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1.
J Affect Disord ; 274: 871-879, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32664028

RESUMO

BACKGROUND: The Integrated Motivational-Volitional (IMV) model of suicidal behavior proposes in its motivational phase that perceptions of defeat and entrapment (total, internal and external entrapment) lead to the development of suicidal ideation and that thwarted belongingness and perceived burdensomeness moderate this process. The aim of this study was to test the motivational phase of the IMV model cross-sectionally in a German sample of psychiatric inpatients. METHODS: A total of 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.92, SD = 14.30) were included in the study and investigated within 14 days after psychiatric admission due to suicide attempt (53%) or acute suicidal crisis (47%). Statistical analyses included a mediation analysis and moderation analyses. RESULTS: Results demonstrate a simple mediation of defeat via entrapment (total, internal and external entrapment) on suicidal ideation. The interaction between thwarted belongingness and perceived burdensomeness was confirmed as a motivational moderator. LIMITATIONS: Limiting factors of the present study are the cross-sectional design and the retrospective assessment of suicidal ideation. CONCLUSION: The main assumptions of the motivational phase of the IMV model could empirically be confirmed. Perceptions of defeat, internal and external entrapment, thwarted belongingness, and perceived burdensomeness should be taken into account with regard to prevention, risk assessment and interventions of suicidal ideation and attempts. However, future investigations based on prospective data are warranted.

2.
J Eur Acad Dermatol Venereol ; 34(4): 810-816, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31838777

RESUMO

BACKGROUND: Atopic eczema (AE) may be associated with several mental health problems. In Germany, existing data from selected patient cohorts may lead to misestimation of the problem. OBJECTIVES: We aimed to cross-sectionally determine associations of AE with depression, anxiety, quality of life (QoL) and social interactions in subjects from the population-based LIFE-Adult-Study. METHODS: Subjects underwent standardized interviews (medical history) and answered standardized questionnaires [Centre of Epidemiologic studies-Depression scale (CES-D), Generalized Anxiety Disorder (GAD-7), Lubben Social Network Scale (LSNS), Short Form Health Survey (SF-8)]. We compared data from subjects with AE with those from subjects with selected other chronic/disabling diseases (cardiovascular, diabetes, cancer) and adjusted for selected sociodemographic parameters. Multivariate binary logistic regression was used for categorical variables, linear regression for continuous variables. RESULTS: Out of 9104 adults included (57% female, median age 54 years), 372 (4.1%) had a history of AE. Compared with controls, subjects with AE showed higher scores for depressive symptoms (9.3% vs. 6.3%; P < 0.001) and anxiety (8.4% vs. 5.6%, P < 0.001). Odds ratio (OR) was 1.5 [CI 1.0; 2.3] (P = 0.031) for depression, which was comparable to OR in patients with a history of cancer (OR 1.6 [1-2.3], P = 0.001. OR for anxiety in AE was 1.5 [1.0; 2.2], P < 0.049, which was slightly higher than in diabetes mellitus (OR 1.2) and stroke (OR 1.4). Other than in diabetes and/or stroke, we did not find a significant association between AE and social isolation. QoL scores were lower in AE than in controls (mean 46.9 vs. 48.0, P < 0.001 for physical and 50.6 vs. 52.5, P < 0.001 for mental components). CONCLUSIONS: Subjects with AE showed higher values for depression and anxiety as well as lower QoL scores compared to controls. With regard to depression, odds in AE and cancer were hardly different. Medical care of AE patients should therefore include mental health evaluation and treatment if indicated.

3.
Epidemiol Psychiatr Sci ; 29: e40, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31364579

RESUMO

AIMS: Despite recent worldwide migratory movements, there are only a few studies available that report robust epidemiological data on the mental health in recent refugee populations. In the present study, post-traumatic stress disorder (PTSD), depression and somatisation were assessed using an epidemiological approach in refugees who have recently arrived in Germany from different countries. METHODS: The study was conducted in a reception facility for asylum-seekers in Leipzig, Germany. A total of 1316 adult individuals arrived at the facility during the survey period (May 2017-June 2018), 569 of whom took part in the study (N = 67 pilot study and N = 502 study sample; response rate 43.2%). The questionnaire (11 different languages) included sociodemographic and flight-related questions as well as standardised instruments for assessing PTSD (PCL-5), depression (PHQ-9) and somatisation (SSS-8). Unweighted and weighted prevalence rates of PTSD, depression and somatisation were presented stratified by sex and age groups. RESULTS: According to established cut-off scores, 49.7% of the respondents screened positive for at least one of the mental disorders investigated, with 31% suffering from somatisation, 21.7% from depression and 34.9% from PTSD; prevalence rates of major depression, other depressive syndromes and PTSD were calculated according to the DSM-5, which indicated rates of 10.3, 17.6 and 28.2%, respectively. CONCLUSIONS: The findings underline the dramatic mental health burden present among refugees and provide important information for health care planning. They also provide important information for health care systems and political authorities in receiving countries and strongly indicate the necessity of establishing early psychosocial support for refugees suffering from psychological distress.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Refugiados/estatística & dados numéricos , Transtornos Somatoformes/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Camarões/etnologia , Transtorno Depressivo/epidemiologia , Eritreia/etnologia , Feminino , Alemanha/epidemiologia , Humanos , Iraque/etnologia , Masculino , Pessoa de Meia-Idade , Nigéria/etnologia , Questionário de Saúde do Paciente , Prevalência , Refugiados/psicologia , Inquéritos e Questionários , Síria/etnologia , Turquia/etnologia , Venezuela/etnologia , Adulto Jovem
4.
Eur Psychiatry ; 56: 43-50, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30530103

RESUMO

OBJECTIVE: To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time. METHODS: This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%). RESULTS: Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI. CONCLUSIONS: This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation.


Assuntos
Depressão/psicologia , Avaliação Momentânea Ecológica , Relações Interpessoais , Ideação Suicida , Adulto , Feminino , Alemanha , Humanos , Pacientes Internados , Masculino , Análise Multinível , Estudos Prospectivos , Fatores de Risco , Autoimagem , Suicídio/psicologia , Adulto Jovem
5.
J Affect Disord ; 245: 788-797, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30448764

RESUMO

BACKGROUND: Several studies provide evidence for a relationship between childhood abuse and suicidality across the lifespan. To examine this association in the context of the Interpersonal Psychological Theory of Suicide (IPTS), we investigated whether its constructs thwarted belongingness, perceived burdensomeness and capability for suicide are potential mediators. METHODS: Eighty-four German psychiatric inpatients with unipolar depression (M = 37.6 years, 69% female) and current or lifetime suicidal ideation were included. For the assessment we used the Childhood Trauma Screener (CTS), the Rasch-based Screening for Depression (DESC-I), the Interpersonal Needs Questionnaire (INQ), the German Capability for Suicide Questionnaire (GCSQ), the Beck Scale for Suicide Ideation (BSS) and the Suicide Behaviors Questionnaire-Revised (SBQ-R). Simple and multiple mediator analyses were applied. RESULTS: Most patients (70%) had experienced childhood abuse. Emotional abuse showed an indirect association with suicidal ideation via thwarted belongingness and perceived burdensomeness, whereas physical and sexual abuse were indirectly related to suicide risk via capability for suicide. LIMITATIONS: The small sample size and the cross-sectional design are limiting factors of the present study. CONCLUSIONS: Childhood abuse is a common experience of inpatients with unipolar depression. This study showed its indirect effects on suicidal ideation and risk for suicide, mediated by the constructs of the IPTS. Further research should investigate this issue in other populations and clinicians should be aware of the devastating effects of childhood abuse.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Transtorno Depressivo/psicologia , Ideação Suicida , Suicídio/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Alemanha , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Teoria Psicológica , Inquéritos e Questionários , Adulto Jovem
6.
Psychooncology ; 27(11): 2623-2630, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29761579

RESUMO

OBJECTIVES: Demoralization as a form of existential distress involves poor coping, low morale, hopelessness, helplessness, and meaninglessness. In a secondary analysis of a cohort of German cancer patients, we aimed to explore latent class structure to assess the contribution that symptoms of demoralization make to anhedonic depression, anxiety, adjustment, and somatic disorders. METHODS: Measures of demoralization, depression, anxiety, physical symptoms, and functional impairment had been completed cross-sectionally by 1527 patients with early or advanced cancer. Latent class analysis used maximum likelihood techniques to define the unobserved latent constructs that can be predicted as symptom clusters. Individual patients were assigned to the most probable class. Classes were compared on demographics, and logistic regression assessed the odds of individual items predicting each class. RESULTS: A 4-class model provided the best fit. Class 1 (n = 829, 54.3%) was defined by the absence of distress; Classes 2 to 4 all carried functional impairment. Class 2 (n = 333, 21.8%) was differentiated by somatic symptoms (sleep, tiredness, and appetite); Class 3 (n = 163, 10.7%) by anhedonia, anxiety, and severe demoralization; and Class 4 (n = 202, 13.2%) by adjustment and moderate demoralization. Members of Class 3 were more likely to be younger, female, anhedonic, depressed, and anxious. In both Classes 3 and 4, functional impairment, physical symptom burden, and suicidal ideation were present. CONCLUSIONS: In contrast with the severe symptom cluster carrying anhedonia, anxiety, and demoralization, the moderate symptom cluster was formed by patients with demoralization and impaired functioning, a clinical picture consistent with a unidimensional model of adjustment disorder.


Assuntos
Adaptação Psicológica , Transtornos de Adaptação/diagnóstico , Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Sintomas Inexplicáveis , Moral , Neoplasias/psicologia , Estresse Psicológico/psicologia , Transtornos de Adaptação/psicologia , Adulto , Idoso , Anedonia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo/psicologia , Feminino , Alemanha , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/mortalidade , Neoplasias/patologia , Índice de Gravidade de Doença , Estresse Psicológico/complicações , Ideação Suicida
7.
Nervenarzt ; 89(7): 828-836, 2018 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-28983641

RESUMO

BACKGROUND: This chronology gives an overview about continuities and changes in the perception of suicidality in German-speaking school psychiatry over the past 200+ years. QUESTIONS: This study was guided by the following questions: has suicidality been perceived as regularly being connected to certain mental illnesses? Which other possible causes have been discussed by psychiatrists from the nineteenth century to the beginning of the twenty-first century? What approaches have major psychiatrists adopted towards suicidal patients and threatened suicide? What treatment and preventive strategies have been suggested? METHODOLOGY: First, we compiled a list of the, in our view, most influential textbooks on psychiatry of German-speaking school psychiatry from 1803 until the present. These textbooks were then skim-read for relevant passages on suicidality. The material gained was elicited, classified and analyzed in relation to the questions at hand. Futhermore, an attempt was made to arrive at contextual estimations. RESULTS: Several authors named a certain set of psychiatric illnesses that are assumed to involve or increase the risk of suicide. These illnesses include depression, schizophrenia and also physical illnesses. In nineteenth century textbooks heredity, anatomical anomalies and nationality were discussed as potential influencing factors. In contrast, more recent books discuss models of how suicidal behavior emerges and often refer to the Werther effect. With respect to therapy there is a trend towards therapeutic discussions and modern psychopharmacotherapy. DISCUSSION: Over time, there have been continuities and changes in psychiatrists' approach to suicidality not only as far as clinical aspects are concerned but also the general approach to and management of suicidal patients.


Assuntos
Psiquiatria , Esquizofrenia , Ideação Suicida , Suicídio , Livros de Texto como Assunto , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Psiquiatria/história , Psiquiatria/tendências
8.
Gesundheitswesen ; 78(4): 209-14, 2016 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-27006989

RESUMO

OBJECTIVES: Depending on the ethnic background of patients, the quality of communication between the parents of pediatric patients and clinicians, as well as the type and frequency of interpreter services was studied in an inpatient setting. METHODS: As part of a questionnaire-based survey, data from parents, doctors and nurses with reference to 220 pediatric patients treated in the Department of Pediatrics at the University Hospital Leipzig from February to May 2013 were analyzed; 18,2% of patients were migrants. RESULTS: No differences were found in the assessment of the quality of communication with clinic staff by migrant and non-migrant parents. Physicians as well as nurses rated the communication with migrant parents compared to non-migrant parents significantly lower. In up to 19,2% (data provided by nursing staff) and 15,3% (data provided by doctors) of the cases characterized by insufficient language skills on the part of migrant parents, interpreter services had to be procured. No professional interpreters were used. CONCLUSION: The results highlight once more the difficulties in communication between clinicians and migrant patients with insufficient language skills. More attention should be paid to the impact of the use of professional interpreters in the health care services.


Assuntos
Barreiras de Comunicação , Comunicação , Pais , Pediatras/estatística & dados numéricos , Relações Médico-Paciente , Migrantes/estatística & dados numéricos , Criança , Cuidado da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Alemanha , Departamentos Hospitalares/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Enfermeiras Pediátricas/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Tradução
9.
J Affect Disord ; 195: 191-8, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26896813

RESUMO

PURPOSE: The Interpersonal Needs Questionnaire (INQ) assesses the two interpersonal constructs perceived burdensomeness (PB) and thwarted belongingness (TB) that lead to suicidal ideation, according to the interpersonal theory of suicide (IPTS). The present study investigates dimensionality and psychometric properties of the German version of the INQ in a population-based representative sample and delivers norm values. METHODS: The German INQ as well as measures of depression and past suicidality were administered to a population-based representative sample of the German general population (n=2513) to analyze its dimensionality and construct validity by confirmatory factor analysis and correlational analysis. RESULTS: Results of the confirmatory factor analysis were in line with the assumption of two-dimensionality of the INQ. The two subscales showed very good internal consistencies (α ≥ 0.89) as well as correlations with depression and suicidality that indicate convergent validity. There were no gender effects but slight age effects in the scores of both subscales. Population-based norms are provided. LIMITATIONS: Convergent validity was solely examined with measures of depression and suicidal thoughts instead of further suitable constructs like loneliness and social support. Divergent validity was not investigated in the study. CONCLUSION: The German version of the INQ shows good psychometric properties making it a promising tool for assessing PB and TB. The provided norms enable researchers to compare INQ scores of their samples with reference values of a population-based representative sample.


Assuntos
Relações Interpessoais , Psicometria , Inquéritos e Questionários/normas , Adolescente , Adulto , Fatores Etários , Idoso , Análise Fatorial , Feminino , Alemanha , Nível de Saúde , Humanos , Idioma , Solidão , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Fatores Sexuais , Ideação Suicida , Suicídio/psicologia , Adulto Jovem
10.
J Psychosom Res ; 79(6): 492-7, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26553385

RESUMO

OBJECTIVE: The study investigates the association between somatosensory amplification and the reporting of side effects. It establishes a German version of the Somatosensory Amplification Scale and examines its psychometric properties in a representative sample of the German population. METHODS: Sample size was 2.469, with 51% taking any medication. Participants answered the Somatosensory Amplification Scale, Generic Assessment of Side Effects Scale, and indicated whether they were taking any medication and the type of medication. Correlational analysis and binary logistic regression were performed. RESULTS: When examining a subsample reporting both medication intake and general bodily symptoms, participants higher in somatosensory amplification rated more of their general bodily symptoms as medication-attributed side effects. However, somatosensory amplification scores were not associated with the intake of any type of medication. In the overall sample, higher somatosensory amplification scores were associated with an increased report of bodily symptoms. Additionally, participants with higher somatosensory amplification reported intake of a greater number of different medications. The psychometric properties of the translated scale were good, and previously established associations of somatosensory amplification with demographic variables (age, sex) were replicated. CONCLUSION: Results suggest a possible attributional bias concomitant to somatosensory amplification which in turn may increase the reporting of side effects after medication intake.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Córtex Somatossensorial/fisiopatologia , Adulto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Fatores de Risco
11.
Nervenarzt ; 86(7): 800-6, 2015 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-26154130

RESUMO

OBJECTIVE: The number and type of traumatic experiences show differential associations with posttraumatic stress disorder (PTSD). OBJECTIVE: The associations of number and type of traumatic experiences with PTSD were investigated in a representative population sample in Germany. MATERIAL AND METHODS: Traumatic experiences and PTSD were assessed with a self-rating questionnaire in a sample of 2510 participants from the general German population. RESULTS: The risk of (partial) PTSD increased with an increasing number of traumatic experiences. In contrast interpersonal and accidental traumatization showed no substantial differences with respect to the risk of PTSD. CONCLUSION: To quantify the relevance of the number and type of traumatic experiences for onset and persistence of PTSD, a multidimensional and complex assessment of those experiences is necessary. This is a great challenge in epidemiological research on this topic.


Assuntos
Acidentes/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Violência/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/psicologia , Acidentes/psicologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causalidade , Comorbidade , Autoavaliação Diagnóstica , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Inquéritos e Questionários , Índices de Gravidade do Trauma , Violência/psicologia , Ferimentos e Lesões/diagnóstico , Adulto Jovem
12.
Nervenarzt ; 86(7): 807-17, 2015 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-26105160

RESUMO

BACKGROUND: Primary care settings have an important gatekeeping function to detect mental diseases, including trauma and posttraumatic stress disorders. OBJECTIVES: To assess the prevalence of trauma and posttraumatic symptoms in a first sample of northeast German primary care patients and to evaluate the diagnostic sensitivity and specificity of the general practitioners. MATERIAL AND METHODS: Traumatic experiences and posttraumatic stress disorders (PTSD) were assessed with self-rating questionnaires in a sample of N = 400 patients from 3 primary care facilities. Additionally, knowledge and diagnostic accuracy of the general practitioners were evaluated. RESULTS: According to the results of the patient health questionnaire (PHQ-15) data from all patients, the majority of patients questioned showed slight to moderate stress from somatic symptoms. Of the patients with complete data 7 % (n = 25) had a complete PTSD according to the results of the questionnaire, which was also identified in the medical assessment with a sensitivity of 40 %. The stress resulting from posttraumatic symptoms was closely associated with the extent of somatic complaints. CONCLUSION: Patients with a history of trauma and posttraumatic symptoms are prevalent in primary care settings. An early diagnosis by the general practitioner can help patients to receive adequate treatment. Patients with somatoform disorders in particular should be screened for trauma and posttraumatic symptoms.


Assuntos
Competência Clínica/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Comorbidade , Autoavaliação Diagnóstica , Feminino , Alemanha/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Transtornos de Estresse Pós-Traumáticos/psicologia , Avaliação de Sintomas/estatística & dados numéricos , Ferimentos e Lesões/psicologia , Adulto Jovem
13.
Int Psychogeriatr ; 27(5): 857-64, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25567546

RESUMO

BACKGROUND: Sexual violence and wartime rapes are prevalent crimes in violent conflicts all over the world. Processes of reconciliation are growing challenges in post-conflict settings. Despite this, so far few studies have examined the psychological consequences and their mediating factors. Our study aimed at investigating the degree of longtime readiness to reconcile and its associations with post-traumatic distress within a sample of German women who experienced wartime rapes in 1945. METHODS: A total of 23 wartime rape survivors were compared to age- and gender-matched controls with WWII-related non-sexual traumatic experiences. Readiness to reconcile was assessed with the Readiness to Reconcile Inventory (RRI-13). The German version of the Post-traumatic Diagnostic Scale (PDS) was used to assess post-traumatic stress disorder (PTSD) symptomatology. RESULTS: Readiness to reconcile in wartime rape survivors was higher in those women who reported less post-traumatic distress, whereas the subscale "openness to interaction" showed the strongest association with post-traumatic symptomatology. Moreover, wartime rape survivors reported fewer feelings of revenge than women who experienced other traumatization in WWII. CONCLUSIONS: Our results are in line with previous research, indicating that readiness to reconcile impacts healing processes in the context of conflict-related traumatic experiences. Based on the long-lasting post-traumatic symptomatology we observed that our findings highlight the need for psychological treatment of wartime rape survivors worldwide, whereas future research should continue focusing on reconciliation within the therapeutic process.


Assuntos
Estupro/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia , II Guerra Mundial , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Alemanha/epidemiologia , Humanos , Escalas de Graduação Psiquiátrica , Testes Psicológicos
14.
Z Gerontol Geriatr ; 47(3): 194-201, 2014 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-24609430

RESUMO

BACKGROUND: World War II (WWII) is probably the most distressing and fatal historical event in Europe's recent past. Research on mental and physical health sequelae of these traumatic experiences from WWII has only started recently. OBJECTIVES: An overview on the findings from several population-based studies investigating the mental and physical health outcomes of traumatic experiences in the German elderly (born prior to 1946), especially from WWII, is given. MATERIAL AND METHODS: The results presented here are based on several population-based representative studies regarding several aspects of mental and physical health in the elderly. RESULTS: About 40-50 % of the elderly German population report at least one traumatic event, mostly from WWII. Traumatic experiences are related to higher rates of depressive and somatoform disorders, posttraumatic stress disorder, and physical morbidity, which are associated with increased health care utilization. CONCLUSION: The findings underline that the negative effects on health are long-term, manifold, and serious. Some of the elderly need psychotherapeutic interventions. Thus, a specific internet-based psychotherapeutic approach (ITT) is briefly presented. However, the majority of the elderly generally use other kinds of medical care, such as primary care, inpatient care, and geriatric care. It seems useful and necessary to pay more attention to the historical and biographical backgrounds of the patients to see and understand the current symptoms from this aspect.


Assuntos
Distúrbios de Guerra/epidemiologia , Distúrbios de Guerra/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , II Guerra Mundial , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/psicologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/psicologia
15.
Minerva Anestesiol ; 80(9): 984-91, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24280816

RESUMO

BACKGROUND: The association of depression and hospital length of stay (LOS) has rarely been examined in surgical patients outside of cardiovascular surgery. This study investigates whether clinically significant preoperative depression shows an independent association with LOS in patients from various surgical fields after adjusting for age, gender and important somatic factors. METHODS: A total of 2624 surgical patients were included in this prospective observational study. Data were collected before the preoperative anesthesiological examination within a computer-assisted psychosocial self-assessment including screening for depression (Center for Epidemiologic Studies Depression Scale, CES-D). Data on peri- and postoperative somatic parameters were obtained from the electronic patient management system of the hospital six months after the preoperative assessment. RESULTS: LOS of patients with clinically significant depression (N.=296; median: 5 days, interquartile range: 3-8 days) was longer than LOS of patients without depression (N.=2328; median: 4 days, interquartile range: 2-6 days) (P<0.001). A multivariate logistic regression model with the binary dependent variable 'above versus below or equal to the median LOS' revealed that the significant association between depression and LOS persisted (OR: 1.822 [95% CI 1.360-2.441], P<0.001) when simultaneously including the covariates age, gender, ASA classification, Charlson Comorbidity Index, surgical field and POSSUM operative severity rating. CONCLUSION: Data suggest that the association of depression and LOS is independent of the impact of age, gender, surgical field, preoperative physical health, severity of medical comorbidity and extent of surgical procedure. Integration of depression therapy into routine care of surgical patients might be an option to improve outcomes.


Assuntos
Depressão/psicologia , Período Pré-Operatório , Procedimentos Cirúrgicos Operatórios/psicologia , Adulto , Comorbidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
16.
Arch Gerontol Geriatr ; 56(1): 175-80, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22878062

RESUMO

The aim of this study was to evaluate the construct validity of the SAIB in a community sample of elderly people. The SAIB was administered to a large community sample representative of the German population aged 60-85 years (n=1593). The original model was assessed and then refined through confirmatory and exploratory factor analyses. Criterion validity was evaluated by comparing SAIB scores with external criteria in 3 categories: subjective health, chronic illness and health care utilization. The originally suggested five factor structure of the SAIB yielded a comparative fit index (CFI) of 0.70 and the weighted root mean square residual (WRMR) was 3.68. A shortened questionnaire with 13 items and four factors resulted in better model fit (CFI 0.97 and WRMR 1.3). Correlations between subjective health and the new scales ranged from 0.06 to 0.33. Effect sizes (Cohens d) of mean differences in factor scores between those with and without healthcare system contact varied by healthcare type, ranging from 0.05 to 0.94; effect sizes were largest in relation to contact with psychotherapy and alternative medicine practitioners. We propose a shortened version of the SAIB with a different scale structure, which resulted in better model fit with our data. Neither the original nor revised SAIB appeared to discriminate well in terms of health care use, suggesting that the illness behavior as currently conceptualized may not fully explain the increased use of healthcare in the elderly.


Assuntos
Comportamento de Doença , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Assistência à Saúde/estatística & dados numéricos , Análise Fatorial , Feminino , Alemanha , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas
17.
Z Gerontol Geriatr ; 46(3): 251-9, 2013 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-22810394

RESUMO

BACKGROUND: Providing care and support for the elderly is a future challenge. MATERIALS AND METHODS: Using regression analysis, a representative population-based sample (n = 1,445) was examined with respect to whether they had considered future housing and which variables influenced their thoughts and preferences. RESULTS: The majority of the sample reported thinking about housing in old age and preferred to stay at home in old age. Thoughts about future housing and housing preferences were predicted by different factors in the age groups analyzed. Thinking about future housing was positively associated with increasing age and depression. Other relevant predictors were gender, living with a partner, images of old age (especially negative ones), and anticipated subjective health. These variables also predicted housing preferences. CONCLUSIONS: Thoughts about future living arrangements are widespread, and their importance increases with age. The wishes reported do contrast to a certain extent with reality. Planning future care as well as developing consultation guidelines should address these issues while considering the reported influences.


Assuntos
Ansiedade/epidemiologia , Ansiedade/psicologia , Comportamento do Consumidor/estatística & dados numéricos , Habitação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
18.
Artigo em Alemão | MEDLINE | ID: mdl-22842889

RESUMO

The family is an important resource in elderly care. It is of great interest if persons who might be in need of care in the future would use this resource. Our study assessed wishes and expectations regarding family care in a representative sample of the general population (≥ 45 years, N = 1,445) using questionnaires. Logistic regressions were performed to analyze the potential impact on the willingness to use or provide family care. One quarter of the participants reported experience in family care. In case of own need 62.9% of participants would prefer care provided by relatives and 56.7% would prefer professional care. Participants are more likely to use family care if they report having relatives, are experienced in care of relatives or do not associate old age with being a burden, e.g. report low values in the image of age "being a burden/demanding". Perceived willingness of the relatives to provide care is more likely if there is little regional distance to the relatives, in male participants and if participants talked about future care with their relatives. Besides structural factors, negative images of old age might have a negative influence on the willingness to use family care. Talking about care in old age seems to have a positive impact.


Assuntos
Cuidadores/estatística & dados numéricos , Comportamento de Escolha , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Idoso , Ageismo , Cuidadores/psicologia , Comunicação , Efeitos Psicossociais da Doença , Feminino , Alemanha , Humanos , Vida Independente/psicologia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos , Viuvez/psicologia
19.
Z Gerontol Geriatr ; 45(5): 404-10, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22782661

RESUMO

Persistent pain is not a normal part of aging. Nevertheless, many older patients have long-lasting, more or less medically unexplained pain symptoms and, consequently, are often severely disabled, incur high health care costs, and have high comorbidity rates. Moreover, the effects of early traumatization, especially due to wars, and even below the level of posttraumatic stress disorder (PTSD) are apparent. However, the developmental and neurobiological underpinnings of somatoform pain disorder, especially in pain-prone elderly patients, and its correlations with a history of war traumatization even decades after the incident remain unclear. Furthermore, a management strategy for this disorder tailored to older people and their special needs is lacking. Adequate therapeutic regimens such as adjusted psychotherapeutic procedures for elderly patients can only be promoted through a better understanding of the neurobiological and biographical underpinnings of this still controversial disorder.


Assuntos
Distúrbios de Guerra/epidemiologia , Dor/epidemiologia , Transtornos Somatoformes/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Guerra , Distúrbios de Guerra/psicologia , Humanos , Dor/psicologia , Prevalência , Transtornos Somatoformes/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos/epidemiologia
20.
Int Psychogeriatr ; 23(8): 1294-300, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21729425

RESUMO

OBJECTIVES: Information on the prevalence and risk factors for depressive disorders in old age is of considerable interest for the assessment of future needs of the health care system. The aim of the study is to determine age- and gender-specific prevalence of major depression (MD), minor depression (MiD), and depressive symptoms, and to analyze risk factors associated with depressive symptoms. METHODS: A representative sample of the German population of 1,659 individuals aged 60 to 85 years were visited at home and answered self-rating questionnaires. Depressive symptoms and syndromes (MD, MiD) were assessed using the Patient Health Questionnaire (PHQ-9). Factors associated with depressive symptoms were determined with linear regression models for the total sample and for men and women separately. RESULTS: Depressive symptoms were found in 28.7% of the participants, while 6.6% were affected by MD or MiD. The highest prevalence of MD and depressive symptoms was found in the oldest age groups. MiD showed an unsteady course across age groups in both sexes. In the total sample as well as in the male subsample, depressive symptoms were significantly associated with increasing age, lower household income, an increasing number of medical conditions, and lower social support. In women only, the number of medical conditions and lacking social support were significantly associated with depressive symptoms. CONCLUSIONS: Depressive symptoms are common in old age and occur on a spectrum ranging from very mild forms to MD. The potential modifiability of a number of risk factors for depressive symptoms opens possibilities of secondary prevention such as treatment of chronic diseases as well as support in requirements of daily living.


Assuntos
Depressão/epidemiologia , Fatores Etários , Idoso/psicologia , Idoso/estatística & dados numéricos , Idoso de 80 Anos ou mais , Depressão/etiologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fatores Sexuais , Apoio Social
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