Maternal bonding styles in smokers and non-smokers: a comparative study.

BACKGROUND: Parental bonding has been implicated in smoking behavior, and the quality of maternal bonding (MB) has been associated with poor mental health and substance use. However, little is known about the association of MB and the smoking of the offspring. METHODS: In our study, 129 smokers and 610 non-smoker medical students completed the parental bonding instrument, which measures MB along two dimensions: care and overprotection. Four categories can be created by high and low scores on care and overprotection: optimal parenting (OP; high care/low overprotection); affectionless control (ALC; low care/high overprotection); affectionate constraint (AC; high care/high overprotection), and neglectful parenting (NP; low care/low overprotection). Nicotine dependence was assessed by the Fagerstrom Nicotine Dependence Test, exhaled CO level, and daily cigarette consumption (CPD). RESULTS: Higher CPD was significantly associated with lower overprotection (p = 0.016) and higher care (p = 0.023) scores. The odds for being a smoker were significantly higher in the neglectful maternal bonding style compared to the other rearing styles (p = 0.022). Besides, smokers showed significantly higher care and lower overprotection scores with the Mann-Whitney U-test than non-smokers, although these associations did not remain significant in multiple regression models. CONCLUSION: Our results indicate that focusing on early life relationship between patient and mother can be important in psychotherapeutic interventions for smoking. Registration trials retrospectively registered.

Career motivation and burnout among medical students in Hungary - could altruism be a protection factor?

BACKGROUND: Burnout is a major issue among medical students. Its general characteristics are loss of interest in study and lack of motivation. A study of the phenomenon must extend beyond the university environment and personality factors to consider whether career choice has a role in the occurrence of burnout. METHODS: Quantitative, national survey (n = 733) among medical students, using a 12-item career motivation list compiled from published research results and a pilot study. We measured burnout by the validated Hungarian version of MBI-SS. RESULTS: The most significant career choice factor was altruistic motivation, followed by extrinsic motivations: gaining a degree, finding a job, accessing career opportunities. Lack of altruism was found to be a major risk factor, in addition to the traditional risk factors, for cynicism and reduced academic efficacy. Our study confirmed the influence of gender differences on both career choice motivations and burnout. CONCLUSION: The structure of career motivation is a major issue in the transformation of the medical profession. Since altruism is a prominent motivation for many women studying medicine, their entry into the profession in increasing numbers may reinforce its traditional character and act against the present trend of deprofessionalization.

The effects of dissection-room experiences and related coping strategies among Hungarian medical students.

BACKGROUND: Students get their first experiences of dissecting human cadavers in the practical classes of anatomy and pathology courses, core components of medical education. These experiences form an important part of the process of becoming a doctor, but bring with them a special set of problems. METHODS: Quantitative, national survey (n = 733) among medical students, measured reactions to dissection experiences and used a new measuring instrument to determine the possible factors of coping. RESULTS: Fifty per cent of students stated that the dissection experience does not affect them. Negative effects were significantly more frequently reported by women and students in clinical training (years 3,4,5,6). The predominant factor in the various coping strategies for dissection practicals is cognitive coping (rationalisation, intellectualisation). Physical and emotional coping strategies followed, with similar mean scores. Marked gender differences also showed up in the application of coping strategies: there was a clear dominance of emotional-based coping among women. Among female students, there was a characteristic decrease in the physical repulsion factor in reactions to dissection in the later stages of study. CONCLUSIONS: The experience of dissection had an emotional impact on about half of the students. In general, students considered these experiences to be an important part of becoming a doctor. Our study found that students chiefly employed cognitive coping strategies to deal with their experiences. Dissection-room sessions are important for learning emotional as well as technical skills. Successful coping is achieved not by repressing emotions but by accepting and understanding the negative emotions caused by the experience and developing effective strategies to deal with them. Medical training could make better use of the learning potential of these experiences.

[Screening childhood behavior problems using short questionnaires II.: The Hungarian version of the SWAN-scale (Strength and Weakness of ADHD-symptoms and Normal-behavior) for screening attention deficit/hyperactivity disorder]. / Gyermekkori viselkedési prblémák felismerésének lehetoségei rövid kérdoívekkel II: A SWAN (Strength and Weakness of ADHD-symptoms and Normal-behavior) skála magyar változata a figyelemhiányos/hiperaktivitás zavar szurésére.

INTRODUCTION: The SWAN (Strength and Weakness of ADHD-symptoms and Normal-behavior) Questionnaire is a short instrument suitable for screening attention deficit/hyperactivity disorder. Its completion by parents or teachers requires a few minutes. Positive re-wording of attention- and activity-related behaviors and the extended 7- point rating scale anchored to average behavior make the instrument especially suitable for normal populations. Here, we report the Hungarian version of SWAN and compare its scales with relevant scales of the Child Behavior Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ). METHOD: Questionnaire data were collected from parents of 156 six-year-old children in a community sample. Of the 156 children 89 were participants of the longitudinal Budapest Infant-Parent Study (BIPS). RESULTS: Internal consistency of the Hungarian SWAN scales was excellent (Cronbach alfa: 0.87-0.93), correlations with relevant CBCL and SDQ scales were as expected (0.40-0.49 and 0.67-0.74) showing that the short questionnaire was suitable for detection of attention and hyperactivity problems. SWAN scores in our sample were normally distributed and scale means were also similar to foreign studies. CONCLUSIONS: These initial Hungarian data confirm international experience with the SWAN. Psychometric indices, distribution of scale scores in the sample and across the sexes were consistent with foreign studies. Following collection of normative data, the Hungarian version of SWAN might be suitable for assessing mental health of children and adolescents, and for screening problem cases. Due to the wider range and the normal distribution of scores, SWAN provides a more suitable phenotype for genetic studies, than symptom scales.

[Screening childhood behavior problems using short questionnaires I.: the Hungarian version of the Strengths and Difficulties Questionnaire]. / Gyermekkori viselkedési problémák felismerésének lehetoégei rövid kérdoívekkel I: a Strengths and Difficulties Questionnaire magyar változata.

INTRODUCTION: The Strengths and Difficulties Questionnaire (SDQ) is a short questionnaire suitable for screening childhood behavior problems. Completing the questionnaire requires 5 minutes of parents' or teachers' time. The scales of the original version showed good agreement with relevant scales of the much longer Child Behavior Checklist (CBCL). In this study, we report the use of the Hungarian version of the SDQ and results of a comparison between the scales of the SDQ and the CBCL. METHODS: Questionnaire data were collected from the parents of 156 six-year-old children from a community sample. Of the 156 children, 89 were participants of the longitudinal Budapest Infant-Parent Study (BIPS). RESULTS: Internal consistency of the Hungarian SDQ scales were moderate-satisfactory (0.43-0.70), correlations between the relevant SDQ and CBCL scales were as expected (0.41-0.65), showing that the short questionnaire was equally suitable for the detection of problems. In our six-year-old age group, the mean of the total problem scores (11.0) was much higher than the means measured in other Western European countries and North-America. However, in developing countries, such as Brazil or China, levels were higher and closer to the Hungarian mean score. CONCLUSIONS: These initial Hungarian data confirm international experience with the SDQ, i.e., psychometric indices and the distribution of scale scores across the sexes are consistent with the results of foreign studies. On the other hand, a cautious generalization of our results indicates a higher level of problems in Hungary than in Western Europe and other developed countries. We think that following further collection of normative data the Hungarian version of the SDQ, which will take only a few minutes to complete, will be suitable for assessing the mental health of children and adolescents, and for the quick screening of problematic cases.

Risk factors for multiple suicide attempts among Roma in Hungary.

In recent years, suicide rates in Hungary have been among the highest in the European Union. Attempted suicide rates in the Roma population are 2-3 times higher than in the non-Roma population. Since individuals making multiple attempts have a higher pro-bability of eventual death by suicide, and there are limited data on suicidal behaviour of the Roma population, the aim of this study was to explore the sociodemographic and psychological background factors of multiple suicide attempts in the Hungarian Roma population. Semistructured interviews were conducted with 150 individuals admitted to hospital toxicology departments, who made suicide attempts by deliberate self-poisoning, 65 of whom were multiple attempters. Detailed information regarding the current attempt and previous suicidal acts was recorded. Patients also completed the Shortened Beck Depression, the Beck Hopelessness Questionnaire, and the Social Support Questionnaire. Independent samples t-tests were used to evaluate differences in psychological variables between the Roma ( N = 90) and non-Roma ( N = 60) groups. Stepwise linear regression and odds ratios analyses were performed to identify potential background factors of multiple suicide attempts. There was a significantly higher level of previous suicidal events among the Roma in the sample population (3.53 vs. 0.84, p < .001). Roma ethnicity was found to be a strong predictor of multiple suicide attempts. Current major depression, hopelessness, and diagnosed mood disorder were identified as significant risk factors of repeated attempts. Smoking (OR = 5.4), family history of suicide (OR = 4.9), and long-term unemployment (OR = 4.6) were additional risk factors among Roma patients. A thorough understanding of the ethnicity-specific risk factors for multiple suicide attempts could facilitate the development of effective intervention and postvention programmes.

Differential Genetic Effect of the Norepinephrine Transporter Promoter Polymorphisms on Attention Problems in Clinical and Non-clinical Samples.

Among the monoaminergic modulatory neurotransmitters, norepinephrine is involved in task orienting, hence noradrenergic genetic variants have been studied in connection to attentional processes. The role of this catecholamine system is also highlighted by the selective norepinephrine transporter blocking atomoxetine, which has proved to be effective in the pharmacological treatment of Attention Deficit Hyperactivity Disorder (ADHD). In the present genetic association study three single nucleotide polymorphisms (rs28386840, rs2242446, rs3785143 SNPs) were analyzed from the 5' region of the norepinephrine transporter (NET, SLC6A2) gene, which have been linked to ADHD previously. Attention problems scores of the mother-rated Child Behavior Checklist (CBCL) were used in separate analyses of 88 preschoolers (59.1% male, 6 years of age) recruited from the general population and 120 child psychiatry patients with ADHD diagnosis (85.8% male, age: 9.8 ± 2.9). The NET SNPs showed associations with attention problems, but the direction was different in the two groups. Regarding the promoter variant rs28386840, which showed the most consistent association, the T-allele-carrier patients with ADHD had lower CBCL attention problems scores compared to patients with AA genotype (p = 0.023), whereas T-allele-carriers in the community sample had more attention problems (p = 0.042). Based on previous reports of lower NE levels in ADHD children and the inverted-U shape effect of NE on cognitive functions, we propose that rs28386840 (-3081) T-allele, which is associated with lower NET expression (and potentially higher synaptic NE level) would support attention processes among ADHD patients (similarly as atomoxetine increases NE levels), whereas it would hinder cortical functions in healthy children.

Association between dopamine D4 receptor (DRD4) gene polymorphisms and novelty-elicited auditory event-related potentials in preschool children.

We investigated associations of the exon III repeat and the -521 C/T polymorphisms of the DRD4 gene with novelty-elicited auditory ERP components and behavioral resistance to distraction in 57 healthy, typically developing 6-year-old children. Dopamine-related gene polymorphisms have previously been linked to processes directing focused attention. We did not find associations between the 7-repeat allele or the T.7 haplotype and the early ERP responses suggesting that DRD4 polymorphisms did not affect the detection of novelty. However, the same polymorphisms affected the late negative components (LN1 and LN2). Late negativities elicited by deviant and novel sounds have been regarded as reflecting reorientation after distraction or additional processing of new information. Children carrying the T.7 haplotype had significantly smaller LN1 and LN2 amplitudes. The presence of the T.7 haplotype also significantly enhanced behavioral resistance to distraction. We suggest that less distraction in T.7 carriers led to less reorienting activity (reflected by the LN components). We also speculate that activation of less sensitive and fewer D4 receptors (as with the T.7 haplotype) is less effective in modulating GABAergic inhibitory signaling, which in turn is reflected in smaller LN amplitudes.

The relationship of biological and psychological risk factors of cardiovascular disorders in a large-scale national representative community survey.

A large-scale national representative community survey of 11,122 persons aged more than 35 years included the investigation of the coincidence of depressive symptoms, vital exhaustion, cardiovascular disorders, stroke, and myocardial infarction. A total of 20.3% of the survey participants reported having experienced a cardiovascular disorder (CVD). Of the subjects reporting a CVD, 52.1% exhibited depressive symptoms (22.0% subthreshold depressive symptoms, 30.1% clinical depression), and 69.7% exhibited vital exhaustion. The authors investigated 3 cardiovascular subgroups: (1) subjects having experienced a myocardial infarction (MI), (2) subjects having experienced stroke, and (3) subjects with a CVD but no experience of either an MI or a stroke. The frequency and severity of depressive symptoms did not differ significantly in the 3 subgroups. CVD subjects with no MI or stroke had almost as high frequencies of depressive symptoms and vital exhaustion as patients who experienced stroke or MI. The strength of relationships between these psychological variables and CVDs do not differ significantly from the relationships between hypertension or diabetes and CVDs. Depressive symptoms and increased vital exhaustion have exceptionally high comorbidity with CVDs. The authors detected the same high comorbidity among patients with a milder CVD and without stroke or MI. The assessment and management of depressive symptoms and vital exhaustion should be routine procedure in clinical cardiology.

The Role of Health Anxiety and Depressive Symptoms in Dry Eye Disease.

PURPOSE: To investigate the associations between health anxiety, depressive and anxiety symptoms, and the severity of the subjective and objective symptoms of dry eye disease (DED). METHODS: Participants completed the following psychological questionnaires: Shortened Health Anxiety Inventory, Shortened Beck Depression Inventory, and Beck Anxiety Inventory. Dry eye symptoms were evaluated using the ocular surface disease index (OSDI). Bilateral tear osmolarity measurement, tear film break-up time (TBUT), ocular surface staining, Schirmer 1 test, and meibomian gland dysfunction assessment were performed. RESULTS: Based on the OSDI score, 56 of the 84 participants enrolled were symptomatic and 28 asymptomatic. According to the objective parameters, 48/56 (85.7%) in the symptomatic group and 23/28 (82.1%) in the asymptomatic group were diagnosed with DED. In terms of the objective parameters, except for TBUT, there were no statistically significant differences between the symptomatic and asymptomatic group (p > 0.108), or between the subgroups with objectively proven dry eye (p > 0.233). The results of the psychological questionnaires were significantly worse in the symptomatic group (p < 0.01) and the symptomatic subgroup with objective dry eye (p < 0.05), than in the asymptomatic groups. In the overall study population the scores of the psychological questionnaires demonstrated significant positive correlations with the OSDI scores (r > 0.306, p < 0.01). CONCLUSIONS: These results support the role of health anxiety and of depressive and anxiety symptoms in DED, and may serve as an explanation for the lack of correlation between subjective symptoms and objective signs of the disease.

Living in fear of experiencing physical and sexual abuse is associated with severe depressive symptomatology among young women.

PURPOSE: To analyze the relationship among fear of being abused, direct experience of physical and sexual abuse, and severe depressive symptoms among young women. METHODS: A cross-sectional survey was conducted in schools and households among 3615 young Hungarian women, ages 15-24 years, of whom 2016 were students. A multistage stratified sampling method was applied. The shortened Beck Depression Inventory (BDI) and the modified Abuse Assessment Screen were used. Odds ratios (ORs) were calculated, and a general linear model was used to test effects of variables on the BDI score. RESULTS: Severe depressive symptoms were significantly more common among women who were abused physically (OR=3.474, 95% CI 2.170-5.562) or sexually (OR=6.436, 95% CI 3.085-13.429) in the past year or abused by a partner (OR=3.167, 95% CI 1.806-5.554) or important person (OR=2.989, 95% CI 1.922-4.648) during their lifetime. Severe depressive symptoms were also found among those young women who reported feeling fearful of someone in the family (OR=5.027, 95% CI 2.805-9.012) or in their environment (OR=3.779, 95% CI 2.120-6.738). In a linear regression analysis, fear of someone in the environment or family had the strongest effect on BDI scores after controlling for frequent anxiety. CONCLUSIONS: Not only the direct lifetime experience of abuse but also the presence of fear of abuse is associated with severe depressive symptomatology among young women. Fear of abuse is also an important factor to take into consideration in assessing young women with depressive symptoms.

[Effects of the D4 dopamine receptor gene variation on behavior problems at 6 years of age]. / A D4 dopamin receptor gén hatása a 6 éves kori viselkedési problémákra.

Association of the 7-repeat allele of the D4 dopamine receptor (DRD4) exon 3 polymorphism with attention deficit/hyperactivity disorder is well-established, and a link with mother-reported aggressiveness was also found in healthy pre-schoolers assessed by the quantitative scale of the Child Behavior Checklist. In the present study, we hypothesized that children carrying the 7-repeat allele would show more attention problems and externalizing (aggressive and delinquent) behavior at 6 years of age. Further, we hypothesized a potential mediating role of early temperament in the relationship of DRD4 gene with behavior problems. Mothers filled in the Achenbach Child Behavior Checklist for 88 six-year-old firstborn children (51 boys, 35 girls) followed from birth. Mother-reported temperament for the same children was assessed by the Rothbart Infant Behavior Questionnaire at 12 months. Genotypes of the DRD4 repeat polymorphism were determined using buccal cells. Significant main effects of gender and DRD4 genotype were observed on 6-year behavioral problems. Boys showed more attention problems and externalizing behavior, and children lacking the 7-repeat variant showed more externalizing and internalizing behavior. These effects remained significant after controlling for 1-year temperament. Our results did not confirm the negative effect of the 7-repeat allele on attention problems and externalizing behavior measured on quantitative scales. On the contrary, we found elevated problem scores in the absence of the 7-repeat allele. Further research including environmental risk factors is needed to clarify the role of the DRD4 gene in the development of externalizing behavior.

Test-retest reliability of auditory ERP components in healthy 6-year-old children.

One prerequisite of using auditory event-related brain potentials (ERP) in developmental and clinical research is to determine their reliability. We examined the individual stability and test-retest reliability of the ERP responses elicited by repetitive, slightly deviant, and novel sounds over 3 months in healthy 6-year-old children. When broken down to 20 ms intervals, the standard-stimulus ERP responses shared > 77%, the deviant-stimulus responses 17-31%, and the novel-stimulus responses > 33% of the individual variation over the two testing sessions; the mean amplitude differences (novel/deviant-standard) did not change significantly between sessions. The sufficiently high individual stability of the ERP responses support the utility of these measurements for studying the effects of novel sounds in this age group.

Physical and sexual abuse: risk factors for substance use among young Hungarian women.

The authors used a multistage stratified sampling method to conduct a cross-sectional survey of a nationally representative sample of 3,615 Hungarian women aged 15 to 24 years to acquire epidemiologic data on physical and sexual abuse and analyze the relationship between abuse and health-risk behaviors. Just over 30% of the young women reported having experienced some type of abuse in their lifetimes. All maladaptive coping strategies, especially sedative use, were more prevalent among those who had experienced physical abuse. The prevalence of smoking, drinking alcohol, and experimenting with drugs was closely related to both physical and sexual abuse. Having experienced abuse is an important factor in young women's development of risky health behaviors. Clinicians should screen for abuse in this age group to prevent behaviors that lead to long-term health problems.

Gender differences in deliberate self-poisoning in Hungary: analyzing the effect of precipitating factors and their relation to depression.

BACKGROUND: The suicide rate in Hungary is one of the highest in the European Union, with a male-female ratio of 3.55:1. Suicide rates correlate positively with suicide attempts, for which depression is the most frequent underlying disorder. AIMS: The aim of this qualitative study was to examine gender differences in suicide attempts, with a focus on the effect of precipitating factors on depression. METHOD: Semistructured interviews were conducted among 150 suicide attempters. Data on circumstances, reason, and method of attempt were recorded. Patients completed the Shortened Beck Depression Inventory, the Beck Hopelessness Scale, the Sense of Coherence Scale, and the Social Support Questionnaire. RESULTS: Interpersonal conflict was found to be the most frequent precipitating factor. There were significant gender differences in depressive symptoms among patients with interpersonal conflicts. We found differences in depressive symptoms according to presence or absence of interpersonal conflicts among men, but not among women. Male suicide attempters who indicated interpersonal conflicts had lower levels of depression. CONCLUSION: Depressive symptoms are frequent among suicide attempters. However, a subgroup of male attempters reporting interpersonal conflicts are characterized by a lower level of depression. This subgroup of attempters would probably not be detected with depression screening programs and may have an unmet need for other forms of screening and prevention.

How to decrease suicide rates in both genders? An effectiveness study of a community-based intervention (EAAD).

BACKGROUND: The suicide rate in Hungary is high in international comparison. The two-year community-based four-level intervention programme of the European Alliance Against Depression (EAAD) is designed to improve the care of depression and to prevent suicidal behaviour. Our aim was to evaluate the effectiveness of a regional community-based four-level suicide prevention programme on suicide rates. METHOD: The EAAD programme was implemented in Szolnok (population 76,311), a town in a region of Hungary with an exceptionally high suicide rate. Effectiveness was assessed by comparing changes in suicide rates in the intervention region after the intervention started with changes in national suicide rates and those in a control region (Szeged) in the corresponding period. RESULTS: For the duration of the programme and the follow-up year, suicide rates in Szolnok were significantly lower than the average of the previous three years (p = .0076). The suicide rate thus went down from 30.1 per 100,000 in 2004 to 13.2 in 2005 (-56.1 %), 14.6 in 2006 (-51.4 %) and 12.0 in 2007 (-60.1 %). This decrease of annual suicide rates in Szolnok after the onset of the intervention was significantly stronger than that observed in the whole country (p = .017) and in the control region (p = .0015). Men had the same decrease in suicide rates as women. As secondary outcome, an increase of emergency calls to the hotline service (200%) and outpatient visits at the local psychiatry clinic (76%) was found. CONCLUSIONS: These results seem to provide further support for the effectiveness of the EAAD concept. Whilst the majority of suicide prevention programs mainly affect female suicidal behaviour, this programme seems to be beneficial for both sexes. The sustainability and the role of the mediating factors (social service and health care utilization, community attitudes about suicide) should be key points in future research.

Age-related differences in distraction and reorientation in an auditory task.

Behavioral and event-related potential measures of distraction and reorientation were obtained from children (6 years), young (19-24 years) and elderly adults (62-82 years) in an auditory distraction-paradigm. Participants performed a go/nogo duration discrimination task on a sequence of short and long (50-50%) tones. In children, reaction times were longer and discrimination (d') scores were lower than in adults. Occasionally (15%), the pitch of the presented tones was changed. The task-irrelevant feature variation resulted in longer reaction times and lower d' scores with no significant differences between the three groups. Task-irrelevant changes affected the N1 amplitude and elicited the mismatch negativity, N2b, P3 and reorienting negativity (RON) sequence of event-related brain potentials. In children, the P3 latency was the same as in young adults. However the RON component was delayed by about 100ms. In the elderly, P3 and RON were uniformly delayed by about 80ms compared to young adults. This pattern of results provides evidence that distraction influences different processing stages in the three groups. Restoration of the task-optimal attention set was delayed in children, whereas in the elderly, the triggering of involuntary attention-switching required longer time.