[Assessing Complicated Grief: A Systematic Literature Review]. / Komplizierte Trauer erfassen: Ein systematischer Review.

OBJECTIVE: To give an overview of English and German speaking bereavement measurements for difficulties in the grieving process and complicated grief. METHOD: Systematic literature review. RESULTS: 22 measures were identified. They are categorised into general, specialized and pre-death measurements. All scales proved to have predominantly good psychometric properties. DISCUSSION: Dozens of measures of grieving have been proposed internationally. Only 3 general and 3 specialized scales are available in German language. CONCLUSION: Up to date no scale exists in German language to assess bereavement difficulties prior to death.

Anger Expression Style Predicts the Domain of the First Smoking Relapse After a Quit Attempt.

BACKGROUND: Risk for smoking relapse may be associated with context-dependent social and behavioral cues. However, lack of research examining the role of trait negative mood such as anger in this relationship and assessment of objective indices related to smoking status (e.g., biochemical measures) may limit existing findings. We examined the roles of trait anger, habitual anger expression behavior, and the situation in which the first incident of smoking lapse following a quit attempt occurs. METHODS: One-hundred and five smokers interested in cessation (mean age, SD: 34.7 ± 11.8) set a quit day and attended multiple post-quit assessments where they were asked to provide biochemical measures including exhaled carbon monoxide (CO) and self-report measurements, including smoking status. RESULTS: Eighty-eight participants (40 women) returned to smoking over the 12-month study period. Self-reported smoking status was verified by exhaled CO measurements. Thirty-one percent of participants who relapsed reported the first lapse occurring at home, 15% at work, 14% at a restaurant or a bar, and 8% in a car. Multinomial logistic regression models found that high levels of anger-out were associated with smoking relapse in situations other than work or home (p <.05). CONCLUSIONS: These results expand prior work suggesting habitual anger expression style may moderate associations between situational factors and risk for smoking relapse, highlighting the need to incorporate findings in treatment methods. Absence of gender differences suggests the situational factors explored here affect relapse independent of gender.

Internalizing psychological symptoms in children and adolescents with fructose malabsorption.

Introduction: Due to an inhibited tryptophan resorption, patients with fructose malabsorption are expected to experience decreased serotonin synthesis. A deficiency of serotonin may cause internalizing mental disorders like depression and anxiety, and a fructose-oriented eating behavior may affect these symptoms. Methods: The parents of 24 children and adolescents with a currently diagnosed fructose malabsorption aged 4;00-13;02 years (M = 8.10, SD = 2.05), the parents of 12 patients with a currently confirmed combination of fructose and lactose malabsorption aged 4;00-12;11 years (M = 8.07, SD = 2.11) and the parents of a comparative sample of 19 healthy participants aged 5;00 to 17;07 years (M = 9.06, SD = 3.04) were interviewed. The interviews were conducted using a screening questionnaire of the German "Diagnostic System of Mental Disorders in children and adolescents based on the ICD-10 and DSM-5 DISYPS-III" and a self-developed questionnaire on eating, leisure and sleeping behavior. Results: On standardized scales parents of children with fructose malabsorption reported higher levels of Depression compared to symptoms of Attention-Deficit/Hyperactivity Disorders (ADHD) and Oppositional Defiant and Conduct Disorders (ODD/CD). Compared to healthy controls, for patients with fructose malabsorption, higher symptom levels of Depression and Anxiety were reported. With regard to eating behavior, within the group with a combination of fructose and lactose malabsorption, a strong positive association between an increased fruit sugar consumption and higher levels of Anxiety and Obsessive-Compulsive Disorders/Tics were found. Discussion: These results suggest a close association between fructose malabsorption and elevated internalizing psychological symptoms in children and adolescents.Clinical trial registration:https://drks.de/search/en/trial/DRKS00031047, DRKS-ID [DRKS00031047].

Acculturation Style Is Associated with Stress and Tobacco Use among East African Immigrants.

While tobacco use rates are relatively high among East African immigrants in the U.S., factors contributing to this high rate are largely unknown. Acculturation is associated with stress and substance use. Whether acculturation styles are related to stress and current tobacco use has not been tested among this population. We conducted a cross-sectional study that included 376 East African adults who provided information on demographic background, acculturation style, acculturative stress, depressive symptoms, and tobacco use. Multivariate analysis indicated that individuals who were distant to both the culture of the host country and the culture of origin (marginalization style) had greater levels of acculturative stress than those who adopted both cultures (integration style; p < .001). Marginalized people were four to eight times and assimilated people were three to four times more likely than integration people to be a current tobacco user (p < .04). This relationship did not change after controlling for demographic information and stress. In this study, acculturation style was associated with perceived stress and current tobacco use among East African immigrants. Research focused on characterizing integrated individuals may guide efforts to develop culturally-relevant strategies to reduce tobacco-related disparities among East African individuals.

Acculturation and Anger Expression Among Iranian Migrants in Germany.

Cultural and biographical influences on the expression of emotions manifest themselves in so-called "display rules." These rules determine the time, intensity, and situations in which an emotion is expressed. To date, only a small number of empirical studies deal with this transformation of how migrants, who are faced with a new culture, may change their emotional expression. The present, cross-sectional study focuses on changes in anger expression as part of a complex acculturation process among Iranian migrants. To this end, Iranian citizens in Iran (n = 61), German citizens (n = 61), and Iranian migrants in Germany (n = 60) were compared in terms of anger expression behavior and acculturation strategy (assimilation, separation, integration, marginalization) was assessed among the migrants, using the Frankfurt Acculturation Scale (FRACC). A questionnaire developed in a preliminary study was used to measure anger expression via subjective anger experience and anger expression within 16 hypothetical situations. Multivariate Analyses of Variance (MANOVA) revealed that Iranians and Iranian migrants reported higher anger experience ratings than Germans and directed their anger more often inward (anger-in). Further findings suggest that transformation processes may have affected Iranian migrants in terms of suppressed anger (anger-in): Iranian migrants with a higher orientation toward German culture reported lower average anger-in scores. These results suggest that there was different emotional expression among Iranian migrants, depending on their acculturation. The results provide new insight into socio-cultural and individual adjustment processes.

Urbanicity, behavior problems and HPA axis regulation in preschoolers.

Growing up in cities is associated with increased risk for developing mental health problems. Stress exposure and altered stress regulation have been proposed as mechanisms linking urbanicity and psychopathology, with most research conducted in adult populations. Here, we focus on early childhood, and investigate urbanicity, behavior problems and the regulation of the hypothalamus-pituitary-adrenal (HPA) axis, a central circuit of the stress system, in a sample of N = 399 preschoolers aged 45 months. Urbanicity was coded dichotomously distinguishing between residences with more or less than 100,000 inhabitants. Behavior problems were measured using the Child Behavior Checklist (CBCL) 1½ - 5. Cortisol stress reactivity was assessed using an age-appropriated game-like stress task, and cortisol in the first morning urine was measured to assess nocturnal HPA axis activity. Urbanicity was not associated with behavior problems, urinary cortisol or the cortisol stress response. Neither urinary cortisol nor salivary cortisol response after stress exposure were identified as mediators of the relationship between urbanicity and behavior problems. The findings suggest no strong association of urbanicity with behavior problems and HPA axis regulation in preschool age. To our knowledge, this is the youngest sample to date studying the relationship between urbanicity and behavior problems as well as HPA axis regulation. Future research should examine at which age associations can first be identified and which mechanisms contribute to these relationships.

Khat use and trait anger: effects on affect regulation during an acute stressful challenge.

Khat (Catha edulis) is a widely used stimulating drug often consumed in daily routine in Yemen and East African countries. Chewing khat acutely elicits states of euphoria and feelings of well-being which later shift into emotional instability and low mood. Little is known about emotional regulation in habitual khat chewers. In this study, we compared self-reports on trait anger as well as positive and negative affect responses to a mental arithmetic challenge. Participants included 135 men and women from Yemen who chew khat regularly, occasionally or not at all. Participants attended a laboratory session that involved resting periods and performing a math challenge. Analyses of variance and regression show that regular khat chewing is associated with higher trait anger, more pronounced negative responses during stress and less pronounced positive emotional states. These results suggest that regular khat chewing is associated with disturbances in emotion regulation processes.

Evaluation of a domain-specific anger expression assessment strategy.

Previous studies have shown that self-reports of an individual's anger expression vary between the home and the work domain. The aim of this study was to investigate the validity of such self-reports by comparing them with reports of intimate partners and work colleagues in the respective domain. Participants (N= 86) rated their anger expression on the general and on domain-specific versions of the State-Trait-Anger Expression Inventory (Spielberger, 1988). The self-rated anger-out-home scores correlated highly with partner ratings of anger-out-home scores (r = .61) and colleague ratings of anger-out-work scores correlated substantially with self-rated anger-out-work scores (r = .54). A similar but weaker correlation pattern emerged for anger control but not for anger-in. Self-other correspondence was higher for the domain-specific anger expression assessment than for the general anger expression assessment. These results demonstrate that the domain-specific strategy for the assessment of self-reported anger expression can validly measure differences in anger expression in different domains.

[Bereavement care in Germany: Framework for a stepped care model]. / Trauerversorgung in Deutschland. Entwurf eines gestuften Versorgungsmodells.

The loss of a loved one can have serious health implications. In Germany, however, bereavement care services often provide support regardless of risk or need. A structural framework within which these services are provided systematically and which enables the establishment of qualitative standards throughout Germany has not yet been proposed. A British stepped care model for professionalized bereavement support is actually being discussed internationally. In this paper the British model is adapted to the German context in order to improve nationwide bereavement care services.

Development and preliminary validation of the Emotions while Learning an Instrument Scale (ELIS).

Learning to play a musical instrument is associated with different, partially conflicting emotions. This paper describes the development and psychometric properties of the Emotions while Learning an Instrument Scale (ELIS). In a longitudinal study with 545 German elementary school children factorial structure and psychometric properties were evaluated. Exploratory and confirmatory factor analyses confirmed a two-factor solution measuring Positive musical Emotions while Learning an Instrument (PELI) and Negative Emotions while Learning an Instrument (NELI). Both subscales yielded scores with adequate internal reliability (Cronbach's α = .74, .86) and relatively stable retest reliabilities over 18 months (r = .11 -.56). Preliminary evidence of congruent and divergent validity of the subscales is provided. Implications for future research of musical emotional experiences in children are discussed.

The Relationship of Acculturation, Traumatic Events and Depression in Female Refugees.

Recent research has identified significant correlations between traumatic events and depression in refugees. However, few studies have addressed the role of acculturation strategies in this relationship. This study explored the relationship between cultural orientation, traumatic events and depression in female refugees from Syria, Afghanistan, Eritrea, Iran, Iraq, and Somalia living in Germany. We expected acculturation strategies to moderate the effect of traumatic experiences on depression. The sample included 98 female refugees in Germany. The depression scale of the Hopkins Symptom Checklist (HSCL) represented the dependent measure. The trauma checklists derived from the Post-traumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ) as well as the Frankfurt Acculturation Scale (FRACC) were used as independent measures for traumatic events and orientation toward the host culture as well as orientation toward the culture of origin, respectively. A moderation analysis was conducted to examine whether the relationship between the number of traumatic events and depression was influenced by the women's orientation toward the culture of origin and the host culture. We identified a significant model explaining 26.85% of the variance in depressive symptoms (Cohen's f2 = 0.37). The number of traumatic events and the orientation toward the host culture exerted significant effects on depressive symptoms. The moderating effect was not significant, indicating that the effect of the number of traumatic events was not influenced by cultural orientation. Based on our results, orientation toward the host culture as well as traumatic experiences exert independent effects on depressive symptoms in refugees.

Attractiveness Ratings for Musicians and Non-musicians: An Evolutionary-Psychology Perspective.

From an evolutionary perspective, musical behavior such as playing an instrument can be considered as part of an individual's courting behavior. Playing a musical instrument or singing might fulfill a function similar to that of a bird's colored feathers: attracting attention. Therefore, musicians may be rated as more attractive than non-musicians. In an online survey, 137 volunteers (95 female) with ages ranging from 16 to 39 years rated the attractiveness of fictitious persons of the opposite sex described in short verbal profiles. These profiles differed with respect to whether the described person made music or not. Additionally, the musicians' profiles varied with regard to whether the described person played music or sang in public or in private only. Results show that musicians' profiles were not generally rated as more attractive than non-musicians', but attractiveness did vary according to setting: private musicians were rated as most attractive, followed by non-musicians and public musicians. Furthermore, results indicate that participants who played a musical instrument or sang themselves gave higher ratings to profiles of musicians. But for participants who do not make music themselves, higher attractiveness ratings for musicians playing instruments or sing in private settings were found. These results indicate that the impression of sharing a common interest (making music) and furthermore making music in private instrumental settings seems to make people attractive to other people. No additional support for the sexual selection hypotheses for the evolution of music was provided by the current results. The musical status of the rater affected his or her judgements, with musicians rating other people as more attractive if they share the common interest in making music. Not the display of being a musician seems to be critical for attractiveness ratings but the perceived or imagined similarity by the rater created by information on musicality, fostering the theoretical significance of the communication aspect of music.

Comparing Attachment Networks During Middle Childhood in Two Contrasting Cultural Contexts.

Cultural psychology assumes that the ecocultural conditions of a particular setting shape children's pathways, resulting in multiple adaptive solutions to universal developmental tasks. While the adaptivity of attachment and children's psychosocial development during the early years has been thoroughly investigated, attachment research during middle childhood continues to reflect Western ideals of family. Adhering to ideas of monotropy, most studies only focus on parental attachment figures. However, this restricted empirical perspective does not only result in a Eurocentric bias, it also neglects theoretical reflections on the growing complexity of attachment during middle childhood, thus only considering a limited selection of all individuals contributing to the children's feeling of security, even in Western settings. To investigate the variability and adaptivity of attachment during middle childhood, this study assessed children's attachment figures in two extreme settings of development, introducing an exhaustive network perspective on attachment during this developmental stage. Children of the Cameroonian Nseh (N = 11) and German children from Bad Nauheim (N = 11) identified and differentiated all individuals contributing to their attachment need in an exploratory and transdisciplinary approach. The socio-structural composition of children's attachment networks follows the context-specific systems of care and concepts of interconnectedness and the ecological features of each setting, resulting in marked differences between both contexts. The functional composition, however, reflects children's preoccupation with similar developmental challenges across settings. Same-aged peers contribute to the children's feeling of safety in both settings, thereby deviating from previous reflections on their subordinate relevance during middle childhood. Overall, these results support the adaptiveness of children's attachment patterns while also demonstrating universal trends across contexts. They highlight the collective nature of attachment during middle childhood that exceeds the impact of individual dyads. Thus, broad and context-sensitive research strategies become a necessary addition to attachment research in order to generate an exhaustive understanding for children's development across cultural contexts.

Anger and psychobiological changes during smoking abstinence and in response to acute stress: prediction of smoking relapse.

Nicotine may be used to manage negative emotions, and recent research suggests that smokers with high levels of hostility may use cigarettes to cope with anger provoking situations. This study evaluated the extent to which a high level of trait anger is associated with risk for relapse among smokers interested in cessation. Chronic smokers with different levels of trait anger provided reports of withdrawal symptoms, craving, and state anger, and collected saliva samples for cortisol during 24-hour ad libitum smoking and the first 24-hour abstinence period of a quit attempt. They also attended a laboratory session conducted after the 24-hour abstinence during which they performed brief mental and social stress challenges and provided blood samples for adrenocorticotropin (ACTH) and cortisol assays. High trait anger was associated with greater increases in state anger, withdrawal symptoms, and craving during the first 24 h of abstinence. It was also associated with greater ACTH concentrations during the laboratory session. High trait anger was also associated with increased risk for early relapse. The findings support the hypothesis that smokers high in anger trait may have greater mood difficulties during abstinence and may be more vulnerable to early relapse than smokers with low anger trait.

Psychometric Examination of an Arabic Version of the State-Trait Anger Expression Inventory.

OBJECTIVES: This study aimed to examine the psychometric properties of an Arabic version of the trait anger and anger expression scales of the State-Trait Anger Expression Inventory (STAXI). METHODS: This study took place between April 2005 and August 2014. Adults in Yemen (n = 334) and Tunisia (n = 200) were recruited from university campuses and a smoking cessation clinic, respectively. The STAXI was translated into Arabic using back-translation methods. An explanatory principal component analysis was conducted to explore the factor structure of the anger expression scale, utilising parallel analyses to determine the number of retained factors. RESULTS: Good internal consistency of the trait anger scale was observed among the Yemeni (Cronbach's alpha = 0.76) and Tunisian (Cronbach's alpha = 0.86) samples. The parallel analysis suggested a three-factor solution for the anger expression scale (anger in, anger out and anger control), in accordance with the original STAXI. The internal consistency of anger in, anger out and anger control factors ranged between 0.51-0.79 in the Yemeni sample and 0.66-0.81 in the Tunisian sample. Overall, items loaded on the anger control factor included all items proposed by the original authors and this factor had higher reliability than the other two factors in both samples. CONCLUSION: The results of the current study provide initial support for the use of the trait anger and anger expression scales of the STAXI in Arabic-speaking countries.

Domain-specific anger expression and blood pressure in an occupational setting.

OBJECTIVE: The purpose of the present study was to extend a previous work in a sample of American undergraduates demonstrating the effects of situational factors on reported anger expression behavior and blood pressure. METHOD: General and domain-specific anger expression behavior and subjective work stress were assessed in 218 nurses from the Frankfurt am Main metropolitan area using the original and three altered versions of the State Trait Anger Expression Inventory (STAXI) and the Job Stress Survey (JSS). The altered versions of the STAXI asked for individuals' anger expression at home, during free time, and at work. Blood pressure and heart rate (HR) were measured in the field during working breaks. RESULTS: Women had higher scores on anger-out and lower on anger-control in the original and in the home version of the STAXI, but no sex difference was found in the work version. Participants scoring high on anger-out at work displayed elevated blood pressures and HR compared with those scoring low on this scale. High job stress was associated with greater reports of anger-in and anger-out behavior. CONCLUSION: The results suggest that the way people express stress at their work place might be an important factor in determining the impact of experienced stress on cardiovascular health.

Khat chewing and acculturation in East-African migrants living in Frankfurt am Main/Germany.

ETHNOPHARMACOLOGICAL RELEVANCE: Khat (Catha edulis, Forsk) is a drug widely used in countries around the Red Sea (East-Africa and Arabian Peninsula). In Germany khat chewing is illegal but nevertheless an often observed habit in immigrants from this region. This study investigates the interrelation between immigrants acculturation processes and traditional khat chewing habits. MATERIALS AND METHODS: Sixty-one khat chewers (14 female) from East-African countries were interviewed about their khat chewing habits and acculturation strategy using standardized questionnaires. RESULTS: Results indicate that immigrants׳ khat chewing behaviors are similar to what is common in countries with traditional khat use. But khat chewing tended to be less among immigrants who were relatively more oriented towards their cultures of origin. Chewing khat was subjectively considered to help coping with problems, to forget bad memories and to concentrate better. CONCLUSIONS: It was concluded that khat chewing serves a functional use of coping with stressful events in the present or in the past within this sample.

Acculturation and cardiovascular reactivity of second-generation Turkish migrants in Germany.

OBJECTIVE: Previous studies have shown that migration and acculturation lead to higher blood pressures and a higher prevalence of cardiovascular diseases. Heightened cardiovascular reactivity is considered as a risk factor for cardiovascular diseases. Therefore, the purpose of the present study was to examine cardiovascular reactivity in young and healthy second-generation Turkish migrants to Germany. METHOD: Forty-one Turkish and 20 German male students worked on a mental arithmetic task for 6 min and underwent the cold pressor test for 90 s. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were taken in intervals of 2 min at baseline and during task periods. Stroke volume (SV), cardiac output (CO), preejection period (PEP), and total peripheral resistance (TPR) were registered continuously by impedance cardiography. The Turkish volunteers were divided into weak and advanced acculturated migrants based on self-ratings given in a questionnaire. RESULTS: Advanced acculturated Turkish students showed greater HR and CO increases and greater PEP and TPR decreases to the mental arithmetic task than Germans or weak acculturated Turkish students. No group differences were found for the cold pressor test. CONCLUSION: Migrants' acculturation is associated with an enhanced beta-adrenergic activation pattern of the sympathetic nervous system that might put them at greater risk with regards to essential hypertension and coronary heart disease.

Effects of a school-based instrumental music program on verbal and visual memory in primary school children: a longitudinal study.

This study examined the effects of a school-based instrumental training program on the development of verbal and visual memory skills in primary school children. Participants either took part in a music program with weekly 45 min sessions of instrumental lessons in small groups at school, or they received extended natural science training. A third group of children did not receive additional training. Each child completed verbal and visual memory tests three times over a period of 18 months. Significant Group by Time interactions were found in the measures of verbal memory. Children in the music group showed greater improvements than children in the control groups after controlling for children's socio-economic background, age, and IQ. No differences between groups were found in the visual memory tests. These findings are consistent with and extend previous research by suggesting that children receiving music training may benefit from improvements in their verbal memory skills.