Mental health and life satisfaction in East and West Germany: Effects of generation and migration of citizens.

Objective: The reunification of Germany after the separation between 1949 and 1990 has offered a unique chance of studying the impact of socialization, political transformation, and migration on mental health. The purpose of this article was to compare mental distress, resources, and life satisfaction (1) between residents of East and West Germany and migrants who have fled from East to West Germany before reunification and (2) between three generations. Methods: We assessed anxiety, depression, resilience, self-esteem, and life satisfaction, comparing groups based on their residency and migration, as well as three different birth cohorts. Using a representative survey of 2006, analyses of variance show the differences between these groups. Based on a representative survey (N = 4,530), the effects of gender (53.6% women), residency/migration (74.4% grown up in the West, 20.4% in the East, 5.3% migrants from the East to the West) from three generations (32% born until 1945, 39% until 1967, and 29% to 1989), and positive and negative mental health indicators were analyzed. Results: Women reported higher distress and lower resilience. Residents of the Western states reported the lowest burden of distress (depressive and anxiety symptoms) and the highest overall life satisfaction, exceeding residents from the Eastern states and migrants from the Eastern to the Western states. Migrants from the Eastern to the Western states, however, reported the lowest resilience and self-esteem. They reported lower satisfaction with income, living conditions (compared to the Western residents), and the lowest levels of satisfaction with family (compared to East and West). Conclusion: Overall, our data point to inequalities between the Eastern and Western states regarding mental health 16 years after reunification favoring the residents of the Western states by lower distress and life satisfaction. Our data attest to the stresses and adjustments associated with migration from the Eastern to the Western states before reunification. A lower level of mental health and life satisfaction in the oldest generation may be related to the sequelae of World War II and also to aging.

Mental health and loneliness in the German general population during the COVID-19 pandemic compared to a representative pre-pandemic assessment.

During the pandemic, the extent of subsequent mental health strains is an important issue. A representative face-to-face survey was conducted to assess mental health consequences in the general population and to identify mental health risk factors. In a representative German sample (N = 2,503), we assessed depression and anxiety symptoms by the PHQ-4 and loneliness by a validated item. An earlier survey (2018) which used the same methods and had comparable response rates served as comparison. Scores of depression and anxiety symptoms increased from an average of 0.89 (SD = 1.21) and 0.77 (SD = 1.17) in 2018 to 1.14 (SD = 1.23) and 1.05 (SD = 1.31) in 2020. Loneliness did not increase (M = 1.35, SD = 0.68 in 2018; M = 1.38, SD = 0.78 in 2020), affecting about one in four participants to some degree. Younger participants and women were most likely to report depression, anxiety, and loneliness. As in the previous survey, social inequality factors contributed to distress and loneliness. The small overall increase of distress was consistent with recent German panel studies. In future studies and mental health interventions female sex, younger age, and socioeconomic disparities need to be considered as vulnerability factors for distress.

Somatic symptoms in the Eastern and Western states of Germany 30 years after unification: Population-based survey analyses.

Background Following German reunification, physical health indicators in the formerly separated states (German Democratic Republic- East/ Federal Republic of Germany-West) have converged. However, it remains unclear how these societal changes have impacted somatic complaints, a major indicator of physical and mental health. Therefore, we investigated how somatic symptom reporting in men and women evolved regarding residency. Methods We administered cross-sectional surveys representative of the German population with comparable sample size in 1994 (N = 3047), 2001 (N = 2050), 2013 (N = 2508) and 2019 (N = 2531) following random route procedure. Men and women aged 14-99 reported demographics and filled the Gießen Complaint List, a standardized questionnaire, to assess major physical symptoms. Results Residency in the Eastern states was a determinant of higher symptom load in 2001 (ß = 0.11, SE = 0.02, [95% CI = 0.07 to 0.15], p < .001) where symptom reporting has been consistently higher compared to the West from 1994 through 2013. However, in 2019, the pattern reversed and residency in the East was associated with lower symptom load (ß = -0.15, SE =0.02, [95% CI = -0.19 to -0.11], p < .001). Predictors of high symptom load among all surveys were higher age, female sex, and low household income. Conclusions Symptom reporting did not converge, but reversed in 2019, with a higher symptom load in the Western states. This finding is particularly intriguing since other determinants, e.g., socioeconomic factors have converged, but have remained unfavorable in the East.

Somatic Symptoms in the German General Population from 1975 to 2013.

The study determines how burden and patterns of somatic symptom reporting developed over almost four decades in the general German population. Additionally, we studied how socio-demographic factors affected the degree of somatic symptoms. Population-based samples representative for West Germany between 18 and 60 years of age were analyzed comparing three cross-sectional samples of 1975 (N = 1601), 1994 (N = 1416), and 2013 (N = 1290) by conducting a three-way analysis of variance (sex, age, survey). The prevalence rates for somatic symptoms in men and women were lower in the more recent surveys; this affected women most strongly. Exhaustion and musculoskeletal complaints remained leading symptoms (affecting 25%, resp. 11% of the men and 30%, resp. 19% of the women). There was a slight increase in women's prevalence of exhaustion from 1994 (15%) to 2013 (19%). As determined by stepwise multiple regression, somatic symptoms were consistently associated with female sex and higher age. In the 2013 survey, education became an additional negative predictor of somatic symptom load, while the impact of age and sex on somatic symptoms reporting decreased. Somatic symptoms remain a major burden in the general population. Findings are interpreted with regard to improved living and health care conditions, different cohort experiences, and more public health information.

Correction to: Declining Sexual Activity and Desire in Women: Findings from Representative German Surveys 2005 and 2016.

As a result of a typesetting error, the number of participants in the study reported in this article was incorrectly stated in the article's Abstract as originally published.

Declining Sexual Activity and Desire in Women: Findings from Representative German Surveys 2005 and 2016.

We estimate (1) sexual activity and sexual desire in women living with and without a partner across the age range in Germany and (2) changes over 11 years. A representative survey of 1345 (response rate: 65%) women between 18 and 99 years from 2016 was compared to a survey of 1314 women age 18-91 from 2005 (response rate: 53%). Sexual activity was assessed as having been physically intimate with someone in the past year; frequency of sexual desire was rated for the past 4 weeks. In 2016, the great majority of women living with a partner were sexually active and indicated sexual desire until the age of 60, which decreased thereafter. Compared to 2005, fewer women cohabited with a partner. Across the age range, women living without a partner reported considerably less sexual activity and desire. The overall proportion of women reporting partnered sexual activity decreased from 67% to 62% in 2016, and absent sexual desire increased from 24% to 26%. Declines of sexual activity and desire affected mostly young and middle-aged women. The decline of sexual activity and desire seems to be due to a reduced proportion of women living with a partner. There was also a generation effect with younger and middle-aged women without a partner becoming less sexually active and experiencing less desire compared to the previous survey. While surveys were methodologically comparable, interpretations are limited by the absence of longitudinal data.

Obesity, depression and hip pain.

INTRODUCTION: Up to 64% of the general population reports experiencing chronic pain, with the hip being one of the most frequent sites. An association has been shown between chronic back pain, obesity and depression. To date, a similar association has not been investigated with chronic hip pain. METHODS: A total of 2,515 subjects were chosen as a representative cross-section of the German population. Each was provided with a questionnaire that included the Regional Pain Scale, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Beck Depression Inventory-Primary Care and Winkler social class index. Participant height and weight values were obtained from self-reports. Using logistic regression methodology, we analysed the association between hip pain, obesity and increased depression scores. RESULTS: A total of 124 (4.9%) subjects reported chronic hip pain and an additional 39 (1.5%) reported chronic hip pain that was disabling. Hip pain affected 1-5 sites (oligolocular) in 47% of cases, and was widespread (6-19 sites) in 50%. Obesity and increased values on the depression scale were associated with an increased likelihood of chronic hip pain (odds ratio [OR] 2.55 and 8.53, respectively) compared with subjects without pain. Increased values on the depression scale (OR 28.22) increased the likelihood of experiencing disabling chronic hip pain in comparison with pain free individuals. CONCLUSIONS: Hip pain is rarely the sole site of pain. Obesity and increased values on the depression scale are associated with chronic hip pain. Increased values on the depression scale are associated with disabling chronic hip pain.

The association of adverse childhood experiences and of resilience with chronic noncancer pain in the German adult population - A cross-sectional survey.

BACKGROUND: Adverse childhood experiences (ACE) might predispose to and resilience might protect against chronic noncancer pain (CNCP). We studied whether ACE are positively associated with CNCP, whether resilience was negatively associated with CNCP and whether resilience buffered a potential association of ACE with CNCP. METHODS: A cross-sectional survey (N = 2,425) representative for the adult German general population was conducted in 2013. The following questionnaires were used: Chronic Pain Grade Questionnaire for CNCP stages; Childhood Trauma Screener for ACE; Brief Resilient Coping Scale for resilience; Patient Health Questionnaire 4 for psychological symptom burden; Giessen Subjective Complaints List for somatic symptom burden. To test the association of ACE and resilience with CNCP stages, logistic regression analyses including sociodemographic variables and psychological and somatic symptom burden as possible confounders were calculated. RESULTS: No statistically significant associations between any CNCP and disabling CNCP respectively with physical, emotional, and sexual abuse; emotional and physical neglect if compared to no chronic pain were found in uni- and multivariate analyses. There was a small effect of combined ACE and a small attenuating effect of resilience on any and disabling CNCP in univariate, but not in multivariate analysis. Large associations were found between age > 65 years with any CNCP (OR 6.51 [95% confidence interval 3.38 to 12.51)] and disabling CNCP (OR 9.33 [95% confidence interval 2.39 to 36.41]), respectively, if compared to no pain. CONCLUSIONS: There was no pain-proneness by single and combined ACE for and no protection by resilience for any and for disabling CNCP in the general adult German population. SIGNIFICANCE: There is no pain-proneness due to adverse childhood experiences for any and disabling chronic noncancer pain. Resilience does not protect against any and disabling chronic noncancer pain. Older age is the strongest predictor of any and disabling chronic noncancer pain.

Declining Sexual Activity and Desire in Men-Findings From Representative German Surveys, 2005 and 2016.

BACKGROUND: Surveys have indicated an increase of sexual activity in aging men; recently, however, a decrease of sexual activity has been reported in young men. AIM: To assess (i) sexual activity and desire and their determinants across the age range in a population-based male sample and (ii) their changes over 11 years. METHODS: A representative survey of men (N = 1,095) 18 to 93 years old from 2016 was compared with a survey from 2005 (N = 1,106 men) with the same age range. Samples were drawn from the German population at random using standardized sampling procedures. Questions were filled out by participants in the presence of a trained interviewer. Sexual activity was compared using logistic regression with the factors survey (2005 vs 2016), living with a partner (yes vs no), and age. Frequency of sexual desire was compared using analysis of covariance with the factors survey (2005 vs 2016), living with a partner (yes vs no), and the covariate age. OUTCOMES: Sexual activity was assessed as having been intimate with someone in the past year; frequency of sexual desire was evaluated within the past 4 weeks. RESULTS: The great majority of men cohabiting with a partner in 2016 was sexually active and indicated sexual desire until 70 years of age; half did so at an older age. Across the age range, men living without a partner reported considerably less sexual activity and desire. Compared with 2005, fewer men reported living with a partner. The overall proportion of men reporting sexual activity deceased from 81% to 73% in 2016 and absent sexual desire increased from 8% to 13%. CLINICAL TRANSLATION: The findings highlight the relevance of living with a partner for sexual activity and desire. We advocate using a measure of sexual activity that encompasses many variants of intimate behavior. STRENGTHS AND LIMITATIONS: Large and methodologically comparable population-based samples were compared. However, interpretations are limited by the absence of longitudinal data. We did not assess the effect of having a partner living elsewhere. CONCLUSION: Sexual activity and desire decreased, especially in the young and middle-age groups. The decrease of men living with a partner contributed to this decreased sexual activity and desire. There was a generation effect, with younger and middle-age men living without a partner becoming less sexually active and experiencing less desire compared with the previous survey. The findings unveil changes in sexual activity and desire in a short time span. Beutel ME, Burghardt J, Tibubos AN, et al. Declining Sexual Activity and Desire in Men-Findings From Representative German Surveys, 2005 and 2016. J Sex Med 2018;15:750-756.

Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms.

BACKGROUND: The aim of the present study was to investigate the relationships of common emotion regulation strategies (suppression and reappraisal) to self-reported fatigue and depersonalization/derealization symptoms. Specifically, we tested the moderating effect of suppression and reappraisal on the link of fatigue with depersonalization and derealization symptoms. Opposite effects were expected for both emotion regulation strategies assuming that cognitive reappraisal has an adaptive buffering effect, while suppression intensifies the association of fatigue and depersonalization/derealization experiences. METHODS: In a representative study (N = 2524) we assessed emotion regulation strategies, fatigue, depersonalization/derealization, distress, and demographic variables via questionnaires. 55.5% of the participants were female, mean age was 49.4 (SD = 18.2) years with age groups represented in comparable proportions. RESULTS: In line with the assumptions, moderated regression analyses revealed an interaction effect of emotion regulation strategies and fatigue. Simple slope analyses indicated a buffering effect of cognitive reappraisal on the positive relation of fatigue with depersonalization and derealization symptoms. In contrast, suppression fosters the positive correlation of fatigue and depersonalization and derealization experiences. LIMITATIONS: Our study is limited to these two habitual emotion regulation strategies employing a cross sectional design. CONCLUSION: Our findings provide comprehensive empirical data investigating depersonalization/derealization symptoms from the perspective of emotion regulation research. Cognitive reappraisal might help people suffering from fatigue to prevent depersonalization and derealization tendencies.

Public Support for Weight-Related Antidiscrimination Laws and Policies.

OBJECTIVE: Weight-related discrimination is prevalent and associated with health impairments for those who are targeted, which underscores the need of antidiscrimination legislation. This study is the first to examine public support of weight-related antidiscrimination laws or policies in Germany, compared to the US and Iceland. METHODS: In a representative German population sample (N = 2,513), public support for general and employment-specific weight-related antidiscrimination policies, weight-based victimization, and weight bias internalization were measured through established self-report questionnaires. RESULTS: Half of the German population sample agreed with antidiscrimination policies. General antidiscrimination laws received lower support than employment-specific laws. Support for policies considering obesity a physical disability was greatest in Germany, whereas support for employment-specific antidiscrimination laws was lower in Germany than in the US and Iceland. Total support for weight-related antidiscrimination policies was significantly predicted by lower age, female gender, obese weight status, residence in West Germany, church membership, and readiness to vote in elections. CONCLUSION: German support for weight-related antidiscrimination policies is moderate. Increasing awareness about weight-related discrimination and laws prohibiting this behavior may help to promote policy acceptance.

Childhood adversities and distress - The role of resilience in a representative sample.

While adverse childhood experiences have been shown to contribute to adverse health outcomes in adulthood, specifically distress and somatic symptoms, few studies have examined their joint effects with resilient coping style on adult adjustment. Hence, we aim to determine the association between resilient coping and distress in participants with and without reported childhood adversities. A representative German community sample (N = 2508) between 14-92 years (1334 women; 1174 men) was examined by the short form of the Childhood Trauma Questionnaire, the Brief Resilience Coping Scale, standardized scales of distress and somatoform symptoms. Childhood adversity was associated with reduced adjustment, social support and resilience. It was also strongly associated with increased distress and somatoform complaints. Resilient coping was not only associated with lower distress, it also buffered the effects of childhood adversity on distress. Our study corroborates the buffering effect of resilience in a representative German sample. High trait resilient subjects show less distress and somatoform symptoms despite reported childhood adversities in comparison to those with low resilient coping abilities.

Shadows of Beauty - Prevalence of Body Dysmorphic Concerns in Germany is Increasing: Data from Two Representative Samples from 2002 and 2013.

Body dysmorphic disorder (BDD) is a psychosomatic disease associated with reduced quality of life and suicidal ideations. Increasing attention to beauty and the development of beauty industries lead to the hypothesis that BDD is increasing. The aim of this study was to test this hypothesis in two representative samples of Germans, assessed in 2002 and 2013. In 2002, n = 2,066 and in 2013, n = 2,508 Germans were asked to fill in the Dysmorphic Concern Questionnaire (DCQ), which assesses dysmorphic concerns. Subclinical and clinical dysmorphic concerns increased from 2002 to 2013 (subclinical from 0.5% to 2.6%, OR = 5.16 (CI95% = 2.64; 10.06); clinical from 0.5% to 1.0%, OR = 2.20 (CI95% = 1.03; 4.73). Women reported more dysmorphic concerns than men, with rates of 0.7% subclinical and 0.8 clinical BDD in women and 0.3% subclinical and 0.1% clinical BDD in men in 2002. In 2013, 2.8% subclinical and 1.2% clinical BDD were found in women and 2.4% subclinical and 0.8% clinical BDD in men. Further studies should assess predictors for developing a BDD and evaluate factors determining the efficacy of disease-specific psychotherapeutic and psychotropic drug treatments.

The German version of the Perceived Stress Scale - psychometric characteristics in a representative German community sample.

BACKGROUND: The Perceived Stress Scale Cohen (J Health Soc Behav 24:385-96, 1983) is a widely and well-established self-report scale measuring perceived stress. However, the German version of the PSS-10 has not yet been validated. Thus, the purposes of this representative study were to psychometrically evaluate the PSS-10, and to provide norm values for the German population. METHODS: The PSS-10 and standardized scales of depression, anxiety, fatigue, procrastination and life satisfaction were administered to a representative, randomly selected German community sample consisting of 1315 females and 1148 male participants in the age range from 14 to 90 years. RESULTS: The results demonstrated a good internal consistency and construct validity. Perceived stress was consistently associated with depression, anxiety, fatigue, procrastination and reduced life satisfaction. Confirmatory factor analysis revealed a bi-dimensional structure with two related latent factors. Regarding demographic variables, women reported a higher level of stress than men. Perceived stress decreased with higher education, income and employment status. Older and married participants felt less stressed than younger and unmarried participants. CONCLUSION: The PSS-10 is a reliable, valid and economic instrument for assessing perceived stress. As psychological stress is associated with an increased risk of diseases, identifying subpopulations with higher levels of stress is essential. Due to the dependency of the perceived stress level on demographic variables, particularly age and sex, differentiated norm values are needed, which are provided in this paper.

[The Quality of the Family Physician-Patient Relationship. Patient-Related Predictors in a Sample Representative for the German Population]. / Die Qualität der Hausarzt-Patient-Beziehung. Patientenbezogene Prädiktoren in einer repräsentativen deutschen Bevölkerungsstichprobe.

BACKGROUND: Patient-centeredness and a strong working alliance are core elements of family medicine. Surveys in Germany showed that most people are satisfied with the quality of the family physician-patient relationship. However, factors that are responsible for the quality of the family physician-patient relationship remain unclear. This study aimed at identifying patient-related predictors of the quality of this relationship. MATERIALS AND METHODS: Participants of a cross-sectional survey representative for the general German population were assessed using standardized questionnaires. The perceived quality of the family physician-patient relationship was measured with the German version of the Patient-Doctor Relationship Questionnaire (PDRQ-9). Associations of demographic and clinical variables (comorbidity, somatic symptom burden, psychological distress) with the quality of the family physician-patient relationship were assessed by applying hierarchical linear regression. RESULTS: 2278 participants (91,9%) reported having a family physician. The mean total score of the PDRQ-9 was high (M=4,12, SD=0,70). The final regression model showed that higher age, being female, and most notably less somatic and less depressive symptoms predicted a higher quality of the family physician-patient relationship. Comorbidity lost significance when somatic symptom burden was added to the regression model. The final model explained 11% of the variance, indicating a small effect. CONCLUSIONS: Experiencing somatic and depressive symptoms emerged as most relevant patient-related predictors of the quality of the family physician-patient relationship.

Family physician-patient relationship and frequent attendance of primary and specialist health care: Results from a German population-based cohort study.

OBJECTIVE: To investigate the association between the quality of the family physician-patient relationship and frequent attendance of primary and specialist health care. METHODS: Cross-sectional survey of a representative German population sample (N=2.266). Family physician-patient relationship was assessed with the Patient Doctor Relationship Questionnaire (PDRQ-9). Determinants of frequent attendance were analyzed using logistic regression. RESULTS: Frequent attendance of family physicians was associated with lower income (OR 1.43, 95% CI 1.02-2.00), not being in paid work (OR 1.58, CI 1.08-2.30), psychological distress (OR 1.14, CI 1.07-1.22), somatic symptoms (OR 1.07, CI 1.04-1.11), and physical comorbidity (OR 1.54, CI 1.36-1.74) in the multivariate analysis. Frequent attendance of specialists was related to psychological distress (OR 1.12, CI 1.04-1.20), somatic symptoms (OR 1.08, CI 1.04-1.11), and physical comorbidity (OR 1.69, CI 1.48-1.93) in the multivariate analysis. Quality of the relationship was associated with frequent attendance only in the univariate analyses. A stronger relationship with the family physician was not associated with reduced contact with specialists. CONCLUSIONS: The quality of the family physician-patient relationship is not independently associated with frequent attendance. PRACTICE IMPLICATIONS: Family physicians should be aware that need factors, i.e. symptom burden and physical comorbidities, are main drivers of frequent attendance.

Procrastination, Distress and Life Satisfaction across the Age Range - A German Representative Community Study.

Addressing the lack of population-based data the purpose of this representative study was to assess procrastination and its associations with distress and life satisfaction across the life span. A representative German community sample (1,350 women; 1,177 men) between the ages of 14 and 95 years was examined by the short form of the General Procrastination Scale (GPS-K; 1) and standardized scales of perceived stress, depression, anxiety, fatigue and life satisfaction. As hypothesized, procrastination was highest in the youngest cohort (14-29 years). Only in the youngest and most procrastinating cohort (aged 14 to 29 years), men procrastinated more than women. As we had further hypothesized, procrastination was consistently associated with higher stress, more depression, anxiety, fatigue and reduced satisfaction across life domains, especially regarding work and income. Associations were also found with lack of a partnership and unemployment. Findings are discussed with regard to potential developmental and cohort effects. While procrastination appears to be a pervasive indicator for maladjustment, longitudinal analyses in high-risk samples (e.g. late adolescence, unemployment) are needed to identify means and mechanisms of procrastinating.

Prevalence of self-reported jaw pain in Germany: two cross-sectional surveys of the general German population.

OBJECTIVES: This study evaluated the prevalence of jaw pain as a local, regional, or widespread pain condition and its association with psychosocial variables in a large representative group of the general population from all regions in Germany. METHODS: In two representative samples consisting of 2524 and 2515 subjects, respectively, the 7-day and 3-month pain prevalences were measured by using the Regional Pain Scale (RPS). Somatic symptom burden (somatization) and pain-related depression were assessed with the Patient Health Questionnaire and the Somatic Symptom Scale, respectively. Binary logistic regression was chosen to calculate the associations between demographic and psychological clinical predictor variables with jaw pain. RESULTS: The 7-day jaw pain prevalence was 4.0 % (95 % CI = 3.2-4.8). Of the subjects with jaw pain, only 9 % had local pain (1 pain site), while the remaining 91 % reported regional pain (2-5 pain sites), or widespread pain (6-19 pain sites). The 3-month prevalence of generally present jaw pain was 0.9 % (95 % CI = 0.6-1.0). Regional or widespread pain was present in 82 % of the participants. Jaw pain was predicted by somatic symptom burden (past 7 days, OR = 1.15 [95 % CI = 1.09-1.22]; past 3 months, OR = 1.13 [95 % CI = 1.02-1.25]), but not by depression. CONCLUSIONS: Most individuals with jaw pain have additional pain in other anatomical regions. They might also exhibit a greater risk for pain-associated somatic symptom burden. CLINICAL RELEVANCE: Assessment of pain distribution in the whole body and the use of a psychometric screening questionnaire for somatic symptom burden are recommended for individuals presenting with jaw pain in a clinical setting.

Is It Attachment Style or Socio-Demography: Singlehood in a Representative Sample.

Since the percentage of single adults is steadily increasing, the reasons for this development have become a matter of growing interest. Hereby, an individual's attachment style may have a connection to the partnership status. In the following analysis, attachment style, gender, age, education, and income were compared in regard to the partnership status. Furthermore, an analysis of variance was computed to compare the attachment style within different groups. In 2012, a sample of 1,676 representative participants was used. The participants were aged 18 to 60 (M = 41.0, SD = 12.3); 54% of the sample were female, and 40% were single. Attachment-related attitudes were assessed with the German version of the adult attachment scale (AAS). Single adult males did not show a more anxious attachment style than single adult females or females in relationships. Younger, i.e., 18 to 30 years old, paired individuals showed greater attachment anxiety than single individuals, whereby single individuals between the ages of 31 to 45 showed greater attachment anxiety than individuals in relationships. In addition, single individuals more frequently had obtained their high school diploma in contrast to individuals in relationships. Concerning attachment style, the individuals who had not completed their high school diploma showed less faith in others independent of singlehood or being in a relationship. Concerning age, older single individuals, i.e., 46 to 60 years, felt less comfortable in respect to closeness and showed less faith in others compared to paired individuals. Logistic regression showed that individuals were not single if they did not mind depending on others, showed high attachment anxiety, were older, and had lower education. An income below € 2000/month was linked to a nearly 13-fold increase of likelihood of being single. In sum, the attachment style had a differential age-dependent association to singlehood versus being in a relationship. Education played also a role, exclusively concerning faith in others.

Do medical students like communication? Validation of the German CSAS (Communication Skills Attitude Scale).

OBJECTIVES: Attitudes towards communication skills of medical undergraduates can be gathered using the Communication Skills Attitude Scale (CSAS). We aimed to develop a German version of the CSAS (CSAS-G) in order to explore attitudes towards communication skills in a German cohort. Additionally the potential influence of demographic factors was examined. METHODS: We realized the CSAS-G and conducted a survey with 529 participants from 3 different years of study. We then carried out an explorative as well as confirmatory factor analysis and compared the attitudinal scores. Multiple regression analysis was performed. RESULTS: The confirmatory analysis confirmed the two-subscale system revealed by the explorative factor analysis. Students indicate low levels of negative attitudes and moderate levels of positive attitudes. Attitudinal scores differ significantly in relation to gender. CONCLUSION: The CSAS-G can be used in German cohorts to evaluate attitudes towards communication skills. Medical students in our study show basically a positive approach. Further investigation is necessary to explore and understand attitudes towards communication skills of German medical students.