three independent raters) humor creation abilities. Results show that both gelotophilia and histrionic self-presentation were positively correlated with quantitative and qualitative humor creation abilities. By contrast, gelotophobia showed slightly negative and katagelasticism no associations with the assessed humor creation abilities. These findings especially apply to the subgroup of participants that created punch lines for each of the six cartoons and partly replicate and extend the results of a previous study by Ruch et al. (2009). Altogether, the results of our study show that individual differences in humor-related traits are associated with the quantity and quality of humorous punch lines. It is argued that behavior-related or performative humor creation tasks should be considered in addition to the CPPT in order to open up new avenues that can cross-fertilize research on individual differences in humor and self-presentation.

Are Repeated Self-Reports of Psychological Variables Feasible for Patients Near the End of Life at a Palliative Care Unit?

BACKGROUND: Patient-reported outcome (PRO) measurement is crucial to assess the benefit of psychotherapeutic interventions. Is repeated assessment of psychometric self-report data possible, as inpatient palliative care patients suffer from physical and psychological symptoms? What is the self-perceived strain caused by the assessment? Objective The main objective of this study was to investigate the feasibility of a repeated comprehensive psychometric self-assessment of inpatient palliative care patients. Secondary objectives were the PROs of the psychometric assessment. DESIGN: We conducted a prospective cohort study. Patients admitted to our palliative care unit (PCU) were reviewed for eligibility within 72 hours. They were asked for weekly self-reports regarding hope (HHI-D), well-being (FACIT-Sp), anxiety and depression (STADI), and quality of life (QoL; EORTC-QLQ-C-30 single item). The strain caused by the assessment was assessed by a numeric rating scale (0-10) and free comments. RESULTS: Within 11 months, 219 patients were admitted to the PCU. In total, 92 patients were eligible. The most frequent exclusion criterion was "life expectancy <1 week." A total of 60 patients participated at the first point of measurement. The mean of self-perceived strain (Likert scale 0-10) due to the assessment was 1.44 (SD 1.99) at T1. Twenty-four patients participated twice. Here we found increased scores for physical well-being and QoL. CONCLUSION: Repeated assessment of psychological conditions is feasible for 27.4% of inpatients at a German PCU. The most limiting factor is life expectancy of only days at admission to the PCU. However, the self-perceived strain is low.

Validation of the Narcissistic Admiration and Rivalry Questionnaire Short Scale (NARQ-S) in convenience and representative samples.

Due to increased empirical interest in narcissism across the social sciences, there is a need for inventories that can be administered quickly while also reliably measuring both the agentic and antagonistic aspects of grandiose narcissism. In this study, we sought to validate the factor structure, provide representative descriptive data and reliability estimates, assess the reliability across the trait spectrum, and examine the nomological network of the short version of the Narcissistic Admiration and Rivalry Questionnaire (NARQ-S; Back et al., 2013). We used data from a large convenience sample (total N = 11,937) as well as data from a large representative sample (total N = 4,433) that included responses to other narcissism measures as well as related constructs, including the other Dark Triad traits, Big Five personality traits, and self-esteem. Confirmatory factor analysis and item response theory were used to validate the factor structure and estimate the reliability across the latent trait spectrum, respectively. Results suggest that the NARQ-S shows a robust factor structure and is a reliable and valid short measure of the agentic and antagonistic aspects of grandiose narcissism. We also discuss future directions and applications of the NARQ-S as a short and comprehensive measure of grandiose narcissism. (PsycINFO Database Record

Extended adjuvant therapy with anastrozole among postmenopausal breast cancer patients: results from the randomized Austrian Breast and Colorectal Cancer Study Group Trial 6a.

BACKGROUND: Clinical trial data have shown that among breast cancer patients who were disease free after 5 years of adjuvant treatment with tamoxifen, further extended treatment with the nonsteroidal aromatase inhibitor letrozole reduces breast cancer recurrence. We examined the efficacy and tolerability of extended adjuvant therapy with another aromatase inhibitor, anastrozole, for 3 years among women who had completed 5 years of adjuvant therapy. METHODS: Austrian Breast and Colorectal Cancer Study Group (ABCSG) Trial 6a is an extension of ABCSG Trial 6, in which hormone receptor-positive postmenopausal patients received 5 years of adjuvant tamoxifen, with or without the aromatase inhibitor aminoglutethimide, for the first 2 years of therapy. For ABCSG Trial 6a, patients who were disease free at the end of Trial 6 were randomly assigned to receive either 3 years of anastrozole or no further treatment. Efficacy data were analyzed with the use of a Cox proportional hazards regression model with two-sided P values and Kaplan-Meier curves, and tolerability data were estimated using logistic regression analysis with odds ratios and 95% confidence intervals (CIs). RESULTS: ABCSG Trial 6a included 856 patients. At a median follow-up of 62.3 months, women who received anastrozole (n = 387) had a statistically significantly reduced risk of recurrence (locoregional recurrence, contralateral breast cancer, or distant metastasis) compared with women who received no further treatment (n = 469; hazard ratio = 0.62; 95% CI = 0.40 to 0.96, P = .031). Anastrozole was well tolerated, and no unexpected adverse events were reported. CONCLUSIONS: These data confirm the benefit of extending adjuvant tamoxifen therapy beyond 5 years with anastrozole compared with no further treatment. Further research is required to define the optimum length of extended adjuvant therapy and to investigate the possibility of tailoring this period to suit different disease types.

Technique and long-term results of intersphincteric resection for low rectal cancer.

PURPOSE: Intersphincteric resection of low rectal tumors is a surgical technique extending rectal resection into the intersphincteric space. This procedure is performed by a synchronous abdominoperineal approach with mesorectal excision and excision of the entire or part of the internal sphincter. This study was designed to evaluate the long-term results of this method focused on continence function and oncologic results. METHODS: From 1984 to 2000, a total of 121 patients were operated on. The patients were evaluated prospectively according to a detailed preoperative and postoperative program. RESULTS: One hundred seventeen patients had rectal cancers, two had dysplastic villous adenomas, and two had carcinoid tumors. Cancers were staged according to the Dukes classification (Stage A in 41 percent, Stage B in 28 percent, and Stage C in 31 percent; median distance from the anal margin, 3 (range, 1-5) cm). Postoperative complications were: one death because of pulmonary embolism, 5.1 percent developed an anastomotic fistula, one patient had a fistula to the bladder requiring reoperation, one patient with ileus needed relaparotomy as well as one for intra-abdominal hemorrhage and a small-bowel fistula. One patient developed a fistula after closing the protective colostomy. Five patients developed late strictures of the coloanal anastomosis. After a median follow-up of 72.86 months, 5.3 percent of patients developed local recurrence. The continence status was satisfactory with 16 patients (13.7 percent) showing continence for solid stool only, and 1 patient (0.8 percent) showing episodes of incontinence. A transient problem was a high stool frequency after closure of the protective stoma. CONCLUSIONS: Intersphincteric resection is a valuable procedure for sphincter-saving rectal surgery. We showed that this technique has satisfactory long-term results in functional and oncologic respects. An important prerequisite is a careful preoperative evaluation of local tumor spread with rectal magnetic resonance imaging excluding infiltration of the external sphincter.

TP53 genotype but not p53 immunohistochemical result predicts response to preoperative short-term radiotherapy in rectal cancer.

OBJECTIVE: To evaluate and compare the predictive power of p53 gene analysis versus p53 immunohistochemical staining in terms of response to preoperative short-term radiotherapy using 25 Gy in operable rectal cancer. SUMMARY BACKGROUND DATA: Recent studies show that p53 may be a determinant of radiosensitivity being required for induction of apoptosis in case of radiation-induced DNA damage. METHODS: Preirradiation biopsy samples of 64 patients with rectal carcinoma were analyzed. Genetic alterations of the p53 gene were detected by complete direct sequencing of exons 2 to 10. Expression of the nuclear phosphoprotein p53 was assessed by immunohistochemical staining. Results were correlated with histopathology of resected specimens and follow-up data, respectively. RESULTS: Mutations of the p53 gene were present in 45% of tumors. Patients with a normal p53 gene had a significant survival advantage. Comparing pre- and postradiotherapy T category, a reduction was seen in patients with normal p53 genotype only. A mutant p53 genotype was highly specific in indicating stable disease concerning T category after irradiation. Protein overexpression was detected in 61%. Overexpression of the p53 protein was not related to survival or response. The concordance between immunohistochemistry and sequencing was only 0.51. CONCLUSIONS: The authors show that downstaging after short-term radiation may occur but is seen in tumors with normal p53 gene only. Moreover, p53 genotype but not p53 immunohistochemistry is predictive for response to preoperative short-term radiotherapy and patient survival.