Validation of the psychometric properties of a "Modified Version of the Hornheider Screening Instrument" (HSI-MV) using a sample of outpatient and inpatient skin tumor patients.

BACKGROUND: The basis for adequate psycho-oncological care is the identification of patients with psychosocial support needs. The German Working Group for Psychooncology also recommends the Hornheider Screening Instrument (HSI) for this purpose. The question, "Is anyone in your family particularly burdened by the hospital stay?" is intended to capture disease-related family stress. But is this item equally suitable for outpatients and inpatients? The study objective was to examine how replacing the original item affects the test performance of this modified version of the HSI and the frequency of psychosocial stress. PATIENTS AND METHODS: 92 outpatients and 98 inpatients with skin tumors assessed their psychosocial situation using different questionnaires. RESULTS: Compared to inpatients, less than half as many outpatients answered the item in the affirmative. If the question was replaced by: "Is someone in your family particularly burdened by your disease or the course of the disease?" this setting-related difference did not arise. The "Alternative item" and the "Modified version of the HIS" (HSI-MV) proved to be superior to the original item and the original HSI with regard to all examined criteria. CONCLUSIONS: The HSI-MV can be used as a reliable and valid instrument for the systematic assessment of psychosocial care needs in outpatient and inpatient settings. Depending on care capacity, a threshold of ≥ 5 or ≥ 4 is appropriate. In addition to screening, the desire for support should be enquired.

Interoceptive awareness and self-regulation contribute to psychosomatic competence as measured by a new inventory.

BACKGROUND: The interrelation of interoception, cognitive appraisal of bodily signals and conscious self-regulatory behavior is insufficiently understood although it may be relevant for health and disease. Therefore, it was intended to develop a novel self-report measure targeting this link. METHODS: Item development was theoretically based on the multidimensional conceptual framework of the psychosomatic intelligence hypothesis and included an iterative process of refinement of items. In a preliminary test a principal components analysis (PROMAX rotation) and item analysis were calculated for item reduction. In the field test an item response theory approach was used for development of final scales and items. For validation purposes, associations with established measures of related constructs were analyzed. RESULTS: The final 44-item questionnaire consisted of 6 interrelated scales: (1) interoceptive awareness, (2) mentalization, (3) body-related cognitive congruence, (4) body-related health literacy, (5) general self-regulation, and (6) stress experience and stress regulation. Psychometric properties of this instrument demonstrated good model fit, internal consistency and construct validity. According to the validation, the final instrument measures a form of competence rather than intelligence and was termed the psychosomatic competence inventory. CONCLUSION: Interoceptive awareness and conscious body-related self-regulation seem to jointly contribute to a basic competence which may serve homeostatic/allostatic control; however, further research is needed to confirm the reported preliminary findings in a large-scale test.

Psychosocial stress of dermatology inpatients and their relatives - Comparison of patients with and without cancer.

BACKGROUND: In the clinical treatment pathways of certified oncological centers, psychotherapeutic services are mandatory. Although patients with somatic, non-oncological illnesses show an equally high prevalence of psychosocial stress, these guidelines do not exist for the general hospital sector. Are these patients really less burdened and is psychological support only needed in individual cases? The example of dermatological patients will be used to show whether the need for psychosocial care and the desire for support vary between individuals with and without malignant disease. PATIENTS AND METHODS: Using the Hornheider screening instrument and distress thermometer, 216 dermatological inpatients assessed their psychosocial stress and that of a close relative. In addition, they were asked about their desire for support and preferred support provider. RESULTS: i) Patients without skin cancer were more frequently and more severely distressed than cancer patients. ii) Patients of both groups assessed their relatives to be approximately equally distressed. Compared with their own distress, cancer patients assessed their relatives as more frequently and on average more severely distressed. More than 50 % of all patients regarded their own disease as the cause of their relatives' distress. iii) The desire for support in both groups was about 18 %. iv) Doctors and psychologists were usually named as potential contact persons. CONCLUSIONS: The expansion of psychosocial support services for non-tumor patients and their relatives seems necessary. The establishment of appropriate screening methods should be considered. Further studies in other clinical areas are required.

A salutogenic inquiry into positive aging - a longitudinal analysis.

Objectives: Based on a gero-salutogenic approach, we investigated the stability of the sense of coherence over a time span of four years in active older individuals and long-term effects of this life orientation on three different indicators of positive aging-subjective well-being, psychological health and physical health. This is the first study to explore associations between gain in sense of coherence and future positive aging. Methods: Our longitudinal sample consisted of 125 physically active individuals (73.5% women) at the mean age of 71 years at follow-up (range: 64 to 87 years; response rate: 73.5%), who completed our questionnaire twice. There were no systematic differences between the follow-up responders and non-responders. Results: The sense of coherence increased over four years, disclosing a small effect size. The baseline sense of coherence had a substantial predictive value for future subjective well-being and psychological health, but not for physical health. Stepwise hierarchical regression analyses showed that both the baseline sense of coherence and gain in sense of coherence predicted future subjective well-being and psychological health. With respect to future physical health, only gain in sense of coherence was significant. Conclusion: Consistent with gero-salutogenic theory, the baseline sense of coherence is an effective predictor of future positive aging, and growth in sense of coherence within a time span of four years is reflected in improved positive aging. It is important to encourage experiences in older age that cultivate the three components of the sense of coherence-feelings of comprehensibility, manageability and meaningfulness.

Psychosocial distress and desire for support among skin cancer patients - impact of treatment setting.

BACKGROUND: Diagnosis and treatment of malignancies are frequently associated with a variety of problems for affected individuals and their relatives. In order to ensure adequate psycho-oncological and social care, it is recommended to routinely assess patients' psychosocial distress. While psychosocial services for inpatients have been expanded in recent years, the outpatient care structure in terms of psycho-oncological support is far from satisfactory, especially in Mecklenburg-Western Pomerania. We therefore set out to investigate the following questions: Does the need for psychosocial care vary in relation to (a) the treatment setting (inpatients vs. outpatients) and (b) the diagnosis? (c) Do patients experiencing psychological distress desire support? PATIENTS AND METHODS: We asked both inpatients and outpatients to rate their psychosocial situation using the Hornheide Questionnaire. Patients were also asked about their desire for psychological support and the preferred contact person. RESULTS: (a) The treatment setting had no impact on the need for psychosocial care and the desire for support. (b) Depending on the type of skin cancer, there were significant differences in the need for such care among the 251 patients surveyed. (c) Despite a certain discrepancy, there was a significant correlation between psychosocial distress (39.0 %; n = 98/251) and desire for support (14.3 %; n = 35/245). (d) Patients experiencing distress primarily chose physicians (n = 21) and psychologists (n = 20) as potential contact persons. CONCLUSIONS: (1) In addition to the level of distress, the desire for support should be inquired. (2) Recommendations by physicians represent an important means of access to psycho-oncological services. (3) Services for outpatient support should be expanded.

Psychosocial distress and desire for support among inpatients with skin cancer.

BACKGROUND: Regular assessment of psychosocial distress is an important component of adequate psycho-oncological and social support in cancer patients. To date, relevant studies on skin cancer patients have primarily included individuals with melanoma. OBJECTIVES: (1) Does the need for psychosocial support vary with the type of skin cancer? (2) Do mentally distressed patients desire support? (3) From the various individuals in the treatment team, whom do patients choose as potential contact person? PATIENTS UND METHODS: Inpatients with skin cancer were asked to self-assess their psychosocial situation using the Hornheide questionnaire. In addition, they were asked about their desire for psychosocial support and the preferred potential contact person. RESULTS: The need for support among the 116 patients surveyed varied significantly depending on the diagnosis (p = 0.007). However, the direct comparison between patients with melanoma (n = 38; 32.8 %) and squamous cell carcinoma (n = 9; 7.8 %) (p = 0.724) or other types of skin cancer (n = 20; 17.2 %) (p = 0.366) revealed no such difference. The prevalence of psychosocial distress (n = 49; 42.2 %) and the desire for support (n = 20; 17.4 %) showed considerable differences. Patients primarily chose a physician (n = 14/35) or a psychologist (n = 13/35) as potential "go-to" person for their mental distress. CONCLUSIONS: Apart from psychosocial distress, the desire for support should be assessed, and patients should be provided access to additional psychosocial care options. With respect to the need for psychosocial support, it does not seem to be justified to preferentially - or even exclusively - consider melanoma patients in clinical practice and research.

Physical Activity, Energy Expenditure, Nutritional Habits, Quality of Sleep and Stress Levels in Shift-Working Health Care Personnel.

BACKGROUND: Among health care personnel working regular hours or rotating shifts can affect parameters of general health and nutrition. We have investigated physical activity, sleep quality, metabolic activity and stress levels in health care workers from both groups. METHODS: We prospectively recruited 46 volunteer participants from the workforce of a University Medical Department of which 23 worked in rotating shifts (all nursing) and 21 non-shift regular hours (10 nursing, 13 clerical staff). All were investigated over 7 days by multisensory accelerometer (SenseWear Bodymedia® armband) and kept a detailed food diary. Physical activity and resting energy expenditure (REE) were measured in metabolic equivalents of task (METs). Quality of sleep was assessed as Pittsburgh Sleeping Quality Index and stress load using the Trier Inventory for Chronic Stress questionnaire (TICS). RESULTS: No significant differences were found for overall physical activity, steps per minute, time of exceeding the 3 METs level or sleep quality. A significant difference for physical activity during working hours was found between shift-workers vs. non-shift-workers (p<0.01) and for shift-working nurses (median = 2.1 METs SE = 0.1) vs. non-shift-working clerical personnel (median = 1.5 METs SE = 0.07, p<0.05). Non-shift-working nurses had a significantly lower REE than the other groups (p<0.05). The proportion of fat in the diet was significantly higher (p<0.05) in the office worker group (median = 42% SE = 1.2) whereas shift-working nurses consumed significantly more carbohydrates (median = 46% SE = 1.4) than clerical staff (median = 41% SE = 1.7). Stress assessment by TICS confirmed a significantly higher level of social overload in the shift working group (p<0.05). CONCLUSION: In this prospective cohort study shift-working had no influence on overall physical activity. Lower physical activity during working hours appears to be compensated for during off-hours. Differences in nutritional habits and stress load warrant larger scale trials to determine the effect on implicit health-associated conditions.

Psychosocial burden and desire for support in outpatients with skin cancer.

BACKGROUND: An important basis for adequate psycho-oncological and psychosocial care of cancer patients is the regular assessment of their psychosocial distress and thus their need for care. For this purpose, there are numerous questionnaires available. The objective of the present study was to assess whether distressed patients require professional support and which screening instrument outpatients with skin cancer prefer. PATIENTS AND METHODS: In a cross-sectional survey, we asked outpatients with skin cancer to fill out three questionnaires assessing psychosocial stress, and to indicate which one they considered most adequate. Patients were offered the following three instruments: Hornheide Questionnaire (27 items), Hornheide Screening Instrument (7 items), and the Distress Thermometer. In addition, we inquired about the patients' desire for support. RESULTS: (1) Comparing subjective distress and patients' declared desire for support revealed a marked divergence. While one-third of the 137 patients were identified as being in need of care, only 11.5% of the sample requested such support. (2) 63.7% of patients chose the long version of the Hornheide Questionnaire. CONCLUSIONS: In addition to their psychosocial burden, patients' desire for support should be assessed. Moreover, apart from screening tools, other ways to provide access to psychosocial care should be considered.

Sense of coherence and pain experience in older age.

BACKGROUND: We investigate to what extent pain in older individuals is predicted by on the one hand chronic morbidity as a resistance deficit, and on the other hand psychological resistance resources and the sense of coherence. For the first time, we tested the salutogenic hypothesis that the sense of coherence mediates the relationship between resources/deficits and pain. METHODS: In our questionnaire study, we assessed selected psychological resistance resources (self-esteem, generalized self-efficacy, optimism, and social support), the number of self-reported medical diagnoses of chronic illness, the sense of coherence, and pain (SF-36 Bodily Pain subscale) in a sample of 387 older persons (at the mean age of 73.8 years). RESULTS: Using hierarchical regression, we found that morbidity and sense of coherence were the only significant predictors of pain, with morbidity showing the strongest effect. Using path analysis, the sense of coherence was a mediator of the relationship between resistance resources/deficits and pain. CONCLUSIONS: With respect to our analytical model, in which pain experience was the criterion variable, morbidity and the sense of coherence are important predictors of pain. Moreover, we found evidence for the salutogenic idea that the sense of coherence represents a mediator variable as it pools resistance/deficits influences on pain. We recommend a prospective design to explore these assumed causal chains in future research.

[The outpatient provision of care for psychiatric patients in a rural area]. / Zur ambulanten Versorgung psychischer Störungen in einer ländlichen Region.

An analysis of reimbursement claims in Mecklenburg West-Pomerania from the year 2007 showed that of all reimbursement claims made for outpatient treatment of patients with mental disorders, the majority has been claimed by general practitioners. Using the reimbursement claims from the last 3 months from 2010, again, most treatment claims were made by general practitioners. The patients were treated by general practitioners in 50.5%. neurologists/psychiatrists 16%, internal practitioners 10.6%, gynaecologists 5.3% and by psychotherapists in 2.3%. The actual analyses of reimbursement claims show again that the majority of patients with psychiatric disorders is not treated by the respective professional group.

Interobserver agreement of the German translation of the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI-SCOPE;D).

The aim of this study is to assess the interobserver agreement of the German translation of the MI-SCOPE. We applied it to transcribed counseling sessions on smoking cessation and relapse prevention with women postpartum. The MI-SCOPE is an instrument to assess and quantify MI-specific processes. Twenty percent random samples for parsing and coding each were drawn from 162 transcripts of MI sessions from the treatment arm of an RCT to assess interobserver agreement. Whole transcripts were coded. Each transcript was randomly assigned to two of three raters who parsed and coded the transcripts separately. Cohen's κ was computed to assess interobserver agreement. Concordance about parses ranged between κ = .702 and κ = .955 (25th percentile-median-75th percentile: .896-.918-.936). The kappas did not differ significantly between the three combinations of raters (H = 2.648; df = 2, p = .266). Concordance about codes for all 46 categories ranged between κ = .590 and κ = .822 (25th percentile-median-75th percentile: .680-.718-.748). The kappas did not differ significantly between the three combinations of raters (H = 4.095; df = 2, p = .129). The German translation of the MI-SCOPE yielded good to excellent κ for parsing as well as for coding. This indicates that MI as an intervention can be taught, learned, and adherence to MI as an intervention may be objectively observed and assessed.

The outpatient provision of care for mental disorders in a rural area: an analysis of reimbursement claims in mecklenburg-west pomerania*.

Mental disorders cause a substantial amount of the burden of disease. Although they are less frequent in rural areas, their provision of care is disproportionately lower. Reimbursement claims in the federal state of Mecklenburg-West Pomerania of the years 2006/2007 serve as the basis for the descriptive distribution of subgroups on the total number of mental disorders and their outpatient care. Of all claims, 35.3% were allotted to neurotic, stress-related and somatoform disorders, 24.2% to affective disorders and 12.5% to substance use disorders. Claims for reimbursement were made for 44.7% by general practitioners, 15.1% by neurologists and psychiatrists, 12.6% by gynaecologists, and 8.1% by internists. Psychotherapists claimed 3.1%. These results cause considerations regarding the establishment of psychotherapeutic and neurological / psychiatric practices as well as the significance of mental disorders in the training of general practitioners.

[The outpatient provision of care for mental disorders in a rural area. An analysis of reimbursement claims in Mecklenburg-West Pomerania]. / "Zur ambulanten Versorgung psychischer Störungen in einer ländlichen Region. Eine Analyse von Abrechnungsdaten der Kassenärztlichen Vereinigung Mecklenburg-Vorpommern.

Mental disorders cause a substantial amount of the burden of disease. Although they are less frequent in rural areas, their provision of care is disproportionately lower. Reimbursement claims in the federal state of Mecklenburg-West Pomerania of the years 2006/2007 serve as the basis for the descriptive distribution of subgroups on the total number of mental disorders and their outpatient care. Of all claims, 35,3% were allotted to neurotic, stress-related and somatoform disorders, 24,2% to affective disorders and 12,5% to substance use disorders. Claims for reimbursement were made for 44,7% by general practitioners, 15,1% by neurologists and psychiatrists, 12,6% by gynaecologists, and 8,1% by internists. Psychotherapists claimed 3,1%. These results cause considerations regarding the establishment of psychotherapeutic and neurological/psychiatric practices as well as the significance of mental disorders in the training of general practitioners.

A salutogenic analysis of developmental tasks and ego integrity vs. despair.

This study examines the hypothesis that the outcome of the Eriksonian crisis of integrity vs. despair is dependent on successful coping with four developmental tasks: maintenance of active involvement, reevaluation of life satisfaction, developing a sense of health maintenance, and reevaluation of the sense of coherence (SOC). A selective sample of 170 rather healthy individuals at the mean age of 67 years filled out a questionnaire assessing everyday activities, satisfaction with past, present, and future life, healthy habits, SOC, and depression. In our final path-analytical model, the SOC had a significant direct effect on all endogenous variables; it also attenuated depression indirectly via activity and via satisfaction with present and future life. Satisfaction with present life showed the strongest mitigating direct effect on depression. The SOC is an important antecedent for successfully resolving the integrity vs. despair crisis, in that a strong SOC is a guiding force behind mastering the other three tasks.

An integrative theoretical framework of acculturation and salutogenesis.

During the last two decades, the number of international migrants worldwide has constantly risen. In this context, cross-cultural dimensions of psychological disorders receive increased attention, especially depression, anxiety and post-traumatic stress disorders among the migrant population. In this paper we propose a theoretical framework for the understanding of migrant mental health. This framework combines elements from Berry's acculturation model and Antonovsky's salutogenic theory. The former illustrates the main factors that affect an individual's adaptation in a new cultural context. The term acculturative stress denotes unresolved problems resulting from intercultural contact that cannot be overcome easily by simply adjusting or assimilating. The latter specifies the relationship between culturally associated stress and mental health more distinctive, introducing the concepts of generalized resistance resources and sense of coherence that determine mental health outcomes of migrants during acculturative stress periods. Specifically, we provide an integrative framework of acculturation and salutogenesis that helps to integrate inconsistent findings in the migrant mental health literature. The current paper focuses on the effect of resource factors for positive mental health outcomes in the migrant population and summarises some implications for future research activities.