Tension and disordered eating behaviors in the daily lives of adolescents and young adults from the general population: Associations and moderating role of trait emotion regulation.

Experiences of tension and difficulties in emotion regulation have been linked to eating pathology in clinical samples and are targeted in respective treatment approaches. The present study aimed to investigate the impact of tension on engagement in disordered eating behaviors (DEBs) and potential moderating effects of trait emotion regulation in young people from the general population. A subsample of 971 adolescents and young adults from an epidemiological cohort study reported on levels of tension and four different DEBs (skipping eating, restrained eating, eating large amounts of food, loss-of-control-eating) via ecological momentary assessment (EMA), as well as on trait emotion regulation via questionnaire. In multilevel models, momentary tension did not predict levels of subsequent DEBs. However, higher average levels of tension across the EMA period predicted higher levels of all DEBs. No interactions with emotion regulation emerged. Individuals experiencing overall higher levels of tension appear to be more prone to engaging in DEBs.

Hair androgen concentrations and depressive disorders in adolescents from the general population.

Although the link between androgens and depression is well established in adults, the effects of cofactors on this association are less clearly understood, particularly in youth. Epidemiological cohort study of adolescents in Dresden, Germany. Analyses comprised data of 985 individuals assessed at baseline and of 512 individuals at 1-year follow-up. We investigated multivariable regression models for cross-sectional and longitudinal associations of hair testosterone, dehydroepiandrosterone (DHEA), and their cortisol ratios with 12-month diagnoses of major depressive disorder (MDD) and MDD without any anxiety disorder assessed with standardized diagnostic interview (DIA-X-5), and with dimensional depression scores (PHQ-9, PROMIS), separately for males and females. The potential moderating effect of social support was determined. Cross-sectional analyses yielded inverse associations of testosterone and DHEA with MDD and MDD without any anxiety disorders in males. In cross-sectional and longitudinal analyses, baseline ratio cortisol/DHEA was significantly, inversely associated to PROMIS-depression in males. Only cross-sectional associations for ratio cortisol/DHEA and PROMIS-depression remained significant after Bonferroni-Holm correction. No robust associations were observed in female participants. Social support exerted no consistent moderating effect on the investigated association. The present observational cohort study showed no consistent association of hair androgen concentrations with depressive disorders in adolescents. However, findings provide some support for the association between the cortisol/DHEA ratio and depression in males. Longitudinal research designs in large samples are needed to understand the interplay between androgens, depression, and developmental and social factors in youth.

Applied relaxation and cortisol secretion: findings from a randomized controlled indicated prevention trial in adults with stress, anxiety, or depressive symptoms.

Previous research has shown that relaxation interventions can reduce distress, anxiety, and depression. The exact mechanisms that underlie the efficacy of relaxation interventions remain unresolved. This study aimed to investigate whether applied relaxation (AR) leads to changes in cortisol secretion and whether these effects mediate fewer symptoms due to AR. Data come from a randomized controlled preventive interventional trial (N = 277) with elevated tension/distress, anxiety, or depressive symptomatology. Participants were randomized to an intervention group (IG; n = 139, received AR training), or a non-interventional control group (CG, n = 138). Psychopathological symptoms were assessed with DASS-21 and diagnoses of mental disorders via DIA-X-5. Cortisol was measured as short-term index in saliva (six times/d for 2 d at pre-, post-, and follow-up [FU] assessment) and long-term index in hair samples (once at pre-assessment and FU, respectively). Data were analyzed as pre-specified secondary analyses of the randomized controlled trial (RCT) on completer basis (n = 134 CG, n = 102 IG), using multivariable-adjusted linear regression models and mediation analyses (the DASS-21 change in the IG vs. CG with cortisol (area under the curve [AUC]) as mediator). From pre- to post-assessment, total daily salivary cortisol (AUC) decreased more strongly in the IG vs. CG (ß-coefficient: -13.83, 95% confidence interval [CI]: -26.85 to -0.81), but was rendered non-significant when adjusting for pre-assessment AUC. This effect was not found for the cortisol awakening response (CAR) or hair cortisol. There was no evidence for a mediation of cortisol (AUC). These findings provide little support for the idea that cortisol reductions explain the beneficial effects of AR on mental health.

How current and past anxiety disorders affect daily life in adolescents and young adults from the general population-An epidemiological study with ecological momentary assessment.

BACKGROUND: Prior research indicated, based on retrospective assessments of symptomatology, that 25% of individuals with "remitted" anxiety disorders (AD) experience a relapse. The present study used ecological momentary assessment (EMA) to examine how ADs affect everyday life among community adolescents and young adults with current or remitted AD compared to healthy controls and to each other. METHODS: Data come from the baseline assessment of the epidemiological Behavior and Mind Health study, conducted in Dresden (Germany) from 11/2015-12/2016. The sub-sample analyzed (n = 648, age 14-21) consisted of 65 participants with current DSM-5 AD-diagnosis, 52 participants with lifetime AD-diagnosis but not within the last 6 months (remitted), and 531 healthy controls (no psychopathology; healthy controls [HC]). EMA of various constructs took place 8 times a day for 4 days. RESULTS: The highest levels of symptoms were reported by those with current AD, followed by remitted AD and HC. Regression analyses revealed significantly worse mood, self-efficacy, quality of life and sleep-quality and more experiential avoidance, stress, negative thoughts and pessimism in remitted and current AD compared to HC. Current AD additional differed significantly from HC in optimism and positive thoughts. Furthermore, individuals with remitted AD without comorbidities differed significantly from HC on five out of 16 constructs. CONCLUSION: Not only current but also remitted AD is associated with diverse negative experiences in everyday life, which cannot merely be explained by comorbidities. As the remaining burden and impairment in individuals with remitted AD might contribute to relapse, interventions might be targeted to improve mental health.

The interaction of 5-HTT variation, recent stress, and resilience on current anxiety levels in adolescents and young adults from the general population.

BACKGROUND: Previous work on gene-environment (GxE) interplay concerning anxiety has focused on the interaction of 5-HTTLPR with childhood adversities or traumatic events whereas the impact of recent stressors is understudied, as is the integration of resilience. The current study aimed to investigate the interactive effect of 5-HTTLPR and recent stress on anxiety in adolescents considering resilience as buffer of a GxE risk constellation. METHOD: In a random population-based sample of 14-21 years old from Dresden, Germany, (N = 1180; genotyped = 942) recent stress (Daily Hassles [DH] Scale, Perceived Stress Scale, Screening Scale of the Trier Inventory for the Assessment of Chronic Stress), resilience (Connor-Davidson resilience scale) and anxiety (Patient Reported Outcome Measurement Information System Anxiety Short Form) were assessed via questionnaire in 2015 or 2016. RESULTS: Fractional regression models revealed that resilience interacted with recent stress in form of DH as well as recent chronic stress and 5-HTTLPR regarding anxiety. Participants carrying the more active LA LA genotype reported consistently higher levels of anxiety when experiencing more DH or more recent chronic stress and having low levels of resilience. When the resilience scores were high, LA LA carriers reported the lowest anxiety scores despite DH or recent chronic stress. CONCLUSION: Findings revealed an interactive relationship between 5-HTTLPR genotype and recent stress suggesting resilience to function as an additional dimension buffering the impact of a GxE risk constellation. Early interventions to build resilience may be useful to prevent an escalation of distress and associated unfavorable health outcomes.

Correction to: Test-retest reliability of the computer-assisted DIA-X-5 interview for mental disorders.

An amendment to this paper has been published and can be accessed via the original article.

Test-retest reliability of the computer-assisted DIA-X-5 interview for mental disorders.

BACKGROUND: There is a need of comprehensive standardized diagnostic assessment tools of psychopathology that match recent changes in diagnostic classification systems, such as the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Therefore, the computer-assisted DIA-X-5 was developed and its test-retest reliability was explored. The DIA-X-5 is based on the DIA-X/M-CIDI (Diagnostisches Expertensystem für psychische Störungen/Munich-Composite International Diagnostic Interview) which referred to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). METHODS: A convenience sample (N = 60, age: 15-67) was interviewed twice with the computer-assisted DIA-X-5 interview, on average nine days apart, by trained and blinded interviewers. The DIA-X-5 is a standardized instrument for research purposes covering symptoms, syndromes and diagnoses from eleven classes of mental disorders according to the DSM-5 with matching F codes of the 10th edition of the International Classification of Diseases (ICD-10). RESULTS: Kappa values ranged from 0.90 for post-traumatic stress disorder to 0.30 for social anxiety disorder. For age of onset and age of recency, test-retest reliability as measured by intra-class correlation was satisfying with values above 0.90 for most disorders. CONCLUSIONS: Test-retest reliability of the DIA-X-5 syndromes and diagnoses were comparable to those of previous DSM-IV/DIA-X diagnoses for most disorders. Due to low case numbers for some diagnoses, further research in larger samples is required.

Obesity and Abdominal Fat Markers in Patients with a History of Stroke and Transient Ischemic Attacks.

BACKGROUND: Abdominal obesity is a well-recognized cardiovascular risk factor. Conflicting data concerning its significance with respect to stroke have been discussed in recent years. The objective of this study was to analyze the association between anthropometric parameters and the risk of stroke and transient ischemic attacks (TIAs) in German primary care. METHODS: Patient recruitment in this large-scale epidemiological study was performed in 3188 representative primary care offices in Germany. Among 6980 study participants, 1745 patients with a history of stroke or TIA were identified and matched for age and gender with 5235 regional controls. Associations between standard anthropometric measures such as body mass index (BMI), waist-to-hip ratio, waist circumference, waist-to-height ratio, and cerebrovascular risk were investigated using logistic regression analysis with adjustment for age, gender, and vascular risk factors. RESULTS: BMI showed no significant associations with the risk of stroke or TIA in any of the applied mathematical models. Markers of abdominal obesity were associated with an increased risk of stroke or TIA in the unadjusted model (waist circumference: odds ratio [OR] 1.15; 95% confidence interval [CI], 1.00-1.32; waist-to-hip ratio: OR 1.21; 95% CI, 1.05-1.38; waist-to-height ratio: OR 1.25; 95% CI, 1.09-1.44, comparisons between top and bottom tertiles). After adjustment for vascular risk factors, all associations were insignificant. CONCLUSIONS: Abdominal obesity is a stronger predictor of risk of stroke or TIA than BMI. However, the association between abdominal obesity and the risk of stroke or TIA is not independent of other vascular risk factors. Stroke-related weight changes should be considered in longitudinal studies examining the role of obesity in cerebrovascular disease.

General practitioners recognizing alcohol dependence: a large cross-sectional study in 6 European countries.

PURPOSE: Although alcohol dependence causes marked mortality and disease burden in Europe, the treatment rate is low. Primary care could play a key role in reducing alcohol-attributable harm by screening, brief interventions, and initiating or referral to treatment. This study investigates identification of alcohol dependence in European primary care settings. METHODS: Assessments from 13,003 general practitioners, and 9,098 interviews (8,476 joint number of interviewed patients with a physician's assessment) were collected in 6 European countries. Alcohol dependence, comorbidities, and health service utilization were assessed by the general practitioner and independently using the Composite International Diagnostic Interview (CIDI) and other structured interviews. Weighted regression analyses were used to compare the impact of influencing variables on both types of diagnoses. RESULTS: The rate of patients being identified as alcohol dependent by the CIDI or a general practitioner was about equally high, but there was not a lot of overlap between cases identified. Alcohol-dependent patients identified by a physician were older, had higher rates of physicial comorbidity (liver disease, hypertension), and were socially more marginalized, whereas average consumption of alcohol and mental comorbidity were equally high in both groups. CONCLUSION: General practitioners were able to identify alcohol dependence, but the cases they identified differed from cases identified using the CIDI. The role of the CIDI as the reference standard should be reexamined, as older alcohol-dependent patients with severe comorbidities seemed to be missed in this assessment.

People with alcohol use disorders in specialized care in eight different European countries.

AIM: To provide a description of patients receiving alcohol treatment in eight different European countries, including the level of comorbidities and functional limitations. METHODS: Drinking behaviours, DSM-IV alcohol use disorder (AUD), mental and somatic comorbidities, disability and health services utilization of 1767 patients from various specialized treatment settings were assessed as representative for regions of eight European countries. Severity of alcohol dependence (AD) in terms of drinking level was compared with a large representative US sample. RESULTS: Patients in specialized care for AUDs showed high levels of consumption [average level of daily ethanol intake: 141.1 g, standard deviation (SD): 116.0 g], comorbidity [e.g. liver problems: 19.6%, 95% confidence interval (CI): 17.5-21.6%; depression: 43.2%, 95% CI: 40.7-45.8%; anxiety: 50.3%, 95% CI: 47.8-52.9%], disability and health services utilization (average number of nights spent in hospital(s) during the last 6 months: 8.8, SD: 19.5 nights). Severity of AD was similar to the US sample, but European men consumed on average more alcohol daily. CONCLUSIONS: High levels of consumption, somatic and mental comorbidities, disability and functional losses were found in this representative treatment sample, indicating that treatment was initiated only at severe stages of AUDs. Earlier initiation of treatment could help avoid some of the health and social burden.

Associations of anxiety disorders, depressive disorders and body weight with hypertension during pregnancy.

The purpose of this study was to prospectively examine the relationships between maternal DSM-IV-TR anxiety disorders, depressive disorders, and body mass index (BMI) with arterial hypertension and blood pressure during pregnancy. In the Maternal Anxiety in Relation to Infant Development (MARI) study, N = 306 women were enrolled in early pregnancy and repeatedly assessed during peripartum period. DSM-IV-TR anxiety and depressive disorders prior to pregnancy, lifetime anxiety/depression liability, and BMI during early pregnancy were assessed with the Composite International Diagnostic Interview for Women (CIDI-V). Based on their prepregnancy status, all participants were assigned to one of the following initial diagnostic groups: no anxiety nor depressive disorder (no AD), pure depressive disorder (pure D), pure anxiety disorder (pure A), and comorbid anxiety and depressive disorder (comorbid AD). Blood pressure measurements were derived from medical records. Arterial hypertension during pregnancy was defined by at least two blood pressure values ≥140 mmHg systolic and/or ≥90 mmHg diastolic. N = 283 women with at least four documented blood pressure measurements during pregnancy were included in the analyses. In this sample, N = 47 women (16.6 %) were identified with arterial hypertension during pregnancy. Women with comorbid AD (reference group: no AD) had a significantly higher blood pressure after adjustment for age, parity, smoking, occupation, household income, and education (systolic: linear regression coefficient [ß] = 3.0, 95 % confidence interval [CI] = 0.2-5.7; diastolic, ß = 2.3, 95 % CI = 0.1-4.4). Anxiety liability was associated with an increased risk of hypertension (odds ratio [OR] = 1.1, 95 % CI = 1.0-1.3) and a higher systolic blood pressure (ß = 0.4, 95 % CI = 0.0-0.7). The adjusted interaction model revealed a significant interaction between the diagnostic group pure A and BMI for hypertension (ORIT = 1.5, 95 % CI = 1.1-2.1). Especially, women with a lifetime history of comorbid anxiety and depression and obese pregnant women with a lifetime history of pure anxiety disorder should be informed about their heightened risk of hypertension, monitored with regular blood pressure measurements, and provided with strategies for prevention and early intervention such as changes in diet and physical activity.

Predictions get tougher in older individuals: a longitudinal study of optimism, pessimism and depression.

PURPOSE: To examine whether optimism/pessimism reliably predicts depression and whether such function is stable also in older age. METHOD: In a prospective study, we observed a representative sample of n = 4,046 primary care patients over 5 years. The Life Orientation Test (LOT-R, measuring optimism/pessimism) and the Depression-Screening Questionnaire were applied. Medical diagnoses were recorded by the treating physician in a structured medical interview. RESULTS: Depression could only be predicted by LOT-R scores in younger-age cohorts. In older adults, test stability and predictive accuracy of optimism/pessimism were markedly reduced, while somatic comorbidity gained importance as a predictor. CONCLUSIONS: Predictive value of screening measures for mental disorders may be specific in older age due to lower trait stability and age-specific psychometric limitations as well as age-related changes in relevant predictors.

Dynamics of affect, cognition and behavior in a general population sample of adolescents and young adults with current and remitted anxiety disorders: An Ecological Momentary Assessment study.

BACKGROUND: Measures of dynamic changes in affect/emotions (variability, instability, inertia) have been linked to anxiety disorders (AD). We examine dynamics in affect, cognition and behavior in youth with current and remitted AD. METHODS: Mental disorders were assessed in a general population sample (N = 1180, age 14-21; Dresden, Germany) using standardized interview. Ecological Momentary Assessment of real-life affect, cognition and behavior took place eight times/day for four days. RESULTS: Individuals with current AD (n = 65) compared to healthy controls (HC, n = 531) revealed heightened variability of anxious and manic symptomatology, experiential avoidance, optimism and positive thoughts. Remitted AD (n = 52) showed lower variability of anxious and manic symptomatology and positive thoughts compared to current AD, while no differences were found compared to HC. Current AD and HC differed significantly in instability. Remitted AD showed lower instability of all constructs except for anger than current AD, and higher instability on all constructs except for positive and negative thoughts compared to HC. Current AD showed higher inertia of anger and negative thoughts than HC, and less inertia of positive thoughts than remitted AD. DISCUSSION: AD in youths is particularly linked to higher variability and instability of intertwined emotion-related experiences that partly persist after remission, informing emotion regulation models and interventions.

Ecological momentary assessment and applied relaxation: Results of a randomized indicated preventive trial in individuals at increased risk for mental disorders.

Applied Relaxation (AR) is an established behavioral mental health intervention, but its efficacy in real life contexts remains unclear. Using randomized controlled trial data, we examined whether AR can effectively reduce mental health problems in daily life. A sample of 277 adults with increased psychopathological symptoms but without 12-month DSM-5 mental disorders at study entry was randomly assigned to an intervention group receiving AR training (n = 139) and an assessment-only control group (n = 138). Ecological momentary assessments were used to assess psychological outcomes in daily life over a period of seven days at baseline, post, and 12-month follow-up, respectively. Multilevel analyses indicated that all psychopathological symptoms decreased more in the intervention group than in the control group from baseline to post (range ß = -0.31 for DASS-depression to ß = -0.06 for PROMIS-anger). However, from post to follow-up, psychopathological symptoms decreased more in the control group than in the intervention group, so that only the intervention effects for PROMIS-depression (ß = -0.10) and PROMIS-anger (ß = -0.09) remained until follow-up. Moreover, positive affect (ß = 0.19), internal control beliefs (ß = 0.15), favorable coping (ß = 0.60), and unfavorable coping (ß = -0.41) improved more in the intervention group than in the control group, and these effects were mostly maintained in the long term. Some effects were stronger among women, older individuals, and individuals with higher initial symptoms. These findings suggest that AR can effectively reduce mental health problems in daily life. Trial registration. The trial has been registered at ClinicalTrials.gov (NCT03311529).

Clinical aspects and targeted inspiratory muscle training in children and adolescents with Fontan circulation: a randomized controlled trial.

Background: Since 1968, thousands of patients with a morphologically or functionally univentricular heart have been treated with a total cavopulmonary connection/Fontan operation. Because of the resulting passive pulmonary perfusion, blood flow is assisted by the pressure shift during respiration. Respiratory training is known to improve exercise capacity and cardiopulmonary function. However, there are limited data on whether respiratory training can also improve physical performance after Fontan surgery. The aim of the present study was to clarify the effects of six months of daily home-based inspiratory muscle training (IMT) aimed at increasing physical performance by strengthening respiratory muscles, improving lung function and peripheral oxygenation. Methods: In this non-blinded randomized controlled trial, the effects of IMT on lung capacity and exercise capacity were measured in a large cohort of 40 Fontan patients (25% female; 12.3±2.2 years) who were under regular follow-up by the outpatient clinic of the Department of Congenital Heart Defects and Pediatric Cardiology of the German Heart Center Munich. After a lung function test and a cardiopulmonary exercise test, patients were randomly assigned in a parallel arm design to either an intervention group (IG) or a control group (CG) via stratified and computer-generated letter randomization from May 2014 to May 2015. The IG completed a daily, telephone-monitored IMT of three sets of 30 repetitions for six months with an inspiratory resistive training device (POWERbreathe medic®), the CG continued their usual daily activities without an IMT until the second examination within the timeframe of November 2014 until November 2015. Results: After six months of IMT, lung capacity values in the IG (n=18) did not increase significantly compared to the CG [n=19; ΔFVC: IG: 0.21±0.16 l vs. CG 0.22±0.31 l; P=0.946 (CI: -0.16, 0.17); ΔFEV1: CG: 0.14±0.30 vs. IG: 0.17±0.20 P=0.707 (CI: -0.20, 0.14)]. Exercise capacity did not improve significantly, yet the maximum workload achieved trended to improve with an increase of 14% in the IG vs. 6.5% in the CG [P=0.113 (CI: -15.8, 1.76)]. There was a significant increase of oxygen saturation at rest in the IG compared to the CG [IG: 3.31%±4.09% vs. CG: 0.17%±2.92%, P=0.014 (CI: -5.60, -0.68)]. Compared to the CG, the mean oxygen saturation at peak exercise no longer dropped below 90% in the IG. This observation is thus not statistically significant, yet of clinical relevance. Conclusions: The results of this study show benefits of an IMT in young Fontan patients. Even if some data are not statistically significant, they may still be clinically relevant and may contribute to a multidisciplinary approach in patient care. IMT should therefore be an additional target and integrated into the training program to improve the prognosis of Fontan patients. Trial Registration: German Clinical Trials Register; DRKS.de; registration ID: DRKS00030340.

Circulating troponin as measured by a sensitive assay for cardiovascular risk assessment in primary prevention.

BACKGROUND: Measuring circulating cardiac troponin using novel sensitive assays has revealed that even minute elevations are associated with increased mortality in patients with coronary artery disease or even in the general population. Less well defined, however, is the incremental value of measuring circulating cardiac troponin I (cTnI) by a sensitive assay for risk assessment in primary prevention. METHODS: We measured circulating concentrations of cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) in 5388 individuals free of known cardiovascular disease recruited into the DETECT study, a prospective longitudinal population-based cohort study. We determined the prognostic implications for incident major adverse cardiovascular events (MACE) during 5 years of follow-up. RESULTS: Circulating cTnI was detectable in 19% of the subjects. Increased cTnI concentrations were associated with established risk factors for atherosclerosis and demonstrated a graded relationship with all-cause mortality and incident MACE during 5-year follow-up. A single measurement of cTnI significantly improved risk prediction over established risk factors, and also added prognostic information, when adjusted for serum concentrations of NT-proBNP and hsCRP. CONCLUSIONS: Minute increases in cTnI are associated with increased mortality and incident MACE in a large primary prevention cohort and, thus, identify contributors to cardiovascular risk not fully captured by traditional risk factor assessment.

Psychometric properties of the dimensional anxiety scales for DSM-V in an unselected sample of German treatment seeking patients.

BACKGROUND: Dimensional assessments are planned to be included as supplements to categorical diagnoses in DSM-V. The aim of this study was to examine the unidimensionality, reliability, validity, and clinical sensitivity of brief self-rated scales for specific anxiety disorders in an unselected German sample of consecutive attendees to a psychological clinic. These scales use a common template to assess core constructs of fear and anxiety. METHODS: Dimensional scales for social anxiety disorder, specific phobia, agoraphobia, panic disorder, and generalized anxiety disorder were administered along with established scales to 102 adults seeking treatment for mental health problems at a German university outpatient clinic for psychotherapy. The computer-assisted clinical version of the Munich-Composite International Diagnostic Interview was used to assess mental disorders according to DSM-IV criteria. Dimensionality and scale reliability were examined using confirmatory factor analyses. Convergent and discriminant validity were examined by testing differences in the size of correlations between each dimensional anxiety scale and each of the previously validated scales. Each dimensional scale's ability to correctly differentiate between individuals with versus without an anxiety diagnosis was examined via the area under the curve. RESULTS: Analyses revealed unidimensionality for each scale, high reliability, and convergent and discriminant validity. Classification performance was good to excellent for all scales except for specific phobia. CONCLUSIONS: The application of the dimensional anxiety scales may be an effective way to screen for specific anxiety disorders and to supplement categorical diagnoses in DSM-V, although further evaluation and refinement of the scales (particularly the specific phobia scale) is needed.

Binary regression: total gain in positive and negative predictive values.

Models that predict disease incidence or disease recurrence are attractive for clinicians as well as for patients. The usefulness of a risk prediction model is linked to the two questions whether the observed outcome is confirmed by the prediction and whether the risk prediction is accurate in predicting the future outcome, respectively. The first phrasing of the question is linked to considering sensitivity and specificity and the latter to the positive and negative predictive values. We present the measures of standardized total gain in positive and negative predictive values dealing with the performance or accuracy of the prediction model for a binary outcome. Both measures provide a useful tool for assessing the performance or accuracy of a set of predictor variables for the prediction of a binary outcome. This concept is a tool for evaluating the optimal prediction model in future research.

Efficacy of Applied Relaxation as indicated preventive intervention in individuals at increased risk for mental disorders: A randomized controlled trial.

The objective was to examine the efficacy of Applied Relaxation (AR) as indicated preventive intervention to reduce psychopathological symptoms and prevent incident mental disorders. In a parallel-group randomized controlled trial, N = 277 adults with elevated tension/distress, anxiety, or depressive symptomatology (Depression-Anxiety-Stress Scale, DASS-21) but no 12-month DSM-5 diagnosis of any mental disorder assessed via standardized interview (DIA-X-5) were randomized to an intervention group (IG; n = 139) receiving group-based AR training, or an assessment-only control group (CG, n = 138). Self-report questionnaires at baseline, post (immediately after the 10 week intervention or a similar time frame in CG) and 12-month follow-up included the DASS-21 as primary outcome measure of intervention efficacy. Incident subthreshold and threshold mental disorders were assessed via DIA-X-5 at 12-month follow-up as primary outcome of prevention efficacy. Intervention and prevention effects were examined on an intent-to-treat basis with missing data replaced using chained multiple imputation. Mixed-model analyses revealed accelerated symptom improvement in IG versus CG with a medium baseline-to-post between-group effect size (d = 0.59, 95%CI: 0.36-0.82). Logistic regression analysis revealed a significantly lower incidence rate for (sub-)threshold mental disorders until 12-month follow-up in IG (34.7%) versus CG (49.3%; Odds Ratio: 0.54, 95%CI: 0.31-0.92, Risk Ratio: 0.70, 95%CI: 0.51-0.96, Risk Difference = -0.15, 95%CI: -0.28 to -0.02). Group-based AR as a promising indicative preventive intervention should be tested in long-term studies and relative to a credible alternative intervention to assure that the intervention effects are not entirely due to demand characteristics, expectancies, or non-specific effects.