Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder.

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n=69) or a wait-list condition (n=70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination-Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d=1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82≤d≤1.11). In the treatment group significant improvement was still observed for all measures 1year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.

Childhood maltreatment and pre-pregnancy obesity: a comparison of obese, overweight, and normal weight pregnant women.

Pre-pregnancy overweight and obesity is associated with poor health outcomes for the mother and the child. General population studies suggest that childhood maltreatment is associated with obesity in adulthood. The aim of our study was to examine the association between pre-pregnancy overweight and obesity and a history of childhood abuse or neglect including different stages of severity of abuse and neglect. Three hundred twenty-six normal weight, overweight, or obese pregnant women reported demographic data, height and weight, and general psychological distress at 18-22 weeks of gestation. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Associations were examined using logistic regression analyses and a reference group of normal weight women. Fifty percent reported a history of abuse or neglect. After adjusting for age, education, income, marital status, and the number of previous children, pre-pregnancy overweight and obesity were strongly associated with severe physical abuse (overweight: OR = 8.33, 95% CI 1.48-47.03; obesity: OR = 6.31, 95% CI 1.06-37.60). Women with severe physical neglect (OR = 4.25, 95% CI 1.23-14.74) were at increased risk of pregnancy overweight. We found a dose-response relationship between physical abuse and pre-pregnancy overweight and obesity. Whereas other studies report an association between childhood maltreatment and pre-pregnancy obesity, this is the first study that found an association between childhood maltreatment and pre-pregnancy overweight. Considering the severe health risks of pre-pregnancy overweight and obesity and the long-term consequences of childhood maltreatment, affected women constitute a subgroup with special needs in prenatal care. Further research is needed to improve the understanding of the underlying mechanisms.

[Child maltreatment in binge eating disorder: a systematic literature review]. / Kindesmisshandlung bei Binge-Eating-Störung: Ein systematischer Literaturüberblick.

OBJECTIVE: This review is to provide a first overview about prevalences and associations of forms of child maltreatment in binge eating disorder (BED). METHODS: Systematic literature search in PubMed and Web of Science in December 2013. Terms considered were "binge eating disorder" AND "child* maltreatment", "child* abuse", "child* sexual abuse", "child* emotional abuse", "child* physical abuse", "child* emotional neglect" as well as "child* physical neglect". Inclusion criteria were studies published between 1990 and 2013, publications in English or German, adult patients, studies that considered patients with full DSM criteria for BED, and studies that reported prevalences of forms of child maltreatment. RESULTS: Eight studies out of 366 met criteria. Child maltreatment rates in BED were more than two times higher than in representative samples, but they were similar to psychiatric comparisons. Up to 83 % of patients with BED reported at least one form of child maltreatment. There were associations to psychiatric comorbidity, but not to gender, obesity and specific features of the eating behaviour. CONCLUSION: Child maltreatment is very prevalent among BED. Its contribution to the development and the maintenance of BED is not understood yet.

[Experience of loss and complicated grief in depressive inpatients]. / Verlusterleben und prolongierte Trauer bei depressiven Patienten.

OBJECTIVE: Inpatients diagnosed with major depression that had lost a loved person were asked about loss-related variables and symptoms of complicated grief (CG). METHODS AND RESULTS: CG was assessed by the Inventory of Complicated Grief (ICG-R). 14.2% of n = 127 individuals with unipolar depression met the criteria for CG. Depressive patients with CG compared to those without CG had a lower educational level; reported a higher loss-related burden at the time of loss, during the survey and the year after the loss; had significant different closeness within the relationships to the deceased; and time of loss was more recently. CONCLUSIONS: An adequate differential diagnostic is essential for the treatment of major depression. Therefore loss-related factors and symptoms of complicated grief must be investigated regularly.

[Working alliance in internet-based therapy for binge eating disorder]. / Die therapeutische Beziehung in einem internetbasierten Programm zur Behandlung der Binge-Eating-Störung.

OBJECTIVE: Findings about the association between working alliance and therapy outcome in Internet-based treatments are contradictory. Evidence for the working alliance in Internet-based treatment for Binge Eating Disorder is still missing and can help to elucidate this question. METHODS AND RESULTS: In an Internet-based cognitive-behavioral intervention, working alliance (WAI-S, mid n = 59; post n = 49) and eating disorder symptoms (EDE-Q, n = 49) as therapy outcome were assessed. A positive working alliance was reported by study participants. Working alliance had significant correlations with and EDE-Q-scales but not with binge eating episodes. CONCLUSIONS: Our study refers to the important role working alliance has for therapy outcome.

Extreme obesity is associated with suicidal behavior and suicide attempts in adults: results of a population-based representative sample.

OBJECTIVE: A number of studies have revealed that the number of completed suicides decreases with increasing body mass index (BMI). However, only few studies have evaluated the association between suicidal behavior, suicide attempts, and the various BMI categories. The aim of this study was to determine whether obesity is positively associated with increased suicide attempts and suicidal behavior with consideration of gender differences. METHODS: In a representative German population-based sample (N = 2436), interviews were conducted in 2011 to examine the prevalence of suicide attempts and suicidal behavior in participants in the different BMI categories. Logistic regression analyses were conducted for suicidal behavior and suicide attempts to examine the association between obesity status and suicidality, controlling for confounding variables. Suicidal behavior was assessed by the Suicidal Behaviors Questionnaire-Revised (SBQ-R), which is a four-item self-report measure of suicidal thoughts and past attempts. BMI was calculated from participants' self-reported height and weight. RESULTS: Analyses revealed that extremely obese participants (BMI ≥ 40.0) had a prevalence rate of suicidal behavior of 33% for female respondents and 13% for male respondents and rates for suicide attempts of 27% for female and 13% for male respondents. No significant gender differences could be found for any of the weight categories. Furthermore, adjusted odd ratios (AOR) showed a significant difference in suicidal behavior in class I obesity (OR, 3.02 [1.50-6.08] and class III obesity (OR, 21.22 [6.51-69.20]. AORs for suicide attempts showed significantly greater odds for class I obesity (OR, 3.49 [1.76-6.90] and class III obesity (OR, 12.43 [3.87-39.86] compared to the normal weight group. CONCLUSION: These results support a positive relationship between suicidal behavior, suicide attempts, and obesity. However contrary to previous findings, no gender differences were found. The findings support the introduction of routine screening for suicidal behavior in extreme obese individuals.

[Anxiety, depression, somatoform symptoms and posttraumatic stress in the offspring of political detainees in Eastern Germany (1945-1989)]. / Ängstlichkeit, Depressivität, Somatisierung und Posttraumatische Belastungssymptome bei den Nachkommen ehemals politisch inhaftierter Personen in Ostdeutschland (1945-1989).

Between 1945 and 1989, approximately 300 000 persons were imprisoned because of political reasons in Eastern Germany. There is that evidence the detainees' offspring are affected by the trauma of their parents. In a study with cross-sectional design, depressive (PHQ-9), somatoform (PHQ-15) and anxiety symptomatology (GAD-7), and Posttraumatic Stress (IES-R) were assessed with self-rating measures in 43 children of former political prisoners. In comparison to 2 representative gender education and age matched samples from the general population, offspring of former political detainees show higher levels of psychopathological symptoms. The life-time prevalence for PTSD was 9.1%. Regarding the psychopathology, children who were born after their parents' imprisonment did not differ from those who were already born when the imprisonment happened. First evidence for the transgenerational transmission of traumatisation and the methods will be discussed critically.

[The German Version of the Childhood Trauma Questionnaire (CTQ): psychometric characteristics in a representative sample of the general population]. / Die deutsche Version des Childhood Trauma Questionnaire (CTQ) - psychometrische Eigenschaften in einer bevölkerungsrepräsentativen Stichprobe.

The Childhood Trauma Questionnaire (CTQ) has become internationally accepted as an assessment of traumatic childhood experiences. The short version assesses aspects of childhood abuse and neglect. In order to check the psychometric properties of the German short form, the CTQ was used within a representative sample of the German population (N=2 500). The five factor structure of the original version showed only a sufficient model fit, because of high intercorrelations and weak internal consistency of the scale "physical neglect". The internal consistency of the other subscales was high with α≥0.80. Construct validity was supported by positive correlations with measures of anxiety/depression and negative correlations with life satisfaction. The German short form of the CTQ is a reliable and valid self rating instrument to assess childhood maltreatment retrospectively. The subscale "physical neglect" should be applied with caution.

[Health-related quality of life and post-traumatic stress disorder in political prisoners of the former GDR]. / Gesundheitsbezogene Lebensqualität und Posttraumatische Belastungsstörungen bei in der DDR politisch Inhaftierten.

PURPOSE: Political persecution was and is a reality in our world. The study investigated effects of political imprisonment in the former German Democratic Republic on the current health-related quality of life and on the existence of a post-traumatic stress disorder (PTSD). METHODS: A sample of 157 former political prisoners was surveyed with a questionnaire containing the EORTC QLQ-C30 and the IES-R. RESULTS: Former political prisoners of the GDR reported a lower quality of life than the general population. There is no consistent impact of imprisonment-related variables (e. g. duration of imprisonment) on health-related quality of life. At least, based on questionnaire data it can be estimated that 50% of the people in the sample suffer from a PTSD. CONCLUSION: The results provide further evidence that former political prisoners suffer from the traumatic experience of political persecution also in a long term.

[Better patient orientation through certified cancer centres in oncological care? Patient satisfaction in breast cancer patients in certified breast cancer centres and noncertified hospitals]. / Grössere Patiententonorientierung Durch Zertifizierte Zentren in der Onkologie? Patientenzufriedenheit von Brustkrebspatientnnen aus Zertifizierten Zentren und Nicht-Zentrumbasierten Krankenhäusern.

OBJECTIVES: We investigated whether patient satisfaction (including its subdimensions) among breast cancer patients depends on the place of the treatment (certified breast cancer centre vs. noncertified clinics). Furthermore, we examined the impact of patient- and disease-related factors on patient satisfaction. METHODS: 652 breast cancer patients (n = 480 from certified breast cancer centres and n = 172 from noncertified clinics) took part in the study after their hospital stay and completed a questionnaire. Data on patient satisfaction (Hamburger Fragebogen zum Krankenhausaufenthalt, HFK), psychological distress (HADS), as well as sociodemographic and disease-related characteristics were collected. RESULTS: Regardless of the place of cancer treatment, breast cancer patients reported a high level of satisfaction. There was only one significant difference between the two patient groups in the subdimension "overall judgement" (breast centre: 1.28 vs. noncertified clinic: 1.19; p = 0.017). In the multivariate analysis, the place of treatment had less explanatory power on patient satisfaction than other factors such as psychological distress. CONCLUSIONS: In this study, there were only few differences in patient satisfaction between the two investigated groups of breast cancer patients. This result is discussed in the context of various moderating factors.

[Increased anxiety and depression as long-term consequences of political imprisonment]. / Erhöhte Angstlichkeit und Depressivität als Spätfolgen bei Menschen nach politischer Inhaftierung in der DDR.

OBJECTIVE: By recent estimates, 200,000 persons were imprisoned for political reasons in the German Democratic Republic (GDR) between 1949 and 1989. Former political prisoners suffer from the experience of political persecution also in a long-term. The aim of this study was to assess long-term effects on anxiety and depression. METHODS: Anxiety and depression were assessed by using the Hospital Anxiety and Depression Scale, German version (HADS). RESULTS: The anxiety of the former political detainees is significantly increased in comparison to an age- and gender matched subsample of the general population (10 vs. 4,8; p < 0,001, effect size d = 1,33). The same applies to the depression (9.7 vs. 5,6; p < 0,001; effect size d = 0,92). CONCLUSIONS: Even many years after the political detention people report highly increased anxiety and depression.