Do the elderly and those with comorbid chronic physical conditions have improved access to outpatient psychotherapy post structural reforms in Germany? Results of the ES-RiP study.

Background: In 2017, a reform of the German outpatient psychotherapy guideline was carried out, aiming to reduce waiting times and facilitate low-threshold access. This study analyzes the extent to which the implementation of the two new service elements 'psychotherapeutic consultation times' and 'acute short-term psychotherapeutic interventions' improved psychotherapeutic care for patients with mental disorders and chronic physical conditions (cMPs), for patients with mental disorders without chronic physical conditions (MnoP), and elderly patients. Methods: In a quantitative secondary analysis, we analyzed health insurance data of patients with psychotherapy billing codes obtained from the National Association of Statutory Health Insurance Physicians (KBV) for the years 2015-2019, evaluating descriptive statistical parameters for specific patient groups and care services. Results: Between 2015 and 2019, the number of mentally ill receiving psychotherapy at least once in the corresponding year increased by 30.7%. Among these, the proportion of cMPs-patients increased from 26.8% to 28.2% (+1.4%), while that of MnoP-patients decreased from 68.3% to 66.4% (-1.9%). The number of elderly people receiving treatment also increased. Conclusion: Since increases and decreases in the percentage shares occur evenly over the years investigated, it is questionable whether the reform in 2017 has had a direct influence on these changes. Study registration: ID DRKS00020344, URL: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html.

Suicidal ideation in patients with diabetes and childhood abuse - The mediating role of personality functioning: Results of a German representative population-based study.

AIMS: Suicidal ideation (SID) in patients with diabetes mellitus is increasingly acknowledged. Still, the underlying mechanisms are unclear. We examined SID prevalences in patients with diabetes, its association with different types of abuse, and a mediating effect of personality functioning. METHODS: In a representative population sample (N = 2,515), diabetes, SID, abuse (ICAST-R), personality functioning (OPD-SQS), and depression/anxiety (PHQ-4) were assessed by self-report. Statistical analyses comprised Chi2-Tests, logistic regression and mediation analyses. RESULTS: The prevalence of SID (21.8 %) was three fold higher in patients with diabetes compared to the general population. Abuse further increased the likelihood to report SID in diabetes patients (sexual: 48.1 % vs. 18.2 %; χ2(1) = 12.233, p <.001; emotional: 35.7 % vs. 15.7 %; χ2(1) = 10.892, p <.001). A dose-response relationship between the number of abuse experiences and SID was observed (one abuse experience: OR = 1.138, 95 %-CI [0.433, 2.990], p =.793, >2 abuse experiences: OR = 2.693, 95 %-CI [1.278, 5.675], p =.009). Impaired personality functioning had an indirect effect on the association between emotional abuse and SID (b = 0.25, 95 %-CI [0.037, 0.551]). CONCLUSIONS: Diabetes patients experience increased SID prevalences, especially those with emotional or sexual abuse. In individuals with a history of emotional abuse, impaired personality functioning partly explained SID and should therefore be considered and addressed in this patient group.

Outpatient Psychotherapy in Germany­An Evaluation of the Structural Reform.

BACKGROUND: A structural reform of the German psychotherapy guideline in 2017 was intended to facilitate access to outpatient guideline psychotherapy. In the present study, we evaluate the effects of this reform in particular for patients a comorbidity of mental disorders and chronic physical conditions (cMP). METHODS: Pre-post analyses of the two primary endpoints "percentage of mentally ill persons who have made an initial contact with a psychotherapist" and "waiting time for guideline psychotherapy" were carried out employing population-based and weighted routine statutory health insurance data from the German BARMER. The secondary endpoints included evaluations from the patients' perspective, based on a representative survey of patients in psychotherapy, and an overview of the health care situation based on data from the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (study registration number: DRKS00020344). RESULTS: From 2015 to 2018, the percentage of mentally ill persons who had made an initial contact with a psychotherapist rose moderately, from 3.7% (95% confidence interval, [3.6; 3.7]) to 3.9% [3.8; 3.9] among persons with cMP and from 7.3% [7.2; 7.4] to 7.6% [7.5; 7.7] among those with mental disorders but without any chronic phyisical condition (MnoP). The new structural elements were integrated into patient care. The interval of time between the initial contact and the beginning of guideline psychotherapy became longer in both groups, from a mean of 80.6 [79.4; 81.8] to 114.8 [113.4; 116.2] days among persons with complex disease and from 80.2 [79.2; 81.3] to 109.6 [108.4; 111.0] days among persons with non-complex disease; most patients considered the waiting time. Approximately 8% of the patients who sought psychotherapy reported that they had not obtained access to a psychotherapist. CONCLUSION: Neither in general nor for patients with cMP did the introduction of the structural reform appreciably lower the access barriers to psychotherapy. Further steps are needed so that outpatient care can meet the needs of all patients and particularly those with cMP.

To trust or not to trust in the thrall of the COVID-19 pandemic: Conspiracy endorsement and the role of adverse childhood experiences, epistemic trust, and personality functioning.

RATIONALE: Conspiracy endorsement is a public health challenge for the successful containment of the COVID-19 pandemic. While usually considered a societal phenomenon, little is known about the equally important developmental backdrops and personality characteristics like mistrust that render an individual prone to conspiracy endorsement. There is a growing body of evidence implying a detrimental role of adverse childhood experiences (ACEs) - a highly prevalent developmental burden - in the development of epistemic trust and personality functioning. This study aimed to investigate the association between ACEs and conspiracy endorsement in the general population, specifically questioning a mediating role of epistemic trust and personality functioning. METHODS: Based on cross-sectional data from a representative German survey collected during the COVID-19 pandemic (N = 2501), we conducted structural equation modelling (SEM) where personality functioning (OPD-SQS) and epistemic trust (ETMCQ) were included as mediators of the association between ACEs and conspiracy endorsement. Bootstrapped confidence intervals (5000 samples, 95%-CI) are presented for all paths. RESULTS: ACEs were significantly associated with conspiracy endorsement (ß = 0.25, p < 0.001) and explained 6% of its variance. Adding epistemic trust and personality functioning as mediators increased the explained variance of conspiracy endorsement to 19% while the direct association between ACEs and conspiracy endorsement was diminished (ß = 0.12, p < 0.001), indicating an indirect effect of personality functioning and epistemic trust in the association between ACEs and conspiracy endorsement. Fit indices confirmed good model fit. CONCLUSIONS: Establishing an association between ACEs and conspiracy endorsement further increases the evidence for early childhood adversities' far-reaching and detrimental effects. By including epistemic trust and personality functioning, these findings contribute to a deeper understanding of the underlying mechanisms in the way that ACEs may be associated with conspiracy endorsement.

Measuring personality functioning with the 12-item version of the OPD-Structure Questionnaire (OPD-SQS): reliability, factor structure, validity, and measurement invariance in the general population.

Background: The assessment of personality functioning is at the core of current dimensional models of personality disorders. A variety of measures from different clinical and research traditions aim to assess basic psychological capacities regarding the self and others. While some instruments have shown reliability and validity in clinical or other selected samples, much less is known about their performance in the general population. Methods: In three samples representative of the German adult population with a total of 7,256 participants, levels of personality functioning were measured with the short 12-item version of the Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQS). We addressed questions of factor structure, reliability, validity, factorial invariance, and provide norm values. Results: Confirmatory factor analysis indicated a satisfactory to good model fit. OPD-SQS models were mostly unaffected by variables such as gender, age, or measurement time. As expected, personality functioning was associated with general psychopathology as well as indices of occupational functioning. Conclusion: The OPD-SQS is a viable measure to assess personality functioning in the general population.

Supplementary data analyses for the associations of child maltreatment and diabetes in adulthood and the mediating effect of personality functioning.

In this article, supplementary data analyses regarding the association between different types of child maltreatment (CM) and diabetes as well as mediation analyses examining the role of personality functioning are provided (original research article: 'Associations of different types of child maltreatment and diabetes in adulthood - the mediating effect of personality functioning: findings from a population-based representative German sample') (Zara et al., 2023). Analyses are based on a representative sample of the German population (N = 5,041). Data was acquired through a representative survey conducted by the independent research institute USUMA Berlin. CM, personality functioning, a diabetes diagnosis as well as symptoms of depression and anxiety were assessed using self-report questionnaires (CTQ, OPD-SQS, PHQ-4). Correlation analyses for all used variables were conducted. Independent t-tests were performed to examine whether symptoms of depression and anxiety are elevated in patients with diabetes and CM (compared to no CM). Regarding the odd ratios (ORs) calculated to examine the association between types of CM and diabetes as well as mediation analyses investigating the role of personality functioning in these associations, sensitivity analyses with persons ≥ 30 years are provided. The additional analyses are intended to add to the body of research showing that patients with diabetes experience symptoms of depression and anxiety more frequently compared to the general population (Kampling and Kruse, 2020; Chireh et al., 2019; Smith et al., 2018), examine the association between different types of CM and diabetes, and explore the role of personality functioning in the association between CM and diabetes.

Mentalizing and epistemic trust as critical success factors in psychosomatic rehabilitation: results of a single center longitudinal observational study.

Background: Inpatient psychosomatic rehabilitation is a key treatment for patients with mental health issues. However, knowledge about critical success factors for beneficial treatment outcomes is scarce. The aim of this study was to evaluate the association of mentalizing and epistemic trust with the improvement of psychological distress during rehabilitation. Methods: In this naturalistic longitudinal observational study, patients completed routine assessments of psychological distress (BSI), health-related quality of life (HRQOL; WHODAS), mentalizing (MZQ), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Repeated measures ANOVA (rANOVAs) and structural equation models (SEMs) were calculated to investigate the association of mentalizing and epistemic trust with the improvement in psychological distress. Results: A total sample of n = 249 patients were included in the study. Improvement in mentalizing was correlated with improvement in depression (r = 0.36), anxiety (r = 0.46), and somatization (r = 0.23), as well as improved cognition (r = 0.36), social functioning (r = 0.33), and social participation (r = 0.48; all p < 0.001). Mentalizing partially mediated changes in psychological distress between T1 and T2: the direct association decreased from ß = 0.69 to ß = 0.57 and the explained variance increased from 47 to 61%. Decreases in epistemic mistrust (ß = 0.42, 0.18-0.28; p < 0.001) and epistemic credulity (ß = 0.19, 0.29-0.38; p < 0.001) and increases in epistemic trust (ß = 0.42, 0.18-0.28; p < 0.001) significantly predicted improved mentalizing. A good model fit was found (χ2 = 3.248, p = 0.66; CFI = 0.99; TLI = 0.99; RMSEA = 0.000). Conclusion: Mentalizing was identified as a critical success factor in psychosomatic inpatient rehabilitation. A key component to increase mentalizing in this treatment context is the improvement of epistemic mistrust.

Associations of different types of child maltreatment and diabetes in adulthood - the mediating effect of personality functioning: Findings from a population-based representative German sample.

PURPOSE: This study aimed to examine the role of personality functioning in the association between various types of child maltreatment (CM) (sexual, physical, and emotional abuse as well as physical and emotional neglect) and diabetes in adulthood. METHODS: Analyses are based on representative data of the German population (N = 5,041) from 2016 to 2019. Self-report questionnaires assessed diagnosis of diabetes, child maltreatment (CTQ), personality functioning (OPD-SQS), and symptoms of depression/anxiety (PHQ-4). Odd ratios were calculated to examine the association between CM and diabetes, and mediation analyses including PHQ-4 as covariate were conducted to examine the role of personality functioning. RESULTS: All CM types significantly elevated the odds of having diabetes in adulthood. Personality functioning mediated the association between abuse and diabetes (sexual: b = 0.012, 95% CI [.002, 0.022], PM = 25.0%, physical: b = 0.009, 95% CI [.001, 0.017], PM = 12.0%, and emotional: b = 0.013, 95% CI [.002, 0.024], PM = 59.8%), but not between neglect and diabetes. CONCLUSIONS: CM is associated with an increased risk of diabetes, with personality functioning being a relevant mediator for CM abuse types. Hence, by focusing on CM prevention and considering impaired personality functioning in diabetes treatment, diabetes self-management and health behavior could be improved.

Epistemic Trust Is a Critical Success Factor in Psychosomatic Rehabilitation-Results from a Naturalistic Multi-Center Observational Study.

Knowledge about critical success factors underpinning beneficial treatment outcomes in psychosomatic inpatient rehabilitation is scarce. The aim of this study was to evaluate the influence of patients' epistemic stance in relation to the improvement of psychological distress during rehabilitation. In this naturalistic longitudinal observational study, n = 771 patients completed routine assessments for psychological distress (BSI-18), health-related quality of life (HRQOL; WHODAS), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Patients were grouped as best, average, and worst responders based on their mean BSI-18 changes during treatment, and their mean change in epistemic trust, mistrust, and credulity was compared using repeated measures analyses of variance (rANOVAs). No associations of performance with sex (p = 0.09), age (p = 0.11), or relationship status (p = 0.58) were found. Best responders reported significantly improved epistemic trust (p = 0.001) and reduced epistemic mistrust (p < 0.001), whereas worst responders reported a significant increase in epistemic mistrust (p < 0.001) and credulity (p < 0.001). Average responders did not change for either epistemic trust (p = 0.11), mistrust (p > 0.99), or credulity (p = 0.96). Our results underscore the role of the epistemic stance in psychosomatic and psychotherapeutic treatments. These results help to better understand what might determine psychosomatic rehabilitation outcomes and indicate the role of epistemic trust as a critical success factor.

Gender-Specific Significance of Peer Abuse during Childhood and Adolescence on Physical and Mental Health in Adulthood-Results from a Cross-Sectional Study in a Sample of Hospital Patients.

Peer abuse (PA) is a widespread and gender-sensitive form of Adverse Childhood Experiences (ACEs). However, research on its influence on physical and mental health in adulthood remains scarce. The aim of this study was to investigate gender-specific associations between PA and physical and mental health in adulthood in a sample of general hospital patients. A cross-sectional study at the University Hospital of Innsbruck was conducted. Data on ACEs, physical and mental health were collected using self-report questionnaires. We compared patients with no ACEs, PA only, ACEs without PA, and ACEs with PA using gender-specific binary logistic regressions to investigate the association of PA with physical and mental health. A total of 2,392 patients were included in the analyses. Women reported more emotional PA (13.1% vs. 9.4%; p = 0.006), while men reported more physical PA (8.3% vs. 5.2%; p = 0.003). PA was associated with a higher likelihood for depression (OR = 2.6), somatization (OR = 2.1), as well as worse physical health (OR = 2.1) in women but not in men. This study is the first to present data on the gender-specific detrimental effect of PA on physical and mental health in adulthood. Especially for women, PA poses a significant health risk. Thus, we should be aware of these effects and offer adequate support for affected individuals.

Is the end in the beginning? Child maltreatment increases the risk of non-suicidal self-injury and suicide attempts through impaired personality functioning.

BACKGROUND: Child maltreatment is a risk factor for a range of mental disorders later in life, including dangerous self-harm and suicide attempts. A better understanding of the mechanisms underlying this association can inform prevention and intervention. OBJECTIVE: To investigate personality functioning as a potential mediator of the association of childhood abuse and neglect and self-harm and suicide attempts in the general population. PARTICIPANTS AND SETTING: Data were drawn from a representative German population sample (N = 2510). METHODS: Participants filled out the Childhood Trauma Questionnaire (CTQ), OPD Structure Questionnaire (OPD-SQS), and items of the Self-Injurious Thoughts and Behaviors Interview (SITBI). In structural equation models, we operationalized impaired personality functioning as the mediator between childhood abuse and neglect and self-harm. RESULTS: Individuals with a history of self-harm (combining suicide attempts, N = 47, and non-suicidal self-injury, N = 83) reported more childhood abuse and neglect (d = 1.39, p < .001) and greater impairments in personality functioning (d = 1.64, p < .001) than the rest of the population. The indirect effect via personality functioning accounted for 48.8 % of the total effect of childhood abuse and neglect on self-harm. In more differentiated analyses, emotional abuse showed the strongest association with self-harm. Only physical and sexual abuse had direct effects. CONCLUSIONS: The results specify the relationship between child maltreatment and self-harm by demonstrating that it is partly mediated by basic functions of personality assessed using a dimensional measure. These abilities constitute modifiable risk factors that can be addressed by psychotherapy.

Capturing Diabetes-Related Distress and Burden From the Perspective of Patients With Type 1 or Type 2 Diabetes: Protocol for an Explorative Mixed Methods Study.

BACKGROUND: Diabetes is one of the most common diseases worldwide and is associated with increased morbidity, mortality, and reduced quality of life. Many patients experience high diabetes-related distress as well as depression and anxiety symptoms, which are associated with poor diabetes self-management. As disease management is a central component in diabetes treatment, poor management enhances the occurrence of micro- and macrovascular complications. This emphasizes the relevance of reducing diabetes-related distress and providing adequate treatment options addressing the individual psychosocial burden of patients with diabetes. Since patients' perspectives diverge significantly from those of practitioners in terms of relevant treatment aspects, the patient perspective on, for example, barriers to and facilitators of diabetes treatment is crucial for adequate and effective treatment as well as improvements to self-management and therefore, needs to be further explored. OBJECTIVE: This study aims to examine diabetes-related distress, the course of distress throughout diabetes management, as well as barriers and facilitating factors in dealing with diabetes from the individual perspective of patients with type 1 and type 2 diabetes. METHODS: The study employs a mixed methods design combining qualitative and quantitative data. Semistructured interviews (N=40) will be conducted with patients with type 1 diabetes (n=20) and patients with type 2 diabetes (n=20). The primary outcomes comprise (1) diabetes-related distress, (2) the severity of distress, (3) the course of distress throughout diabetes management, (4) barriers, and (5) facilitating factors. Questionnaires will provide data on the following secondary outcomes: diabetes-related emotional distress (the Problem Areas in Diabetes scale), symptoms of depression and anxiety (Patient Health Questionnaire, German version), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire), mentalizing capacities (Mentalization Questionnaire), epistemic trust (Epistemic Trust, Mistrust and Credulity Questionnaire) and experiences of child maltreatment (Childhood Trauma Questionnaire), and the overall health status of the patient (routine medical data). RESULTS: As of April 2022, the conceptualization phase of the study was finalized. Ethics approval was received in January 2022 from the local ethics committee of the Justus Liebig University Giessen - Faculty of Medicine (AZ 161/21). CONCLUSIONS: This study will provide insights into the individual perspective of patients with type 1 and type 2 diabetes regarding their experiences with diabetes management and what they perceive to be relevant, obstructive, or beneficial. The insights gained could help further tailor diabetes treatment to the individual needs of patients with diabetes and therefore optimize diabetes self-management. TRIAL REGISTRATION: German Clinical Trial Register DRKS00024999; https://tinyurl.com/2wb4xdh8. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/38477.

Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood.

Background: Adverse childhood experiences (ACEs) are associated with posttraumatic and complex posttraumatic stress disorder symptoms in adulthood (PTSD/cPTSD), as well as reduced epistemic trust (trust in the authenticity and personal relevance of interpersonally transmitted information) and impaired personality functioning. The present work aims to investigate the predictive value of epistemic trust-the capacity for social learning-on the mediating effect of personality functioning in the association of ACEs and PTSD/cPTSD. Methods: We conducted structural equation modeling (SEM) based on representative data of the German population (N = 2,004). Personality functioning (OPD-SQS) was applied as a mediator between ACEs and PTSD/cPTSD (ITQ), while epistemic trust (ETMCQ) was added as predictor for OPD-SQS. TLI, CFI, and RMSEA (95%-CI) determined the models' fit. Results: N = 477 (23.8%) participants reported at least one ACE and n = 218 (10.9%) reported ≥4 ACEs. Fit indices were good for both PTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.041-0.078) and cPTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.043-0.081). ACEs were significantly associated with cPTSD (ß = 0.44, p < 0.001) and PTSD (ß = 0.29, p < 0.001), explaining 20 and 8% of its variance. Adding personality functioning as a mediator increased the explained variance of cPTSD and PTSD to 47 and 19% while the direct association between ACEs and cPTSD/PTSD decreased (ß = 0.21/ß = 0.17), thus, indicating a partial mediation. Including epistemic trust substantially increased the explained variance for personality functioning (41%) compared to ACEs as a single predictor (16%). Conclusion: We add to previous research emphasizing the association between ACEs and PTSD/cPTSD symptoms. Offering insights on underlying mechanisms, we show that epistemic trust and personality functioning are relevant mediators. Since both are modifiable by psychotherapy, knowledge about the role of these constructs can inform research on psychotherapeutic interventions and prevention.

Supplementary data for the mediation effect of personality functioning - Gender differences, separate analyses of depression and anxiety symptoms and inferential statistics of the relationship between personality functioning and different types of child maltreatment.

This article provides supplementary data for the original research article 'The Mediation Effect of Personality Functioning Between Different Types of Child Maltreatment and the Development of Depression/Anxiety Symptoms - a German Representative Study' [1]. The representative data were acquired as part of a broader survey on different aspects of mental health in the German population. This supplementary data article contains the statistical analyses of the relationship between the different subtypes of child maltreatment (CM) and impairments of personality functioning, which were only presented as a diagram in the original article. Additionally, the analyses conducted separately for symptoms of depression and anxiety as well as gender are provided. For the mediation analyses, the variables of depression/anxiety symptoms, personality functioning and CM types were standardized. The data may be useful for discussion, further insights and as a starting point for the development of further studies.

Measuring physical, cognitive, and emotional aspects of exhaustion with the BOSS II-short version - results from a representative population-based study in Germany.

BACKGROUND: The aim of the present study was the construction and psychometric evaluation of a shortened version of the Burnout Screening Scales II (BOSS II), a measure for exhaustion and burnout. METHODS: To this end, among a representative sample of the German general population (N = 2429, 52.9% women), we shortened the scale from 30 to 15 items applying ant-colony-optimization, and calculated item statistics of the short version (BOSS II-short). To estimate its reliability, we used McDonald's Omega (ω). To demonstrate validity, we compared the correlation between the BOSS II-short and the BOSS II, as well as their associations with depression, anxiety, and quality of life. Furthermore, we evaluated model fit and measurement invariance across respondent age and gender in confirmatory factor analyses (CFA). Finally, we present adapted norm values. RESULTS: The CFA showed an excellent model fit (χ2 = 223.037, df = 87, p < .001; CFI = .975; TLI = .970; RMSEA [90%CI] = .036 [.031;.040]) of the BOSS II-short, and good to very good reliability of the three subscales: 'physical' (ω = .76), 'cognitive' (ω = .89), and 'emotional' (ω = .88) symptoms. There was strict measurement invariance for male and female participants and partial strict invariance across age groups. Each subscale was negatively related to quality of life ('physical': r = -.62; 'cognitive': r = -.50; 'emotional': r = -.50), and positively associated with depression ('physical': r = .57; 'cognitive': r = .67; 'emotional': r = .73) and anxiety ('physical': r = .50; 'cognitive': r = .63; 'emotional': r = .71). CONCLUSIONS: Overall, the BOSS II-short proved to be a valid and reliable instrument in the German general population allowing a brief assessment of different symptoms of exhaustion. Norm values can be used for early detection of exhaustion.

Conspiracy endorsement and its associations with personality functioning, anxiety, loneliness, and sociodemographic characteristics during the COVID-19 pandemic in a representative sample of the German population.

BACKGROUND: In the context of the COVID-19 pandemic, many individuals have been found to endorse conspiracy beliefs. Socio-demographic variables, personality functioning, anxiety, and loneliness could be risk factors for this endorsement. METHODS: In a representative sample of the German population (N = 2,503) measures of conspiracy mentality, conspiracy-related beliefs toward COVID-19, personality functioning (OPD-SQS), anxiety (HADS), and loneliness (UCLA) were assessed. Pearson product-moment correlations and multiple linear regression analyses were conducted. RESULTS: Conspiracy mentality and conspiracy-related beliefs toward COVID-19 were strongly correlated. Regression analyses found younger age, male gender, lower education, and lower income to be associated with conspiracy mentality. The subscales relationship model and self-perception of the OPD-SQS were positively related to conspiracy mentality whereas interpersonal contact was negatively associated. Higher levels of anxiety were statistically predictive for conspiracy mentality. CONCLUSION: Our findings indicate a contribution of personality functioning to the understanding of conspiracy mentality and thus to the advancement of interventions during the pandemic.

An Integrated Psychosomatic Treatment Program for People with Diabetes (psy-PAD).

BACKGROUND: Many people with diabetes have permanently elevated blood sugar concentrations and a high level of diabetes-related psychological stress, also called "diabetes distress." In clinical practice, diabetes distress is often an impediment to successful self-management. psy-PAD is a psychodynamically oriented short-term therapy program whose goal is to reduce diabetes distress and improve glycemic control. METHODS: A randomized controlled trial was conducted with 143 patients with either type 1 or type 2 diabetes who were being treated in eleven specialized diabetological practices. psy-PAD in the intervention group (eight sessions) was compared with optimized standard care as the control condition. The inclusion criteria were HbA1c ≥ 7.5% combined with diabetes distress (PAID >35, or doctor's determination). The primary endpoint was the HbA1c at six months (t1). Diabetes-related distress (PAID), depressive symptoms (HADS-D, PHQ-9), anxiety symptoms (HADS-A), health-related quality of life (SF-36), panic (short form of the PHQ-D), body mass index (BMI), and triglyceride levels were secondary endpoints. Follow-ups were conducted at six (t1) and 12 months (t2) (trial registration: DRKS00003247). RESULTS: The intergroup comparison at t1 revealed a significant, clinically relevant reduction of HbA1c by -0.53 percentage points (95% confidence interval [-0.89; -0.16], p = 0.005). The secondary analyses revealed relevant differences in the point estimators for diabetes distress at t1 and t2, depressive symptoms at t2 and BMI at t1. CONCLUSION: For people with diabetes and diabetes distress who do not achieve satisfactory glycemic control despite intensive treatment in specialized diabetological practices, integrated psychosomatic-psychotherapeutic treatment can lower blood sugar levels over the intermediate term and also reduce diabetes distress and depressive symptoms over a one-year period.

The mediation effect of personality functioning between different types of child maltreatment and the development of depression/anxiety symptoms - A German representative study.

BACKGROUND: Child maltreatment (CM) is associated with an increased risk to develop symptoms of depression/anxiety across an individual's lifespan. Recent studies indicated that impairments in personality functioning might mediate this association. The purpose of this study is to add evidence of this mediating effect by regarding different types of CM (emotional, physical and sexual abuse as well as emotional and physical neglect) in the general population. METHODS: A representative sample of the German population (N = 2,354) completed a set of standardized measures (OPD-SQS: Operationalized Psychodynamic Diagnosis - Structure Questionnaire Short, PHQ-4: Patient Health Questionnaire, CTQ: Childhood Trauma Questionnaire). Mediation analyses were carried out to examine the association between CM types, symptoms of depression/anxiety, and personality functioning. RESULTS: Up to two-thirds of the associations between CM types and symptoms of depression/anxiety are mediated by personality functioning [indirect effect: emotional abuse (ß = 0.219, 95%-CI: 0.187-0.251, p < .001), physical abuse (ß = 0.151, 95%-CI: 0.123-0.178, p < .001), sexual abuse (ß = 0.163, 95%-CI: 0.138-0.188, p < .001), emotional neglect (ß = 0.131, 95%-CI: 0.104-0.159, p < .001) and physical neglect (ß = 0.102, 95%-CI: 0.078-0.127, p < .001)]. LIMITATIONS: Symptoms of depression/anxiety were measured with screening instruments and results are based on cross-sectional data. CONCLUSIONS: The present investigation expands the evidence on the mediating effect of personality functioning in the association between CM and depression/anxiety symptoms based on data of the general population. Our results show the relevance of types, as the mediating effects are slightly stronger in CM abuse types than in CM neglect types. Knowledge about impaired personality might be an angle for clinical interventions and inspire future research.

Evaluating effects of the structural reform of outpatient psychotherapy for patients with mental disorders in Germany: comparing patients with and without comorbid chronic physical condition - rationale and study protocol of the ES-RiP project.

INTRODUCTION: In 2017, in Germany, a structural reform of the outpatient psychotherapy guideline took place, aiming to reduce waiting times, to facilitate flexible low-threshold access (eg, general reachability by phone) and to lower access barriers for specific patient groups. The reform included new service elements, such as the implementation of additional psychotherapeutic consultations, acute short-term psychotherapeutic interventions and relapse prophylaxis as well as the promotion of group therapies, the facilitation of psychotherapists' availability, and the installation of appointment service centres. The ES-RiP project aims to thoroughly evaluate the effects of the reform with a special focus on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs) compared with patients with a mental disorder but no long-term physical condition (MnoP). The project aims to evaluate (a) the extent to which the reform goals were achieved in the large group of patients with cMPs compared with MnoP, (b) the barriers that might hinder the implementation of the new guideline and (c) the procedures required for further developing and improving outpatient psychotherapy. METHODS AND ANALYSIS: A mixed-methods design (quantitative, qualitative) along with a multilevel approach (patients, service providers, payers) triangulating several data sources (primary and secondary data) will be applied to evaluate the reform from different perspectives. ETHICS AND DISSEMINATION: Ethical approval was obtained from the coordinating committee as well as one local ethics committee, Justus Liebig University Giessen and Marburg - Faculty of Medicine (approval number: AZ 107/20) and Heidelberg (approval number: S-466/2020). The results of this study will be disseminated through expert panels, conference presentations and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: DRKS00020344.

Measuring Impairments of Mentalization with the 15-Item Mentalization Questionnaire (MZQ) and Introducing the MZQ-6 Short Scale: Reliability, Validity and Norm Values Based on a Representative Sample of the German Population.

Deficits in mentalization are indicated by impaired emotional awareness and self-reflectiveness, and are associated with various mental disorders. However, there is a lack of validated research instruments. In this study, the psychometric properties of the Mentalization Questionnaire (MZQ) were evaluated in a representative German population sample with n = 2487 participants. Analyses included evaluation of the MZQs acceptance, reliability, and validity. Factorial validity was established with exploratory (EFA) and confirmatory factor analyses (CFA) after the dataset was randomly split. Dimensionality was evaluated with a bi-factor model. For convergent validity, correlations with the OPD SQS, PHQ-4, and POMS were calculated. While acceptance was good, internal consistencies (ω = 0.65-0.79) and factor structure of the original four subscales were not acceptable (TLI = 0.87, CFI = 0.91, RMSEA = 0.071). EFA indicated a 3-factor solution, which was not confirmed by CFA (TLI = 0.89, CFI = 0.91, RMSEA = 0.073). Correlations between subscales and bi-factor analyses indicated an underlying general factor (TLI = 0.94, CFI = 0.96, RMSEA = 0.053). A shortened 6-item version was comparable to the original scale. Age and sex-specific representative norm-values are presented. The MZQ is a feasible, reliable and valid self-report instrument to measure representations of inner mental states. However, when applied to non-clinical samples, the total score of the MZQ should be used.