Functional Somatic Disorders, Their Subtypes, and Their Association With Self-Rated Health in the German General Population.

OBJECTIVE: The heterogeneous conceptualizations and classifications of persistent and troublesome physical symptoms impede their adequate clinical management. Functional somatic disorder (FSD) is a recently suggested interface concept that is etiologically neutral and allows for dysfunctional psychobehavioral characteristics as well as somatic comorbidity. However, its prevalence and impact are not yet known. METHODS: We analyzed 2379 participants (mean age = 48.3 years, 52.5% female) from a representative German community survey using operationalized FSD criteria. These criteria defined FSD types based on somatic symptom count, type, and severity assessed by the Bodily Distress Syndrome Checklist. In addition, the associations of those types with health concerns, comorbidity, psychological distress, and self-rated health were determined. RESULTS: There were four clearly demarcated groups with no relevant bothering symptoms, with one or with few bothering symptoms from one organ system, and with multiple bothering symptoms from at least two organ systems. Psychological distress, health concerns, and comorbidity steadily increased, and self-rated health decreased according to the number and severity of symptoms. Somatic symptom burden, health concerns, and comorbidity independently predicted self-rated health, with no interaction effect between the latter two. CONCLUSIONS: Our data support an FSD concept with two severity grades according to persistent and troublesome symptoms in one versus more organ systems. The delimitation of subtypes with psychobehavioral characteristics and/or with somatic comorbidity seems useful, while still allowing the demarcation of a group of participants with high symptom burden but without those additional characteristics.

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.

Effects of Post-awakening Light Exposure on Heart Rate Variability in Healthy Male Individuals.

Light-induced effects on the autonomic nervous system (ANS) are assumed to be mediated by retinal projections to the hypothalamic suprachiasmatic nucleus (SCN) via different routes. Light information for the circadian system is detected by a subset of intrinsically photosensitive retinal ganglion cells (ipRGCs), however, inconsistency exists in research concerning the effects of light exposure on heart rate variability (HRV). Two within-subject experiments were conducted in a standardized sleep laboratory to investigate effects of light intensity (study I, n = 29: 2 days dim vs. bright light) and spectral composition (study II, n = 24: 3 days using red vs. blue vs. green light) on HRV parameters (RMSSD, LF, HF-HRV, LF/HF ratio). Light exposure was conducted for one-hour in the post-awakening phase at 5:00 AM. Results revealed no significant light intensity effect comparing dim light versus bright white light on HRV parameters. Light color of different wavelengths significantly influenced all HRV parameters except the low frequency, with moderate to large effect sizes. RMSSD values were elevated for all three colors compared to norm values, indicating stronger parasympathetic activation. LED light of different spectral compositions demonstrated bidirectional effects on spectral components of the HRV. Red light decreased the LF/HF ratio within 30 min, whereas with blue light, LF/HF ratio consistently increased across 40 min of light exposure.

Evaluating the psychometric properties of the German adaptation of the client attachment to therapist scale.

BACKGROUND: The present study examines the psychometric properties of the German adaptation of the Client Attachment to Therapist Scale (CATS). The validity of the scale as originally proposed has recently been brought into question, as patients were identified as "pseudosecure". METHODS: We examined the measure's factorial structure, as well as reliability and validity towards related measures using a clinical sample of N = 354 participants. RESULTS: We found the original model, consisting of 36 items to be lacking in terms of model fit and construct validity. A shortened 12-item version exhibited markedly improved model fit and reliability. Correlations to related constructs demonstrated that none of the scale's validity was lost by shortening it. Furthermore, we showed scalar invariance across groups of age and sex. CONCLUSIONS: The shortened CATS-S can be recommended for future use in clinical research in German-speaking populations as a valid, reliable, and economical alternative to the longer version.

Measuring physical, cognitive, and emotional aspects of exhaustion with the BOSS II-short version - results from a representative population-based study in Germany.

BACKGROUND: The aim of the present study was the construction and psychometric evaluation of a shortened version of the Burnout Screening Scales II (BOSS II), a measure for exhaustion and burnout. METHODS: To this end, among a representative sample of the German general population (N = 2429, 52.9% women), we shortened the scale from 30 to 15 items applying ant-colony-optimization, and calculated item statistics of the short version (BOSS II-short). To estimate its reliability, we used McDonald's Omega (ω). To demonstrate validity, we compared the correlation between the BOSS II-short and the BOSS II, as well as their associations with depression, anxiety, and quality of life. Furthermore, we evaluated model fit and measurement invariance across respondent age and gender in confirmatory factor analyses (CFA). Finally, we present adapted norm values. RESULTS: The CFA showed an excellent model fit (χ2 = 223.037, df = 87, p < .001; CFI = .975; TLI = .970; RMSEA [90%CI] = .036 [.031;.040]) of the BOSS II-short, and good to very good reliability of the three subscales: 'physical' (ω = .76), 'cognitive' (ω = .89), and 'emotional' (ω = .88) symptoms. There was strict measurement invariance for male and female participants and partial strict invariance across age groups. Each subscale was negatively related to quality of life ('physical': r = -.62; 'cognitive': r = -.50; 'emotional': r = -.50), and positively associated with depression ('physical': r = .57; 'cognitive': r = .67; 'emotional': r = .73) and anxiety ('physical': r = .50; 'cognitive': r = .63; 'emotional': r = .71). CONCLUSIONS: Overall, the BOSS II-short proved to be a valid and reliable instrument in the German general population allowing a brief assessment of different symptoms of exhaustion. Norm values can be used for early detection of exhaustion.

[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.

Increase in cortisol concentration due to standardized bright and blue light exposure on saliva cortisol in the morning following sleep laboratory.

Research studies on LED light exposure and cortisol are inconsistent and not comparable due to different types of light, exposure times, and sample sizes. Therefore, one hour of standardized exposure LED light at different intensities and the spectral composition during the post-awakening phase at 7:30 were compared. A sample of 23 (Study 1) and 26 (Study 2) healthy males were randomly assigned to: 1) bright white light (414 lux) and 2) dim darkened light (<2 lux) as well as 3) red light (235 lux) and 4) blue light (201 lux) exposure conditions. Results from repeated measures ANOVA confirm that light exposure affects the cortisol concentration. Study 1 revealed an increase in the saliva cortisol concentration after bright light exposure compared to dim light. An increase in the cortisol concentration of blue light compared to red light (Study 2) and dim light was found. This study shows that bright light and blue light affect the cortisol response in contrast to dim light and red light conditions. The HPA axis showed a stimulatory effect by bright versus dim light and different wavelengths of light exposure.Lay summaryThe effects of LED light exposure on the stress hormone cortisol were investigated. The light exposure took place during the hours people would start working at the office. The results showed that after one hour of exposure to bright light or blue light the stress hormones increase in contrast to dim light and red light conditions. Thus, stress hormones can be altered by the types of light people are exposed to.

The effects of light exposure on the cortisol stress response in human males.

It is assumed that the production of cortisol is modulated by light exposure. While initial evidence supports this principal effect, the specific effect of light (intensity and wavelength) onto the cortisol stress response is still not completely understood. One between-subject experiment was conducted in a standardized sleep laboratory setting to investigate the effect of light intensity (dim white vs. bright white light) and spectral composition (red vs. blue) on the cortisol response after the Maastricht Acute Stress Test (MAST). 112 healthy young males (24.83 ± 4.10 years of age) were randomly assigned to one of the four light conditions. Across conditions, light exposure was conducted for one-hour post-awakening and the light effect was measured based on eight saliva samples. The analysis indicates significant main effects for time and light condition as well as a significant interaction effect. Notably, bright light exposure evoked the highest cortisol levels when compared to dim white, red, and blue light. Our findings illustrate the crucial role of light intensity and wavelength for the cortisol stress response, in line with current theoretical knowledge of underlying neurobiological mechanisms. LAY SUMMARY Effects of different light sources were tested on healthy male adults in the morning after a stress test. Their stress responses showed that a bright light exposure increased the stress hormone level greatest compared to dim white, red or blue light sources. Findings point toward the crucial role of light intensity associated with the hormonal stress response.

Fibromyalgia revisited: do latent class analyses of symptom profiles in the general population confirm 2016 fibromyalgia diagnostic criteria?

OBJECTIVES: The definition of the 2016 diagnostic criteria of fibromyalgia (FM) syndrome and of FM severities was based on studies with clinical samples. We tested if somatic symptom profiles consistent with the symptom pattern of the FM 2016 diagnostic criteria and of severities of FM can be found in the general population. METHODS: Somatic symptom burden was measured by the Somatic Symptom Scale - 8 in 2,531 persons aged ≥14 years representative for the general German population. We used latent class analysis of SSS-8 items to identify somatic symptom profiles. The profiles were described by their association with age, gender, self-reported disabling somatic disease, psychological symptom burden, illness worries and self-perceived health. RESULTS: We identified five somatic symptom profiles. The majority of the population (40.9%) had a profile characterised by the absence of bothering symptoms. 5.9% had a profile defined by "considerable bothering" back and extremities pains, fatigue and sleep problems. This symptom profile was associated with older age, self-reported somatic diseases, psychological symptom burden and fair to poor general health. 63.2% of persons meeting FM 2016 criteria belonged to this profile. 17.8% of the sample were characterized by little perturbation by multiple somatic symptoms and good to fair general health. 36.8% of persons meeting FM 2016 criteria belonged to this profile. CONCLUSIONS: Two somatic symptom profiles consistent with the 2016 FM diagnostic criteria were identified in the general German population. These symptom profiles differed in somatic and psychological symptom burden and general health supporting the distinction of FM severities.

Effects of stress on chewing and food intake in patients with anorexia nervosa.

OBJECTIVE: The present study investigates the impact of psychosocial stress on chewing and eating behavior in patients with anorexia nervosa (PAN ). METHOD: The eating and chewing behavior of PAN were examined in a standardized setting by means of a chewing sensor. These procedures encompassed n = 19 PAN , age, and gender matched to n = 19 healthy controls (HC). Food intake and chewing frequency were assessed in two experimental conditions: rest versus stress (via Trier Social Stress Test). To verify stress induction, two appraisal scales were employed. In addition, chronic stress, psychological distress and eating disorder symptoms were assessed. RESULTS: In terms of food intake and chewing frequency, the results of the 2x2 ANOVA demonstrated a significant effect of condition and group. During stress, all participants demonstrated a higher chewing frequency and a decreased ingestion. In general, patients ate less at a lower chewing frequency (vs. HC). However, sample specific analyses demonstrated that the eating and chewing behavior of PAN remained unchanged regardless of the condition, except for their drinking. Food choices were comparable between the groups, but appetite values significantly differed. DISCUSSION: The increase in chewing frequency in all participants during stress suggests that chewing might impact affect regulation, however, not specifically in PAN . Future research should clarify to what extent the normalization of chewing behavior could ameliorate ED-symptoms (incl. food intake) in PAN . The application of a chewing sensor could support this aim and future interventions.

Retraction Note: Psychometric properties of a short version of the Job Anxiety Scale.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12874-020-01166-w .

Psychometric properties of a short version of the Job Anxiety Scale.

BACKGROUND: Occupational stress and specifically job anxiety are crucial factors in determining health outcomes, job satisfaction as well as performance. In order to assess this phenomenon, the Job Anxiety Scale is one of the instruments available. It consists of 70 items that are clustered in 14 subscales and five dimensions. The aim of this paper is to create a more efficient, short version of the Job Anxiety Scale, while retaining the five dimensions, and to assess its psychometric properties. METHODS: The sample consists of 991 - mostly psychosomatic - patients from two different clinics. We applied methods of factor analysis and bivariate correlations to explore and test factor structure and the nomological net of related constructs. RESULTS: After reducing the item pool via the construction of subsets and tests using ant-colony-optimization, a 15-item version of the Job Anxiety Scale evinced very good psychometric properties. We found very good model fit, high internal consistency, and invariance across participant age and sex. It displayed improved discriminant validity compared to the original scale, and we found the expected pattern of convergent correlations. CONCLUSIONS: With this short version of the Job Anxiety Scale, researchers can assess job related worries in a much more economic manner. The questionnaire is particularly useful in large-scale surveys and/or in samples that struggle with extensive assessments.

Norm values and psychometric properties for the German health regulatory focus scale - results of a representative survey.

BACKGROUND: The health regulatory focus is an application of Higgins' regulatory focus theory to a health-specific context. It explains individual differences in health motivation, strategies, and behavior. Previous research found the Health Regulatory Focus Scale (HRFS) to be a reliable and valid measure for the construct. However, an evaluation of the HRFS in a representative sample has not been performed as of yet. Neither are there any normative values available. METHODS: We collected a representative sample from the German general population to perform a confirmatory factor analysis, an analysis of measurement invariance, and to calculate norm values. RESULTS: A two-factor model evinced good model fit with a good reliability for the two subscales. We found evidence for strict invariance across gender groups and partial strict invariance across age groups. In addition, we are presenting normative values for the general population. CONCLUSIONS: The findings of the present study are in line with previous research in confirming the HRFS as a valid and reliable tool suitable for the assessment of the health regulatory focus. The reported normative values allow for comparisons of individuals with their respective sociodemographic group.

Investigation of the factorial structure and psychometrics of the German version of the Florida Shock Anxiety Scale.

Cardiovascular diseases are among the leading causes of death, worldwide.To protect those vulnerable to cardiac arrest, defibrillators performing reanimation by automatic discharge are implanted. Due to the high pain intensity of such a procedure, many patients develop anxiety disorders. To diagnose the fear-relevant symptoms, the English version of the Florida Shock Anxiety Scale (FSAS) is used. The present study investigates the quality of the German version of the FSAS using a confirmatory factor analysis. Therefore, a sample of N = 138 participants (n = 38 female and n = 100 male; age: M = 60.99, SD = 11.58) with implanted or wearable cardioverter defibrillators was examined. Similar to the English version, the most suitable model includes the two factors 'consequence' and 'trigger stimulus'. Although, in our investigation, it is not a second order model but a bi-factorial model which reaches the best fit. Both the internal consistency and the convergent validity were checked and showed sufficiently good values. In summary, the German version of the FSAS may also be recommended for the diagnosis of shock-induced anxiety disorder.

[Psychometric Evaluation and Norm Values of an Ultra-Short Version of the Sense of Coherence Scale "SOC-3"]. / Psychometrische Evaluation und Normwerte einer Ultrakurzform der Sense of Coherence Scale "SOC-3".

Sense of coherence is a psychological resource which contributes substantially to an individual's ability to cope well with stressful situations. In the present study we investigate an ultra-short form of the Sense of Coherence Scale (SOC-3) in a representative sample of the German general population (N=2.018). The 3-item model evinced excellent model fit qualities and acceptable reliability. We present evidence for partial strict invariance across sex and age groups. In terms of construct validity, our analyses demonstrate strong overlap between the SOC-3 and two longer versions (-9 and -29). In addition, correlations to related constructs such as attachment styles, physical and mental health, as well as quality of life were similar between the SOC versions. For the first time, normative values for the German population are presented to allow for the classification of individual scores. We recommend the SOC-3 as a screener for applied sciences and for large-scale surveys in particular.

Implicit Attachment Schemas and Therapy Outcome for Panic Disorder Treated with Manualized Confrontation Therapy.

BACKGROUND: Different studies have shown that a patient's attachment correlates with the psychotherapy outcome. However, these findings are based on the traditional interview and paper and pencil attachment methods. Latency-based methods like the Implicit Association Test (IAT) have not yet been investigated in clinical attachment research, specifically in therapy outcome research. OBJECTIVES: It can be hypothesized that patients with positive schemas of their mother and their partner may show a better psychotherapeutic outcome than those with less positive schemas of their mother/partner. METHOD: A sample of 103 patients suffering from panic disorder with or without agoraphobia (age 36.73, SD = 10.80), including 56% of patients with affective or other anxiety disorders as comorbidities without a personality disorder, based on the Structured Clinical Interview for DSM-IV (SCID-I/II), were treated with a manualized cognitive-behavioral confrontation therapy. Two IATs (for mother and partner) were implemented before the therapy (t1). The symptom reduction was assessed by the Symptom Checklist-90 (SCL-90) and the Beck Depression Inventory (BDI) with symptoms at t1 and IAT at t1 as predictors of symptoms at t2. RESULTS: The results confirmed a moderate to high therapeutic effect of the confrontation therapy. Furthermore, the mother's IAT at t1 predicted the Global Severity Index (ß = 0.20) as well as the Anxiety subscale (ß = 0.18) at t2 above and beyond the t1 measurement of the criteria. CONCLUSIONS: Implicit attitudes of the mother predicted the symptom reduction and a better therapeutic outcome. Relationship aspects with less impact awareness predicted the therapeutic outcome, even though mostly cognitive-behavioral techniques were used.

Norm values and psychometric properties of the brief symptom inventory-18 regarding individuals between the ages of 60 and 95.

OBJECTIVE: The SCL-90 and the SCL-90-R are the most applied measures regarding psychological distress. To reduce and prevent an overload to of the individuals, the Brief Symptom Inventory with 18 items (BSI-18) was developed based on the SCL-90. Since psychological disorders more frequently occur at an older age, there is a growing need for efficient instruments to measure distress in the elderly. However, the BSI-18's psychometric properties, norm values, and factorial structure have not yet been investigated in this age group. METHODS: The aim of this study was to evaluate the BSI-18 in a sample of elderly people and to establish norm values for this specific population. Subsequently, demographic information and BSI-18 results were collected from a sample totaling 884 (55% female, mean age of 70.75 years, SD = 7.08, age range = 60-95 years). The questionnaire contains three six-item scales: somatization (SOMA), anxiety (ANX), and depression (DEPR), which form a general symptom index (GSI). RESULTS: We found an acceptable to good model fit for a three-factor-model with a general GSI factor. The BSI-18's psychometric properties were satisfactory. Strict measurement invariance was shown for age and gender. Additionally, we found differences in psychological distress based on sociodemographic variables. CONCLUSIONS: These findings underline the growing need for preventive mechanisms for elderly people such as, e.g., (re)activating their social networks and strengthening their physical and psychological well-being.

[Psychometric evaluation of the German version of the Health Regulatory Focus Scale]. / Psychometrische Überprüfung der deutschen Version der Health Regulatory Focus Scale.

Psychometric evaluation of the German version of the Health Regulatory Focus Scale Objectives: This study examines the psychometric properties of the German version of the Health Regulatory Focus Scale (HRFS), which measures health-related promotion- and prevention-based motivation. METHODS: The study is based on data from the 28th (N = 332) and 29th survey wave (N = 253) of the Saxony Longitudinal Study. It examines item characteristics, factorial, convergent and prognostic validity as well as the influence of sociodemographic variables. RESULTS: The psychometric properties of the German version are excellent, after removal of Item 5. A two-factor structure as well as good validity were confirmed. CONCLUSION: The shortened German version of the HRFS is well suited to capturing the health related regulatory focus of this test and makes it useful in the area of health promotion and prevention.

Psychometric evaluation of the patient health questionnaire stress scale.

The "Patient Health Questionnaire (PHQ)" is a screening instrument, designed for time-efficient detection and severity assessment of depression, anxiety, and other syndromes in medical settings. Besides the questions on psychological symptoms, there are items on psychosocial functioning, on stressors and critical life events. However, for the stress items there are no psychometric properties available until now. The present study is thought to investigate item characteristics, internal consistency as well as factorial and construct validity of the stress scale of the PHQ. A representative sample of the general population of Germany was collected by a demography consulting company (USUMA, Berlin). Per random-route procedure, households and members of the households were selected. The sample was representative for the German community regarding age, gender, and education. In this investigation the following questionnaires were administered: PHQ-Stress, Questions on Life Satisfaction Modules (FLZ-M), Type-D Scale-14 (DS14). The sample included N = 2396 participants with mean age of 48.50 (SD = 17.75; range = 14 to 92) and 55.2 % being female. Reliability of the PHQ stress scale was acceptable (ω = 0.776), but some factor loadings were comparatively low. Model fit indices showed mixed results, some indicating unacceptable and some indicating acceptable fit of the 10-item stress scale of the PHQ. Correlations with related constructs demonstrated the scale's convergent validity. The results of this validation study indicate that the PHQ stress scale, which provides a one-dimensional total stress score, is a valid, good practical and reliable self-report instrument for assessing the severity of psychosocial stress.

[Physician-assisted interhospital transfer-an analysis from Schleswig-Holstein]. / Arztbegleitete Interhospitaltransporte ­ eine Analyse aus Schleswig-Holstein.

BACKGROUND: The need for interhospital transport (IHT) of intensive care patients is increasing due to changes in the hospital environment. Interhospital transports are challenging and require careful operational planning of personnel and rescue vehicles. OBJECTIVE: To investigate the need for IHT, an analysis was conducted in the service area of the emergency medical service central dispatch center (IRLS) in Schleswig-Holstein. MATERIAL AND METHODS: Emergency physician-assisted IHT were analyzed in the period from 01.10.2021 to 30.09.2022. RESULTS: Of a total of 158,823 documented IRLS missions, 2264 (1.4%) records could be identified and included as IHT: 1389 IHT (61.4%) were managed by specialized ambulances, 875 (38.6%) by primary care ambulances. Primary care ambulances were mainly used for time-critical transfers and outside the duty hours of the intensive care ambulances, 21.2 % were by air. Of all IHT, 43.1% were required to hospitals with a higher level of medical care. CONCLUSION: Emergency physician-assisted IHT are a relevant part of the emergency service's operational spectrum and concern both primary care and specialized rescue vehicles. A relevant number of urgent IHT were recorded outside the duty hours of the intensive care ambulances. For emergency transports during nighttime, an expansion of air-based transfer capacities should be considered due to the time advantage. For less urgent IHT, an adjustment of the capacities of specialized ground-based vehicles in Schleswig-Holstein seems reasonable.