Evaluation of an online-based self-help program for patients with generalized anxiety disorder - A randomized controlled trial.

Objectives: This study aimed to evaluate the effects of an online self-help intervention for generalized anxiety disorder (GAD). Our primary outcomes were generalized anxiety symptoms, measured using the Generalized Anxiety Disorder - 7 (GAD-7; Spitzer et al., 2006), and wellbeing based on the World Health Organization Wellbeing Index - 5 (WHO-5; Topp et al., 2015). Methods: A total of 156 German-speaking patients aged 18 to 65 with a diagnosis of GAD and internet access were included in this randomized controlled trial. The intervention group (N = 78) received access to a 12-week online self-help program, while the waitlist control group (N = 78) received access after the 12-week waiting period. Results: The intervention group showed a significant improvement in generalized anxiety symptoms compared to the control group (t(df = 123.73) = 4.52, p < .001) with a large effect size (d = 0.88, 95 %-CI: 0.50; 1.26). Additionally, the intervention group demonstrated a significant increase in wellbeing compared to the control group (t(df = 87,86) = 3.48, p < .001), with a moderate effect size (d = 0.62, 95 % CI: 0.27; 0.98). However, no significant effects were observed for secondary outcomes of functional impairments, work productivity, mental health literacy, and healthcare demands. For exploratory outcomes, improvement was found for anxiety and worry symptoms. Conclusions: These findings suggest that an online-based self-help intervention effectively reduces GAD symptoms and improves overall wellbeing. Future research should explore the long-term effects of this intervention and investigate potential mechanisms underlying its efficacy. Public health implications: Online-based self-help programs provide a promising treatment option for individuals with GAD who face barriers to traditional face-to-face therapy.

The perils of aiming too high: Discrepancy between goals and performance in individuals with depressive symptoms.

BACKGROUND AND OBJECTIVES: Negative evaluation processes play a pivotal role in the development and maintenance of depressive symptoms. However, it remains to be understood, whether evaluation processes in depression are impaired by maladaptive goal setting. METHOD: In a non-clinical sample (N = 50) of individuals with high (BDI-II-Score: 13-29) and low (BDI-II-Score: 0-3) levels of depressive symptoms goal setting prior to working on a cognitive task was measured. Goal feasibility was experimentally manipulated using an easy and a difficult version of the task. RESULTS: When goal feasibility was low, a high level of depressive symptoms was associated with setting unattainable goals. Whereas individuals with low level of depressive symptoms adjusted their goals to a lower (more realistic) level when task difficulty increased, individuals with high level of depressive symptoms initially adhered to significantly higher goals, so that their performance failed to meet their self-set standards. After depressed individual revised their goals downwards, their subsequent performance on the task also worsened. LIMITATIONS: The use of a non-clinical sample with self-reported depressive symptoms limits the generalizability of our findings to a clinical population. Future research would benefit from the use of a larger sample with patients suffering from clinical depression. CONCLUSIONS: The findings support the notion that negative evaluation processes in depressed individuals might be linked with their tendency to generate intractable conflicts between self-set inappropriate high goals and their own capacities to perform. However, the findings need to be confirmed in clinical samples to draw conclusions about the role of goal setting in negative evaluation processes in depression.

Genetic, psychosocial and clinical factors associated with hippocampal volume in the general population.

The hippocampus--crucial for memory formation, recall and mood regulation--is involved in the pathophysiology of dementia and depressive disorders. Recent genome-wide association studies (GWAS) have identified five genetic loci associated with hippocampal volume (HV). Previous studies have described psychosocial and clinical factors (for example, smoking, type 2 diabetes and hypertension) to have an impact on HV. However, the interplay between genetic, psychosocial and clinical factors on the HV remains unclear. Still, it is likely that genetic variants and clinical or psychosocial factors jointly act in modifying HV; it might be possible they even interact. Knowledge of these factors might help to quantify ones individual risk of or rather resilience against HV loss. We investigated subjects (N=2463; 55.7% women; mean age 53 years) from the Study of Health in Pomerania (SHIP-2; SHIP-TREND-0) who underwent whole-body magnetic resonance imaging (MRI) and genotyping. HVs were estimated with FreeSurfer. For optimal nonlinear model fitting, we used regression analyses with restricted cubic splines. Genetic variants and associated psychosocial or clinical factors were jointly assessed for potential two-way interactions. We observed associations between HV and gender (P<0.0001), age (P<0.0001), body height (P<0.0001), education (P=0.0053), smoking (P=0.0058), diastolic blood pressure (P=0.0211), rs7294919 (P=0.0065), rs17178006 (P=0.0002), rs6581612 (P=0.0036), rs6741949 (P=0.0112) and rs7852872 (P=0.0451). In addition, we found three significant interactions: between rs7294919 and smoking (P=0.0473), rs7294919 and diastolic blood pressure (P=0.0447) and between rs7852872 and rs6581612 (P=0.0114). We suggest that these factors might have a role in the individual susceptibility to hippocampus-associated disorders.

Dissociation and emotion regulation in borderline personality disorder.

BACKGROUND: Although some evidence suggests that borderline personality disorder (BPD) is primarily a disorder of the emotion regulation system, findings remain inconsistent. One potential explanation for this is the moderating role of dissociation. METHOD: In this study, 33 female subjects with BPD and 26 healthy controls (HC; matched by education level and nicotine intake) were presented idiographic aversive, standard unpleasant and neutral scripts. Modulation of startle reflex and electrodermal responses (skin conductance level; SCL) were measured during imagery of emotional and neutral scripts. Additionally, self-reports of emotional experience (valence and arousal) and present-state dissociation were assessed. RESULTS: Patients with BPD showed elevated levels of dissociative experiences during testing. Present-state dissociation mediated group differences in SCL and startle response between the HC and BPD groups. CONCLUSIONS: These results suggest that careful attention must be paid to the moderating effect of dissociative symptoms on the psychophysiological responses of BPD patients. Furthermore, the findings have important implications for the assessment and treatment of BPD, including the need to carefully assess BPD patients for dissociative symptoms and to incorporate the treatment of dissociation.

[The short version of the Brief Symptom Inventory (BSI -18): preliminary psychometric properties of the German translation]. / Die Kurzform des Brief Symptom Inventory (BSI -18): erste Befunde zu den psychometrischen Kennwerten der deutschen Version.

The short version of the Brief Symptom Inventory (BSI-18) is an easily applicable, reliable and valid self-report measure in wide international use. It assesses the syndroms of somatisation, depression and anxiety by means of 6 items each. For the psychometric evaluation of the German translation, undergraduate students, non-clinical subjects and psychosomatic outpatients were administered the BSI-18. Across these populations, all scales showed satisfactory to good internal consistencies (Cronbachs alpha ranged between 0.63 and 0.93). The item-total correlation as item discrimination index was sufficiently high, patricularly in the patient sample (rit ≥ 0.40). The correlations of the BSI-18 with measures of similar dimensions were moderate to high indicating a good convergent validity. Criterion-related validity was established in so far that patients scored significantly higher in all BSI-18 scales than did the non-clinical samples. With some exceptions, the German translation of the BSI-18 has similarly good psychometric qualities as the American original.

[Familial transmission of depression: the importance of harm avoidance]. / Familiäre Transmission depressiver Störungen : Die Bedeutung von Schadensvermeidung.

BACKGROUND: Previous research about the aetiology of depression has analysed how depression-associated personality traits influence familial transmission. Using the community-based sample of the Greifswald Family Study, we investigated longitudinally to which extent the temperament factor harm avoidance influences the correlation between parent's depression and the depression of their offspring (with regard to possible sex differences). METHODS: To test this familial transmission a structural equation model was conducted with the data of 193 children (mean age 19.5, SD=2.41) and their biological parents. Depression was assessed with structured clinical interviews, and harm avoidance with Cloninger's Temperament and Character Inventory (TCI, JTCI). RESULTS: The harm avoidance scores of the mothers were significantly correlated with the harm avoidance scores of their children, but the correlation of the father's and children's scores did not reach significance. The extent of harm avoidance at the first assessment of the 14-year-old children predicted depression 5 years later. CONCLUSION: These results indicate the importance of personality as a vulnerability marker for developing affective disorders. The results are discussed with respect to prevention programmes for children and parents with depression, especially if they exhibit strongly avoidant or anxious behaviour.

Association of airflow limitation with trauma exposure and post-traumatic stress disorder.

Trauma exposure and post-traumatic stress disorder (PTSD) are associated with self-reported asthma and chronic obstructive pulmonary disease. However, these conditions have not yet been related to objective measures of lung function. 1,772 adults from the general population were assessed regarding their medical histories and spirometric lung function. Additionally, they were administered a PTSD interview, and assigned to three groups: no trauma; trauma, but no PTSD; and trauma with PTSD. Adjusting for sociodemographic, clinical and lifestyle factors, subjects with PTSD had significantly higher odds ratios for most asthma-related symptoms than PTSD-negative participants (OR 3.2-8.8). The mean ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was lowest in the PTSD group and highest in those without trauma exposure. Traumatic stress was independently associated with FEV1 and FEV1/FVC. Participants with PTSD, compared with those without, had a significantly increased risk for airflow limitation independent of its definition (OR 4.2-7.8). This is the first study relating traumatic stress and PTSD, respectively, to objective parameters of lung function. Our findings suggest an association of trauma exposure and PTSD with airflow limitation, which may be mediated by inflammatory processes.

[Psychiatric symptoms in German short-term and long-term prisoners]. / Psychische Symptombelastung bei Kurz- und Langzeitgefangenen in Deutschland.

Previous studies have indicated high prevalence rates of mental disorders among prisoners. Based on a sample of 98 male German long-term prisoners and 94 male German short-term prisoners, psychiatric symptoms were comparatively assessed by means of the brief symptom inventory (BSI). The study showed a considerable increased in psychological stress, especially with regard to long-term prisoners. In this context a significant difference (p<0.01) was found between short-term and long-term prisoners where 65% of long-term prisoners and 40% of short-term prisoners showed a noticeable increase in the amount of psychological stress. Furthermore, high prevalence rates of a history of attempted suicide (29.7%) and self-injurious behavior (43.2%) were found. The following clinical implications are deduced from this study: there is a general need for treatment during imprisonment, especially with respect to long-term prisoners. In addition, the high rates of attempted suicide and self-injurious behavior require a focus on a more elaborated crisis management as well as psychotherapeutic treatment for this population.

[Psychiatric disorders and childhood trauma in prisoners with antisocial personality disorder]. / Psychische Störungen und Kindheitstraumata bei Strafgefangenen mit antisozialer Persönlichkeitsstörung.

Previous studies indicate high prevalence rates of mental disorders and trauma among prisoners. Based on a sample of 102 male German prisoners, the comorbidity and childhood trauma experiences in 72 criminals with antisocial personality disorder were investigated. Furthermore, associations of antisocial personality disorder and early traumatic experiences with the age at first conviction and the lifetime months of imprisonment were examined. Subjects had high rates of comorbid lifetime and current disorders as well as childhood trauma experiences. Physical abuse in childhood and adolescence was identified as a predictor for lifetime months of imprisonment, antisocial personality disorder was found to be a predictor for the age at first conviction. Our findings confirm the hypothesis of prisoners with antisocial personality disorder being a severely traumatized population with serious mental disorders. Traumatic childhood experiences and antisocial personality disorder are associated with criminality variables. This has important implications on preventive treatments as well as on how prison services are addressing these problems.

Association between depression and subclinical carotid atherosclerosis in patients with Type 1 diabetes.

AIMS: Recent studies have suggested an association between depression and subclinical atherosclerosis as measured by presence of carotid atherosclerotic plaque and increased intima-media thickening in non-clinical populations. Given the high prevalence of depression in patients with Type 1 diabetes and the diabetes-related risk factors for atherosclerosis, we hypothesized that this relation might also be of special relevance in Type 1 diabetic patients. METHODS: Intima-media thickness (IMT) and the presence of plaques in the carotid arteries were quantitatively assessed by high-resolution ultrasound in 175 adults (89 men, 86 women) with an established diagnosis of Type 1 diabetes. Having been treated for depression or current Beck Depression Inventory scores > 10 were considered to indicate depression. RESULTS: In men, the risk of plaque was higher in depressed subjects relative to non-depressed participants after adjustment for age, smoking status, systolic blood pressure, dyslipidaemia and body mass index [odds ratio (OR) 5.19; 95% confidence interval (CI) 1.29, 20.81]. Depressed women did not have an increased risk of plaque compared with non-depressed women (OR 0.97; 95% 95% CI 0.22, 4.34). We did not observe an association between depression and IMT, in men or in women. CONCLUSIONS: In line with previous research, our findings suggest a link between depression and subclinical atherosclerosis in Type 1 diabetic men, but not in women.

[At the border of social psychiatric care systems--a study of "high utilizers" in Mecklenburg-Vorpommern]. / Am Rande sozialpsychiatrischer Versorgungsstrukturen--eine Untersuchung zur "Systemsprengerproblematik" in Mecklenburg-Vorpommern.

Research in social psychiatry has partly neglected the problem of comparatively disturbed persons, who are characterized by a shift from the regular social psychiatric care system into homelessness, closed psychiatric treatment or other desintegrated areas. Against this background in Mecklenburg-Vorpommern, an evaluation of all clinical and complementary institutions engaged in psychiatry was realized. 83.5 % of the institutions took part in the study and 137 (5.21 %) persons were identified as critical. 59.4 % of the institutions, especially therapeutic living groups, remarked that they had treated critical persons during the last year. Sociodemographically, the critical persons could be characterized by comparatively limited interpersonal relationships und a high unemployed status. A factor analysis has resulted in 4 factors characterizing the problematical behaviour: (i) aggression, low social adjustment and impulsivity; (ii) suicidal behaviour; (iii) delinquency and substance use; (iv) manipulative behaviour and pestering. Defining a comparatively high of disturbed behaviour, 51 persons could be identified.

Impulsiveness in obsessive-compulsive disorder: results from a family study.

OBJECTIVE: Although obsessive-compulsive disorder (OCD) is usually conceptualized as an anxiety disorder some studies suggested it to be a deficit of impulse control. The purpose of this study was to assess impulsiveness in OCD families and compare it to control families. METHOD: Seventy cases and their 139 relatives were compared with 70 controls and their 134 relatives from a German family study on OCD (German Epidemiologic Network for OCD Studies). All subjects were interviewed and diagnosed according DSM-IV criteria and were administered the Barratt Impulsiveness Scale (BIS) and PADUA-Inventory to assess obsessive-compulsive symptoms. RESULTS: OCD subjects had significantly higher scores of cognitive impulsiveness. However, first-degree relatives of OCD cases and of controls had comparable BIS-11 scores. Significant associations of aggressive obsessions and checking with cognitive impulsiveness were found. CONCLUSION: OCD is a severe mental disorder that is characterized by a lack of cognitive inhibition. However, impulsiveness does not represent a familial trait in families of OCD subjects.

[Categorical versus dimensional classification of personality disorders: are dimensional models the future?]. / Kategoriale versus dimensionale Klassifikation von Persönlichkeitsstörungen: sind dimensionale Modelle die Zukunft?

The classification of personality disorders (PD) according to ICD-10 and DSM-IV has been critisized for several reasons. For example, those who have attempted to validate the presence of a non-arbitrary distinction between normal and abnormal personality functioning have suggested that no such distinction exists. Furthermore, PDs frequently co-occur with a number of Axis-I conditions and other Axis-II disorders leading to multiple diagnoses. Therefore, many have suggested classifying PDs dimensionally, rather than categorically. However, there are only a few studies that have investigated the applicability of these models with respect to PDs, and most of these studies used the Big Five. In this study we investigated the applicability of the Seven-Factor model of temperament and character for the classification of PDs. Our results show that the Seven-Factor model discriminates well between PDs and healthy controls, as well as between PDs and Axis-I disorders. We discuss our findings and present a modified scheme to diagnose PDs.

[Suicide attempts in alcohol dependents: clinical characteristics und differentiation of the applied methods]. / Suizidversuche bei Alkoholabhängigen: klinische Charakteristika und Differenzierung nach der verwendeten Methode.

INTRODUCTION: Suicidal behavior is common in alcohol-dependent subjects. In terms of methods used, violent and non-violent suicide attempts can be distinguished. To confirm the validity of this distinction from a clinical point of view a sample of inpatient alcohol-dependent subjects is explored. METHODS: Subjects with a diagnosis of alcohol dependence according to DSM-IV and ICD-10 who took part in an inpatient withdrawal treatment program were included. Characteristics of alcohol dependence and suicidal behavior as well as lifetime diagnosis of other psychiatric disorders were assessed using the SSAGA. Clinical syndromes, personality and temperament were obtained by MMPI-2, TCI and NEO-FFI. RESULTS: Of the 182 included patients, alcoholics with a history of suicide attempts reported more depressive pathology and a personality profile characterized by emotional instability, psychopathy and decreased self-control. DISCUSSION: Distinguishing alcohol dependent suicide attempters according to methods used, no significant differences between violent and non-violent methods could be found. Therefore the clinical validity of this distinction could not be confirmed.

[Temperament and character in persons with borderline personality disorder]. / Temperament und Charakter bei Personen mit Borderline-Persönlichkeitsstörung.

High comorbidity, suicidal ideation, difficult temperament, and character are key symptoms of persons with borderline personality disorder (BPD). We investigated 478 persons, 40 of whom had a BPD according SCID-II, self-rating. Participants were examined with a semistructured interview and several self-rating questionnaires in their households. Taking the high comorbidity of persons with BPD into account, we compared the BPD group with four control groups with different axis 1 or personality disorders and one nonclinical group. Persons with BPD showed high comorbidity with affective, anxiety, and alcohol use disorders. With respect to suicidality, 75% reported that they wish to be dead at least sometimes, and about one-third said that they had already attempted suicide. Regarding temperament and character dimensions, our analyses revealed higher novelty seeking for persons with BPD compared to participants without BPD, although this difference was primarily attributable to males with BPD. Additionally, participants with BPD reported higher harm avoidance compared to control groups, while this was more distinctive for females. Finally, we found that persons with BPD had very low levels of self-directedness. This effect was independent from gender and was found in all group comparisons. Therapy of BPD should take into account high comorbidity and suicidality of patients. Moreover, our results show that low self-directedness seems to be specific for persons with BPD. Therefore, therapy must address those deficits by focusing on skills training as well as on aspects of maturation.

[Effect of temperament, effect of alcohol expectancies and peer group on amount of drinking and alcohol-related problems in adolescence]. / Der Einfluss von Temperament, Alkoholwirksamkeitserwartungen und Bezugsgruppe auf Trinkmenge und Alkoholprobleme im Jugendalter.

OBJECTIVE: The purpose of this longitudinal study was to investigate the relationship between temperament (novelty seeking, harm avoidance and reward dependence), alcohol expectancies, membership in a deviant/substance-using peergroup and drinking behaviour of adolescents drawn from a general population. METHODS: 147 adolescents about 15 years of age were interviewed and completed several self-rating questionnaires. We gathered additional information by interviewing their parents. One year after the initial assessment the adolescents only were interviewed and given questionnaires again. RESULTS: Adolescents with alcohol problems at the time of the second interview reported less harm avoidance, less reward dependence, and were more likely to be a member of a deviant/substance-using peergroup a year before, compared to offspring without alcohol problems. Furthermore, they held more positive alcohol expectancies than adolescents without alcohol problems. Taking into account the quantity of alcohol consumed per occasion, all results were confirmed, but temperament did not predict the extend of alcohol consumed after one year. CONCLUSIONS: Alcohol expectancies and peer group deviance/substance-use are strongly associated to alcohol problems and the amount of alcohol consumed. Therefore, they should be the focus of prevention and intervention in this age group.

The relation between suicidal feelings and mental disorders in the elderly: results from the Berlin Aging Study (BASE).

BACKGROUND: The purpose of this study was to demonstrate the influence of several risk factors (particularly physical and mental disorders, loneliness and housing conditions) on the wish to die in the elderly. METHOD: Using data from a population-based sample of 516 senior citizens (70 to 103 years of age) in Berlin (Germany), we compared 54 persons with death wishes with 462 persons without death wishes on several psychosocial risk factors, physical health and psychiatric diagnoses. A logistic regression analysis was also conducted. RESULTS: . The data indicate that the wish to die is strongly associated with the presence of a mental disorder, especially major depression, while higher age, female gender, subjective assessment of physical health and negative living conditions were all only moderately related to death wishes. CONCLUSIONS: Our results emphasize the need for very careful diagnosis of death wishes in the very old and question the view that it is a normal and understandable phenomenon in older age.