Stress and burnout in the context of workplace psychosocial factors among mental health professionals during the later waves of the COVID-19 pandemic in Hungary.

Background: While literature is abundant on the negative mental health impact of the COVID-19 outbreak, few studies focus on the Central and Eastern European region. Objectives: We examined stress, burnout, and sleeping troubles among mental health professionals in the context of psychosocial risk factors related to participation in COVID care during the fourth and fifth waves. Materials and methods: Mental health professionals (N=268) completed an online cross-sectional survey in Hungary, between November 2021 and April 2022. Of the respondents, 58.2% directly participated in COVID care. The main data collection instrument was the Copenhagen Psychosocial Questionnaire (COPSOQ II), including 20 subscales on work-related psychosocial factors and 3 outcome scales (stress, burnout, and sleeping troubles). We added a question on competence transgression, and items on sociodemographic and professional background. Results: Participation in COVID care was associated with higher work pace (59.08 versus 49.78), more role conflicts (55.21 versus 45.93), lower scores on the influence at work (38.18 versus 51.79), predictability (44.71 versus 57.03), reward (55.82 versus 65.03), role clarity (70.19 versus 75.37), social support from supervisor (59.24 versus 65.55), job satisfaction (54.36 versus 62.84), trust regarding management (55.89 versus 67.86), justice and respect (44.51 versus 54.35) scales. Among those involved in COVID care, only the stress score was higher (47.96 vs. 42.35) in the total sample; however, among psychiatrists, both stress (52.16 vs. 38.60) and burnout scores (58.30 vs. 47.06) were higher. Stepwise multiple regression revealed that work-family conflict, emotional demands and workplace commitment were independent predictors of higher stress and burnout scores; furthermore, competence transgression had a significant effect on stress, and being a psychiatric specialist had a significant effect on burnout. These models explained 40.5% of the variance for stress and 39.8% for burnout. Conclusion: During the fourth and fifth waves, although COVID care was more well-organized, psychiatrists, as specialist physicians responsible for the quality of the care, were still experiencing challenges regarding their competence and influence at work, which may explain their increased levels of stress and burnout.

The Semmelweis Study: a longitudinal occupational cohort study within the framework of the Semmelweis Caring University Model Program for supporting healthy aging.

The Semmelweis Study is a prospective occupational cohort study that seeks to enroll all employees of Semmelweis University (Budapest, Hungary) aged 25 years and older, with a population of 8866 people, 70.5% of whom are women. The study builds on the successful experiences of the Whitehall II study and aims to investigate the complex relationships between lifestyle, environmental, and occupational risk factors, and the development and progression of chronic age-associated diseases. An important goal of the Semmelweis Study is to identify groups of people who are aging unsuccessfully and therefore have an increased risk of developing age-associated diseases. To achieve this, the study takes a multidisciplinary approach, collecting economic, social, psychological, cognitive, health, and biological data. The Semmelweis Study comprises a baseline data collection with open healthcare data linkage, followed by repeated data collection waves every 5 years. Data are collected through computer-assisted self-completed questionnaires, followed by a physical health examination, physiological measurements, and the assessment of biomarkers. This article provides a comprehensive overview of the Semmelweis Study, including its origin, context, objectives, design, relevance, and expected contributions.

[Association between self-efficacy, depression and self-care in type 2 diabetes mellitus]. / Az énhatékonyság, a depresszió és az öngondoskodás kapcsolata 2-es típusú diabetes mellitusban.

INTRODUCTION: Type 2 diabetes care mostly depends on self-care. However, a large proportion of patients suffer from depression, which has a negative effect on adherence. Treating depression is important for the effective therapy of diabetes. In the last years, examination of self-efficacy has become an important topic in adherence research. It has arisen that an appropriate self-efficacy may minimalize the negative effect of depression on self-care. OBJECTIVE: We aimed to determine the prevalence of depression in a Hungarian sample, to examine the correlation between depressive symptoms and self-care, and the possible mediating effect of self-efficacy between depression and self-care. METHOD: In the cross-sectional questionnaire study, we analyzed data of 262 patients. Median age was 63 years, average BMI was 32.5 (SD = 6.18). MEASURES: socio-demographic data, DSMQ (Diabetes Self-Management Questionnaire), PHQ-9 (Patient Health Questionnaire), Self-Efficacy for Diabetes Scale. RESULTS: Frequency of depressive symptoms is 18% in our sample. Depressive symptoms (PHQ-9 score) and self-care (DSMQ score) were in inverse correlation (r = -0.275, p<0.001). In the model, we examined the impact of self-efficacy; beside controlling for age and gender, BMI (ß = 0.135, t = -2.367) and self-efficacy (ß = 0.585, t = 9.591, p<0.001) were independent impacts, while depressive symptoms lost their significance (ß = -0.033, t = -0.547). DISCUSSION: Prevalence of depression was identical to literature. Depressive mood had a negative effect on self-care, while self-efficacy may play a mediating role in the connection between depression and self-care. CONCLUSION: Reinforcing the theory on the mediating role of self-efficacy may open new perspectives for the treatment of depression as a comorbidity of type 2 diabetes. Orv Hetil. 2023; 164(17): 667-674.

Integrated care for older multimorbid heart failure patients: protocol for the ESCAPE randomized trial and cohort study.

ESCAPE: Evaluation of a patient-centred biopsychosocial blended collaborative care pathway for the treatment of multimorbid elderly patients. THERAPEUTIC AREA: Healthcare interventions for the management of older patients with multiple morbidities. AIMS: Multi-morbidity treatment is an increasing challenge for healthcare systems in ageing societies. This comprehensive cohort study with embedded randomized controlled trial tests an integrated biopsychosocial care model for multimorbid elderly patients. HYPOTHESIS: A holistic, patient-centred pro-active 9-month intervention based on the blended collaborative care (BCC) approach and enhanced by information and communication technologies can improve health-related quality of life (HRQoL) and disease outcomes as compared with usual care at 9 months. METHODS: Across six European countries, ESCAPE is recruiting patients with heart failure, mental distress/disorder plus ≥2 medical co-morbidities into an observational cohort study. Within the cohort study, 300 patients will be included in a randomized controlled assessor-blinded two-arm parallel group interventional clinical trial (RCT). In the intervention, trained care managers (CMs) regularly support patients and informal carers in managing their multiple health problems. Supervised by a clinical specialist team, CMs remotely support patients in implementing the treatment plan-customized to the patients' individual needs and preferences-into their daily lives and liaise with patients' healthcare providers. An eHealth platform with an integrated patient registry guides the intervention and helps to empower patients and informal carers. HRQoL measured with the EQ-5D-5L as primary endpoint, and secondary outcomes, that is, medical and patient-reported outcomes, healthcare costs, cost-effectiveness, and informal carer burden, will be assessed at 9 and ≥18 months. CONCLUSIONS: If proven effective, the ESCAPE BCC intervention can be implemented in routine care for older patients with multiple morbidities across the participating countries and beyond.

The prevalence and mental health correlates of exposure to offensive behaviours at work in Hungary: results of a national representative survey.

BACKGROUND: Within the last decades, a substantial number of reports have established bullying behaviours as a severe risk to the health and safety of workers. However, in Hungary, the severity of this issue remains largely unknown. Therefore, the current study aimed to 1) determine the prevalence of offensive workplace behaviours in the Hungarian working population and 2) examine the relationship between exposure to these offensive behaviours and certain mental health indicators. METHODS: The cross-sectional analyses of the present study are based on a sample of 13,104 active workers being representative of the Hungarian working population according to gender, age, educational level, and 18 occupational sectors. The mid-length version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II) was used to measure workplace offensive behaviours (bullying, sexual harassment, threats of violence, and physical violence) in the 12 months preceding the survey. Examined mental health correlates included depressive symptomatology (Beck Depression Inventory), functional somatic symptoms (PHQ-15), perceived stress (Perceived Stress Scale), and general well-being (WHO Well-being Index). RESULTS: Almost half (48.7%) of the sample reported exposure to some form of offensive behaviour; 37.6% of participants reported occasional-, while 11.1% reported weekly or daily exposure. More women than men were exposed to offensive workplace behaviours, and those targeted the most were individuals aged 18-29 and in companies employing 20-49 employees. Top managers reported the lowest amount of bullying, while unskilled labourers reported the most frequent exposure. A moderately strong relationship was discovered between exposure to workplace offensive behaviours and all indicators of mental health. CONCLUSION: Workplace bullying was revealed to be a significant public health concern according to this large, representative data set from Hungary. Strategies to reduce the occurrence and impact of these behaviours on employee health should be a priority for occupational health and safety interventions.

Pain acceptance and illness intrusiveness in low-back pain: A longitudinal study.

Background: In chronic pain syndromes, acceptance of pain may be a better approach than pain control. So far, little data have been available on how pain and its acceptance affect illness intrusiveness among patients with low-back pain (LBP). Objective: The present longitudinal study evaluates the impact of pain acceptance on illness intrusiveness in patients with LBP. Methods: Study participants were asked to complete the following questionnaires during their visit (T1) at one of four diverse rheumatologic outpatient clinics, and then 2-3 months later (T2) via phone or online: Chronic Pain Acceptance Questionnaire (CPAQ), Illness Intrusiveness Rating Scale (IIRS), Roland-Morris Disability Questionnaire (RMDQ), Patient Health Questionnaire Depression subscale (PHQ9), and socioeconomic data. Results: One hundred and twenty-seven individuals completed the questionnaires at baseline (31 having acute, 15 subacute and 81 chronic low back pain) and 97 at follow-up. Illness intrusiveness was negatively correlated with chronic pain acceptance both at T1 (r = -0.39) and T2 (r = -0.44). Illness intrusiveness scores have not changed significantly from T1 (M = 28.59 SD = 13.08) to T2 (M = 28.24, SD = 15.76). In a multiple regression model-including pain intensity, functional status, pain acceptance, depression severity, age, sex and educational level-the independent predictors of follow-up illness intrusiveness scores were lower pain acceptance and higher depression scores. Conclusions: In our study, patients with acute, subacute and chronic low back pain reported similar levels of illness intrusiveness. In addition, illness intrusiveness scores have not changed significantly during the 2-month follow-up period and pain acceptance proved to be a significant independent predictor of illness intrusiveness among patients with chronic low-back pain.

Validation of the Hungarian PHQ-15. A latent variable approach.

BACKGROUND AND PURPOSE: Somatic symptoms without a clear-cut organic or biomedical background, also called "medically unexplained" or "somatoform" symptoms, are frequent in primary and secondary health care. They are often accompanied by depression and/or anxiety, and cause functional impairment. The Patient Health Question-naire Somatic Symptom Scale (PHQ-15) was developed to measure somatic symptom distress based on the frequency and bothersomeness of non-specific somatic symptoms. The study aimed to (1) evaluate the Hungarian version of the PHQ-15 from a psychometric point of view; (2) replicate the bifactor structure and associations with negative affect described in the literature; and (3) provide the Hungarian clinical and scientific community with reference (normal) values split by sex and age groups. METHODS: PHQ-15, depression (BDI-R), and subjective well-being (WHO-5) scores obtained from a large (n = 5020) and close to representative community sample (Hun-garostudy 2006) were subjected to correlation analysis and linear structural equation modeling. RESULTS: The PHQ-15 showed good internal consistency (Cronbach's α = 0.810; McDonald's ω = 0.819) and moderate to strong correlation with the BDI-R (rs = .49, p < 0.001) and WHO-5 (rs = -.48, p < 0.001). Fit of the bifactor structure was excellent; in independent analyses, the general factor was strongly associated with depression (ß = 0.656±0.017, p < 0.001) and well-being (ß = -0.575±0.015, p < 0.001), whereas the symptom specific factors were only weakly or not related to these constructs. The PHQ-15 score was higher in females and showed a weak positive association with age. The Hungarian PHQ-15 is a psychometrically sound scale which is positively associated with depression and ne-gatively related to subjective well-being. The bifactor structure indicates the existence and meaningfulness of a gene-ral factor representing the affective-motivational component of somatic symptom distress. CONCLUSION: The Hungarian version of the PHQ-15 is a brief and usable tool for the pre-screening of somatization disorder (DSM-IV) or somatic symptom disorder (DSM-5). The reported reference values can be used in the future for both clinical and research purposes.

Definition and Characteristics of Behavioral Medicine, and Main Tasks and Goals of the International Society of Behavioral Medicine-an International Delphi Study.

BACKGROUND: In the past decades, behavioral medicine has attained global recognition. Due to its global reach, a critical need has emerged to consider whether the original definition of behavioral medicine is still valid, comprehensive, and inclusive, and to reconsider the main tasks and goals of the International Society of Behavioral Medicine (ISBM), as the umbrella organization in the field. The purpose of the present study was to (i) update the definition and scope of behavioral medicine and its defining characteristics; and (ii) develop a proposal on ISBM's main tasks and goals. METHOD: Our study used the Delphi method. A core group prepared a discussion paper. An international Delphi panel rated questions and provided comments. The panel intended to reach an a priori defined level of consensus (i.e., 70%). RESULTS: The international panel reached consensus on an updated definition and scope of behavioral medicine as a field of research and practice that builds on collaboration among multiple disciplines. These disciplines are concerned with development and application of behavioral and biomedical evidence across the disease continuum in clinical and public health domains. Consensus was reached on a proposal for ISBM's main tasks and goals focused on supporting communication and collaboration across disciplines and participating organizations; stimulating research, education, and practice; and supporting individuals and organizations in the field. CONCLUSION: The consensus on definition and scope of behavioral medicine and ISBM's tasks and goals provides a foundational step toward achieving these goals.

The validity of the diabetes self-management questionnaire (DSMQ) in Hungarian patients with type 2 diabetes.

BACKGROUND: A wide range of measuring instruments are available for diabetes self-management. According to several studies, a relatively new instrument, the diabetes self-management questionnaire (DSMQ), shows a consistent relationship with outcomes of diabetes treatment as well, such as glycated hemoglobin (HbA1c). Furthermore, the questionnaire is short, but covers the main aspects of diabetes management. Given the increasing prevalence of diabetes in Hungary, our goal was to adapt this user-friendly questionnaire and analyze its validity. METHODS: After the standard translation process, we analyzed a sample of 221 people. The construct validity of the questionnaire was tested with HbA1c and body mass index. Morisky Medication Adherence Scale-8 values were tested via Pearson correlations. Known-groups validity of the DSMQ in relation to groups based on glycemic control levels was investigated using one-way ANOVA. RESULTS: The "sum scale" of the questionnaire and the HbA1c values show an inverse relationship (r = - 0.253, p < 0.01). Body mass index was related to the "sum scale" (r = - 0.214, p < 0.01) and to the "physical activity" (r = - 0.219, p < 0.01), while questionnaire results reflecting medication adherence correlated with the "glucose management" (r = - 0.291, p < 0.01), "health-care use" subscale (r = 0.236, p < 0.01) and the "sum scale" (r = 0.281, p < 0.01). A significant difference (F = 6.225, p = 0.002) was found between the DSMQ mean scores of the three groups, defined by good, medium, and poor glycemic control levels. CONCLUSIONS: The Hungarian version of the DSMQ was considered a valid tool for the measurement of diabetes self-management. With its help, problematic areas of self-management could be uncovered, and interventions can be improved.

[Fear and avoidance beliefs in chronic pain. The translation and validation of the Hungarian version of the FABQ questionnaire]. / A félelem és elkerülési hiedelmek krónikus fájdalomban. A FABQ kérdoív magyar változatának fordítása és validálása.

INTRODUCTION: Chronic low back pain is one of the top reasons for seeking medical advice. In the background of the dysfunction besides the somatic pain dysfunctional thinking, negative emotional states, or interpersonal problems can be identified as well. One of the most important factors making the rehabilitation difficult is the fear and avoidance of physical activity. AIM: The aim of the study was to adapt and validate the Fear Avoidance Beliefs Questionnaire (FABQ-H) in Hungarian. METHODS: The FABQ (16 items) was translated into Hungarian and filled in by 90 patients suffering from low back pain for at least three months. For cross validation the FABQ-H results of 43 patients were compared with pain intensity the Oswestry Low Back Pain Questionnaire (ODI), the Roland-Morris Disability Questionnaire (RDQ), the Zung Depression Scale (Zung) and the Pain Catastrophising Scale (PCS). RESULTS: The internal consistency of the FABQ-H was good: the Cronbach's alpha was 0.8. Correlation analysis revealed that the FABQ showed significant correlation only with the Pain Catastrophising Scale (r = 0.373, p = 0.014). CONCLUSION: Our results confirm that the FABQ-H is a valid questionnaire that can be well implemented. Orv Hetil. 2017; 158(24): 949-955.

Quantifying Multiple Work-Related Psychosocial Risk Factors: Proposal for a Composite Indicator Based on the COPSOQ II.

PURPOSE: To determine national reference values for the Copenhagen Psychosocial Questionnaire (COPSOQ II) across occupational sectors and develop a composite score to estimate the cumulative effect of multiple work-related stressors, in order to facilitate the implementation of occupational health directives on psychosocial risk assessment. METHOD: Cross-sectional data was collected via an online questionnaire. The sample included 13,104 individuals and was representative of the general Hungarian adult working population in terms of gender, age, education, and occupation. Mean scores were calculated for 18 scales on work environment and for 5 outcome scales of the COPSOQ II across 18 occupational sectors. We analyzed the association between a composite psychosocial risk score (CPRS), reflecting severity of exposure to multiple risk factors, and high stress, burnout, sleep troubles, and poor self-rated health. RESULTS: We found occupation-related differences in the mean scores on all COPSOQ II scales. Scores on the "Stress" scale ranged from 47.9 to 56.2, with the highest mean score in accommodation and food services sector. Variability was greatest with respect to emotional demands (range 40.3-67.6) and smallest with respect to role clarity (range 70.3-75.7). The prevalence of negative health outcomes increased with the CPRS. Five risk categories were formed, for which the odds ratio of negative outcomes ranged from 1.6 to 56.5. CONCLUSION: The sector-specific psychosocial risk profiles covering 18 work environmental factors can be used as a reference in organizational surveys and international comparisons. The CPRS proved to be a powerful predictor of self-reported negative health outcomes.

Proposal for an Update of the Definition and Scope of Behavioral Medicine.

PURPOSE: We aim to provide an update of the definition and scope of behavioral medicine in the Charter of ISBM, as the present version was developed more than 25 years ago. METHODS: We identify issues which need clarification or updating. This leads us to propose an update of the definition and scope of behavioral medicine. RESULTS: Issues in need of clarification or updating include the scope of behavioral medicine (biobehavioral mechanisms, clinical diagnosis and intervention, and prevention and health promotion); research as an essential characteristic of all three areas of behavioral medicine; the application of behavioral medicine; the terminology of behavioral medicine as a multidisciplinary field; and the relationship and distinction between behavioral medicine, mental health, health psychology, and psychosomatic medicine. CONCLUSION: We propose the following updated definition and scope of behavioral medicine: "Behavioral medicine can be defined as the multidisciplinary field concerned with the development and integration of biomedical and behavioral knowledge relevant to health and disease, and the application of this knowledge to prevention, health promotion, diagnosis, treatment, rehabilitation, and care. The scope of behavioral medicine extends from biobehavioral mechanisms (i.e., the interaction of biomedical processes with psychological, social, societal, cultural, and environmental processes), to clinical diagnosis and intervention, and to public health."

Defining the Field of Behavioral Medicine: A Collaborative Endeavor.

PURPOSE: To respond to comments on our proposal for an update of the definition and scope of behavioral medicine. METHODS: We identify common themes in the comments and provide a response. RESULTS: We discuss the relationship of behavioral medicine to other disciplines and fields, the scope of behavioral medicine, and issues related to the application of behavioral medicine. CONCLUSION: Based on the comments of our esteemed colleagues and our reflection on those comments, we now offer the following refined definition and scope of behavioral medicine. 'Behavioral medicine can be defined as the field characterized by the collaboration among multiple disciplines concerned with the development and integration of biomedical and behavioral knowledge relevant to health and disease, and the application of this knowledge to prevention, health promotion, diagnosis, treatment, rehabilitation, and care. The scope of behavioral medicine extends from bio-behavioral mechanisms (i.e. the interaction among biomedical, psychological, social, societal, cultural and environmental processes related to health and disease), to clinical diagnosis and intervention, and to public health'. We propose to use this refined definition and scope as the starting point for seeking further input from the ISBM member societies.

[The role of regular physical activity in the prevention and intervention of symptoms of anxiety and anxiety disorders].

Anxiety disorders are the most common mental illness, but are not uniform, many clinical diagnoses include the symptoms of anxiety. That is the reason why there are relatively small numbers of population surveys and randomized-controlled trials which have examined the relationship between exercise and the various anxiety symptoms/ disorders. In our review we summarize meta-analytic studies, epidemiological surveys and randomized controlled studies which examine the role of regular physical activity in the prevention and treatment of subclinical anxiety/anxiety symptoms and anxiety disorders. The meta-analytic studies and randomized-controlled trials examining the relationship between subclinical anxiety disorders and anxiety symptoms demonstrated small to moderate effect of exercise in the decrease of anxiety symptoms, especially for moderate-intensity exercise. This relationship was confirmed for both acute and chronic exercise, for state and trait anxiety in different sex, age and state of health groups. In the case of the anxiety disorders based on reviewed studies, we can conclude that there is a potential association between decreased symptoms of anxiety and exercise. The regular, moderate-intensity exercise can reduce and alleviate the symptoms of anxiety - at least in panic, agoraphobia and generalized anxiety disorders. The reviewed studies have been highlighted the fact, that exercise can be effective in psychiatric practice as an alternative or adjuvant therapy. Physically healthy people with anxiety symptoms, or patients with anxiety disorders can perform exercise, there are no contraindications. Although based on previous studies, we cannot assume that the relationship is causal, but we cannot ignore the evidences that are already available.

[The importance of the doctor-patient communication in the care of somatizing patients]. / Az orvos-beteg kommunikáció jelentosége a szomatizáló páciensek ellátásában.

The term "somatization" refers to the manifestation of multiple somatic complaints not explained by organic changes. According to the literature, 15-25 percent of all medical visits are related to somatization. As medical training does not put enough emphasis on the evaluation of the possible psychological background of certain somatic symptoms, physicians may feel powerless and make unjustified diagnostic and therapeutic efforts. The patients may also feel helpless and frustrated, their anxiety and the intensity of their complaints may increase. As stress is an important factor in the somatization process, stress reduction and improvement of coping are key elements of the treatment guidelines for chronic diseases. Evidence based interventions range from short counselling and medication to cognitive and behavioral psychotherapy. Reattribution, a short (10-30 minutes) structured intervention that can be implemented in primary or secondary care, in certain cases can result in significant decrease in somatic symptoms and anxiety.

[The relationship of work-related psychosocial risk factors with depressive symptoms among Hungarian workers: preliminary results of the Hungarian Work Stress Survey]. / Munkahelyi pszichoszociális kockázati tényezok kapcsolata a depressziós tünetegyüttessel a magyar munkavállalók körében. Az Országos Munkahelyi Stresszfelmérés elozetes eredményei.

INTRODUCTION: Research has shown that psychosocial stress acts as a risk factor for mental disorders. AIM: The present study aims at processing the preliminary results of the Hungarian Survey of Work Stress, concerning the relationship between depressive symptoms and work stress. METHODS: Cross-sectional survey among Hungarian workers was carried out (n = 1058, 27.5% man, 72.5% woman, age 37.2 years, SD = 11 years). Psychosocial factors were measured using the COPSOQ II questionnaire, while BDI-9 was used for the assessment of depressive symptoms. Statistical analysis was carried out applying Spearman's correlation and logistic regression. RESULTS: A quarter of the workers reported moderate or severe symptoms of depression (BDI≥19). The study confirmed the association between depressive symptoms and work-family conflict (OR = 2.21, CI: 1.82-2.68), possibilities for development (OR = 0.76, CI: 0.59-0.97) meaning of work (OR = 0.69, CI: 0.59-0.89) and commitment (OR = 0.60, CI: 0.47-0.78). CONCLUSION: The results point toward the need of such organizational measures that allow for the reduction of psychosocial stress.

Hungarian adaptation of the Tinnitus Handicap Inventory: reliability and validity.

The objective of this study was to determine the reliability and validity of the Hungarian version of the original Tinnitus Handicap Inventory (THI). In the study design the original THI (THI-US) was translated into Hungarian by three independent investigators. The final Hungarian version (THI-HUN) was constructed on the basis of these Hungarian interpretations and then administered to 72 patients suffering from chronic tinnitus. Construct validity was assessed using short version of Beck's Depression Inventory (BDI), Perceived Stress Scale (PSS4 version), Visual Analogue Scale (VAS) (loudness, annoyance and pitch of tinnitus), pure tone audiometry and tinnitometry. The 72 participants were 43 women and 29 men. Their mean age was 49.86 years with a mean tinnitus duration of 4.16 years. In the results THI-HUN and its subscales showed good internal consistency reliabilities (α = 0.95-0.74), with significant correlation between THI-HUN total score and subscales and the BDI, PSS4 and VAS annoyance. There was a high or moderate correlation between THI-HUN total score and VAS loudness, tinnitus duration, hearing loss and subjective perception of tinnitus loudness. The VAS pitch of tinnitus, the subjective perception of tinnitus pitch, age, gender and level of education did not show any correlation with THI-HUN total score. The test-retest reliability was high (r = 0.97). We conclude that a valid and reliable THI-HUN questionnaire was constructed.

Gender differences in deliberate self-poisoning in Hungary: analyzing the effect of precipitating factors and their relation to depression.

BACKGROUND: The suicide rate in Hungary is one of the highest in the European Union, with a male-female ratio of 3.55:1. Suicide rates correlate positively with suicide attempts, for which depression is the most frequent underlying disorder. AIMS: The aim of this qualitative study was to examine gender differences in suicide attempts, with a focus on the effect of precipitating factors on depression. METHOD: Semistructured interviews were conducted among 150 suicide attempters. Data on circumstances, reason, and method of attempt were recorded. Patients completed the Shortened Beck Depression Inventory, the Beck Hopelessness Scale, the Sense of Coherence Scale, and the Social Support Questionnaire. RESULTS: Interpersonal conflict was found to be the most frequent precipitating factor. There were significant gender differences in depressive symptoms among patients with interpersonal conflicts. We found differences in depressive symptoms according to presence or absence of interpersonal conflicts among men, but not among women. Male suicide attempters who indicated interpersonal conflicts had lower levels of depression. CONCLUSION: Depressive symptoms are frequent among suicide attempters. However, a subgroup of male attempters reporting interpersonal conflicts are characterized by a lower level of depression. This subgroup of attempters would probably not be detected with depression screening programs and may have an unmet need for other forms of screening and prevention.

A challenging epigenetic message: telomerase activity is associated with complex changes in lifestyle.

As an outcome of The 2009 Nobel Prize in Physiology or Medicine, a connection has been highlighted between the length of telomeres and epigenetic effects, such as intensive changes in lifestyle and nutrition as well as behavioural and psychological factors. In this review, the various elements of molecular, cell biological, nutritional and lifestyle changes are introduced and discussed.

Psychometric properties and construct validity of the brief Wisconsin inventory of smoking dependence motives in an Internet-based sample of treatment-seeking Hungarian smokers.

INTRODUCTION: Both full and brief versions of the Wisconsin Inventory of Smoking Dependence are promising new measurement tools for studying tobacco dependence. We assessed the psychometric properties and construct validity of the Wisconsin Inventory of Smoking Dependence Motives (WISDM)-68 and WISDM-37. METHODS: Participants were adult, treatment-seeking Hungarian daily smokers (N = 720) with Internet access who were also registered on a smoking cessation Web site. Using confirmatory factor analyses (CFAs), we tested the measurement models of both WISDM-68 and WISDM-37, internal consistency of subscales of WISDM-37, and gender invariance. We tested the associations between heaviness of smoking, tobacco dependence symptoms, smoking environment, and subscales of WISDM-37. RESULTS: Although the measurement model of WISDM-68 did not fit adequately, the measurement model of WISDM-37, including 11 correlating factors (affiliative attachment, automaticity, loss of control, cognitive enhancement, craving, cue exposure/associative processes, social/environmental goads, taste, tolerance, weight control, affective enhancement), satisfactorily represents the data. Latent structures are equal in both genders. Internal consistency of subscales of WISDM-37 ranges between 0.67 and 0.90. Tobacco dependence symptoms were significantly linked with all motives, heaviness of smoking was related significantly only to affiliative attachment, automaticity, loss of control, cognitive enhancement, craving, and tolerance, while tobacco dependence symptoms and gender were controlled. Gender was associated only with the weight control motive. CONCLUSIONS: Concurring with previous reports using other types of sample, WISDM-37 has sufficient psychometric properties and good construct validity to make it useful in measuring the multidimensional nature of tobacco dependence even in Internet-based research. Without precedent, gender equality of WISDM-37 is also supported.