A web-based knowledge database to provide evidence-based information to cancer patients: Utilization within the PIKKO study.

PURPOSE: Cancer is associated with an urgent need for understandable and reliable information, which is often not satisfied by information available online. Therefore, as part of the PIKKO project, a web-based knowledge database (WDB) was introduced to provide cancer patients with quality-assured, evidence-based information. This paper aims to provide insights into the usage (Who? How? What?) and the effects regarding health literacy of the WDB. METHODS: A patient survey and automatically generated logfile data were evaluated. Two user groups, patients and patient navigators (PNs), were compared. RESULTS: The 13 PNs were responsible for 1/3 of all accesses over the entire duration of the project. The 413 patients used WDB twice on average and spent an average of 12 min per session online (PNs: 9 min per session, more frequently). The top 3 topics of interest were 'therapy', 'nutrition' and 'carcinogenesis' for the patients, and 'therapy', 'naturopathy' and 'legal regulations/support' for the PNs. Of the patients surveyed, 69% said that WDB was helpful in making informed decisions, 76% found the information they wanted and 90% thought WDB was an appropriate way to provide information. CONCLUSION: Our WDB provided important information about cancer and its treatment on a digital way both, to patients and PNs. In routine cancer care, the WDB can improve health literacy and informed decision-making. TRIAL REGISTRATION: This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21 Feb 2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703.

Measuring Change in Attachment Insecurity Using Short Forms of the ECR-R: Longitudinal Measurement Invariance and Sensitivity to Treatment.

Attachment insecurity is important for psychotherapy both as an aspect influencing the therapeutic process as well as potential outcome variable of a treatment. Two German short forms of the Experiences in Close Relationships - Revised (ECR-R) have been proposed to assess individual differences in attachment anxiety and avoidance. In this research, we examined whether these questionnaires are suitable for measuring change in attachment anxiety and avoidance by testing longitudinal measurement invariance in two independent clinical samples (N1 = 493, N2 = 273) using a pre-post design. Results indicated that strict longitudinal measurement invariance can be assumed for both measures. Thus, changes in scale scores before and after treatment can be interpreted as changes in the latent dimensions of attachment anxiety and avoidance. Both questionnaires were also sensitive to treatment in that attachment insecurity was overall reduced after therapy. Although both measures appear to be generally suitable for investigating treatment effects, they exhibited consistent problems with structural validity across samples that should be reexamined in future research.

[New Normative Values for the German Short Version of the Resilience Scale (RS-13)]. / Neunormierung der deutschen Kurzform der Resilienzskala (RS-13).

OBJECTIVE: In a representative survey conducted in Germany, normative values for the German short version of the RS-13 resilience scale were updated and compared with the data from a previous representative survey conducted in 2001. METHODS: In a representative study conducted by the social science research institute USUMA GmbH in 2021, people aged 16 to 95 years (N=2,505) were randomly selected and interviewed by telephone. Data were compared to representative data collected in 2001 (N=2,045), and the influence of demographic variables on resilience was examined. RESULTS: The internal consistency of the RS-13 was α=0.92. Current norm data of the RS-13, differentiated by gender and age, were generated. Access to these data is provided by an online tool, which can be used for the norm-oriented interpretation of individual resilience values (http://rs13.shinyapps.io/RS13). In the current 2021 sample, the mean resilience score was significantly higher than in 2001 (d=0.28, 95% CI [0.22-0.34]). Age was significantly negatively associated with resilience, education and net household income showed a significant negative correlation. DISCUSSION: The RS-13 has good psychometric properties. Providing updated normative values of the RS-13 is justified due to the significantly higher scores in 2021 compared to 2001. The updated normative values allow for the comparison of future data with those of the German general population. In addition, the online tool can be used for the norm-oriented interpretation of individual resilience scores as part of diagnostic procedures. CONCLUSION: The RS-13 is a reliable, valid and economical instrument for assessing resilience in its theoretical understanding of a stable personality trait. Future studies investigating resilience should consider age, education and income as relevant influencing variables.

[The significance of educational biography for the professional self-image of GDR psychotherapists]. / Die Bedeutung der Bildungsbiografie für das professionelle Selbstverständnis von DDR-Psychotherapeut:innen.

OBJECTIVE: Since the reunification of Germany, a debate on the professional activities of GDR psychotherapists has rised up. This debate is partly conducted by the spirit of coming to terms with the past and partly by legitimizing therapeutic activities in the GDR. The aim of this work is to show in individual patterns the professional self-image of selected GDR psychotherapists. The study focused from a sociological perspective with the intention of differentiating this topic. In course of this, the range of political positioning of GDR psychotherapists will also be determined on a case-by-case basis and it will be shown how this was shaped in the often named "niche of psychotherapy". METHODS: Based on-biographical interviews, educational biographical trajectories of GDR psychotherapists were reconstructed. The interviews were analyzed using grounded theory in a circular process of material selection and theory development. According to the principle of maximum contrast (theoretical sampling), four women were selected for reconstruction from a sample of 39 interviews from the joint project Seelenarbeit im Sozialismus (Soul Work in Socialism) and analyzed using Teifel's (2005) coding guide based on educational theory. RESULTS: Within the four cases, extremely individual educational biographies emerge on the levels of the coding strategy (meaning/structure perspective and mode of action), each showing different characteristics with regard to their ability to adopt a reflexive stance and the adoption of professional agency. The cases also show different characteristics with regard to their different positions on the system of GDR. DISCUSSION: The results of the case reconstructions can be summarized in an overarching scheme. This shows that the role of each individual's educational access, their educational paths and their individual practice of action must be seen in relation to the influence of the political system and the ability to adopt a professional attitude. The psychotherapists of the GDR cannot be understood per se as a group acting subversively against the state.

[The Relationship between Personality Structure, Burnout and Procrastination in Psychology and Medical Students, Taking into Account Social Support and Scope for Decision-Making in Studies]. / Der Zusammenhang von Persönlichkeitsstruktur, Burnout und Prokrastination bei Psychologie- und Medizinstudierenden unter Einbeziehung von sozialer Unterstützung und Entscheidungsspielraum im Studium.

BACKGROUND: Burnout and procrastination are widespread phenomena among students. The role of personality structure has been little researched so far. OBJECTIVE OF THE STUDY: The relationship between personality structure and study-related work disorders in psychology and medical students is examined, taking into account resources and demands. METHODS: As part of a cross-sectional study, data was collected online from 61 German colleges and universities. Personality structure variables (levels of personality functioning, OPD-SFK; attachment, ECR-RD 12; emotion regulation, ERQ), study-related work disorders (burnout, MBI-SS-d; procrastination; APSI-d) as well as resources (social support, F-SozU K-6; scope for decision-making in studies, self-developed scale) and demands (Corona pandemic, self-developed scale) were assessed. The research question was answered by means of a hierarchical regression analysis. RESULTS: From February 2020 to December 2021, 775 students (49.2% psychology students, 50.8% medical students; age M=24.1 years, SD=5.1 years; 82.3% female, 17.4% male, 0.3% diverse) participated in the survey. In the overall model, 30.4% of the variance in burnout exhaustion, 16.2% of the variance in burnout cynicism, 20.9% of the variance in burnout inefficiency and 30.1% of the variance in procrastination was explained (p<0.001). Levels of personality functioning showed significant negative correlations with all burnout variables as well as with procrastination (p<0.001). The emotion regulation strategy reappraisal was associated with lower burnout inefficiency and procrastination (p<0.001), and the emotion suppression strategy with lower burnout cynicism (p≤0.01). Scope for decision-making in studies was negatively associated with all burnout variables and procrastination (p<0.001), and social support was negatively associated with burnout inefficiency (p≤0.01). The general stress level during the Corona pandemic showed a positive association with burnout exhaustion (p≤0.001). CONCLUSIONS: Personality structure (levels of personality functioning, emotion regulation) is significantly related to study-related burnout and procrastination. Training opportunities to promote emotion regulation skills could be very helpful for vulnerable student groups in dealing with burnout and procrastination.

[Aspects of Utilization of Psychotherapy in Germany in Times of the GDR and Later]. / Aspekte der Inanspruchnahme von Psychotherapie in Deutschland zu Zeiten der DDR und danach.

Objective The aim of the study was to examine real differences in the use of psychotherapy in the New Federal States during the GDR era and today. In addition, differences according to the willingness seeking psychotherapy as well as barriers in opinions and contact to the mentally ill between people from the New Federal States, the Old Federal States and people who moved from the New Federal States to the Old Federal States (internal migrants) should be recorded, taking into account generational effects (experience of the Cold War - birth before / after January 1st, 1980). Methods To investigate these questions, the data from a representative survey in the New Federal States of N=2729 people as well as the data from a second online based survey of people from the New and Old Federal States as well as internal migrants with a total of N=4789 participants were evaluated.Results There was a prevalence of 1% for the use of psychotherapy during the GDR era. Overall, the prevalence of therapy experiences among people who experienced the GDR and were born before January 1st in 1980 was almost 13%. They also reported greater willingness seeking help for mental suffering since the end of the Cold War. The prevalence among younger people was about 12%. In the second survey, there were significant differences, among the older respondents. East Germans today and even during the GDR era were less willing to seek psychotherapy for mental suffering, they also have less contact to mentally ill people. Differences according to desires for distance from mentally ill people, self stigmatization in the presence of a mental illness and discrimination against mentally ill people emerged between East Germans, West Germans and internal migrants depending on generational affiliation.Discussion Barriers that prevent the use of psychotherapy should be taken into account on a generational and socialization specific basis. Socialization as a relevant factor might explain a lack of willingness to utilize psychotherapy amongst people that experienced the GDR era and still live in the new Federal States.

The impact of the COVID-19 pandemic restrictions on the health care utilization of cancer patients.

BACKGROUND: COVID-19 has impacted both society and medical care. While Germany entered the first lockdown in spring 2020, the PIKKO study (Patient information, communication and competence empowerment in oncology) was still active. The intervention modules, patient navigator (PN), services of the Saarland Cancer Society (SCS), psycho-social counseling and different courses, and online knowledge database (ODB) continued to be offered, but in an adapted form. It was the aim of this supplementary survey to identify the restrictions and burdens of the pandemic containment strategies on the PIKKO patients and thus on the PIKKO study itself. Furthermore, this work shows how the PIKKO modules were used during the lockdown. METHODS: All patients in the PIKKO intervention group (IG) were invited to complete a questionnaire, n = 503. Furthermore, utilization of the SCS and log files of the ODB were analyzed. For socio-demographic data and contacts with the PN, data from the regular PIKKO surveys were used. In addition to descriptive statistics, chi²-tests, F-tests and linear regression analyses were performed. RESULTS: 356 patients participated in this supplemental survey. 37.6% reported restrictions. "Restrictions on accompanying persons", "ban on visits to the wards" and "protective mouth-nose-mask" were reported as the greatest burdens. 39.0% expressed fears that the restrictions would have an impact on the course of their disease. Linear regression analyses showed differences in feelings of burden among age groups (more among < 60-year-olds), gender (more among women), children in the household (more with children), and preexisting financial stress (more with financial worries). In April 2020, there was more patient contact with PNs by phone, more SCS psycho-social counseling by phone, adapted SCS course offering, but with significantly fewer participants, and high activity on the ODB. CONCLUSION: Cancer patients in the IG reported restrictions from the pandemic containment strategies and feared an impact on their recovery. However, whether a burden is perceived as heavy depends more on gender, age, or pre-existing burdens than on whether the lockdown affects PIKKO or not. The utilization of counseling, courses or the ODB despite lockdown shows the need for such services, especially in times of crisis. TRIAL REGISTRATION: This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21 Feb 2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703 .

(De-)centralized health care delivery, surgical outcome, and psychosocial health of transgender and gender-diverse people undergoing vaginoplasty: results of a retrospective, single-center study.

PURPOSE: Previous research on genital gender-affirming surgery lacked to build a framework that took various surrounding factors into account. E.g., transgender health care services are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different medical institutions spread over several locations). The present study investigated the effects of different structural and clinical aspects of gender-affirming genital surgery on psychosocial outcomes. METHODS: We surveyed former transgender and gender-diverse people who completed a vaginoplasty between 2014 and 2018. 45 participants were included in the study. We calculated hierarchical linear regression analyses to assess the relationship between psychosocial outcome measures (gender congruence, mental health, quality of life) and different aspects of gender-affirming genital surgery (e.g., setting of service delivery). To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identify predictors that are actually related to the outcomes. RESULTS: A non-responder analysis revealed no systematic bias in the recruitment procedure. Treatment satisfaction was a significant predictor for gender congruence. Moreover, we found the setting of service delivery (centralized, decentralized) to predict psychological health and the physical health dimension of quality of life. The effect sizes of our models were moderate to high, and models explained up to 26% of the total variance with a power up to 0.83. CONCLUSION: The present study is an exploratory attempt into the manifold relationships between treatment-related factors (e.g., aesthetic outcome), the setting of service delivery, and their effects on gender-affirming genital surgery.

Efficacy of group therapy to reduce mental distress in women with non-metastatic breast cancer: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Group treatments have proven to be effective for many mental disorders and showed beneficial effects in patients with medical illness. Aim of this systematic review and meta-analysis is to summarize the efficacy of group therapy for women with non-metastatic breast cancer. METHODS: We included studies comparing group therapy for women with non-metastatic breast cancer to non-active control groups, active control conditions, and individual psychotherapy. The primary outcome was mental distress, secondary outcomes were quality of life, coping, existential outcomes, fatigue, pain, and side effects. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, PsycINFO, and DARE complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups. RESULTS: Thirty-seven studies (5902 patients) were included. Small effects on mental distress in favor of group treatment were found (non-active control groups: n = 19, g = 0.42, 95% CI [0.29; 0.56], I2  = 61.6%; active control conditions: n = 6, g = 0.20, 95% CI [0.06; 0.35], I2  = 0%). Cognitive-behavioral therapy (CBT) and third wave CBT group approaches proved to be most effective. Group treatments also showed beneficial effects on secondary outcomes, with most profound evidence on quality of life and coping. CONCLUSIONS: Results suggest that group interventions have the potential to reduce mental distress in women facing breast cancer. In the light of the considerable heterogeneity of most study effects, there is a need for more rigorous studies to strengthen the promising evidence and for trials examining the impact of patient and intervention characteristics on outcomes. REGISTRATION: PROSPERO international prospective register of systematic reviews, CRD42020184357.

Patient information, communication and competence empowerment in oncology: Results and learnings from the PIKKO study.

PURPOSE: Many concepts for accompanying and supporting cancer patients exist and have been studied over time. One of them was PIKKO (a German acronym for "Patient information, communication and competence empowerment in oncology"), which combined a patient navigator, socio-legal and psychological counseling (with psychooncologists), courses dealing with various supportive aspects, and a knowledge database with validated and easy-to-understand disease-related information. The aim was to increase the patients' health-related quality of life (HRQoL), self-efficacy as well as health literacy and to reduce psychological complaints such as depression and anxiety. METHODS: To this purpose, an intervention group was given full access to the modules in addition to treatment as usual, while a control group received only treatment as usual. Over twelve months, each group was surveyed up to five times. Measurements were taken using the SF12, PHQ-9, GAD, GSE, and HLS-EU-Q47. RESULTS: No significant differences were found in scores on the mentioned metrics. However, each module was used many times and rated positively by the patients. Further analyses showed a tendency higher score in health literacy with higher intensity of use of the database and higher score in mental HRQoL with higher intensity of use of counseling. CONCLUSION: The study was affected by several limitations. A lack of randomization, difficulties in recruiting the control group, a heterogeneous sample, and the COVID-19 lockdown influenced the results. Nevertheless, the results show that the PIKKO support was appreciated by the patients and the lack of measurable effects was rather due to the mentioned limitations than to the PIKKO intervention. TRIAL REGISTRATION: This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21.02.2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703.

Self-regulation profiles reflecting distinct levels of eating disorder and comorbid psychopathology in the adult population: A latent profile analysis.

OBJECTIVE: Previous research showed that individuals with eating disorders (EDs) can be subtyped by their levels of psychopathology and self-regulation abilities. However, nothing is known about whether self-regulation abilities are solely suited to depict the heterogeneity in ED and comorbid psychopathology in nonclinical samples. Therefore, this study sought to explore self-regulation profiles and their ability to discriminate ED, depression and anxiety disorders, and personality dysfunction in the adult population. METHODS: Within a German representative sample, N = 2391 adults (18-92 years) were examined using latent profile analysis to identify profiles based on established cognitive and emotional self-regulation scales including attention control, cognitive reappraisal, and difficulties in identifying feelings. Profiles were validated with ED, depression, anxiety, and personality dysfunction measures. RESULTS: The final solution selected as best balancing goodness of fit and interpretability included four profiles-High-Functioning, Moderate-Functioning, Dysregulated, and Alexithymic-with high explanatory power of R2  = .99. Profiles were characterized primarily by differences in difficulties in identifying feelings followed by differences in attention control and differed significantly regarding ED, depression and anxiety disorders, and personality dysfunction, with the Dysregulated profile showing the most unfavorable correlates. CONCLUSIONS: This study uniquely revealed that low cognitive and emotional self-regulation were indicators for ED, depression, anxiety, and personality dysfunction in the adult population. Future research should investigate whether the identified profiles predict the development of ED and comorbid psychopathology longitudinally. PUBLIC SIGNIFICANCE: Individuals with eating disorders present with difficulties in cognitive and emotional self-regulation, likely maintaining their symptoms. This representative study in the German adult population sought to build profiles based on cognitive and emotional self-regulation that differed in eating disorder and comorbid psychopathology. We discuss the potential to detect individuals with elevated eating disorder and comorbid psychopathology based on the identified profiles in nonclinical settings.

[Psychometric Properties of the Qualiskope-A for Measuring Patient Satisfaction with Outpatient Medical Treatment: Use in Oncology and Transferability to Inpatient Care]. / Psychometrische Eigenschaften des Qualiskope-A zur Messung der Patientenzufriedenheit mit der ambulant-ärztlichen Behandlung: Einsatz in der Onkologie und Übertragbarkeit auf die stationäre Versorgung.

AIM: The Qualiskope-A is a German-language PREM (Patient Reported Experience Measure) which, with the help of 27 items allocated to four scales, enables measurement of patient satisfaction with outpatient medical treatment along four dimensions of patient satisfaction. This study examined whether the questionnaire delivers reliable results in an oncological population and whether its application can be extended to inpatient care. METHOD: Required data was collected as part of the PIKKO study. Initially, descriptive statistics and internal consistency (Cronbach's alpha) of the PREM's scales were analyzed. In addition, a sub-sample that assessed the same doctor at two consecutive measurement time points was observed with regard to test-retest reliability (Spearman correlation (rs) between both measurement time points). The measurement model of the Qualiskope-A was then examined using confirmatory factor analysis. To test the transferability to inpatient care, measurement invariance with regard to outpatients and inpatients was computed. RESULTS: A total of 476 patients was included in the study. Every score of the Qualiskope-A showed a left-skewed distribution in the sample and revealed pronounced ceiling effects. Cronbach's alpha coefficients were consistently>0,8. Within the test-retest group (n=197), a strong correlation (rs>0,5) was observed between the measurement time points. The fit indices calculated using confirmatory factor analysis showed a good model fit (CFI=0,958; RMSEA=0,026; SRMR=0,040; every factor loadings>0,6). The fit indices, calculated as part of the investigation of measurement invariance, consistently met the defined threshold values. CONCLUSION: The Qualiscope-A shows good reliability in the examined oncological sample. It can be used in both outpatient and inpatient settings (no indications of non-invariance were found). Due to pronounced ceiling effects, however, the item scaling should be revised.

[Sooner or Later you are no Longer Needed - Even as a Psychotherapist?+A Systematic Literature Review on how Psychotherapists Deal with their Own Aging Process]. / Früher oder später wird man ­ auch als Psychotherapeut:in ­ nicht mehr gebraucht? Eine systematische Literaturübersicht zum Umgang von psychotherapeutisch Tätigen mit dem eigenen Altern.

Up to now, there is little bundled knowledge about how psychotherapists deal with their own aging. The aim of the present study was a systematic review of the existing literature on the topic of psychotherapists' aging. In a systematic literature search, which was primarily conducted via electronic databases, 55 relevant hits (empirical studies, literature-based texts, books and book contributions, and free text forms) were identified, whose relevant contents were systematically compiled. The literature search revealed a lack of empirical research on the question of how psychotherapists deal with their own aging. Within the systematic review, key findings were presented in areas of 1. age-related issues and challenges among older psychotherapists, 2. resources and sources of experience among older psychotherapists, and 3. engagement with aging and exit from psychotherapy practice. The systematic review illustrates the comprehensiveness of the topics that are relevant in the context of psychotherapists' aging. Dealing with aging also includes the discussion of one's own retirement, whereby the literature suggests a high propensity to work among older psychotherapists, who highly value their status and their individual professional freedoms in old age. It was shown that one's own aging is associated with diverse effects on professional identity and psychotherapeutic work. Future empirical research should address age-related changes in the context of psychotherapeutic work and inquire about attitudes of psychotherapists towards age-related issues. Interests and plans of (older) psychotherapists should be heard and their resources should be used.

[General Self-Efficacy Scale (GSE) in Simple Language: Internal Consistency, Standard Values and Correlations with Demographic Variables in a Representative German Sample]. / Skala Selbstwirksamkeitserwartung in Leichter Sprache (SWE-LS): interne Konsistenz, Normwerte und Zusammenhänge mit demografischen Variablen in einer repräsentativen Stichprobe.

BACKGROUND: Approximately 6,2 million people with limited literacy live in Germany. They are unable to communicate in written language beyond single sentences and thus experience limited social participation in many everyday areas. In addition, they are also excluded from participation in survey-based social science research. METHOD: In order to enable persons with limited literacy to participate in written surveys, existing questionnaires need to be converted to easy language and their psychometric quality needs to be reexamined. We went through this process for the Self-Efficacy Expectancy (SWE) questionnaire and tested the new scale in easy language (SWE-LS) on a representative sample of the German population aged 14 years and older (N=2,531). RESULTS: The SWE-LS scale showed good internal consistency (Cronbach's-Alpha=0,84) and adequate item difficulty and discriminatory power. We found correlations consistent with expectations for the demographic variables surveyed. Thus, men and persons with higher education and higher income showed significantly higher self-efficacy expectations. The effect was also evident for East Germans versus West Germans, married persons living together versus separated, unmarried, or persons living as singles. DISCUSSION: Compared to the original SWE scale, the SWE-LS scale in easy language has no methodological disadvantages. The additional effort of linguistic adaptation and renewed psychometric testing is thus directly offset by enabling participation in survey-based research by over 12% of the adult population. A systematic translation of particularly frequently used questionnaires or those that do not concern fundamental research but research areas in which demographic variables themselves are part of the research object would be desirable.

[Relationship Between Social Integration, Global Self-Esteem, and Physical and Mental Health in a Representative German Sample]. / Zusammenhang von sozialer Teilhabe, globalem Selbstwert sowie physischer und psychischer Gesundheit in einer repräsentativen deutschen Stichprobe.

INTRODUCTION: Beyond participation as a civil right, social participation has already been considered from legal, ethical, socio-psychological and political perspectives as an important component of the self- and external evaluation of a person as a valuable member of a society. Thus, social psychological studies frequently showed the importance of the sense of belonging as a central psychological component of social participation for both personal and social self-esteem. From a medical-psychological perspective, the association of global self-esteem and self-efficacy with health is well established. However, it is an open question whether social participation is directly related to psychological and physical well-being or whether this relationship is mediated via global self-esteem. MATERIAL AND METHODS: Based on a nationwide representative survey in Germany (N=2.531; age 14-93, M=48.58; 55.4% women), the variables social participation (KsT-5), global self-esteem (SISE), and physical and mental health (EQ5D) were measured using standardized questionnaires to examine a potential mediation. RESULTS: As expected, significant positive correlations between social participation, global self-esteem and physical and mental health were found with medium ranged effect sizes. However, global self-esteem only partially mediated the association between social participation and health, i. e. a direct significant association between social participation and health could be proven. DISCUSSION: The results underline the direct relevance of social participation for physical and mental health. This opens a hitherto hardly used perspective for health promotion in interaction with socio-political challenges in the topics of integration, inclusion and the sense of belonging.

Adverse events in psychotherapy randomized controlled trials: A systematic review.

Objective: Although evidence for benefits of psychotherapy is substantial, less is known about potential harm. Therefore, we systematically summarized randomized controlled trials (RCTs) to compile evidence-based data on the frequency and characteristics of adverse events (AEs) of psychotherapy. Method: This systematic review of result publications is based on a review of harm consideration in psychotherapy study protocols. Results: On the basis of 115 study protocols, 85 RCTs with 126 psychotherapy and 61 control conditions were eligible for inclusion. The sample consisted of 14,420 participants with the most common mental disorders. Harmful events, e.g., AEs, number of individuals with symptom deterioration, were explicitly reported in 60% of the studies. Conceptualization, recording, and reporting of AEs were heterogeneous. For most reported AEs, the association to study treatment remained unclear. Conclusions: Because the AE recording approaches of the individual studies differed substantially, results could only be compared to a limited extent. Consistent with other findings, this review demonstrates that AEs can be expected to affect more than one in ten participants. Serious AEs occurred more than in one in 21 participants in psychotherapy RCTs. To allow a balanced risk/benefit evaluation of psychotherapy, systematic harm monitoring and reporting should become standard in psychotherapy RCTs.

Pre-surgery optimization of patients' expectations to improve outcome in heart surgery: Study protocol of the randomized controlled multi-center PSY-HEART-II trial.

The PSY-HEART-I trial indicated that a brief expectation-focused intervention prior to heart surgery improves disability and quality of life 6 months after coronary artery bypass graft surgery (CABG). However, to investigate the clinical utility of such an intervention, a large multi-center trial is needed to generalize the results and their implications for the health care system. The PSY-HEART-II study aims to examine whether a preoperative psychological intervention targeting patients' expectations (EXPECT) can improve outcomes 6 months after CABG (with or without heart valve replacement). EXPECT will be compared to Standard of Care (SOC) and an intervention providing emotional support without targeting expectations (SUPPORT). In a 3-arm multi-center randomized, controlled, prospective trial (RCT), N = 567 patients scheduled for CABG surgery will be randomized to either SOC alone or SOC and EXPECT or SOC and SUPPORT. Patients will be randomized with a fixed unbalanced ratio of 3:3:1 (EXPECT: SUPPORT: SOC) to compare EXPECT to SOC and EXPECT to SUPPORT. Both psychological interventions consist of 2 in-person sessions (à 50 minute), 2 phone consultations (à 20 minute) during the week prior to surgery, and 1 booster phone consultation post-surgery 6 weeks later. Assessment will occur at baseline approx. 3-10 days before surgery, preoperatively the day before surgery, 4-6 days later, and 6 months after surgery. The study's primary end point will be patients' illness-related disability 6 months after surgery. Secondary outcomes will be patients' expectations, subjective illness beliefs, quality of life, length of hospital stay and blood sample parameters (eg, inflammatory parameters such as IL-6, IL-8, CRP). This large multi-center trial has the potential to corroborate and generalize the promising results of the PSY-HEART-I trial for routine care of cardiac surgery patients, and to stimulate revisions of treatment guidelines in heart surgery.

Continual rehabilitation motivation of patients with postparalytic facial nerve syndrome.

PURPOSE: To evaluate the continued rehabilitation motivation in patients with postparalytic facial synkinesis (PFS). METHODS: In this single-center cross-sectional survey, the multidimensional patient questionnaire for assessment of rehabilitation motivation (PAREMO-20) was used to assess the rehabilitation motivation. Associations Sunnybrook and Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, general quality of life (SF-36), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire (PHQ)-9, technology commitment and affinity, and interest in further therapy were analyzed. RESULTS: 69 adults with PFS (73% women; median age: 54 years) answered the survey. In comparison to prior treatment forms, there was a significant higher future interest in computer-based home facial training (p < 0.0001). For PAREMO Psychological burden subscore, SF36 Emotional role was the highest negative correlative factor (p < 0.0001). For PAREMO Physical burden subscore, SF-36 General health was the highest negative correlative factor (p = 0.018). Working (p = 0.033) and permanent relationship (p = 0.029) were the only independent factors correlated to PAREMO Social Support Subscore. Higher positive impacts of technology affinity was inversely correlated to PAREMO Knowledge subscore (p = 0.017). Lower SF-36 Role physical subscore p = 0.045) and a lower SF-36 General health (p = 0.013) were correlated to a higher PAREMO Skepticism subscore. CONCLUSIONS: Patients with PFS seem to have a high facial motor and non-motor psychosocial impairment even after several facial therapies. Rehabilitation-related motivation increases with both, higher facial motor and non-motor dysfunction. Social and emotional dysfunction are drivers to be interested in innovative digital therapy forms.

[Biographical Interviews with GDR Psychotherapists - First Hypotheses on their Social Positioning and Professional Action]. / Lebensgeschichtliche Interviews mit DDR-PsychotherapeutInnen.

OBJEKTIVE: First results of a socio-historical analysis of the life stories of GDR psychotherapists are presented. Interviews, carried out as part of the project Seelenarbeit im Sozialismus, are intended to enable statements about social and family backgrounds, educational paths and social position. An exemplary case is presented in order to develop hypotheses for the design of professional behavior by GDR psychotherapists. METHODS: Narrative/biographical interviews are processed as a source for historical and sociological research strategies. For a descriptive presentation of the topics described in the interviews, a cross-case category system was created inductively, which should enable statements about the frequency of certain characteristics. The individual case is analyzed by using the grounded theory method. RESULTS: A first overview of the sample relates to the demographic characteristics of the interviewed persons, their level of awareness and professional qualifications. The interviewed psychotherapists can be assigned to different decades of the historical development of GDR psychotherapy with regard to their years of birth. They are further determined with regard to their social origin (parenting professions), their professional career (distribution of qualification paths), their party membership (SED or block party) and experience disadvantages by the state. In the case study, the dependence of the professional attitude on socializing influences is illustrated. DISCUSSION: Ultimately, the study can show a heterogeneous group of psychotherapists from the GDR, whose biographies can be used to trace the historical development of psychotherapy in the GDR. A look at the actors' families shows that the profession from fathers were often located in the field of self-employed entrepreneurs or academics. In addition, only a few psychotherapists were members of the SED, but frequent disadvantages by the state are named. As a conclusion there is an advice of a high importance of personal reflexivity and a reflective professional self-image.Conclusions Further evaluations should prove the social and political positioning as well as the professional self-image of GDR psychotherapists.

[A Short Version of the Body Experience Questionnaire (FBeK): Results of Clinical and Non-Clinical Samples]. / Eine Kurzversion des Fragebogens zur Beurteilung des eigenen Körpers (FBeK): Ergebnisse aus klinischen und bevölkerungsrepräsentativen Stichproben.

OBJECTIVES: The aim of this study was the development and evaluation of a short (9-item) version of the body experience questionnaire (FBeK-9). METHOD: Based upon a representative survey from 1996, a 15-item version of the FBeK was constructed which was then evaluated in another representative sample (n=2510) as well as three clinical groups, namely patients with depressive disorders (n=106), patients with eating disorders (N=107), and patients suffering from pain (N=90). Depressive and anxiety symptoms and pain disability (PHQ-9, PHQ-4, PDI) were also assessed. Item selection and the determination of the factor structure were performed using exploratory and confirmatory factor analysis and led to the development of the FBeK-9. The final three subscales were tested for invariance related to sex, age and disorder. In addition, convergent validity was assessed and norms were provided. RESULTS: Models of confirmatory factor analyses revealed acceptable fit indices ((CFI) =0.982,(ω ) =0.020) in all samples. The subscales "uncertainty/impaired sensation","attractiveness/self-confidence" and "accentuation of the body/sensitivity" indicated acceptable reliability (ω=0.707) and correlated with depressive and anxiety symptoms and pain in an expected manner. We also could show differences between the normative sample and the clinical groups. Measurement invariance was shown for age and sex. CONCLUSIONS: It can be concluded that the 9-item version of the body experience questionnaire also provides a reliable, valid and economically efficient measure that can be used in studies of body experience in non-clinical and clinical samples. In the future, more validity studies should be performed.