Adolescents' life between violence and discipline. Medical care in the "Jugendhäuser" juvenile detention centers in East Germany in the 1960s-1980s.

Background: In 1952-1989, special juvenile detention centers, called Jugendhäuser, were established in the German Democratic Republic. There, juvenile delinquents had to not only complete their sentences, but they were also supposed to be re-educated into conscious socialist personalities through a system of collective education proposed by Soviet pedagogue Anton Makarenko. Among twelve Jugendhäuser in East Germany, the ones in Halle and Dessau were considered to have the most severe conditions due to the praxis of mental and physical violence. For the first time, based on the personal files of former juvenile prisoners and archival documents of medical services, we reconstruct a picture of the health status of prisoners and medical care in both these Jugendhäuser. Methods: We analyzed personal files of juvenile prisoners from the Archive of the Correctional Facility in Halle and unpublished documents from the Saxony-Anhalt State Archive, Magdeburg Department, the State Archive in Leipzig and the Stasi Records Archive in Halle. For the examination of these sources, we implemented the historical-critical method. Results: The Jugendhäuser had a system of outpatient and inpatient treatment. Although the medical services rated the level of health care as good at those detention centers, numerous complaints from juveniles, as well as cases of failure to provide assistance, indicated certain deficiencies. Cases of violence in juvenile prisons were common, especially in the Jugendhaus Halle. Brawls between inmates led to injuries and sometimes even to deaths. Fear of beatings resulted in desperate acts such as self-harm, suicide and escapes from prison. Conclusion: The health status of young prisoners in the Jugendhäuser in Halle and Dessau was negatively affected by violence and often by lack of medical care. The prevalence of violence can be attributed to challenges of the penal system as well as deficiencies of the medical services. Since repressive means were used to overcome the violence, such efforts were not successful. The medical services did not offer specialized care for juveniles with mental and learning disorders or those who required psychological or even psychotherapeutic support. Physical health issues were also often ignored due to the stigmatization of sick juveniles as malingerers.

Early Childhood Care in the Former East Germany and Mental Stress in Adulthood.

BACKGROUND: It is still debated in Germany whether early childhood care outside the family might cause mental stress in adulthood. In the German Democratic Republic (GDR-the former East Germany before unification), children were often cared for outside the family from a very early age. METHODS: To determine the relation between early childhood care outside the family and mental stress in adulthood, we carried out a survey among 1575 persons who were born and socialized in the GDR. They were classified into four care groups according to the age at which they were first cared for outside the family. Associations with depressiveness, somatization disorders, and anxiety disorders in adulthood were tested with logistic regression analysis. Care group-specific prevalences of experiences of abuse and neglect in childhood were estimated with analysis of variance. RESULTS: Comparisons of persons cared for outside the family before the age of three, or from the age of three onward, with persons cared for within the family in their preschool years did not reveal any difference with respect to depressiveness (odds ratio [OR] = 0.95; 95% confidence interval [0.58; 1.55]; OR = 1.05 [0.63; 1.74]), somatization disorders (OR = 1.11 [0.74; 1.67]; OR = 1.09 [0.71; 1.66]), or anxiety disorders (OR = 0.87 [0.46; 1.64]; OR = 1.12 [0.59; 2.10]). Nor were there any intergroup differences with respect to experiences of abuse and neglect. Certain features of the very small group of children who had long-term care outside the family are discussed in the article. CONCLUSION: No relation was found between earlychildhood care in day-care centers in the GDR and mental stress in adulthood. The data were too sparse for any conclusions about specific aspects of care outside the home (e.g., quality or child-rearing norms).

[Further training to become a specialist in pathology in the GDR]. / Weiterbildung zum Facharzt für Pathologie in der DDR.

Pathology in the GDR was firmly rooted in the tradition of German pathology. Further training imparted sound morphological knowledge. Until the late 1970s, it was primarily autopsy pathology. Scientific relations with the West-with centers where the discipline was developing dynamically-were severely hampered for political reasons; normal conference attendance was reserved for a few selected cadres. The inefficiency of the planned economy led to increasing material bottlenecks. GDR pathology had become a relic by the end of the GDR regime.

Differences in breast and cervical cancer screening between West and East Germany: a secondary analysis of a german nationwide health survey.

BACKGROUND: Breast cancer and cervical cancer are among the most common cancers in women in Germany. Early detection examinations such as mammography and the cervical smear test (Pap-test) have been shown to contribute to the reduction in the mortality and/or incidence of these cancers and can be utilised free of charge by women in certain age groups as part of national screening programmes. Analyses show that the use of health services varies regionally, especially when comparing the federal states of the former German Democratic Republic (GDR, Eastern Germany) and the Federal Republic of Germany (FRG, Western Germany). This study investigated to what extent the utilisation of mammography examinations and Pap-tests by women differs in federal states of former GDR and FRG. METHODS: For this purpose, we analysed data from the nationwide health survey GEDA14/15 conducted by the Robert Koch Institute (RKI) in 2014 and 2015. We calculated weighted proportions and compared attendance between eastern and western German states by a Chi-Square-test. Additionally, we conducted regression analysis to adjust for socio-economic status, living environment and place of birth. RESULTS: 2,772 female participants aged 20-34 years were analysed for Pap-test attendance in the last two years and 4,323 female participants aged 50-69 years old were analysed for mammography screening attendance in the last two years. 50-69-year-old women in eastern German states were with 78.3% (95%-CI 75.3%, 81.2%) more likely to attend mammography screening than in western Germany with 73.4% (95%-CI 71.8%, 74.9%). Pap-test uptake was statistically significantly higher in the East of Germany with 83.3% (95%-CI 79.6%, 87.1%) compared to 77.5% (95%-CI 75.8%, 79.3%) in the West of Germany. This relationship was robust to adjusting for socio-economic status, living environment and place of birth. CONCLUSIONS: Cultural influences and socialization in the GDR might explain the higher utilisation of these cancer screening examinations at least to some extent. This could have many reasons, for example a higher health awareness through education or a possible greater trust in medical structures and the associated higher compliance of women. These hypotheses should be further explored to increase the uptake of screening examinations by women in Germany.

The Extension of Late Working Life in Germany: Trends, Inequalities, and the East-West Divide.

The extension of late working life has been proposed as a potential remedy for the challenges of aging societies. For Germany, surprisingly little is known about trends and social inequalities in the length of late working life. We use data from the German Microcensus to estimate working life expectancy from age 55 onward for the 1941‒1955 birth cohorts. We adjust our calculations of working life expectancy for working hours and present results for western and eastern Germany by gender, education, and occupation. While working life expectancy has increased across cohorts, we find strong regional and socioeconomic disparities. Decomposition analyses show that among males, socioeconomic differences are predominantly driven by variation in employment rates; among women, variation in both employment rates and working hours are highly relevant. Older eastern German women have longer working lives than older western German women, which is likely attributable to the German Democratic Republic legacy of high female employment.

[Comparison of Self-Reported Childhood Maltreatment Between East and West Germany]. / Selbstberichtete Kindesmisshandlungen im Vergleich zwischen Ost- und Westdeutschland.

OBJECTIVE: The socioecological model emphasize the relevance of political, cultural and economic socialization effects for the prevalence of childhood maltreatment, which are analyzed by comparing child maltreatment between East and West German subjects who came of age before the fall of the Berlin Wall. METHODS: Using an online survey, a representative general population sample with respect to age, gender distribution and income was assessed regarding child maltreatment and current psychological distress using standardized self-report instruments. RESULTS: Of 507 study participants, 22,5% reported being born and socialized in East Germany. They reported significantly less emotional abuse than the 77,5% who grew up in the FRG. The East and West German subjects did not differ in any other form of abuse. CONCLUSION: Our findings underline the importance of socialization and enculturation effects on memory, which should be considered when interpreting the results.

Regional differences in the assessment of depressive symptoms in the former German Democratic Republic and Federal Republic of Germany.

AIM: The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health. SUBJECT AND METHODS: To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802). RESULTS: Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning-with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude. CONCLUSION: We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded.

Healthy, happy, rational: reflections on genetic counselling in the GDR.

The development of genetic counselling in the German Democratic Republic (GDR) was closely connected to a well-established system of prenatal care and a process that placed reproductive decisions in the hands of women. It was embedded in the pronatalist reproductive policy of the GDR and a narrative of medical and (socialist) humanistic progress. As in other countries at that time, it promoted the goal of avoiding the birth of children with disabilities and was hence based on ableist premises. In this paper, I focus on communicative aspects of genetic counselling, as it was established in the 1970s and 1980s in university and district clinics. Thus, on the one hand I explore the communication of genetic counselling to the public; and on the other, I study the communication processes in genetic counselling centres themselves. In contrast to the USA, where the 'genetic counsellor' became established as a professional identity in the 1970s, there was no distinct profession of 'genetic counsellor' in the GDR. Instead, counselling was practised by physicians or biologists with a special interest in human genetics. This resulted in a strong emphasis in these clinical encounters on diagnosis and technical solutions, as well as an educational impetus. I propose that an important goal of genetic counselling in the GDR was to generate a sense of 'rationality' in prospective parents. To achieve this, those advocating and giving counselling explicitly sought to distance this practice from the eugenic ideas of the past, and to dispel superstitious ideas of heredity and religious ideas of fate. In addition, they attempted to alleviate emotions such as fear and guilt. It was in that context that counselling physicians and biologists provided interpretations of genetic findings, risk figures and disease values. I show how different interests and experiences shaped these and how risk evaluations structured counsellor-counsellee communication.

[On the way to democracy-The transformation process 1990/1991 and the role of the Association for Psychiatry and Neurology in the GDR]. / Auf dem Weg zur Demokratie ­ der Transformationsprozess 1990/91 und die Rolle der Gesellschaft für Psychiatrie und Nervenheilkunde in der DDR.

OBJECTIVE: The transition from socialist dictatorship to liberal democracy in the GDR was associated with political and social upheaval. The transformation accompanying the democratic sociopolitical process is examined using the example of the Association for Neurology and Psychiatry of the GDR, which led to its unification with the German Association for Psychiatry and Neurology (DGPN). METHOD: For the historical investigation material from the archives of the DGPPN as well as the personal belongings of the protagonists of the time were used and eyewitness interviews were conducted. RESULTS: The transformation process can also be seen for the Association for Neurology and Psychiatry of the GDR. As at the political level, there was also a loss of legitimacy at the board level of the Association for Psychiatry and Neurology in 1990. The new understanding of democracy required the participation of all members. The Spokesman Council and the DGPN (East) were responsible for establishing and consolidating democratic structures. CONCLUSION: Beyond the transformation process, little is known about the merger. The phase of reorientation at the beginning of the 1990s should be examined for the DGPN as well as the question of how to deal with the suspected political abuse of psychiatry in the GDR.

Psychology and the fall of Communism: The special case of (East) Germany.

The fall of Communism is now universally agreed to be what the philosopher Hegel called a world historical event-one that few predicted but nearly everyone saw as inevitable after it happened. In the aftermath many lives-and worldviews-changed, not only, but also in the human sciences. These remarks attempt to address in a preliminary way both the impact of the fall of Communism on psychology in former East Germany (including changes in personnel and approach) and the ways in which these sciences were employed as resources for reflection on the Communist past as well as the transition to new social and political regimes.

General practice in the German Democratic Republic (1949-1990) : A discipline between threat and professionalization.

BACKGROUND: In the 1950s the socialist health policy in East Germany did not follow a clear-cut course with regard to outpatient medical care. Whilst state-run policlinics gradually took the place of doctors in private practice, the required qualifications of physicians working in outpatient care remained unclear. After preparatory lobbying by committed physicians from the outpatient sector, the 1960 Weimar Health Conference finally paved the way for the preservation and professionalization of general practice in East Germany. AIM: The article analyzes the formation of general practice as a specialty in East Germany between 1945 and 1990. We scrutinize the status of general practitioners and their field in the socialist health system as well as the foundation of their medical society. Our paper aims to contribute to a broader history of general practice in Germany. METHODS: We draw on literature from that time, unpublished archival material, and interviews with contemporary witnesses. RESULTS: After the establishment of standards for specialist training in the early 1960s, general practice was introduced as a field of specialty in 1967. By this, East Germany had a compulsory specialist training in general practice much earlier than West Germany. In 1971, a specialist society for general practice was founded in East Germany. However, institutionalization at the medical faculties was still lacking. Meanwhile, the nationalization of outpatient care continued. In the years that followed, primary medical care was increasingly provided in policlinics. In 1989, of 40,000 physicians in the GDR, only about 340 were still practicing in their own offices. CONCLUSION: Within the nationalized GDR health system a committed group of physicians, under difficult political circumstances, pushed for professionalization of general practice and its recognition as a field of specialty. When general medicine was recognized as a specialty in 1967, this happened earlier than in other countries and constituted an important milestone.

Increased alcohol-specific mortality in Germany during COVID-19: State-level trends from 2010 to 2020.

INTRODUCTION: The COVID-19 pandemic may have led to an increase in the alcohol-specific mortality. Against this backdrop, the aim of this report is to explore alcohol-specific mortality trends in Germany of the years 2010 to 2020. METHOD: Alcohol-specific mortality data aggregated by sex, 5-year age groups and state were collected from the annual cause-of-death statistics and analysed descriptively by visual inspection. RESULTS: The overall alcohol-specific mortality rate (age-standardised) has mainly decreased between 2010 and 2020. However, increased alcohol-specific mortality rates for the year 2020 compared to 2019 were found for both, women (+4.8%) and men (+5.5%), particularly in age groups between 40 and 69 years. Changes in alcohol-specific mortality rates differed between federated states, with steeper increases in East Germany. DISCUSSION AND CONCLUSIONS: Different mechanisms related to the increase in alcohol consumption, particularly among high-risk drinkers, and reduced resources in health care may have led to an increase in alcohol-specific mortality in Germany in 2020. Despite the recent decline in the alcohol-specific mortality in Germany, an increase in the death toll was observed in 2020.

Paying attention to each other. An essay on the transnational intersections of industrial economy, subjectivity, and governance in East Germany's social-psychological training.

This article examines a little-known chapter both in the history of socialist labor relations and the history of psychology: Social Psychological Training (SPT) for industrial leaders in the German Democratic Republic (GDR). Based on previously untapped archival sources, it uncovers the transnational genesis of SPT and its intricate relationships with Western "therapeutic culture" of the 1970s. Governmental perspectives are addressed, as well as the level of individual appropriation of SPT and possible unintended side effects of techniques that were drawn from the social psychological and therapeutical fields. This case study helps to explore the functions of psychological expertise in authoritarian political contexts, as well as the polyvalence of group methods of change, the effects of which could turn out repressive as well as liberating on both sides of the Iron Curtain. The history of SPT solicits a polycentric view on therapeutic culture, capturing its diverse manifestations and interconnections between different societies and political economies.

[Differences in Area Specific Life Satisfaction Between East and West Germans in the Years 1991, 2006 and 2020]. / Unterschiede in der Zufriedenheit verschiedener Lebensbereiche zwischen Ost- und Westdeutschen in den Jahren 1991, 2006 und 2020.

RESEARCH: Question How did the general and area specific life satisfaction evolve between East and West Germany between 1991 and 2020? METHODS: Based on three representative surveys in the years 1991, 2006 and 2020 life satisfaction between East and West Germany was examined using mean comparison with tests of significance. The influence of relevant sociodemographic variables was calculated using Univariate Variance Analyses. RESULTS: 1991 large differences in the general life satisfaction as well as with satisfaction in the areas of living, spare time, health, finances and occupational did occur, with people in East Germany reporting to be less satisfied. These differences align during the observation time. DISCUSSION: The discrepancy in the general and area specific life satisfaction between East and West Germans did align during the last 30 years. A reason might be the improved economical living conditions in East Germany.

[Sex- and Regionalspecific Differences in Child Abuse and Violence Before the German Reunification. Results from GESA, a Multi-Cohort Study]. / Geschlechts- und regionalspezifische Unterschiede von Kindesvernachlässigung und Gewalt vor der deutschen Wiedervereinigung. Ergebnisse aus GESA, einem Multi-Kohorten Konsortium.

Results from a population-based study suggest sex-specific patterns of self-reported child maltreatment, more frequently reported in former West than East Germany. Aim of the current study was to examine these patterns in two regional samples of the former East- (SHIP, 2008 - 2012) and West German (KORA, 2013 - 2014) population. Child maltreatment was assessed using the Childhood Trauma Screener (CTS). Overall, child maltreatment was less often reported in the East German sample, compared to the West German sample. The most prominent differences were identified in self-rated emotional violence (east 6.1%, west 8.7%), physical violence (east 5.7%, west 10.3%) and physical neglect (east 10.0%, west 19.2%). However, we could not find differences in sex-specific patterns between the East and West German samples. Results were discussed within a historical context, since the events took place before the German reunification in two oppose political systems.

[Personal Resources of Adolescents in Eastern and Western Germany - Results of the KiGGS Study 15 and 25 years after the German Reunification]. / Personale Ressourcen von Jugendlichen in Ost- und Westdeutschland ­ Ergebnisse der KiGGS-Studie 15 und 25 Jahre nach der Wende.

QUESTIONS: More than 15 years after the German reunification, were there differences in the personal resources among adolescents born around 1989 between East and West? How did the differences of this generation develop? METHODS: Data from the study on the health of children, adolescents and young adults in Germany (KiGGS study) from the years 2003-2006 and 2014-2017 are used to determine the prevalence of low personal resources in 14-17-year-old adolescents in Eastern and Western Germany. Cross-sectional data at both time periods are compared between East and West, and longitudinal data are used to follow the cohort over the course of age RESULTS: Around 15 years after the German reunification, 14- to 17-year-olds from East Germany more frequently show fewer personal resources and have lower self-efficacy expectations than adolescents of the same age in West Germany. 10 years later, these differences are barely visible and have partially reversed. The east-west differences found cannot be explained by the different socio-economic situations of the families in East and West. DISCUSSION: The results show that in the 2000s, adolescents born around 1989 from families living in Eastern Germany, showed a higher risk of having fewer personal resources than adolescents from families living in Western Germany. 25 years after the German reunification this is no longer recognizable. While the differences between East and West decrease over time, the importance of the socio-economic situation of the family for the personal resources of adolescents as a whole increases, to the detriment of those with a lower socioeconomic status. The results indicate the need for targeted interventions to strengthen psychosocial resources especially for children and adolescents in phases of transformation and biographical breaks.

Internet-based imagery rescripting intervention for adult survivors of institutional childhood abuse in the former German Democratic Republic - a pilot study.

Background: From 1949 to 1990, about 500,000 children and adolescents in the former German Democratic Republic (GDR) were placed in institutional care. Many of these individuals experienced physical and sexual abuse as well as general maltreatment. While this population group is in great need of psychosocial support, few low-threshold interventions aimed at the needs of adult survivors of institutional childhood abuse exist. Objective: This pilot study examines the efficacy of an internet-based imagery rescripting intervention in reducing psychopathological symptoms, within a population of survivors of institutional abuse from state childcare institutions, in the former GDR. Additionally, a case study is presented, depicting the treatment of a woman suffering from PTSD after having been institutionalised in the former GDR. Method: Participants received 10 internet-based writing assignments, based on the principles of imagery rescripting, specifically tailored to the needs of survivors of institutional childhood abuse in the GDR. The participants received personalised feedback on their assignments. Symptoms of posttraumatic stress disorder (PTSD), complex posttraumatic stress disorder (CPTSD), depression, and anxiety were assessed at pre- and post-treatment. Results: A total of 15 participants completed the intervention (mean age 56.2 years; 66.7% female). Paired t-tests showed a significant reduction of PTSD, CPTSD, depression, and anxiety symptoms. Large effect sizes were found for PTSD (d = 1.26), CPTSD (d = .97), depression (d = 1.08) and anxiety (d = 1.20). Conclusion: The results of this pilot study provide preliminary evidence for the efficacy and feasibility of the intervention in treating psychopathological symptoms in survivors of institutional abuse in the GDR. The case study additionally demonstrates the applicability of the intervention. A randomised controlled trial should be applied to further evaluate the intervention and its effects. Trial registration: German Clinical Trials Register identifier: DRKS00020266..

Antecedentes: Desde 1949 a 1990, alrededor de 500.000 niños y adolescentes en la antigua República Democrática Alemana (RDA) fueron internados en instituciones. Muchas de estas personas experimentaron abuso físico y sexual, así como malos tratos en general. Si bien este grupo de población tiene una gran necesidad de apoyo psicosocial, existen pocas intervenciones elementales dirigidas a las necesidades de los sobrevivientes adultos de abuso infantil institucional.Objetivo: Este estudio piloto examina la eficacia de una intervención de reescritura de imágenes vía Internet para reducir los síntomas psicopatológicos, en una población de sobrevivientes de abuso institucional de instituciones estatales de cuidado infantil, en la antigua RDA. Además, se presenta un estudio de caso que describe el tratamiento de una mujer que sufre de TEPT después de haber sido institucionalizada en la antigua RDA.Método: Los participantes recibieron 10 asignaciones de escritura vía Internet, basadas en los principios de la reescritura de imágenes, específicamente adaptadas a las necesidades de los sobrevivientes de abuso infantil institucional. Los participantes recibieron comentarios personalizados sobre sus tareas. Los síntomas del trastorno de estrés postraumático (TEPT), el trastorno de estrés postraumático complejo (TEPT-C), la depresión y la ansiedad se evaluaron antes y después del tratamiento.Resultados: Un total de 15 participantes completaron la intervención (edad media 56,2 años; 66,7% mujeres). Las pruebas t pareadas mostraron una reducción significativa de los síntomas TEPT, TEPT-C, depresión y ansiedad. Se encontraron tamaños de efecto grandes para TEPT (d = 1,26), TEPT-C (d = 0,97), depresión (d = 1,08) y ansiedad (d = 1,20).Conclusión: Los resultados de este estudio piloto proporcionan evidencia preliminar de la eficacia y viabilidad de la intervención en el tratamiento de síntomas psicopatológicos en sobrevivientes de abuso institucional en la RDA. El estudio de caso demuestra además la aplicabilidad de la intervención. Se debe aplicar un ensayo controlado aleatorizado para evaluar más a fondo la intervención y sus efectos.

Individual and Work-Related Predictors of Exhaustion in East and West Germany.

Chronic exhaustion is a consequence of detrimental working conditions and demands, as well as inadequate coping techniques, potentially resulting in burnout. Previous research has studied occupational environment and individual factors as predictors of exhaustion. Although these differ between former East and West German states, the regional distinction regarding exhaustion has been neglected. To fill this gap, we used the Copenhagen Burnout Inventory in a representative German sample from 2014 to assess the burnout symptom exhaustion. Estimating ordinary least squares regressions, important burnout predictors were compared between the former East and West German states. Regional differences concerning occupational environments were related to the associations between individual factors, situational aspects of technostress and exhaustion. Associations between individual factors (e.g., female sex, lower working hours, age, partnership status, and household income) and exhaustion were stronger in East Germany, whereas technostress (strain of internet use, number of e-mails during leisure time, and social pressure to be constantly available) was more strongly associated with exhaustion in West Germany. Despite lower financial gratification and a higher social pressure to be constantly available in the East, West Germans were more afflicted by exhaustion. Individual factors and technostress should thus be considered when focusing on job-related mental health issues.