Measuring Change in Attachment Insecurity Using Short Forms of the ECR-R: Longitudinal Measurement Invariance and Sensitivity to Treatment.

Attachment insecurity is important for psychotherapy both as an aspect influencing the therapeutic process as well as potential outcome variable of a treatment. Two German short forms of the Experiences in Close Relationships - Revised (ECR-R) have been proposed to assess individual differences in attachment anxiety and avoidance. In this research, we examined whether these questionnaires are suitable for measuring change in attachment anxiety and avoidance by testing longitudinal measurement invariance in two independent clinical samples (N1 = 493, N2 = 273) using a pre-post design. Results indicated that strict longitudinal measurement invariance can be assumed for both measures. Thus, changes in scale scores before and after treatment can be interpreted as changes in the latent dimensions of attachment anxiety and avoidance. Both questionnaires were also sensitive to treatment in that attachment insecurity was overall reduced after therapy. Although both measures appear to be generally suitable for investigating treatment effects, they exhibited consistent problems with structural validity across samples that should be reexamined in future research.

[Information and Counseling needs Regarding Parenthood Decisions: Are Existing Services Sufficient and what Role does Depression Play?] / Informations- und Beratungsbedarf bei Elternschaftsentscheidungen: Genügen bestehende Angebote und welche Rolle spielen Depressionen?

OBJECTIVE: Support needs in parenting decisions and the associated desire for information and counseling services are insufficiently researched, especially in relation to groups of people with mental health burdens. The aim of this study was to assess information and counseling needs in parenting decisions. In addition, we investigated whether more severe depressive symptomatology is associated with increased needs. METHODS: A sample of 187 individuals between the ages of 20 and 44 was surveyed in an online study. RESULTS: Not having enough information on the topic was expressed by 45% of participants, and the desire for information related to multiple topics. A larger offer of professional coun-seling was desired by 65% of the participants, 74% (rather) did not know where to get it. Existing counseling services were used infrequently in relation to needs and with predominantly moderate satisfaction. Greater depressive symptomatology was not associated with increased information or counseling needs. DISCUSSION AND CONCLUSION: Findings suggest an expansion of support services on parenting decisions. Further research into the needs of different groups and barriers to using existing services is essential.

Periodontal maintenance: individual patient responses and discontinuations.

AIM: There is a lack of data on long-term impact of different psychological variables on periodontitis. Aim of the current study was to investigate the impact of psychological factors in patients with chronic periodontitis (CP; according to the 1999 Classification of Periodontal Diseases) to explain adherence to or discontinuation of supportive periodontal therapy (SPT) in a university setting. METHODS: A sample of n = 119 patients were examined in a questionnaire-based, cross-sectional survey. All patients had received active periodontal treatment (APT) and were reevaluated in a university setting (Kiel) before 2016 [T1: start SPT]. Patients who showed sufficient adherence to SPT of ≥ 2 years (maximum ± 6 months of deviation between SPT intervals, last visit and questionnaire at T2) were assigned to the adherence group (AG: n = 58), or, if they interrupted SPT or stopped treatment altogether, to the non-adherence group (NAG: n = 61). In addition to dental parameters, we assessed socio-demographic, treatment-related (critical attitudes/complaints), dental as well as psychological variables (especially psychological attachment, but also dental fear, patient participation style, personality functioning) and examined between-group differences as well as possible mediating factors of non-adherence to treatment continuation. RESULTS: For both groups we found similar average observation time (NAG/AG: 15.9(8.9)/14.9(10.6)years). There were significant differences in age, critical attitudes, dental fear, and patient participation style between the groups. With the help of exploratory sequential mediation models, we found a significant indirect pathway of the impact of attachment anxiety on discontinuation of treatment mediated through dental fear and number of critical attitudes/complaints. CONCLUSION: Considering the limitations, dentists should be aware of personality-related risk-factors such as attachment anxiety as well as their interplay with levels of dental fear and critical attitudes which may influence adherence to SPT. TRIAL REGISTRATION: The clinical trial was retrospectively registered in the DRKS-German Clinical Trials Register ( https://www.drks.de ) with registration DRKS00030092 (26/08/2022).

Does clinically relevant psychopathology in adolescents necessarily require treatment or does it "grow out"?

OBJECTIVE: To determine the treatment effect of psychodynamic therapy for adolescents in comparison to normative developmental progression in two groups without treatment: healthy adolescents and adolescents with juvenile diabetes. RESEARCH DESIGN AND METHODS: In a 3-wave longitudinal study, n = 531 adolescents (n = 303 treated adolescents, n = 119 healthy, n = 109 with diabetes) and their parents filled out psychopathology questionnaires (Youth Self-Report [YSR] and Child Behaviour Checklist [CBCL]). Growth curve modeling (GCM) was used to examine within-person change in psychopathology while controlling for stable between-person differences. RESULTS: GCM analyses revealed significant within-person reductions in patients' YSR and CBCL (d = 1.02-1.99) at the end of treatment. When accounted for the control groups' developmental progression (d = .14-.94), patients' within-person change remained significantly higher (d = .48-.82). In all three groups, parents rated the severity of psychopathology significantly lower, and within-person change significantly higher than the adolescents him/herself. CONCLUSIONS: Psychodynamic therapy led to a significant symptom reduction in treated adolescents and was superior to development-related symptom changes occurring in the two control groups. Hence, clinically relevant symptoms in adolescents do not "grow out", but require psychotherapeutic treatment. Differences between adolescents and their parents in the evaluation of symptom severity and change require attention in psychotherapy treatment and research.

The Validity of Somatic Symptom Disorder in Patients With Gastrointestinal Complaints.

BACKGROUND AND GOAL: The current diagnostic concept of somatic symptom disorder (SSD) aims to capture psychological burden due to bodily complaints independent of the medical cause. The aim of this study was to compare patients with chronic gastrointestinal (GI) complaints with SSD (SSD+) and without SSD (SSD-) along sociodemographic, clinical, and psychological characteristics. STUDY: This cross-sectional study included 199 patients (n=92 SSD+ and n=107 SSD-) with distressing and chronic abdominal/lower GI complaints (≥6 mo) recruited from several primary, secondary, and tertiary medical care units. SSD+ patients were separated from SSD- patients by psychobehavioral positive criteria. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, insecure attachment, mentalizing capacity, and levels of personality functioning) were measured. Nonparametric group comparisons were performed to analyze the differences of sociodemographic, clinical, and psychological characteristics between SSD+ and SSD- patients. RESULTS: About half of the SSD+ patients had a functional GI disorder and a third had an inflammatory bowel disease. SSD+ patients reported higher GI pain severity, higher health-related and work-related impairment, and higher psychological distress, especially illness anxiety, as well as higher mentalizing and personality functioning deficits. CONCLUSIONS: Overall, psychobehavioral positive criteria of SSD seem to be a valid identifier of patients exhibiting a high psychological burden, independent of the medical explanation of the GI complaints. There is a substantial overlap of SSD and general mental burden, but also evidence for a specific disease entity.

Intraindividual dynamics between alliance and symptom severity in long-term psychotherapy: Why time matters.

Objective: The association between alliance and therapy outcome is one of the most investigated factors in psychotherapy research. However, even studies using advanced methods estimate effects over a specific time period (interval) between measurement occasions. Thus, it remains unknown how the magnitude and direction of effects depend on the considered time interval, resulting in limited comparability across studies. The current study examines the influence of time on the within-person relationship between alliance and symptom severity. Method: Alliance (WAI-SR) and symptom severity (SCL-K11) were assessed every fifth session in N = 650 patients receiving up to 100 weekly sessions (mode = 55; M = 41.03; SD = 27.23) of individual psychotherapy in a German outpatient clinic. Bivariate continuous-time (CT) structural equation modeling (SEM) was used to estimate within-person cross- and auto-effects. Results: Analysis revealed significant reciprocal within-person cross-effects with stronger relative effects of SCL-K11 on WAI-SR (a21) than vice versa (a12). CT analysis showed that both cross-lagged effects increased for longer time intervals with strongest effects for time intervals of about 40 sessions (a21 = -.47; a12 = -.19). Conclusions: Alliance and symptom severity showed a reciprocal relationship. Expanding current evidence, our analysis showed how the magnitude of these effects depends on the considered time interval. Applying CT-SEM on longitudinal data of the alliance outcome association complements current cross-lagged panel analysis and allows to compare results of studies which are based on different time intervals between measurement occasions. Methodological, theoretical, and clinical implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Self-Reported Levels of Personality Functioning from the Operationalized Psychodynamic Diagnosis (OPD) System and Emotional Intelligence Likely Assess the Same Latent Construct.

We tested the hypothesis that structural integration, as assessed in the Operationalized Psychodynamic Diagnosis (OPD) system, and emotional intelligence (EI), as studied in personality psychology, might be closely related constructs at a general level, as both might assess general personality functioning. In three studies (n1 = 166, n2 = 204, n3 = 349), we used a self-report measure of OPD structural integration and measures of Trait and Ability EI. Structural integration and Trait EI display very high correlation at general factor level (r = .77 - .82) and almost perfect latent correlation (r = .85 - .90). This correlation cannot be explained away by the general positivity of self-views or socially desirable responding. There is also substantial latent correlation between structural integration and Ability EI (r = .20 - .65). Results replicate over different samples from different countries and extend to the DSM-5 self-report personality functioning scale.

Applying Item Response Theory to the OPD Structure Questionnaire: Identification of a Unidimensional Core Construct and Feasibility of Computer Adaptive Testing.

Recent developments in the dimensional assessment of personality functioning have made the implementation of latent measurement models increasingly attractive. In this study, we applied item response theory (IRT) to a well-established personality functioning instrument (the OPD Structure Questionnaire) to identify a unidimensional latent trait and to evaluate the feasibility of computer adaptive testing (CAT). We hypothesized that the use of IRT could reduce the test burden - compared to a fixed short form - while maintaining high precision over a wide range of the latent trait. The OPD-SQ was collected from 1235 patients in a psychosomatic clinic. IRT assumptions were fulfilled. A 9-factor model yielded sufficient fit and unidimensionality in exploratory factor analysis with bifactor rotation. Items were iteratively reduced, and a graded-response IRT model was fitted to the data. Simulations showed that a CAT with approximately 7 items was able to capture an OPD-SQ global severity score with an accuracy similar to that of a fixed 12-item short form. The final item bank and CAT yielded satisfactory content validity. Strong correlations with depression and anxiety replicated previous results on the OPD-SQ. We concluded that IRT applications could be useful to reduce the test burden of personality functioning instruments.

Differential effects of adult attachment in cognitive-behavioural and psychodynamic therapy in social anxiety disorder: A comparison between a self-rating and an observer rating.

Different measures of attachment are usually weakly correlated. In a subsample of an RCT comparing short-term cognitive-behavioural therapy (CBT) and psychodynamic therapy (PDT), we examined the association between attachment and outcome using two attachment measures. The sample comprises 148 patients with social anxiety disorder who were treated in the SOPHO-NET trial. Pretreatment attachment was assessed using the Adult Attachment Prototype Rating (AAPR) and the Bielefeld Questionnaire of Client Expectations (BQCE). Regression models were used to predict the therapeutic alliance (HAQ) at session 8, the Liebowitz Social Anxiety Scale (LSAS) at the end of therapy and a 6-month follow-up. Attachment groups (secure, avoidant, and ambivalent) classified with the AAPR and the BQCE were not significantly correlated (Cohen's κ = 0.08). Only the BQCE was associated with the HAQ indicating avoidantly attached patients showing lower HAQ scores than securely attached (Cohen's d = 0.722). Regarding the AAPR, we found an interaction effect of treatment and attachment related to the post-treatment LSAS scores. Post hoc tests revealed that securely attached patients in CBT had lower scores than securely attached in PDT (d = 0.922) and, on a trend level, avoidantly attached in CBT (d = 0.782). We conclude that attachment-outcome associations are affected by the applied measure. The identified differential effects suggest that psychotherapists should adapt the interventions on the attachment of their patients.

The impact of psychological attachment on the relationship between periodontal health and dental fear in patients with versus without psoriasis: a questionnaire-based, cross-sectional study.

BACKGROUND: While there is increasing evidence for the relevance of psychosocial variables such as dental fear or psychological attachment in dentistry, much less is known about the mechanisms that determine the strength of those associations. One potential moderator is the occurrence of a comorbid chronic disease such as psoriasis, which is linked to relevant disease parameters such as periodontal inflammation. The aim of the study was to test a moderation model of the relationship between dental fear, psychological attachment and psoriasis on periodontal health. METHODS: A total of 201 patients (100 with psoriasis, 101 without psoriasis) were included in a questionnaire-based, cross-sectional study. Dental status was measured with the Community Periodontal Index (CPI), dental fear was measured with the Hierarchical Anxiety Questionnaire (HAQ), and psychological attachment was measured with the Relationship Questionnaire (RQ). In addition to the examination of main effects, bootstrapping-based analyses were conducted to test the moderating influence of psychological attachment on the association between CPI and dental fear, gain moderated by group (with vs. without psoriasis). RESULTS: Controlling for several covariates, higher CPI scores were associated with higher levels of dental fear only in individuals without psoriasis under conditions of higher levels of psychological attachment anxiety and lower levels of attachment avoidance. CONCLUSION: In individuals without psoriasis, psychological attachment can moderate the association between periodontal health and dental fear. This may provide a useful framework for reducing dental fear through interventions on the level of the dentist-patient relationship.

The Effect of Hopelessness and Perceived Group Compatibility on Treatment Outcome for Patients With Personality Dysfunction.

Improvement in life satisfaction is hard to achieve for any patient with personality psychopathology, and possibly even moreso for those who feel hopeless at the start of treatment. The present research investigated the potential influence of hopelessness in the treatment of patients with personality dysfunction, using data from patients who completed an intensive group therapy program designed to reduce symptom distress and support optimal psychosocial functioning (N = 80). In the present study, we sought to examine whether hopelessness would moderate (i.e., strengthen or weaken) relations between compatibility ratings and life satisfaction outcome. Hopelessness had a significant moderating effect on the relationship between compatibility and outcome, suggesting that, for patients who entered treatment feeling more hopeless, higher appraisals of fit within the group facilitated better gains in life satisfaction. If replicated, the findings underlie the importance of focusing on increasing hope and perceived group affiliation in the treatment of personality dysfunction.

Influence of patient and therapist agreement and disagreement about their alliance on symptom severity over the course of treatment: A response surface analysis.

The alliance is dyadic in its nature with both the patient and the therapist contributing. Relatively little is known about the effects of congruence between patient and therapist perception of alliance on treatment outcome. The current study investigated how patient and therapist agreement and disagreement about the alliance predict symptom severity over the course of long-term psychotherapy. We investigated N = 361 patients nested within N = 102 therapists longitudinally every 5th session across long-term treatment. Multilevel polynomial regression with response surface analysis was used to predict symptom severity five sessions later from congruence of the alliance ratings. Throughout treatment, patient and therapist agreement about stronger alliances significantly predicted lower subsequent patient-reported symptom distress. Patient and therapist disagreement was a marginally significant predictor of subsequent symptom distress. There was no significant difference in the effects of alliance agreement and disagreement on symptoms across time in long-term treatment. Findings support the importance of alliance agreement and disagreement as predictors of subsequent patient symptom severity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Improving social functioning and life satisfaction among patients with personality dysfunction: Connectedness and engagement in integrative group treatment.

Reduced social impairment and improved life satisfaction are important objectives in group treatment for patients with personality dysfunction. Knowledge regarding patient characteristics and group treatment processes that contribute to these outcomes, however, remains limited. Dispositional connectedness, the valuing of interpersonal connections, may be an important patient factor that influences patients' experience of group treatment in ways that facilitate therapeutic benefits. The present study investigated the roles of dispositional connectedness and group engagement in contributing to improvement in social functioning and life satisfaction through integrative group treatment for personality dysfunction. Seventy-nine patients who completed an integrative group treatment programme were assessed for dispositional connectedness at baseline and social functioning and life satisfaction at pretreatment and posttreatment; each also provided ratings of group engagement during treatment. Regression analyses using bootstrap confidence intervals found significant indirect effects for dispositional connectedness regarding improvement in both social functioning and life satisfaction, through the mediating effect of group engagement. Thus, patients who entered treatment with tendencies towards interpersonal connectedness perceived a higher level of engagement in the group environment. Group engagement in turn contributed to greater improvement in social functioning and to greater improvement in life satisfaction following treatment. The findings indicate dispositional connectedness as a salient characteristic in selecting patients for group treatment and highlight the role of an engaged interpersonal climate in facilitating improvement in social functioning and life satisfaction.

[Level of personality functioning (OPD-2) and the symptom severity of posttraumatic stress disorder - a cohort study]. / Steht das strukturelle Integrationsniveau nach OPD-2 in Zusammenhang mit der Symptomschwere einer Posttraumatischen Belastungsstörung (PTBS)? ­ Eine Kohortenstudie bei Patienten einer Trauma-Ambulanz.

Level of personality functioning (OPD-2) and the symptom severity of posttraumatic stress disorder - a cohort study Objectives: To investigate the affirmed correlation between the level of personality functioning (OPD-2, Axis IV "Structure") and the symptom severity of posttraumatic stress disorder based on clinical routine data was the main goal of this study. Method: Cross-sectional data was acquired between 2013 and 2016 using random samples of standardized questionnaires in the trauma outpatient clinic of the Department of Psychosomatics and Psychotherapy, University Hospital in Münster, Germany. The German version of the PDS (Ehlers et al. 1996) measured the symptoms and the severity of PTSD, level of personality functioning was assessed by the OPD-SFK (Ehrenthal et al. 2015) Results: Level of personality functioning in OPD-SFK and the severity of posttraumatic symptoms are significantly correlated to each other. The less the functioning of the psychic structure the more the symptom severity shows up. The results were confirmed with different sets of predictors in our statistical models. Conclusions: The level of the personality functioning (OPD-2) is related to the severity of posttraumatic symptoms. Whether a low-level personality functioning is a disposal for PTSD or more likely a result of a traumatic life event, should be discussed.

[Level of personality functioning and attachment style as predictors of the successful referral to outpatient psychotherapy]. / Persönlichkeitsstruktur und Bindungsstil als Prädiktoren für die erfolgreiche Aufnahme einer ambulanten psychotherapeutischen Behandlung.

Level of personality functioning and attachment style as predictors of the successful referral to outpatient psychotherapy Objectives: Outpatient psychotherapy is a key element in the effective treatment of mental health problems. First results suggest that interpersonal problems lead to difficulties in receiving outpatient psychotherapeutic treatment. The relationship between these difficulties, attachment style, and the level of personality functioning is still unclear. Methods: We invited 1011 patients of a psychosomatic-psychotherapeutic university outpatient clinic to participate in the study. The clinical diagnoses according to ICD-10, as well as symptoms of depression (PHQ-D), and quality of life (SF-36) were recorded. Hypothesized predictors for the successful referral to outpatient therapy were patient age, availability of local outpatient treatment, number of ICD-10 diagnoses, the motivation for psychotherapy (FPTM), fear of stigmatization (Stig-9), level of personality functioning (OPD-SQ), and attachment style (ECR-RD). Results: We were able to catamnestically reassess n = 300 patients (67.3 % of patients initially referred to outpatient therapy). A smaller number of clinical diagnoses, greater availability of psychotherapeutic care and higher therapy motivation, as well as a lower level of personality functioning predicted the successful referral to outpatient psychotherapy, while the combination of impaired personality functioning and avoidant attachment style was a negative predictor. Conclusions: Contrary to expectations, patients with a lower level of personality functioning are more successful in receiving outpatient psychotherapy. However, patients with a combination of impaired personality functioning and a high degree of attachment avoidance run the risk of not asserting their need for treatment.

Improving self-esteem through integrative group therapy for personality dysfunction: Investigating the role of the therapeutic alliance and quality of object relations.

OBJECTIVE: We aimed to investigate change in self-esteem through intensive group treatment for personality dysfunction, by exploring: (a) the relationship between patients' experience of therapeutic alliance and improvement in self-esteem during treatment, including patients' quality of object-relations (QOR) as a possible moderator; and (b) the association between improvement in self-esteem during treatment, and depressive symptoms 9 months later. METHOD: Eighty patients with personality dysfunction, consecutively enrolled in a group-oriented treatment program, were assessed at pretreatment, posttreatment, and 9 months follow-up. RESULTS: Especially for patients with lower QOR, alliance predicted self-esteem change during treatment. In addition, change in self-esteem during treatment predicted follow-up depression severity, even when controlling for within-treatment symptom change. CONCLUSIONS: Patients with impoverished inner relational representations may benefit more from a secure alliance in terms of improving their self-esteem. Change in self-esteem may also be important in preventing relapse of depressive symptoms in people with personality dysfunction.

Therapeutic agency, in-session behavior, and patient-therapist interaction.

OBJECTIVE: The aim of this study was to investigate associations between patients' subjective agency, their observable in-session behavior, and the patient-therapist interaction during the early phase of psychotherapy. METHODS: The sample included 52 depressed patients in psychodynamic psychotherapy. After Session 5, the patients' agency and the quality of the therapeutic alliance were assessed. Based on session recordings, two independent observers rated the patients' involvement, their interpersonal behavior, and the therapists' directiveness. RESULTS: Higher agency was associated with stronger therapeutic alliances. Patients who indicated higher agency in their therapy participated more actively in the session and showed less hostile impact messages. Patients' agency was not related to therapists' directiveness. CONCLUSIONS: Patients' sense of agency in psychotherapy was associated with more active involvement and affiliative interaction. The findings support the idea that patients need to feel capable of acting within and having an influence on their therapy to benefit from it.

Therapeutic Agency Inventory: Development and psychometric validation of a patient self-report.

Objectives: Therapeutic agency is defined as a patient's intentional influence over the process of psychotherapeutic change. However, there is a lack of conceptually sound self-report measures with adequate psychometric properties. The aim of this study was to develop and psychometrically evaluate the patient-rated Therapeutic Agency Inventory (TAI).Method: Based on the literature, we developed items related to therapeutic agency and investigated their psychometric properties in a naturalistic study with a sample of 334 psychotherapy participants. We assessed changes in TAI scores in a subsample of 58 patients over the course of inpatient psychotherapy and related TAI scores to therapeutic improvement.Results: The TAI consists of 15 items. We performed exploratory factor analyses, and the following three factors were extracted: In-session activity, therapy-related processing, and therapist-oriented passivity. Internal consistency was .84 for the total score and ranged between .73 and .80 for each of the factors. The TAI was significantly associated with other psychotherapy process factors, self-efficacy expectations, control beliefs, lower overall psychological distress, and lower depression scores. Changes in agency during psychotherapy predicted therapy outcome, even after controlling for baseline distress.Conclusions: The TAI is a reliable, valid, and change-sensitive self-report instrument that can be used to assess agency in psychotherapy.

[Is the influence of religiousness on fearful, depressive and somatic symptoms and psychic traumatization overestimated? A representative cross-sectional study]. / Religiosität: in ihrem Einfluss auf ängstliche und depressive Symptome sowie Körperbeschwerden und Traumata überschätzt? Eine repräsentative Querschnittstudie.

Is the influence of religiousness on fearful, depressive and somatic symptoms and psychic traumatization overestimated? A representative cross-sectional study Objectives: The aim of this study is to prove if religious faith, spirituality and religious praxis are joined with lower depression, anxiety and physical pain-level and if subjects with traumatic experiences report more spirituality. Methods: In this consecutive study, 2508 adults of a representative sample in Germany were interviewed about religious faith and spirituality in relation to depression, anxiety, physical disorders as well as traumatic experiences. Results: Unlike our hypotheses people who are charged with mental (PHQ-4; Löwe et al. 2010) or physical disorders (GBB_8; Kliem et al. 2017) report more spirituality and more private religious/spiritual praxis than people without mental or physical problems. As expected people with traumatic experiences in their childhood (CTS; Grabe et al. 2012) describe significantly more spirituality than people without these experiences. Conclusions: Other than expected people with more mental or physical disorders report more spirituality and more private religious/spiritual praxis. It is to discuss if spirituality is less a protective factor for mental or physical disorders than disorders activate to look for spirituality and private religious/spiritual praxis.

Depression profile in cancer patients and patients without a chronic somatic disease.

BACKGROUND: To investigate whether depressed oncology patients show a specific depressive symptom profile, we compared depression symptoms in depressed cancer patients (CANCER-DEP) and depressed patients without a chronic somatic disease (NONCANCER-DEP). METHODS: Of a total of 2493 outpatients from a comprehensive cancer center and a center for psychosocial medicine, 1054 (42.3%) met the DSM-5 criteria for depression, measured with the Patient Health Questionnaire 9. Based on the Patient Health Questionnaire 9 scores, differences in severity of each of the 9 individual DSM-5 depression symptoms between CANCER-DEP (n = 542) and NONCANCER-DEP (n = 512) were examined. Non-depressed cancer patients (CANCER-NONDEP; n = 1216) served as a comparison group for somatic symptoms independent of depression in cancer. To control for depression severity, group comparisons were performed separately for patients with major depression and any depressive disorders. RESULTS: Depressed cancer patients reported significantly lower levels of the cognitive-emotional depression symptoms "worthlessness" and "suicidal thoughts" than NONCANCER-DEP. Only 1 out of 5 somatic depression symptoms ("changes in appetite") was more pronounced in CANCER-DEP than in NONCANCER-DEP. Confirming previous research, somatic depression symptoms occurred more frequently in CANCER-DEP than in CANCER-NONDEP. CONCLUSIONS: The lower level of cognitive-emotional symptoms in CANCER-DEP than in NONCANCER-DEP is discussed in relation to different psychosocial phenomena. Our results indicate that somatic depression symptoms are similarly pronounced in CANCER-DEP and NONCANCER-DEP, and that CANCER-DEP show greater somatic depression symptoms than CANCER-NONDEP. The presence of high levels of somatic symptoms should alert clinicians to investigate for a potential comorbid depression in cancer patients.