Examining the interplay between internet use disorder tendencies and well-being in relation to sofalizing during the COVID-19 pandemic.

AIMS: The present study investigated the potential links between Internet Use Disorder tendencies, well-being and the impact of COVID-19 on Internet usage patterns. METHOD: A sample of 2498 participants filled out the Compulsive Internet Use Scale (CIUS), the Satisfaction with Life Scale (SWLS; the cognitive facet of well-being) and the Sofalizing Scale which comprises the Online Displacement and Social Compensation dimensions. Participants were also asked to report the extent to which changes in Internet use occurred due to COVID-19 pandemic (i.e., reductions, no changes, increases). The present study comprised a survey study with cross-sectional character. RESULTS: The statistical analyses demonstrated that the aforementioned variables were robustly associated with each other. In a first mediation model, the association between higher levels of Internet Use Disorder and reduced well-being was partially mediated by the two dimensions of the Sofalizing scale called Online Displacement and Social Compensation. The results of the second mediation model showed that the relationship between changes in Internet use due to COVID-19 pandemic and well-being was fully mediated by CIUS scores, suggesting that increased Internet use due to the COVID-19 pandemic increased levels of Internet Use Disorder tendencies, which in turn decreased levels of well-being. DISCUSSION: The findings are discussed in the context of human social needs in a time of crisis, where meeting people in-person was restricted.

Study protocol for a randomised controlled trial of an e-health stepped care approach for the treatment of internet use disorders versus a placebo condition: the SCAPIT study.

INTRODUCTION: Excessive internet use can lead to problems for some individuals. The WHO has introduced Gaming Disorder in the International Classification of Diseases-11 (ICD-11). Previous research has shown that other internet applications can cause serious mental health problems as well. It is important to provide measures of prevention, early intervention and therapy for internet use disorders (IUDs). METHODS AND ANALYSIS: The study 'Stepped Care Approach for Problematic Internet use Treatment' is a randomised, two-arm, parallel-group, observer-blind trial. The aim of the study is to investigate if a stepped care approach is effective to reduce symptom severity for IUD. The sample is primarily recruited online with a focus on employees in companies with support of health insurances. After screening, the stepped care approach depends on the success of the previous step-that is, the successful reduction of criteria-and comprise: (1) app-intervention with questionnaires and feedback, (2) two telephone counsellings (duration: 50 min) based on motivational interviewing, (3) online therapy over 17 weeks (15 weekly group sessions, eight individual sessions) based on cognitive-behavioural therapy. A follow-up is conducted after 6 months. A total of 860 participants will be randomised. Hierarchical testing procedure is used to test the coprimary endpoints number of Diagnostic and Statistical Manual of Mental Disorders, fifth edition and ICD-11 criteria. Primary analysis will be performed with a sequential logit model. ETHICS AND DISSEMINATION: The study has been approved by the Ethics Committees of the Universities of Lübeck (file number: 21-068), Mainz (file number: 2021-15907) and Berlin (file number: 015.2021). Results will be reported in accordance to the CONSORT statement. If the approach is superior to the control condition, it may serve as part of treatment for IUD. TRIAL REGISTRATION NUMBER: DRKS00025994.

Risk and Protective Factors of Child-to-Parent Violence: A Comparison Between Physical and Verbal Aggression.

Child-to-parent violence (CPV) is a social problem that remains vastly understudied compared with other forms of family violence. The aim of this study is to identify family and child risk and protective factors of CPV, and to investigate whether they differentially predict physical and verbal parent-directed violence among boys and girls. Predictors include parenting behavior during childhood (physical and verbal violence, warmth, monitoring) and respondents' individual characteristics (suicidal ideation, self-control, problematic substance use). Data were examined from a large representative sample of ninth graders (N = 6,444) in Lower Saxony, Germany. Bivariate analyses showed that female adolescents were more likely to aggress verbally, while no gender differences were found for physical CPV. Multilevel logistic regression models revealed that direct experiences of parental physical and verbal violence during childhood were among the strongest predictors of physical and verbal CPV, both among males and females. While parental monitoring was not significantly associated with CPV, parental warmth protected girls from physical parent-directed aggression. Furthermore, high self-control was protective against verbal CPV as well as boys' physical CPV, while problematic substance use predicted physical violence toward parents in both sexes but only boys' verbal CPV. Suicidal ideation was a risk factor of aggression in males only. Except for parental warmth, the importance of risk and protective factors did not substantially vary across child gender. These findings broaden our understanding of different family and child-related factors that either promote or prevent CPV. Specifically, they point to the importance of the parenting context and especially harsh discipline practices for the occurrence of both physical and verbal CPV.

The role of inhibitory control and decision-making in the course of Internet gaming disorder.

BACKGROUND AND AIMS: Internet gaming disorder (IGD) is associated with impaired inhibitory control and more impulsive decision-making. However, it remains unclear whether these associations are cross-sectional or predictive. We aimed to test the hypotheses that lower inhibitory control and more impulsive decision-making correlate with, are predicted by and predict more time spent on gaming and higher IGD severity. METHODS: A stratified convenience sample of 70 male participants (18-21 years) was recruited to achieve broad data variability for hours spent on gaming and IGD severity. In three annual assessments (T1, T2, T3), we measured gaming behaviour and IGD severity using the Video Game Dependency Scale (CSAS-II). Both gaming-related measures were correlates (T1), predictors (T2), or outcomes (T3) of inhibitory control and decision making, which were assessed at T2 using a go/no-go task and an intertemporal-choice task, respectively. RESULTS: Higher IGD severity at T1 predicted more impulsive decision-making at T2 (ß = 0.45, 95% CI = 0.14-0.76). Lower inhibitory control at T2 predicted more hours spent on gaming at T3 (ß = -0.13, 95% CI = -0.25 to -0.02). We found weak or no evidence for the other associations. DISCUSSION AND CONCLUSIONS: Lower inhibitory control predicts more time spent gaming, possibly due to insufficient top-down regulation of the behaviour. Impulsive decision-making is rather a consequence of IGD than a predictor, which may be due to altered reward learning. One-dimensional etiological assumptions about the relationship between neurocognitive impairments and IGD seem not to be appropriate for the complexity of the disorder.

Evaluation of the Universal Prevention Program Klasse2000 in Fourth Grade Primary School Children: Protocol for a Propensity Score-Matching Approach.

BACKGROUND: Klasse2000 is the most widely adopted school-based prevention program in Germany. It addresses health promotion, addiction, and violence prevention in primary schools. As a universal prevention program, it has reached more than 1.4 million German children in the past 25 years. OBJECTIVE: The effectiveness of Klasse2000 will be evaluated with a large representative survey among students. Students who have participated in the prevention program (intervention group) will be compared with students who did not participate (control group). The comparison will cover the following outcome domains: well-being, self-esteem, emotion regulation, food habits, behavioral problems, and school and classroom atmosphere. Furthermore, victimization and perpetration regarding bullying, alcohol consumption, smoking, and media consumption are assessed. METHODS: To control for potential group differences, treatment effects will be estimated using propensity score-matching, which matches students from the intervention and control groups based on an identical propensity score or a propensity score that does not differ by more than a previously defined distance. The treatment effect will then be estimated in the matched sample taking the matching process into account. RESULTS: Enrollment of schools began in March 2017. A total of 6376 students participated in the survey (n=4005 in control group; n=2371 in Klasse2000). The parent survey was returned by 52.13% (3324/6376) of parents. Results are expected in mid-2020. CONCLUSIONS: The results on the effectiveness of the Klasse2000 prevention program will form an empirical basis for legitimizing universal prevention programs and for planning future prevention approaches. TRIAL REGISTRATION: German Clinical Trials Register DRKS00014332; https://tinyurl.com/y2trvq4p. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14371.

Caregiver Reports of Screen Time Use of Children with Autism Spectrum Disorder: A Qualitative Study.

Screen based media have progressively become an integral part in the daily lives of children and youths with and without autism spectrum disorder (ASD). However, research that exclusively pursues the functionality of screen media use of children with ASD is extremely rare. Through a triangulated approach, the present study aims to fill this gap. We conducted 13 interviews with parents of children with ASD and supplemented this interview-study with an online survey including parents of children with ASD (n = 327). Children with ASD mostly used screen media (especially television) for their wellbeing, which is associated with chances and risks. Based on the parental interviews it is suggested that the media usage of children with ASD should be supervised. The results are discussed in terms of their practical implementation.

Psychometric properties and measurement invariance of the Beck hopelessness scale (BHS): results from a German representative population sample.

BACKGROUND: The Beck Hopelessness Scale (BHS) has been the most frequently used instrument for the measurement of hopelessness in the past 40 years. Only recently has it officially been translated into German. The psychometric properties and factor structure of the BHS have been cause for intensive debate in the past. METHODS: Based on a representative sample of the German population (N = 2450) item analysis including item sensitivity, item-total correlation and item difficulty was performed. Confirmatory factor analyses (CFA) for several factor solutions from the literature were performed. Multiple group factor analysis was performed to assess measurement invariance. Construct validity was assessed via the replication of well-established correlations with concurrently assessed measures. RESULTS: Most items exhibited adequate properties. Items #4, #8 and #13 exhibited poor item characteristics- each of these items had previously received negative evaluations in international studies. A one-dimensional factor solution, favorable for the calculation and interpretation of a sum score, was regarded as adequate. A bi-factor model with one content factor and two method factors (defined by positive/negative item coding) resulted in an excellent model fit. Cronbach's alpha in the current sample was .87. Hopelessness, as measured by the BHS, significantly correlated in the expected direction with suicidal ideation (r = .36), depression (r = .53) and life satisfaction (r = -.53). Strict measurement invariance could be established regarding gender and depression status. Due to limited research regarding the interpretation of fit indices with dichotomous data, interpretation of CFA results needs to remain tentative. CONCLUSION: The BHS is a valid measure of hopelessness in various subgroups of the general population. Future research could aim at replicating these findings using item response theory and cross-cultural samples. A one-dimensional bi-factor model seems appropriate even in a non-clinical population.

Cross-sectional relationship of perceived familial protective factors with depressive symptoms in vulnerable youth.

BACKGROUND: There are multiple negative consequences associated with heavy episodic drinking and close associations between substance abuse and depression, alcohol-intoxicated adolescents (AIA) represent a vulnerable group. We aim to add to the current literature by investigating the cross-sectional relationship of perceived familial protective factors with depressive symptoms in AIA in hospitals, with respect to sex. Depression is among the 10 leading causes of disabilities during childhood and adolescence, with girls being more vulnerable than boys. Considerable evidence reveals a strong association between depression and alcohol abuse. The family provides the possibility to positively influence depressive symptoms. METHODS: We present cross-sectional data of a German multisite, epidemiological cohort study on AIA. By using youth's self-reports, we assessed sociodemographic data, as well as data on perceived familial protective factors and depressive symptoms using items of the Communities that Care Youth Survey instrument. We performed descriptive and multigroup analyses to evaluate the measurement invariance of the used instruments. Moreover, to investigate the relationships between the constructs, we used structural equation modelling. RESULTS: The study sample comprised 342 AIA, with a mean age of 15.5 years (SD = 1.2; 48.1% girls). The final structural equation model achieved an acceptable model fit of χ2 (69, 342) = 110.056; p = .001; TLI = 0.97; CFI = 0.98; RMSEA = 0.046; SRMR = 0.042, and the rewards for prosocial involvement in the family context correlated significantly negatively with present depressive symptoms, (ß = - 0.540, p <  0.001). The effects were stronger in boys (ß = - 0.576, p <  0.001) than in girls (ß = - 0.519, p <  0.001). CONCLUSION: In vulnerable youth in Germany, depressive symptoms are correlated to good experiences within the family. Future research should assess whether interventions that enhance parental support reduce the risk of depressive symptoms in AIA. Our findings highlight the need for family-based prevention programmes, particularly for AIA with an increased risk of depression.

The latent nature of prolonged grief - A taxometric analysis: Results from a representative population sample.

Individuals suffering from prolonged grief disorder (PGD) show severe grief reactions after the death of a significant other, even beyond a period of grieving that is within a person's cultural and religious context. In addition to this core element, PGD can manifest in various ways. Symptoms may include persistent preoccupation, intense emotional pain, or impairment in important life domains. The symptoms, furthermore, have to be of culturally or religiously inappropriate extent or severity, taking into account different norms of grieving. PGD is discussed as a distinct diagnostic category in the revision of the International Classification of Diseases (ICD-11). Nosology of PGD has been highly debated surrounding the suggested inclusion in the DSM-5, which had been declined due to insufficient evidence. This paper addresses the latent nature of PGD. Using a short form of the Inventory of Complicated Grief-Revised (ICG-R), we applied three popular taxometric methods: MAXEIG, MAMBAC and L-Mode. Data stemmed from a subsample of N = 1445 bereaved individuals that participated in a large representative German population survey (N = 2520). The analysis strongly indicated a dimensional latent structure of PGD. Implications of the conceptualization of PGD on a continuum are discussed, regarding measurement, diagnosis, etiology and future research.

German Beck Scale for Suicide Ideation (BSS): psychometric properties from a representative population survey.

BACKGROUND: Suicidal ideation has been identified as one of the major predictors of attempted or actual suicide. Routinely screening individuals for endorsing suicidal thoughts could save lives and protect many from severe psychological consequences following the suicide of loved ones. The aim of this study was to validate the German version of the Beck Scale for Suicide Ideation (BSS) in a sample representative for the Federal Republic of Germany. METHODS: All 2450 participants completed the first part of the Scale, the BSS-Screen. A risk group of n = 112 individuals (4.6%) with active or passive suicidal ideation was identified and subsequently completed the entire BSS. RESULTS: Satisfactory internal reliability (α = .97 for the BSS-Screen; α = .94 for the entire BSS) and excellent model fit indices for the one-dimensional factorial structure of the BSS-Screen (CFI = .998; TLI = .995; RMSEA = .045 [95%-CI: .030-.061]) were confirmed. Measurement invariance analyses supported strict invariance across gender, age, and depression status. We found correlations with related self-report measures in expected directions comparable to previous studies, indicating satisfactory construct validity. LIMITATIONS: Our study involved cross sectional data, hence neither predictive validity nor retest-reliability were examined. As only the risk group of n = 112 individuals completed the entire measure, confirmatory factor analyses could not be conducted for the full BSS. CONCLUSION: The German translation of the BSS is a reliable and valid instrument for assessing suicidal ideation in the general population. Using it as a screening device in general and specialized medical care could substantially advance suicide prevention.

Brief assessment of subjective health complaints: Development, validation and population norms of a brief form of the Giessen Subjective Complaints List (GBB-8).

OBJECTIVE: Although there is no causal relationship to medical morbidity, routine clinical assessment of somatic symptoms aids medical diagnosis and assessment of treatment effectiveness. Regardless of their causes, somatic symptoms indicate suffering, distress, and help-seeking behavior. The aim of the present study was to develop and validate a brief self-report questionnaire to assess somatic symptom strain. METHODS: A brief form of the Giessen Subjective Complaints List (GBB-8) was developed and validated in a large population sample representative of the Federal Republic of Germany (N=2008). Psychometric analyses included confirmation of factor structure, classical item analysis, and measurement invariance tests. The sample furthermore served as a norm group. As indicators of construct validity, correlations with measures of anxiety, depression, alexithymia, and primary care contact were computed. RESULTS: Psychometric analyses yielded excellent scale properties regarding item characteristics, factor structure, and measurement invariance tests (Cronbach's alpha=0.88; CFI=0.980, TLI=0.965, RMSEA=0.049) for the second-order four-factor model; strict invariance was confirmed for gender, depression status, and physician contacts; strong invariance was confirmed regarding age and age×gender. CONCLUSIONS: The GBB-8 with its four subscales exhaustion, gastrointestinal complaints, musculoskeletal complaints, and cardiovascular complaints proves to be an economic measure of subjective symptom strain. Psychometric analyses deem it suitable for epidemiological research. The availability of norms makes it a potential everyday tool for general practitioners and psychosomatic clinics.

Differential Influences of Parenting Dimensions and Parental Physical Abuse during Childhood on Overweight and Obesity in Adolescents.

Besides other explanatory variables, parenting styles and parental violence might also be responsible for setting a path towards overweight/obesity in childhood. While this association has consistently been observed for adults, findings for adolescents still remain scarce and inconsistent. Therefore, the goal of this study is to add evidence on this topic for children and adolescents. Analyses are based on a sample of 1729 German, ninth-grade students. To analyze associations between parenting dimensions and weight status, non-parametric conditional inference trees were applied. Three gender-specific pathways for a heightened risk of overweight/obesity were observed: (1) female adolescents who report having experienced severe parental physical abuse and medium/high parental warmth in childhood; (2) male adolescents who report having experienced low or medium parental monitoring in childhood; and (3) this second pathway for male adolescents is more pronounced if the families receive welfare. The importance of promoting parenting styles characterized by warmth and a lack of physical abuse is also discussed. This is one of only a few studies examining the association of parenting dimensions/parental physical abuse and weight status in adolescence. Future studies should include even more parenting dimensions, as well as parental physical abuse levels, in order to detect and untangle gender-specific effects on weight status.

[Psychometric Evaluation of an Arabic Version of the PHQ-4 Based on a Representative Survey of Syrian Refugees]. / Psychometrische Prüfung einer Hocharabischen Übersetzung des PHQ-4 anhand einer repräsentativen Befragung syrischer Geflüchteter.

Background: This study addresses the need for methodologically sound, brief screening procedures (e. g., the PHQ-4) which need to be validated for refugees in their native languages. Method: A cohort of Syrian refugees in the state of Lower Saxony was investigated with the PHQ-4 translated into Standard Arabic language by a professional translation bureau. Based on representative data, the prevalence of anxiety and depressive disorders was estimated among refugees. N=864 persons of mainly male sex (68%) answered with a mean age of M=31.5 (SD=9.3 years, ranging from 16 to 93 years). Results: Internal consistency was good (PHQ-2, respectively GAD-2: α=0.76/0.83; women α=0.76/0.83; men: α=0.76/0.83). Confirmatory factor analyses revealed good to excellent fit: RMSEA=0,068 [95%-KI: 0.028, 0.117], TLI=0.971, CFI=0.995. Measurement invariance was demonstrated for sex. The prevalence of depression was 20%, which corresponds to results reported for the German population; generalized anxiety was moderately higher in the Syrian sample (19.3 vs. 15.2%). Discussion: The Arabic version of the PHQ-4 is an ultra-short and valid screening procedure suitable for refugees from Arabic countries. The finding that the prevalence of depression and anxiety symptoms was moderate may be due to the sample composition, which comprised predominantly young men. Given the often traumatic circumstances of their flight, additional symptoms beyond the scope of this study (esp. PTSD) can be expected.

Dimensional latent structure of PTSD-symptoms reporting: Is it adding by subtracting?

Although posttraumatic stress disorder (PTSD) is used as a distinct diagnosis in clinical practice, its symptoms were characterized as a dimensional structure in several taxometric analyses. However, a categorical latent structure of PTSD could be superimposed by using indistinct PTSD symptoms that can appear within the framework of other trauma-induced syndromes (e.g., depression, anxiety disorders). For that reason, in revising the International Classification of Diseases (ICD-11), a core set of cardinal symptoms that determine the presence of PTSD as selectively as possible will be used. To determine whether the latent status of a recommended core set of PTSD symptoms is dimensional, the authors analyzed the latent status of PTSD symptoms reported by participants who had experienced at least 1 traumatic event during their lifetime in 2 nationwide surveys of the German population (N = 1,212). Using the Posttraumatic Diagnostic Scale (PDS), they applied 3 popular taxometric methods: maximum eigenvalue, mean above minus below a cut, and latent mode factor analysis, using the core set and PTSD symptom clusters of previous taxometric studies. Although the analysis replicated findings of previous taxometric analyses using symptom clusters, the item core-set approach indicated a categorical solution of PTSD cardinal symptoms. These results seem to support the procedure used by the ICD-11 expert group. (PsycINFO Database Record

The eating disorder examination-questionnaire 8: A brief measure of eating disorder psychopathology (EDE-Q8).

OBJECTIVE: The aim of this study was to develop, evaluate, and standardize a short form of the well-established Eating Disorder Examination-Questionnaire (EDE-Q). The newly developed EDE-Q8 was required to reflect the originally postulated structure of the EDE-Q. METHOD: Data were drawn from two nationwide representative population surveys in Germany: a survey conducted to develop the EDE-Q8 in 2009 (N = 2,520); and a survey conducted in 2013 (N = 2,508) for the evaluation and calculation of EDE-Q8 percentiles. RESULTS: The EDE-Q8 had excellent item characteristics, very good reliability and a very good model fit for the postulated second-order factorial structure. Furthermore, a strong correlation between the EDE-Q8 and a 13 item short form of the Eating Attitudes Test was observed. DISCUSSION: The EDE-Q8 appears to be particularly suitable in epidemiological research, when an economical assessment of global eating disorder psychopathology is required. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:613-616).

Prevalence of Internet gaming disorder in German adolescents: diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample.

BACKGROUND AND AIMS: Internet gaming disorder (IGD) is included as a condition for further study in Section 3 of the DSM-5. Nine criteria were proposed with a threshold of five or more criteria recommended for diagnosis. The aims of this study were to assess how the specific criteria contribute to diagnosis and to estimate prevalence rates of IGD based on DSM-5 recommendations. DESIGN: Large-scale, state-representative school survey using a standardized questionnaire. SETTING: Germany (Lower Saxony). PARTICIPANTS: A total of 11 003 ninth-graders aged 13-18 years (mean = 14.88, 51.09% male). MEASUREMENTS: IGD was assessed with a DSM-5 adapted version of the Video Game Dependency Scale that covered all nine criteria of IGD. FINDINGS: In total, 1.16% [95% confidence interval (CI) = 0.96, 1.36] of respondents were classified with IGD according to DSM-5 recommendations. IGD students played games for longer periods, skipped school more often, had lower grades in school, reported more sleep problems and more often endorsed feeling 'addicted to gaming' than their non-IGD counterparts. The most frequently reported DSM-5 criteria overall were 'escape adverse moods' (5.30%) and 'preoccupation' (3.91%), but endorsement of these criteria rarely related to IGD diagnosis. Conditional inference trees showed that the criteria 'give up other activities', 'tolerance' and 'withdrawal' were of key importance for identifying IGD as defined by DSM-5. CONCLUSIONS: Based on a state-wide representative school survey in Germany, endorsement of five or more criteria of DSM-5 internet gaming disorder (IGD) occurred in 1.16% of the students, and these students evidence greater impairment compared with non-IGD students. Symptoms related to 'give up other activities', 'tolerance' and 'withdrawal' are most relevant for IGD diagnosis in this age group.

A brief form of the Perceived Social Support Questionnaire (F-SozU) was developed, validated, and standardized.

OBJECTIVES: Development of a brief instrument (F-SozU K-6) for the measurement of perceived social support in epidemiologic contexts by shortening a well-established German questionnaire (F-SozU K-14). STUDY DESIGN AND SETTING: The development of the F-SozU K-6 consisted of two phases; phase 1: the F-SozU K-14 was presented to a general population sample representative for the Federal Republic of Germany (N = 2,007; age: 14-92 years). Six items for the short form were selected based on the maximization of coefficient alpha. Phase 2: the new short form (F-SozU K-6) was evaluated and standardized in an independent second population survey (N = 2,508, age: 14-92 years). RESULTS: The F-SozU K-6 showed very good reliability and excellent model fit indices for the one-dimensional factorial structure of the scale. Furthermore, strict measurement invariance was detected allowing unbiased comparison of means and correlation coefficients and path coefficients between both sexes across the full lifespan from adolescence (14-92 years). Well-established associations of perceived social support with depression and somatic symptoms could be replicated using the short form. CONCLUSION: The F-SozU K-6 presents a reliable, valid, and economical instrument to assess perceived social support and can thus be effectively applied within the frameworks of clinical epidemiologic studies or related areas.