Efficacy of an internet-based written imagery rescripting intervention for survivors of institutional childhood abuse - A randomized controlled trial.

BACKGROUND: Institutional childhood abuse can have a long-term impact on the survivors' mental health, however, treatment for this group is limited and not always accessible. An internet-based intervention was developed, with the aim to reduce psychological sequelae relating to institutional abuse. OBJECTIVE: This study aimed to examine the efficacy of an online imagery rescripting intervention for survivors of institutional abuse, through assessing symptoms of depression, anxiety, PTSD, and CPTSD. PARTICIPANTS AND SETTING: Seventy-two adult survivors of institutional childhood abuse in the former German Democratic Republic were randomized either to the intervention (n = 38) or to the waitlist condition (n = 34). The intervention consisted of 10 modules, based on written imagery rescripting, and involved asynchronous therapist contact. METHODS: Primary outcomes included symptoms of depression (PHQ-9), anxiety (GAD-7), PTSD (ITQ), and CPTSD (ITQ DSO). The intervention condition was assessed at baseline, post-intervention, 3-, and 6-month follow-up. RESULTS: Intention-to-treat analyses revealed a significant symptom reduction from baseline to post-assessment with medium to large effects for all main outcomes (d = 0.45 to d = 0.76), in favor of the intervention condition. Significant interactions between condition (intervention vs. wailist) and time (baseline vs. post-assesment) were revealed for all main outcomes (p < .001 to p = .024). The effects were maintained at follow-up. CONCLUSIONS: The results suggest online writing-based imagery rescripting as a promising treatment option for adults formerly institutionalized in residential care. Future research is needed to explore its effectiveness for other groups of patients suffering from abuse and neglect.

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.

Loss-Related Characteristics and Symptoms of Depression, Prolonged Grief, and Posttraumatic Stress Following Suicide Bereavement.

(1) Background: The aim of the present study was to examine symptom classes of major depressive disorder (MDD), prolonged grief disorder (PGD), and posttraumatic stress disorder (PTSD) in a sample of suicide-bereaved individuals, while accounting for loss-related characteristics. (2) Methods: A latent class analysis was conducted to identify classes of the suicide bereaved, sharing symptom profiles, in a German suicide-bereaved sample (N = 159). (3) Results: Our analyses revealed three main classes: a resilient class (16%), a class with high endorsement probability for PGD symptoms (50%), and a class with high endorsement probability for combined PGD/PTSD symptoms (34%). Prolonged grief and intrusive symptoms emerged across all classes, while MDD showed low endorsement probability. Our results indicate an association between class membership and time passed since the loss; however, this applies only to the comparison between the PGD and the resilient class, and not for the PGD/PTSD class. (4) Conclusions: Our results may provide information about the predictability of symptom clusters following suicide bereavement. The findings also represent a significant step towards tailoring treatments based on the needs of relevant suicide-bereaved subgroups through a symptom-level approach. Time passed since loss might explain differences between symptom clusters.

Efficacy of an online-group intervention after suicide bereavement: A randomized controlled trial.

Introduction: People bereaved by suicide are at high-risk for developing mental disorders and suicidal tendencies. Grief after suicide differs from grief after other types of death, and bereaved persons may require support tailored to their situation. In this study, we evaluate an online intervention for individuals bereaved by suicide and its effectiveness on mental health. Methods: A total of 140 participants were included in the intervention and randomized to either the treatment or the waitlist control group. The intervention consisted of 12 weekly modules, based on cognitive-behavioral methods, and took place as a webinar in a group format. Primary outcomes were depression and suicidality; secondary outcomes were symptoms of prolonged grief, PTSD, posttraumatic cognitions, hopelessness, and grief-specific symptoms. Results: Symptoms of posttraumatic avoidance improved significantly in the intention-to-treat analyses (d between = 0.43) and in treatment completers (d between = 0.56), posttraumatic intrusion improved in treatment completers (d between = 0.50) compared to the waitlist control group. In the intervention group, psychopathological symptoms decreased significantly from baseline to 6-month follow-up. Furthermore, factors such as higher scores of depression, grief, suicide ideation, and posttraumatic stress symptoms were identified at baseline, which impacted the effectiveness of the intervention. Conclusions: The results of this study indicate that completing an online group intervention for the suicide bereaved could reduce trauma-related outcomes. However, the waiting control group also improved significantly from pre- to post-measurement in all other outcomes. Future studies with active control groups are needed to further examine the effectiveness.

Suicide risk after suicide bereavement: The role of loss-related characteristics, mental health, and hopelessness.

BACKGROUND: Suicide bereavement is associated with increased risk for severe negative mental health outcomes and suicidality. The purpose of this study was to examine the association between mental health symptoms and suicidal ideation among suicide bereaved while taking multiple factors into account. METHODS: The sample consisted of N = 157 German suicide bereaved who were interested in receiving an online intervention. The Beck Scale for Suicide Ideation (BSS) was used to distinguish between participants with and without suicidal ideation. A hierarchical regression analysis determined the effect of the most common mental health symptoms on suicidal ideation: symptoms of depression (BDI-II), prolonged grief (ICG-D), post-traumatic stress (IES-R), and hopelessness (H-RB). RESULTS: No significant differences emerged for sociodemographic or loss-related characteristics between suicide bereaved individuals with and without suicidal ideation. Depressive symptom severity was associated with higher suicidal ideation. When controlling for hopelessness, the effect of depression decreased considerably, while hopelessness itself turned out to be the most important predictor variable. DISCUSSION: Increased levels of hopelessness commonly reported by suicide bereaved may represent a stronger risk factor for suicidal ideation than mental health disorders. Screening for and targeting hopelessness appears crucial for suicide prevention in this population.

[Disease burden of borderline personality disorder: cost of illness, somatic comorbidity and mortality]. / Krankheitslast der Borderline-Persönlichkeitsstörung: Krankheitskosten, somatische Komorbidität und Mortalität.

BACKGROUND: Severe mental illnesses (SMI) are characterized by high psychosocial impairment as well as by increased somatic morbidity and mortality. The term SMI commonly includes psychotic, bipolar and severe unipolar depressive disorders but borderline personality disorder (BPD) also shows severe sequelae of the disease. MATERIAL AND METHODS: Published reviews and studies since 2010 examining disease burden of BPD, in terms of direct and indirect costs of illness, somatic comorbidity, and mortality were included. Furthermore, administrative data (clinically recorded billing data in Germany), comorbidity and mortality from a comprehensive analysis (n > 59 million, age ≥ 18 years) are reported. RESULTS: International studies reveal an increased disease burden, comorbidity, and mortality for BPD. In Germany BPD (administrative 1­year prevalence 0.34%) is associated with increased rates of somatic sequelae of trauma, hepatitis, HIV, COPD, asthma, and obesity. The estimated reduced life expectancy is 5.0-9.3 years of life lost (depending on age and sex). DISCUSSION: The burden of disease in BPD is clearly increased (cost of illness, somatic comorbidity and mortality). The increased mortality can mainly be explained by deaths as a consequence of poor physical health and associated BPD-related health behavior and only to a lesser degree by suicide. These results highlight the importance of classifying BPD as an SMI and the necessity to provide not only psychotherapeutic and psychiatric but also adequate somatic prevention and treatment. Individual improvement of everyday care as well as establishing new interdisciplinary and multiprofessional services could enhance health equality for people with BPD.

The relationship between guilt, depression, prolonged grief, and posttraumatic stress symptoms after suicide bereavement.

OBJECTIVE: A profound feeling of guilt and its role in complicating psychological reactions are accepted as central issues in suicide bereavement. However, research examining the relationship of guilt with mental disorders commonly following suicide bereavement is still lacking. This study aimed to examine the association between guilt and symptoms of depression, prolonged grief disorder, and posttraumatic stress disorder (PTSD) after suicide bereavement, as well as its moderating role in the association between the time which elapsed since bereavement and psychopathological symptoms. METHODS: 154 self-selected adult German participants bereaved by suicide completed online questionnaires assessing sociodemographics, characteristics related to the loss, guilt, depression, prolonged grief, and PTSD. RESULTS: Significant positive correlations were found between guilt and all assessed psychopathological symptoms. Further, guilt was a significant correlate with symptoms of depression, prolonged grief, PTSD over and above sociodemographic factors, and time that elapsed since the loss. Guilt furthermore moderated the link between the time which elapsed since bereavement and depressive symptoms, while this effect was not observed for prolonged grief and posttraumatic stress symptoms. CONCLUSION: Our findings replicate theoretical frameworks linking feelings of guilt with mental disorders after suicide bereavement. Accordingly, they highlight the necessity to adapt psychotherapeutic interventions according to the specific needs of this population to maximize treatment effectiveness.

[Psychological Interventions for People Bereaved by Suicide: A Systematic Review]. / Wirksamkeit von Interventionen für Hinterbliebene nach einem Suizid: ein Systematischer Review.

BACKGROUND: Suicide bereavement is a significant risk factor for psychological and somatic disorders. However, to date there exists only a limited number of suicide bereavement interventions, and little is known about their efficacy. METHODS: A computerized search in databases such as PsychINFO, PubMed, Medline was conducted. Randomized controlled trials (RCTs) that compared an intervention for suicide bereaved to a control condition were included after a quality assessment of two independent researchers. In total, six studies with N = 473 participants were included. Cohen's d was used to calculate the effect sizes. RESULTS: The results indicated small to medium effect sizes for within-group differences for the main outcomes in the intervention condition, while no significant between-group differences were revealed. CONCLUSIONS: Interventions for suicide bereavement can reduce mental health symptoms, however the results do not appear robust between group comparisons. Thus, it could not be demonstrated that an intervention following the suicide of a close relative is more effective than no intervention or an unspecific intervention. Future research should focus on high-quality intervention studies.