Anxiety, depression, somatization and psychological distress before and 2-6 years after a late termination of pregnancy due to fetal anomalies.

BACKGROUND: For many women, a late termination of pregnancy (TOP) can be an enormous psychological burden. Few studies have investigated the long-term psychological impact of late TOP. METHODS: N = 90 women answered a questionnaire containing questions about anxiety, depression and somatization (Brief-Symptom Inventory, BSI-18) shortly before (T1) and 2-6 years after (T4) their late termination of pregnancy. RESULTS: Prior to the late TOP, 57.8% of participants showed above-average levels of overall psychological distress (66.7% anxiety, 51.1% depression, 37.8% somatization). This number decreased significantly over time for all scales of the BSI-18. 2-6 years later, only 10.0% of women still reported above-average levels (17.8% anxiety, 11.1% depression, 10.0% somatization). CONCLUSIONS: Our results support those of previous research showing that late TOP has a substantial psychological impact on those experiencing it in the short-term. In the long-term, most women return to normal levels of psychological distress, although some still show elevated levels. Limitations of the study include monocentric data collection, drop-out between T1 and T4, and the relatively wide range of two to six years after TOP. Further research should be conducted in order to identify factors that impact the psychological processing of the experience.

Impact of Home-Based Work during the COVID-19 Pandemic on Mental and Physical Health in a German Population-Based Sample.

Background: The COVID-19 outbreak necessitated physical distancing, as part of secondary prevention, at a personal and professional level. Working from home (WFH) became increasingly important. In this study, the impact of the COVID-19 pandemic restrictions on physical and mental health is investigated, compared with pre-pandemic data, and with employees who WFH and are on-site. Methods: Data from the German Saxon longitudinal study population were used. Attitudes towards WFH as well as mental and physical health assessments during the COVID-19 pandemic were examined. Comparisons were made with corresponding pre-pandemic scores and between employees WFH and on-site in 2022. Results: In total, 319 participants with equal gender distribution were included. Of those, 86 worked from home stating better organizability of their work, more time for partnership, less stress, and greater work satisfaction. Compared to pre-pandemic data, the D-score, PHQ-4, G-Score, and PHQ-SSS-8 showed a significant increase. No difference in physical or mental health between employees WFH and on-site was observed. Conclusion: In general, COVID-19 restrictions had a negative impact on mental and physical health. Although WFH is well accepted, it did not show significant health benefits.

[Discrimination-Sensitive Psychotherapy: How High Is The Privilege Awareness Among Psychotherapists?] / Diskriminierungssensible Psychotherapie: Wie hoch ist das Privilegienbewusstsein von Psychotherapeut*innen in Deutschland?

OBJECTIVE: Discrimination can have a negative impact on mental health and thus can play a crucial role in the context of psychotherapy. This paper outlines the potentials and the relevance of an (intersectional) privilege awareness of psychotherapists for a discrimination-sensitive psychotherapy. The aim of this study was to assess the privilege awareness of psychotherapists in Germany for the first time as well as its thematization in the training of psychotherapists. In addition, the connection between belonging to a marginalized group and the privilege awareness was investigated. METHODS: 270 psychotherapists (in training) based in Germany participated in an online survey (2022). Privilege awareness was assessed with an adapted version of the Awareness of Privilege and Oppression Scale-2, translated into German, regarding the following axes of discrimination: heterosexism, classism, and racism. Three self-written items additionally surveyed the thematization of discrimination and privilege in psychotherapy training. The relationship between belonging to a marginalized group and privilege awareness was examined using linear regression analysis. RESULTS: Nearly 65% (N=270) of participants felt unprepared or somewhat unprepared to deal with patients' experiences of discrimination, with approximately 40% (N=270) indicating that discrimination was not addressed in training. Privilege was addressed much less frequently. Belonging to a marginalized group was associated with higher privilege awareness (B=0,47, 95%-confidence interval: 0,27-0,67, F(2, 267)=15,41, p<0,001). CONCLUSION: There is a need to include the impact of discrimination and privilege on mental health and the therapeutic relationship as an integral part of psychotherapy training to enhance its quality as well as the quality of future psychotherapies.

[Anxiety, Depression, Psychological Strain and Physical Complaints before and after the Covid-19 Pandemic in a German Longitudinal Study with Adults from Saxony]. / Ängstlichkeit, Depressivität, psychische Belastung und Körperbeschwerden vor und nach der Covid-19-Pandemie in einer deutschen Längsschnittstudie bei Erwachsenen aus Sachsen.

OBJECTIVE: The objective of the study was to investigate whether psychological distress increased in a German community sample from Saxony during the course of the Corona pandemic. METHODS: In 2017/2018 and 2022, N=289 participants (54.7% female) of the Saxon Longitudinal Study were interviewed about their psychological well-being using questionnaires (PHQ-4, SSS-8). RESULTS: There is a significant increase in complaints (anxiety, depression, psychological distress, physical complaints) compared to 2017/2018 to 2022 with effect sizes in the small and medium range (Cohens d=0.26-0.62). CONCLUSION: Data collection was not due to the pandemic but was routine as part of an ongoing long-term study. The Covid-19 pandemic led to an increase in psychological distress and physical complaints in a Saxonian, age-homogeneous population sample.

Variables associated with oral health-related self-efficacy - results of a cross-sectional study.

BACKGROUND: Oral health-related self-efficacy (OH-SE) is pivotal for oral health and is associated with other oral-health related variables, such as dental fear and anxiety (DF/A) and dental hygiene behaviors (DHB). This study attempts to analyze associations between OH-SE and oral healthrelated variables in a German population to extend previous research by analyzing whether OH-SE can be predicted by these variables, as this might contribute to the development of treatment interventions. METHODS: OH-SE, DF/A, oral health-related quality of life (OHRQoL), self-perceived dental condition, satisfaction with general health, DHB, and socioeconomic status were assessed as a part of the Saxon Longitudinal Study in an adult sample (n = 309, 56.3% female, all Saxon secondary school 8th graders in 1987). The associations of OH-SE with these variables were examined by means of correlation, multiple linear regression analyses, and group comparisons. Significance (p), standardized regression coefficients (ß), and effect size (Cohen's d) were calculated. RESULTS: The correlation analyses revealed increased OH-SE to be accompanied by low levels of DF/A, high levels of OHRQoL, high levels of self-perceived dental condition, increased satisfaction with general health and socioeconomic status (all r ≥ 0.142; all p ≤ 0.013). In the regression analysis, OH-SE was mainly predicted by self-perceived dental condition and satisfaction with general health (R2 = 0.157) as well as by daily frequency of toothbrushing, OHRQoL, and socioeconomic status on a trend-level basis. In the group comparisons OH-SE was lower in participants with moderate for manifest DF/A and higher in individuals with higher OHRQoL, better self-perceived dental condition, increased satisfaction with general health, increased daily frequency of toothbrushing, more dental appointments, and above-average socioeconomic status (trend level; all t ≥ 1.57; p ≤ 0.059). CONCLUSIONS: In this cross-sectional study, high levels of OH-SE were mainly predicted by general health as well as self-perceived dental condition. It was also associated with decreased DF/A, increased DHB, higher OHRQoL, and higher socioeconomic status. Future research should analyze these associations in longitudinal designs to address whether interventions focusing on adherence to good DHB improve (dental) health and thus OH-SE. This might be a promising approach, particularly in relation to the treatment of DF/A.

Analysis of Air Rescue for Offshore Wind Energy: A Retrospective Analysis of Structural and Process Quality for the Years 2014 to 2017.

In order to achieve the emission targets required by the German Federal Environment Agency (Umweltbundesamt), the offshore wind industry has become 1 of the central building blocks of the so-called "energy turnaround." After the first offshore wind farm (OWF), Alpha Ventus, started operation in 2010, the number of OWFs in the North Sea and Baltic Sea has grown steadily. Because of the ongoing growth of the industry, the number of workers on-site has more than quadrupled in recent years. Although the majority of OWFs are located in the exclusive economic zone up to 130 km from the mainland, the same legal provisions of the Occupational Health and Safety Act (Arbeitsschutzgesetz) apply here as on the mainland. This means that the operators of the wind farms are legally obligated to maintain a seamless rescue chain. Because of the distance to the mainland, rescue helicopters are the means of choice to ensure prompt emergency preclinical care and, if necessary, rapid evacuation. The company Northern HeliCopter GmbH, part of the DRF Luftrettung since 2019, offers as part of WINDEACare rescue helicopters stationed at 3 locations on the North Sea and Baltic Sea to its contract partners an emergency medical staffed air rescue service, which is operational 24 hours a day, 365 days a year. This article is the first to provide a detailed overview of a new field in prehospital emergency care on the high seas and, to this end, has recorded all offshore missions performed from 2014 through 2017 with evaluation of related medical and aeronautical data.

Impact of Dental Anxiety on Dental Care Routine and Oral-Health-Related Quality of Life in a German Adult Population-A Cross-Sectional Study.

The interaction between dental anxiety and the establishment of a consistent dental care routine has been an ongoing challenge. Unfortunately, there is limited available data concerning the detailed dental care practices of individuals with dental anxiety. Therefore, this study aims to explore how dental anxiety influences dental care habits and oral-health-related quality of life within an adult population. By utilizing the Dental Anxiety Scale (DAS) and the German Oral Health Impact Profile (OHIP-G5), we assessed their extent. To evaluate the differences, we performed analyses of variance (Anova), an independent t-test and rank correlation. The findings of this study unveil a significant correlation between elevated DAS scores and reduced frequency of tooth brushing; calculus removal and appointments for professional teeth cleaning. Interestingly; the use of dental floss and mouthwash solution as well as toothbrush hardness appeared to be not significantly affected by dental fear. Moreover, individuals with dental anxiety demonstrated a preference for manual toothbrushes over electric ones. In addition, higher DAS scores were found to be strongly associated with greater OHIP-G5 scores, thus leading to a substantial decline in overall oral health-related quality of life.

Essential Skills for Health Communication, Barriers, Facilitators and the Need for Training: Perceptions of Healthcare Professionals from Seven European Countries.

Many healthcare professionals are unaware of the necessary skills and barriers hindering interpersonal health communication. This study aimed to evaluate the healthcare professional's perception regarding health communication training's necessity, barriers, facilitators and critical skills in health communication. Data from a cross-sectional online survey in the framework of the H-Com project were utilized. The study included 691 healthcare professionals (physicians, nurses, students and allied health professionals) from seven European countries. Only 57% of participants had participated in health communication training, while 88.1% of them indicated a willingness to be trained in health communication. Nurses were more likely (OR = 1.84; 95% CI 1.16, 2.91) to have received such training, compared to physicians. Most examined communication skills, barriers and facilitators of effective communication, and perceived outcomes of successful communication were considered crucial for most participants, although physicians overall seemed to be less concerned. Most agreed perceived outcomes were improved professional-patient relations, patient and professional satisfaction, physical and psychological health amelioration and patients' trust. Nurses evaluated the importance of these communication skills and communication barriers, facilitators and outcomes higher than physicians. Physicians may underestimate the importance of communication skills more than nurses. Health communication should become an integral part of training for all health professionals.

Insomnia symptoms in adulthood. Prevalence and incidence over 25 years.

OBJECTIVE/BACKGROUND: Despite its high prevalence, little information is available about the course of insomnia symptoms over the life span. In this study, we analyzed the self-reported insomnia symptoms of the general population over more than 20 years, covering young up to middle adulthood. PATIENTS/METHODS: Data from waves 12 to 32 of the Saxon Longitudinal Study (1996-2021), were analyzed. Based on data from the 12th wave, n = 115 adults (48 men (41.7%), 67 women (58.3%), Mage = 23.59, SD = 0.59) completed the G-Score Item #3 in the following 18 waves, thus forming the basis for our analyses. The G-Score Item #3 reads "In the last 12 months, have you had the following complaints? Please indicate how often they occurred - Insomnia". The G-Score Item #3 was dichotomized using a cut-off score of 2, and prevalence and incidence rates were calculated by gender. RESULTS: The minimum prevalence rate was 23.48% (Mage = 32.11, SD = 0.40), and the maximum was 47.83% (Mage = 48.43, SD = 0.64), indicating an increase in insomnia symptoms with age. In most cases, no evidence was found for gender differences in prevalence rates. The incidence rates were 10.43% for the 1st year of follow-up and 8.7% for the 5th year and 6th year of follow-up, respectively. CONCLUSIONS: This study provides further evidence for the high prevalence rates of insomnia symptoms in the general population. As this study is the first epidemiological study of insomnia symptoms based on a single-item (screening) instrument, it should be rather seen as an extension than a replication of previous study findings.

[Psychosocial Care of Early Bereaved Parents - A Quantitative Cross-Sectional Study at German Maternity Wards]. / Psychosoziale Betreuung früh verwaister Eltern ­ Eine quantitative Querschnittsstudie an deutschen Entbindungsstationen.

INTRODUCTION: The death of an infant shortly after birth places a massive psychological burden on the parents involved. The availability of compassionate obstetric care is an important contributor to the prevention of sequelae. METHODS: The aim of this study is to survey the current practice of psychosocial care for parents in perinatal infant death in German hospitals and to investigate the association between hospital size and number of information services for parents and between support services for hospital staff and number of information services for bereaved parents. In a quantitative cross-sectional study in the form of a full survey, professionals in 206 German hospitals with maternity wards were interviewed using questionnaires. The data were analyzed using a regression analysis. RESULTS: 206 hospitals participated in the survey. The analyses confirm: Hospital size has a highly significant positive influence on the number of services for bereaved parents. The number of services provided to hospital staff has a highly significant positive influence on the number of informational services provided to bereaved parents. CONCLUSION: Recommendations for action from this study are: Special training of clinic staff on the topic of perinatal infant death, strengthening of the doctor-patient relationship through Balint or supervision groups, and promotion of internal and external interdisciplinary collaboration.

[Psychometric Evaluation of a Single-Item-Screener for Sleep Disturbances]. / Psychometrische Überprüfung eines Ein-Item-Screeners für Schlafbeschwerden.

OBJECTIVE: Sleep disturbances are one of the most prevalent health complaints in the general population. Thus, the need for validated screening instruments and prevention measures is high. The aim of the current study is to evaluate a potential single-item screening instrument and therefore, contribute to an improved early detection. METHODS: Data from Saxony Longitudinal Study (SLS) is being analyzed. Based on data of 32nd wave (n=321, 172 women, 149 men, M age=48.42, SD=0.64), the G-Score Item #3 ("Have you had the following complaints in the last 12 months? Please indicate how often they occurred. - sleeplessness"), a potential screening instrument, is psychometrically evaluated. A Receiver Operating Characteristic (ROC)-Analysis is calculated to assess the predictive validity of the G-Score Item #3. RESULTS: Retestreliability for the G-Score Item #3 is 0.70 (p<0.001). Correlation with the Jenkins Sleep Scale (JSS) was r=0.79 (p<0.01). The area under the curve (AUC) is 0.92, providing evidence for a very good predictive validity. DISCUSSION AND CONCLUSION: This study provides evidence for the use of the G-Score Item #3 as a screening instrument for sleep disturbances by showing good psychometric properties and brevity.

Are Attitudes towards COVID-19 Pandemic Related to Subjective Physical and Mental Health?

In this paper, we investigate the relationship between a person's psychological distress, subjective physical health and their attitudes towards the COVID-19 pandemic. The evaluation was performed on the basis of data from two waves of the Saxon Longitudinal Study, carried out in 2019 (pre-pandemic) and 2021. The number of study participants in both waves was 291. We tested in autoregressive cross-lagged models the stability of the respondents' health status before and during the pandemic and reviewed their influence on attitudes towards COVID-19. Our results show that COVID-19-related concerns are controlled by subjective physical health, while pandemic denial is linked to psychological distress. In an unknown and critical situation, with limited control over the situation, the strategy of avoidance or suppression may be used by individuals for protection by psychologically downplaying the stressor and danger.

A dataset for dental anxiety and psychological distress in 1550 patients visiting dental clinics.

OBJECTIVES: Information was collected to identify anxiety in dental patients visiting a dental clinic using the Dental Anxiety Scale, their level of psychological distress using the Brief Symptom Inventory-18 and identifying a correlation between these groups as well as the gender and age. DATA DESCRIPTION: This data contains a set of 1550 patients' answers to questionnaires taken before dental treatment in a dental clinic. It is divided into male and female patients as well as according to their age. The level of Dental Anxiety can be interpreted by answers chosen in the Dental Anxiety Scale (DAS) and the level of psychological distress by answers chosen in the Brief Symptom Inventory-18 (BSI-18). This dataset should help to encourage more research in the field of dental anxiety and we hope to see more comparisons with our data in the future or in different regions of the world.

[Internal Migration and Mental Health - Relevant Factors 20 and 30 years after Unification: Results of a Longitudinal Study in German]. / Binnenmigration und psychische Gesundheit in der Sächsischen Längsschnittstudie ­ Relevante Faktoren 20 und 30 Jahre nach der Wiedervereinigung.

Aim The aim of the present study was to determine the relevant factors in the mental health of people who experienced internal migration in comparison with people who did not. Methods Data from a longitudinal study in Saxony were used to compare the psychological distress of individuals who migrated internally with that of those who did not in 2010 and 2020. Bootstrapping-based mediation analysis was applied to examine possible mediators between internal migration and mental health.Results Individuals who experienced internal migration reported less mental distress compared to those who did not in 2010, but not in 2020, but these effects disappeared after including covariates and mediators. Important mediators in 2010 were life situation, political solidarity with FRG, winner of German Unification and job security; in 2020, these were threat of old-age poverty and experiences with system.Discussion Internal migration influences mental distress through different factors. Especially the current life circumstances play a crucial role.

Patient's and the Therapist's Attachment Representations, Attachment to Therapists, and Self-Esteem-Change Through Psychotherapy.

Objectives: The present naturalistic study aims to investigate the differential effects of the patient's and the therapist's attachment representations on the attachment to the therapist as perceived by the patient, and their impact on self-esteem-change through psychotherapy. Methods: Attachment variables of N = 573 patients as well as N = 16 therapists were assessed. Attachment representations were measured for therapists and patients via the Bielefelder Questionnaire for Client Attachment Exploration, the Relationship Specific Attachment to Therapist Scales and the Adult Attachment Interview. The patient's attachment to therapists was evaluated and patients' self-esteem was measured via the Frankfurter Selbstkonzeptskalen at the beginning and end of psychotherapy. Results: Although there were significant effects of the patient's attachment representations on the perceived attachment to the therapist as well as between the perceived attachment to the therapist and the amount of self-esteem-change, the therapist's attachment style had no significant influence on the perceived attachment to the therapist. Conclusion: Self-esteem-change through psychotherapy is influenced by the actually formed attachment relationship as perceived by the patient. The patient's attachment representations but not the therapist's attachment style contributes to the actual patient's attachment to the therapist.

Psychological and Socio-Economical Determinants of Health: The Case of Inner German Migration.

A substantial body of research has shown worse health conditions for East- vs. West-Germany in the wake of reunification. In the present study, we investigate how these differences between the two formerly divided regions developed and what maintains them. Specifically, we consider the associations between health status, income satisfaction, and health-related locus of control. In a quasi-experimental and longitudinal study design, we are particularly interested in the differences between individuals who stayed in East-Germany and those who were born in the East but migrated to West-Germany. To this end, we examined data from seven waves of the Saxony Longitudinal Study (2003-2009). Specifically, we tested a cross-lagged panel model with random effects, which evinced very good model fit. Most parameters and processes were equivalent between individuals who stayed in East-Germany vs. moved to West-Germany. Crucially, there was the expected pattern of positive correlations between health, income, and locus of control. In addition, we found substantially lower values for all three of these variables for the individuals who stayed in East-Germany (vs. moved to West-Germany). A possible explanation is the increase in socio-economic status that the internal migrants experienced. These findings present an important contribution of research in order to foster a better understanding on the social dynamics in Germany related to internal/domestic migrants and implications in the context of health outcomes (e.g., significantly more unemployment in East vs. West-Germany), especially since almost 20-25% of East-German citizens migrated to West-Germany. Until now, there are no similar studies to the Saxony longitudinal project, since the data collection started in 1987 and almost every year an identical panel has been surveyed; which can be particularly useful for health authorities. The study mainly focuses on social science research and deals with the phenomenon of reunification, approaching several subjects such as mental and physical health, quality of life and the evaluation of the political system. Yet even though many people have experienced such a migration process, there has been little research on the subjects we approach. With our research we deepen the understanding of the health consequences of internal migration.

Autonomic Nervous System Response to Psychosocial Stress in Anorexia Nervosa: A Cross-Sectional and Controlled Study.

To foster understanding in the psychopathology of patients with anorexia nervosa (PAN) at the psychological and physiological level, standardized experimental studies on reliable biomarkers are needed, especially due to the lack of disorder-specific samples. To this end, the autonomic nervous system (ANS) response to a psychosocial stressor was investigated in n = 19 PAN (BMI: 18.7 ± 3.3 kg/m2), age, and gender-matched to n = 19 healthy controls (HC; BMI: 24.23 ± 3.0 kg/m2). For this purpose, heart rate (HR) and heart rate variability (HRV) parameters were assessed in a cross-sectional study design under two experimental conditions: (1) rest and (2) stress (Trier Social Stress Test). In addition, psychological indicators of stress were assessed. An 2 × 2 × 8 ANOVA demonstrated similar HR and HRV patterns (except LF-HRV) between PAN and HC at rest. Under stress, PAN (vs. HC) demonstrated a blunted HR [condition*time*group: F (2.91, 104.98) = 9.326, p = 0.000, η2 = 0.206] and an attenuated HRV response (reduced SNS/PNS reactivity). Significant effects of stress appraisal (SA) and BMI on HRV-reactivity were revealed. SA on SDNN = Condition*time*SA = F (4.12, 140.15) = 2.676, p = 0.033, η2 = 0.073. BMI on LF/HF-Ratio = Condition*time*BMI = F (3.53, 60.16) = 3.339, p = 0.019, η2 = 0.164. Psychological indices suggested higher levels of chronic and appraised stress in PAN relative to HC. Additional analyses demonstrated that ED-symptoms are highly correlated with the latter constructs, as well as with psychological burden, but not with weight. Further, it was shown that abnormalities in reactivity persisted despite normalized ANS activity. Overall, we suggested that besides weight recovery, improvement in stress appraisal could be beneficial for cardiac health. In this light, a combination of therapy (e.g., development and activation of coping skills, cognitive reappraisal) and biofeedback training may improve treatment outcomes and regulate stress reactivity.

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.

A Brief Assessment of Body Image Perception: Norm Values and Factorial Structure of the Short Version of the FKB-20.

The Body Image Questionnaire-20 (FKB-20) is one of the most applied self-report measures in the context of body image assessment in German-speaking regions. A version of the FKB-20 capturing an ideal concept of body image is also available. A special property of the scale is its high sensitivity for individuals suffering from anorexia nervosa. The present research provided a short version of this scale (for both variants) and examined its validity in a representative sample (N = 2,347) of the German population. We utilized factor analysis methods to identify the optimal short scale of the measure, finding excellent model fit and reliability for a two-factor model (FKB-6) for both real and ideal body image. Both versions of the FKB-6 can be considered invariant across sex and age groups. Good reliability indices were shown for both versions of the FKB-6. The reliability indices were similar to those mentioned in previous studies. Our study also revealed, that large discrepancies between the real and an ideal body image are correlated with somatic and body dysmorphic symptoms. Finally, we provided norm values for comparisons of individual scores with the general population. The FKB-6 is a valid and a reliable measure that economizes assessments by clinicians and researchers.