Impact of depersonalization on the course of depression: longitudinal observations from the gutenberg health study.

BACKGROUND: Symptoms of depersonalization (DP) and derealization (DR) are a risk factor for more severe impairment, non-response to various treatments, and a chronic course. In this study, we investigated the effects of DP/DR symptoms in patients with clinically significant depressive symptoms on clinical characteristics and various outcomes in a representative population-based sample with a 5-year follow-up. METHODS: The middle-aged sample comprised n = 10,422 persons at baseline, of whom n = 9,301 were free from depressive and DP/DR symptoms. N = 522 persons had clinically significant depression (PHQ-9 ≥ 10) and co-occurring DP/DR symptoms, and n = 599 persons had clinically significant depression (PHQ-9 ≥ 10) without DP/DR symptoms. RESULTS: There were substantial health disparities between persons with and without depression. These disparities concerned a wide range of life domains, including lower quality of the recalled early life experiences with the parents, current socioeconomic status, social integration (partnership, loneliness), current social and interpersonal stressors (family, work), functional bodily complaints (e.g., tinnitus, migraine, chest pain), unhealthy lifestyle, and the prevalence of already developed physical diseases. These disparities persisted to the 5-year follow-up and were exceptionally severe for depressed persons with co-occurring DP/DR symptoms. Among the depressed persons, the co-occurrence of DP/DR symptoms more than doubled the risk for recurrence or persistence of depression. Only 6.9% of depressed persons with DP/DR symptoms achieved remission at the 5-year follow-up (PHQ-9 < 5). Depression with and without co-occurring DP/DR worsened self-rated physical health significantly. The impact of depression with co-occurring DP/DR on the worsening of the self-rated physical health status was stronger than those of age and major medical diseases (e.g., heart failure). However, only depression without DP/DR was associated with mortality in a hazard regression analysis adjusted for age, sex, and lifestyle. CONCLUSIONS: The results demonstrated that DP/DR symptoms represent an important and easily assessable prognostic factor for the course of depression and health outcomes. Given the low remission rates for depression in general and depression with DP/DR in particular, efforts should be made to identify and better support this group, which is disadvantaged in many aspects of life.

Depressive symptoms predict the incidence of common chronic diseases in women and men in a representative community sample.

BACKGROUND: Depression, the most frequent and harmful mental disorder, has been associated with specific somatic diseases as the leading cause of death. The purposes of this prospective study were to predict incident chronic diseases based on baseline depressive symptoms and to test sex-dependent effects. METHODS: In a representative German community sample of over 12 000 participants, baseline depressive symptoms (assessed using the Patient Health Questionnaire-9) were tested as a predictor of new onset of cardiovascular disease (CVD), chronic obstructive lung disease, diabetes, cancer, and migraine at 5-year follow-up. To study disease incidence, we created subsamples for each chronic disease by excluding participants who already had the respective disease at baseline. Potential confounders were included in logistic regression models and sex-specific analyses were performed. RESULTS: Controlling for demographic characteristics and loneliness, in men and women, baseline depressive symptoms were predictive of CVD, chronic obstructive lung disease, diabetes, and migraine, but not of cancer. When we additionally adjusted for metabolic and lifestyle risk factors, there was an 8% increase of chronic obstructive lung disease and migraine per point of depressive symptoms. There was a trend for CVD (4%; p = 0.053). Sex-sensitive analyses revealed trends for the relevance of depressive symptoms for CVD in men (p = 0.065), and for diabetes in women (p = 0.077). CONCLUSIONS: These findings underscore the need to implement screening for depression in the treatment of major somatic illnesses. At the same time, depressed patients should be screened for metabolic and lifestyle risk factors and for somatic diseases and offered lifestyle interventions.

Regional differences in the assessment of depressive symptoms in the former German Democratic Republic and Federal Republic of Germany.

AIM: The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health. SUBJECT AND METHODS: To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802). RESULTS: Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning-with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude. CONCLUSION: We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded.

Self-Criticism in the General Population: Development and Psychometric Properties of the Depressive Experiences Questionnaire Self-Criticism 4 (DEQ-SC4).

Self-criticism is a stable personality trait identified as a serious risk factor for psychopathology and weight-related health problems. Therefore, it is relevant to epidemiological research, which requires a relatively brief instrument for measuring trait self-criticism in the general population. The current study introduces a brief measure of self-criticism and presents empirical results that inform on its reliability and validity. Based on the six-item version of the Depressive Experiences Questionnaire Self-Criticism (DEQ-SC6), thorough psychometric analyses on a German representative sample (N = 2,516) were conducted and resulted in the final four-item scale: the Depressive Experiences Questionnaire Self-Criticism 4 (DEQ-SC4). Its internal consistency was good and a one-dimensional factor structure showed a good model fit. In terms of construct validity, the DEQ-SC4 was moderately linked to symptoms of depression and a non-linear association between the DEQ-SC4 and body mass index was observed, with the highest levels of self-criticism reported by underweight participants. In addition, the DEQ-SC4 showed high positive correlations with another short version of the DEQ-SC and the Big Five personality dimensions assessed in samples of university students (N = 206) and patients (N = 55), meeting theoretically-based expectations. The DEQ-SC4 therefore represents a brief screening measure of self-criticism in the general population with good psychometric properties.

Impact of the COVID-19 pandemic on depression, anxiety, loneliness, and satisfaction in the German general population: a longitudinal analysis.

PURPOSE: Cross-sectional studies found high levels of depression and anxiety symptoms, and loneliness during the first wave of the COVID-19 pandemic. Reported increases were lower in longitudinal population-based findings. Studies including positive outcomes are rare. This study analyzed changes in mental health symptoms, loneliness, and satisfaction. METHODS: Respondents of the German Socio-Economic Panel (N = 6038) were surveyed pre-pandemic (2017/2019) and during the first (June 2020) and second wave (January and February 2021) of the pandemic. Self-report screeners assessed depression and anxiety symptoms, loneliness, life and health satisfaction. Difference scores were analysed using ANCOVAs focusing on time, gender, age groups. RESULTS: Depression and anxiety symptoms and health satisfaction increased from pre-pandemic to the first wave, but declined in the second pandemic wave. Loneliness increased and life satisfaction decreased during the first and the second wave of the pandemic. Young adults and women reported more distress and loneliness, even after controlling for pre-pandemic scores, education, and income. All effects remained stable when controlling for self-reported previous diagnosis of depression or region of residence. CONCLUSION: Increases and decreases in mental health symptoms and health satisfaction showed little variation. Of concern are the strong increases of loneliness and decreased life satisfaction being important targets for interventions. Main risk factors are young age and female gender.

[Differences in Area Specific Life Satisfaction Between East and West Germans in the Years 1991, 2006 and 2020]. / Unterschiede in der Zufriedenheit verschiedener Lebensbereiche zwischen Ost- und Westdeutschen in den Jahren 1991, 2006 und 2020.

RESEARCH: Question How did the general and area specific life satisfaction evolve between East and West Germany between 1991 and 2020? METHODS: Based on three representative surveys in the years 1991, 2006 and 2020 life satisfaction between East and West Germany was examined using mean comparison with tests of significance. The influence of relevant sociodemographic variables was calculated using Univariate Variance Analyses. RESULTS: 1991 large differences in the general life satisfaction as well as with satisfaction in the areas of living, spare time, health, finances and occupational did occur, with people in East Germany reporting to be less satisfied. These differences align during the observation time. DISCUSSION: The discrepancy in the general and area specific life satisfaction between East and West Germans did align during the last 30 years. A reason might be the improved economical living conditions in East Germany.

[Sex- and Regionalspecific Differences in Child Abuse and Violence Before the German Reunification. Results from GESA, a Multi-Cohort Study]. / Geschlechts- und regionalspezifische Unterschiede von Kindesvernachlässigung und Gewalt vor der deutschen Wiedervereinigung. Ergebnisse aus GESA, einem Multi-Kohorten Konsortium.

Results from a population-based study suggest sex-specific patterns of self-reported child maltreatment, more frequently reported in former West than East Germany. Aim of the current study was to examine these patterns in two regional samples of the former East- (SHIP, 2008 - 2012) and West German (KORA, 2013 - 2014) population. Child maltreatment was assessed using the Childhood Trauma Screener (CTS). Overall, child maltreatment was less often reported in the East German sample, compared to the West German sample. The most prominent differences were identified in self-rated emotional violence (east 6.1%, west 8.7%), physical violence (east 5.7%, west 10.3%) and physical neglect (east 10.0%, west 19.2%). However, we could not find differences in sex-specific patterns between the East and West German samples. Results were discussed within a historical context, since the events took place before the German reunification in two oppose political systems.

Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies.

BACKGROUND: The Patient Health Questionnaire-9 (PHQ-9) has been proposed as a reliable and valid screening instrument for depressive symptoms with one latent factor. However, studies explicitly testing alternative model structures found support for a two-dimensional structure reflecting a somatic and a cognitive-affective dimension. We investigated the bidimensional structure of the PHQ-9, with a somatic (sleeping problems, fatigability, appetitive problems, and psychomotor retardation) and a cognitive-affective dimension (lack of interest, depressed mood, negative feelings about self, concentration problems, and suicidal ideation), and tested for sex- and regional-differences. METHODS: We have included data from the GEnder-Sensitive Analyses of mental health trajectories and implications for prevention: A multi-cohort consortium (GESA). Privacy-preserving analyses to provide information on the overall population and cohort-specific information and analyses of variance to compare depressive, somatic and cognitive-affective symptoms between sexes and cohorts were executed in DataSHIELD. In order to determine the dimensionality and measurement invariance of the PHQ-9 we tested three models (1 factor, 2 correlated factors, and bifactor) via confirmatory analyses and performed multi-group confirmatory factor analysis. RESULTS: Differences between sex and cohorts exist for PHQ-9 and for both of its dimensions. Women reported depressive symptoms in general as well as somatic and cognitive-affective symptoms more frequently. For all tested models an acceptable to excellent fit was found, consistently indicating a better model fit for the two-factor and bifactor model. Scalar measurement invariance was established between women and men, the three cohorts, and their interaction. CONCLUSIONS: The two facets of depression should be taken into account when using PHQ-9, while data also render support to a general factor. Somatic and cognitive-affective symptoms assessed by the PHQ-9 can be considered equivalent across women and men and between different German populations from different regions.

Experienced Childhood Maltreatment in a Sample of Pedophiles: Comparisons With Patients of a Psychosomatic Outpatient Clinic and the General Population.

BACKGROUND: Adverse childhood events have a lasting impact on mental health. Studies on patients with pedophilia focus on traumatic events as sexual abuse in their childhood, in which further childhood maltreatment is rarely described. AIM: In addition to previous studies on patients with pedophilia that focus on traumatic events as sexual abuse, we further investigate different types of childhood maltreatment. METHODS: We compared 3 samples using the Childhood Trauma Questionnaire: patients with pedophilia, psychotherapy outpatients, and general population (GP). Descriptive analyses were conducted for prevalence rates. To assess statistical differences between the samples concerning retrospective childhood trauma, we conducted t-tests and a multivariate analysis of variance. Binary logistic regression analyses were conducted to identify predictors of childhood maltreatment. OUTCOMES: Emotional and sexual abuse was associated with pedophilic sexual preference. RESULTS: Significant differences of experienced childhood maltreatment were found between the samples with the patients with pedophilia reporting the highest rates. Psychotherapy outpatients reported more childhood maltreatment than the GP except for sexual abuse. CLINICAL IMPLICATIONS: Our results speak to a burdened and stressful childhood of patients with pedophilia; a fantasized, sexualized world in an abusive and neglecting childhood may function as a refuge and lead to "psychic withdrawal." STRENGTHS & LIMITATIONS: This is the first study comparing a small sample of patients with pedophilia with psychotherapy outpatients and a representative sample of the GP. The use of an established and standardized questionnaire of childhood maltreatment represents a strength. However, the questionnaire's exclusive focus on abuse and neglect represents a limitation as it fails to examine other sources of adverse childhood experiences (eg, intrafamily relationships or loss of a parent). CONCLUSION: A better understanding can help establish more effective treatment and prevention programs for patients with pedophilia. Marx CM, Tibubos AN, Brähler E, et al. Experienced Childhood Maltreatment in a Sample of Pedophiles: Comparisons With Patients of a Psychosomatic Outpatient Clinic and the General Population. J Sex Med 2020;17:985-993.

Perceived Stress Scale (PSS-10) psychometric properties in migrants and native Germans.

BACKGROUND: With the increasing diversity of the German population, it is important to test the psychometric validity and reliability of the German version Perceived Stress Scale (PSS-10) specifically between German natives and residents with a migration background. METHODS: Using nationally representative data (N = 2527), this study conducted an Exploratory Factor Analysis (EFA) to determine the most appropriate factor structure, a Multi-Group Confirmatory Factor Analysis (MGCFA) to compare the validity of the two-factor structure and tested the PSS-10 measurement invariance between the German native and migrant sub-samples. Lastly, reliability of the PSS-10 was examined via Cronbach's alpha, omega and individual item analyses across the two sub-samples. RESULTS: The EFA results support a two-factor structure in the migrant sample. The MGCFA showed adequate model fit for both sub-samples and the PSS-10 is strict invariant between German natives and migrants. Cronbach's alpha and omega for Perceived Helplessness (PHS: factor 1) and Perceived Self-Efficacy (PSES: factor 2) demonstrate good internal consistency in both German and migrant sub-samples. CONCLUSIONS: The key conclusions are: (1) the German version PSS-10 is suitable for German residents with a migration background. (2) Despite good internal consistency for the total scale, the PSS-10 measures two aspects: (a) perceived helplessness and (b) perceived self-efficacy. Future research would profit from analyzing the two subscales separately, not only using the total score.

The association between recalled parental rearing behavior and depressiveness: a comparison between 1st immigrants and non-immigrants in the population-based Gutenberg Health Study.

BACKGROUND: Studies in immigrant youth have suggested differences in parenting patterns by immigration status. Knowledge of variation in recalled parenting pattern and its distinctive impact on mental health in adult immigrants, however, is limited. Therefore, the purpose of the current study was to investigate similarities and differences in recalled maternal and paternal rearing behavior and its association with depressiveness in adult 1st generation immigrants compared to non-immigrants. METHODS: Seven hundred and forty-three 1st generation immigrants (M = 57.4, SD = 10.1 years) and 6518 non-immigrants (M = 60.3, SD = 10.7 years) participated in a population-based study. Regarding countries of origin, the largest subgroups were immigrants from Eastern-Europe, Former-SU, and Arabic-Islamic countries. All participants completed the ultra-short version of The Recalled Parental Rearing Behavior-questionnaire and the PHQ-9 assessing depressiveness. Multiple linear regressions with depressiveness as outcome variable were analyzed separately for each facet of parental rearing behavior adjusting for socio-demographic and migration-related variables. RESULTS: In addition to differences in depressiveness and socioeconomic status, 1st generation immigrants recalled both their mothers and fathers as more controlling and overprotecting than non-immigrants. Parental emotional warmth was negatively associated with depressiveness across all groups. The relationship between parental control, respectively parental rejection and depressiveness, however, varied in direction and severity between the groups. CONCLUSION: The results support the notion that parental warmth is a universal protective factor against depressiveness, whereas the impact of parental control on mental health might be more culturally influenced. Analyses point to the importance of considering the unique contribution of fathers' rearing behavior on mental health, particularly in immigrant samples.

Noise annoyance predicts symptoms of depression, anxiety and sleep disturbance 5 years later. Findings from the Gutenberg Health Study.

BACKGROUND: Cross-sectional studies have shown that noise annoyance is strongly associated with mental distress, however, its long-term effects on mental health is unknown. We therefore investigated whether noise annoyance predicts depression, anxiety and sleep disturbance in a large, representative sample 5 years later. METHODS: We investigated longitudinal data of N = 11 905 participants of the Gutenberg Health Study, a population-based, prospective, single-centre cohort study in mid-Germany (age at baseline 35-74 years). Noise annoyance was assessed at baseline and 5-year follow-up (sources: road traffic, aircraft, railways, industrial, neighbourhood indoor and outdoor noise; and day vs. nighttime). Depression, anxiety and sleep disturbance were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-2. Participants suffering from depression, anxiety or sleep disturbance at baseline were excluded from the respective multivariate analyses of new onset at follow-up. RESULTS: General noise annoyance remained stable. Daytime noise annoyance predicted new onset of depressive, anxiety symptoms (also nighttime annoyance) and sleep disturbance (beyond respective baseline scores). Additional predictors were female sex, lower age and low socioeconomic status (SES). Regarding specific sources, daytime baseline aircraft annoyance predicted depression and anxiety. Sleep disturbance was most consistently predicted by neighbourhood annoyance (baseline and follow-up) and follow-up annoyance by aircraft (night) and road traffic (day and night). CONCLUSIONS: We identified current and past noise annoyances as risk factors for mental distress and sleep disturbance. Furthermore, women, younger adults and those with lower SES are particularly susceptible to noise annoyance. Our results indicate the need to provide regulatory measures in affected areas to prevent mental health problems.

[Psychometric Evaluation and Norm Values of an Ultra-Short Version of the Sense of Coherence Scale "SOC-3"]. / Psychometrische Evaluation und Normwerte einer Ultrakurzform der Sense of Coherence Scale "SOC-3".

Sense of coherence is a psychological resource which contributes substantially to an individual's ability to cope well with stressful situations. In the present study we investigate an ultra-short form of the Sense of Coherence Scale (SOC-3) in a representative sample of the German general population (N=2.018). The 3-item model evinced excellent model fit qualities and acceptable reliability. We present evidence for partial strict invariance across sex and age groups. In terms of construct validity, our analyses demonstrate strong overlap between the SOC-3 and two longer versions (-9 and -29). In addition, correlations to related constructs such as attachment styles, physical and mental health, as well as quality of life were similar between the SOC versions. For the first time, normative values for the German population are presented to allow for the classification of individual scores. We recommend the SOC-3 as a screener for applied sciences and for large-scale surveys in particular.

[Measurement invariance and normative data of the 8-item short form of the Center of Epidemiological Studies-Depression Scale (CES-D-8)]. / Normierung und Evaluation der Messinvarianz der 8-Item-Kurzform der Center of Epidemiological Studies-Depression Scale (CES-D-8).

Measurement invariance and normative data of the 8-item short form of the Center of Epidemiological Studies-Depression Scale (CES-D-8) Objectives: Female gender is a risk factor for depression. It is questionable whether a given psychometric instrument depicts depressive symptom severity in men and women alike. Therefore, we examined measurement invariance of the Center of Epidemiological Studies Depression Scale-8 (CES-D-8) between women, men and different age groups. Additionally, we aimed providing normative data for CES-D-8. Methods: We assessed depressive symptoms in a German population-based sample (N = 2,507) with the CES-D-8. Gender-distorted items were excluded in the short form. Results: Using confirmatory factor analysis (CFA), we found good model fit for men, women and the overall sample. A multi-group CFA confirmed measurement invariance of CES-D-8 regarding the tested factors and their interaction. Gender- and age-group-specific norms were computed. Conclusion: The use of the CES-D-8 can be recommended in epidemiological contexts, for practice and research. Different values between women and men of different age groups can be compared appropriately from a psychometric perspective.

[Psychosomatic medicine in the Gutenberg Health Study (GHS) - research questions, measurement instruments, selected results]. / Psychosomatische Medizin in der Gutenberg- Gesundheitsstudie (GHS) ­ Fragestellungen, Messverfahren, ausgewählte Ergebnisse.

Psychosomatic medicine in the Gutenberg Health Study (GHS) - research questions, measurement instruments, selected results Goal: Main questions from the Gutenberg Health Study (GHS) related to psychosomatic medicine are presented: (1) Prevalence and incidence of mental illnesses, (2) Sex-specific risk- and protective factors for mental health, (3) Interplay between psychological and somatic diseases and (4) methodical-psychometric developments. Methods: The GHS is an ongoing, prospective and interdisciplinary cohort study in Mainz. The comprehensive examinations include psychological characteristics and clinical and laboratory tests. 15010 respondents were selected in the baseline study from 2007 until 2012 and re-examined after 2.5 years and 5 years. Results: Of the first 5000 respondents in the baseline study 413 women (8.7 %) and 276 men (5.8 %) indicated depressive symptoms (PHQ-9 > = 10). After five years, half of the participants with depressive symptoms at baseline also indicated depressive symptoms five years later. Risk factors for men were a lack of social support, for women smoking and Type D personality. The proportion of new cases of depression at follow-up was 4.4 %. Risk factors were symptoms of anxiety, Type D, smoking and comorbid cancer. Protective were age and social support. Findings on the association of physical and mental disorders and their behavioral and biological links (atherosclerosis, inflammation) are presented. Conclusions: Prospective assessment of biological, psychological and social parameters offers the possibility to study their interplay in the development of mental and somatic illnesses.

Recalled parental rearing behavior in adult women and men with depressive and anxiety symptoms: Findings from a community study.

Objectives: Addressing the lack of population-based data, the purpose of this representative study was to assess sex- and age-specific associations of maternal and paternal rearing behavior with depressiveness and anxiety controlling for sociodemographic and somatic variables. Methods: 8,175 subjects participating in a population-based study completed standardized questionnaires measuring Recalled Parental Rearing Behavior and distress. Results: Women recalled their fathers as more controlling and warmer, and their mothers as more rejecting than men. Comparisons between age groups (≤ 60 vs. > 60 years) revealed that younger participants recalled more parental control and emotional warmth. In addition to sociodemographic and somatic risk factors, paternal rejection and maternal control were associated with depressiveness and anxiety both for women and men (OR 1.58-1.96; OR 1.37-1.66). Maternal warmth was negatively related to distress (OR 0.66-0.69). Conclusions: Findings suggested sex- and age-specific differences in recalled maternal and paternal rearing behavior. The current results highlighted the important role of recalled parental rearing behavior besides sociodemographic factors and somatic diseases for the occurrence of depression and anxiety symptoms across the age groups.

New onset of depression in aging women and men: contributions of social, psychological, behavioral, and somatic predictors in the community.

BACKGROUND: Based on the vulnerability-stress model, we aimed to (1) determine new onset of depression in individuals who had not shown evidence of depression at baseline (5 years earlier) and (2) identify social, psychological, behavioral, and somatic predictors. METHODS: Longitudinal data of N = 10 036 participants (40-79 years) were evaluated who had no evidence of depression at baseline based on Patient Health Questionnaire (PHQ-9), no history of depression, or intake of antidepressants. Multivariate logistic regression models were used to predict the onset of depression. RESULTS: Prevalence of new cases of depression was 4.4%. Higher rates of women (5.1%) than men (3.8%) were due to their excess incidence <60 years of age. Regression analyses revealed significant social, psychological, behavioral, and somatic predictors: loneliness [odds ratio (OR) 2.01; 95% confidence interval (CI) 1.48-2.71], generalized anxiety (OR 2.65; 1.79-3.85), social phobia (OR 1.87; 1.34-2.57), panic (OR 1.67; 1.01-2.64), type D personality (OR 1.85; 1.47-2.32), smoking (OR 1.35; 1.05-1.71), and comorbid cancer (OR 1.58; 1.09-2.24). Protective factors were age (OR 0.88; 0.83-0.93) and social support (OR 0.93; 0.90-0.95). Stratified by sex, cancer was predictive for women; for men smoking and life events. Entered additionally, the PHQ-9 baseline score was strongly predictive (OR 1.40; 1.34-1.47), generalized anxiety became only marginally, and panic was no longer predictive. Other predictors remained significant, albeit weaker. CONCLUSIONS: Psychobiological vulnerability, stress, and illness-related factors were predictive of new onset of depression, whereas social support was protective. Baseline subclinical depression was an additional risk weakening the relationship between anxiety and depression by taking their overlap into account. Vulnerability factors differed between men and women.

Fatigue in survivors of malignant melanoma and its determinants: a register-based cohort study.

PURPOSE: Fatigue has found increasing attention as a debilitating and lasting condition of cancer patients. However, it has remained unclear to what degree long-term survivors of malignant melanoma suffer from fatigue. Therefore, this study aimed to determine fatigue and its link with quality of life, aftercare behavior, and mental and physical symptoms among melanoma survivors. METHODS: A register-based sample of 684 long-term survivors an average of 8.4 (SD = 1.72; range 5.67-12.17) years after diagnosis was compared to 2049 participants from a representative survey by the Multidimensional Fatigue Inventory. In a hierarchical linear regression, statistical predictors for fatigue were ascertained. RESULTS: Overall fatigue was not increased in melanoma survivors except for younger melanoma survivors under 40 years. As in the general population, fatigue increased with age, and it was higher in women compared to men. Fatigue was associated with decreased quality of life, reduced functioning, and increased physical and mental symptoms. Substantial predictors (30% explained variance) were higher age, additional chronic illness, self-blame, detrimental interactions and lack of social support, and also fear of recurrence. There was neither an effect of medical parameters (clinical stage, time since diagnosis) nor of participation in follow-up care. CONCLUSIONS: Fatigue needs to be taken seriously in the aftercare of melanoma survivors as it is associated with multiple functional and quality of life impairments and heightened distress. Reduction of fatigue in melanoma patients should address younger survivors (under 40 years) and older survivors (over 60 years) with additional chronic illness and focus on illness coping and social support.

Improving the Course of Depressive Symptoms After Inpatient Psychotherapy Using Adjunct Web-Based Self-Help: Follow-Up Results of a Randomized Controlled Trial.

BACKGROUND: We recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression. OBJECTIVE: The aims of this study were (1) to determine whether a Web-based self-help adjunctive to multimodal inpatient psychotherapeutic treatment could also improve the course of depressive symptoms and (2) to identify predictors of residual depressive symptoms at follow-up. METHODS: Overall, 229 patients were randomized either to the Web-based self-help intervention group (Deprexis) or an active control group (Web-based information about depression and depressive symptoms) in addition to multimodal inpatient psychotherapy. Participants in both groups were able to access their respective Web-based programs for 12 weeks, which meant that they typically had access after discharge from the inpatient unit (mean hospitalization duration: 40 days, T1). Follow-up was performed 6 months after study intake (T3). RESULTS: At follow-up, participants of the Web-based self-help group had considerably lower symptom load regarding depressive symptoms (d=0.58) and anxiety (d=0.46) as well as a better quality of life (d=0.43) and self-esteem (d=0.31) than participants of the control group. Nearly 3 times as many participants of the intervention group compared with the control group achieved remission in accordance with less deterioration. The number needed to treat based on the Beck Depression Inventory-II (BDI-II) improved over time (T1: 7.84, T2: 7.09, and T3: 5.12). Significant outcome predictors were BDI at discharge and treatment group. CONCLUSIONS: Web-based self-help as an add-on to multimodal inpatient psychotherapy improved the short-term course of depressive symptoms beyond termination. Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up. Challenges and barriers (eg, costs, therapists' concerns, or technical barriers) of adding Web-based interventions to inpatient treatment have to be addressed. TRIAL REGISTRATION: ClinicalTrials.gov NCT02196896; https://clinicaltrials.gov/ct2/show/NCT02196896.

Effects of cognitive-behavioral therapy with relaxation vs. imagery rescripting on psychophysiological stress responses of students with test anxiety in a randomized controlled trial.

Background and objectives: Psychophysiological measures were assessed in university students during a test simulation before and after group treatment for test anxiety based on cognitive behavioral therapy (CBT), including relaxation techniques (CBT + R) or imagery rescripting (CBT + ImRs) and a moderated self-help group (SH) to understand if psychophysiological stress responses change after treatment. Design: Students suffering from test anxiety were recruited (n = 180) and three different test anxiety treatments administered in 3-hr group sessions once a week over a period of five weeks. Methods: During an experimental socially evaluative situation state anxiety and physiological stress responses of participants were obtained before and after treatment. Results: In all treatment groups, self-reported state anxiety in a stressful socially evaluative situation declined after treatment. Contrary to our hypotheses no significant reduction of physiological reactivity scores after intervention was found in any of the three group treatments. Conclusions: CBT and SH treatments are successful in reducing self-reported state anxiety in a socially evaluative situation, but psychophysiological stress responses in test anxiety patients remained unchanged despite all treatments.