Anxiety and depression in the general population in Colombia: reference values of the Hospital Anxiety and Depression Scale (HADS).

PURPOSE: The objective of this study was to generate normative values and to test psychometric properties of the Hospital Anxiety and Depression Scale (HADS) for the general population of Colombia. While there are several normative studies in Europe, Latin American normative values are missing. The identification of people with mental distress requires norms obtained for the specific country. METHODS: A representative face-to-face household study (n = 1,500) was conducted in 2012. The survey questionnaire contained the HADS, several other questionnaires, and sociodemographic variables. RESULTS: HADS mean values (anxiety: M = 4.61 ± 3.64, depression: M = 4.30 ± 3.91) were similar to those reported from European studies. Females were more anxious and depressed than males. The depression scale showed a nearly linear age dependency with increasing scores for old people. Mean scores and percentiles (75 and 90%) are presented for each age decade for both genders. Both anxiety and depression correlated significantly with the total score of the multidimensional fatigue inventory and with the mental component summary score of the quality of life questionnaire SF-8. Internal consistency coefficients of both scales were satisfying, but confirmatory factorial analysis results only partially supported the two-dimensional structure of the questionnaire. CONCLUSION: This study supports the reliability of the HADS in one Latin American country. The normative scores can be used to compare a patient's score with those derived from a reference group. However, the generalizability to other Latin American regions requires further research.

[Prevalence of personal exhaustion in the general population in Germany and its coherences towards further psychosomatic disorders]. / Prävalenz von psychischer und physischer Erschöpfung in der deutschen Bevölkerung und deren Zusammenhang mit weiteren psychischen und somatischen Beschwerden.

The delineated mental and somatic symptoms in the context of burnout have to be seen as serious health complaints. Exhaustion is one of the symptoms in this context. The present study focuses the prevalence of exhaustion symptoms (assessed with a screeninger for mental wellbeing) in the German general population and the correlation with anxiety and depression as well as further symptoms that co-occur. For this purpose, data of 2 433 persons from a population-based representative sample were analysed. After setting a cut-off point the results reveal that 6% of the population show serious mental impairments, which can be interpreted as a exhaustion prevalence rate. Moreover, the results imply clear relationships of exhaustion and other symptoms as well as mental and somatic impairments and the intake of pharmaceuticals.

[Are urban dwellers more depressed and anxious than the rural population? Results of a representative survey]. / Sind Städter depressiver und ängstlicher im Vergleich zur Landbevölkerung? Ergebnisse einer repräsentativen Bevölkerungsumfrage.

This study investigates the association between urbanicity and mental health in the general population. We conducted a representative survey (N = 5,036) measuring depression (PHQ-2), anxiety (GAD-2) as well as life satisfaction (FLZM). Results support the assumption that the prevalence rate for pathological scores of depression and anxiety are higher in urban than in rural areas. But, there is no clear linear association between urbanicity and mental health. Urbanicity seems to be a distal factor for higher rates in anxiety and depression. Urban-rural differences in other studies can not be transferred to the German population that easily. Future studies have to take variables on an individual and community level into account to analyse the relationship between urbanicity and mental health.

Psychometric Properties of the German Narcissism Inventory 90 (NI-90) in a clinical and non-clinical sample of adolescents: a comparative study.

BACKGROUND: The Narcissism Inventory (NI) is a frequently used German inventory for measuring narcissism in clinical settings; an additional short version (NI-90) also exists. Psychometric properties of the NI-90 scales were examined in clinical and non-clinical adolescent samples. METHODS: Two adolescent samples were assessed with the NI-90: a non-clinical sample (n = 439, mean age ± SD = 15.05 ± 1.77 years) and a clinical sample (n = 235, 18.26 ± 0.77 years). Confirmatory factor analysis and principle component analysis were used to scrutinize the structure of the scales. Multiple regression analysis was used to predict the scores on two scales (helpless self; negative body self). RESULTS: This study revealed heterogeneity in the NI-90 scales, which in turn explains the wide range seen in Cronbach's α (from 0.53 to 0.93). The postulated 4-factor structure could not be replicated in both samples. Multiple regression analysis revealed that personality disorder did not significantly predict negative body self or helpless self scores, whereas eating, mood, as well as somatoform and conversion disorders did. One NI-90 scale (greedy for praise and reassurance) showed sufficient psychometric quality for the measurement of narcissism in both samples. CONCLUSION: Based on the results, the authors recommend revising the NI-90. Items that may be useful for measuring aspects related to affective and body image complaints are presented. The greedy for praise and reassurance scale may be valuable for measuring features of 'overt' narcissism.

[Mood in the German population: norms of the Multidimensional Mood Questionnaire MDBF]. / Die Stimmung in der deutschen Bevölkerung: Referenzwerte für den Mehrdimensionalen Befindlichkeitsfragebogen MDBF.

Mood may be associated with several aspects of psychopathology. Though mood is more context dependent than other psychological variables it is useful to calculate norms. Based on a representative sample of the German general population (N=2 443), mood was assessed with the Multidimensional Mood Questionnaire MDBF (short form A). The correlations among the 3 bipolar scales (good - bad mood, alertness - tiredness and calmness - restlessness) ranged between 0.70 and 0.75. Good mood and alertness decline with increasing age. Males (compared to females) show higher mean values in alertness and calmness. The mean scores presented in this article can be used as comparison values for clinical samples.

Subjective underchallenge at work and its impact on mental health.

PURPOSE: To investigate the relation between subjective underchallenge at work and the degree of depressiveness and life satisfaction. METHODS: A representative sample of the German general population of N = 1,178 (52.5% men; age: M = 40.4 years, SD = 11.3) was included in this study. Measurements contain Satisfaction with Life Scalè (SWLS) and the Patient Health Questionnairè (PHQ-D). To assess subjective underchallenge at work, a ten-item scale was developed for the purpose of this study. The association between subjective underchallenge at work, life satisfaction and depressiveness was examined by means of path analyses. RESULTS: A significant positive association was found between subjective underchallenge at work and depressiveness, mediated by life satisfaction. This association was not moderated by income but by level of education. Participants with a medium educational level displayed a weaker association than participants with either a high or a low educational level. CONCLUSION: Not only work overload but also feeling underchallenged at work can have a negative impact on mental health and well-being. This is not an issue for blue-collar workers only and deserves more attention in future research.

Anxiety and depression in cardiac patients: age differences and comparisons with the general population.

BACKGROUND: Anxiety and depression are often found in cardiac patients, but also in the general population. Therefore, evaluation of these symptoms in patients requires a comparison with norm values. The purpose of this study was to explore differences between cardiac patients and the general population in age dependency of anxiety and depression, and to discuss possible reasons for these differences. METHODS: A sample of German cardiac patients (n = 2,696) and a sample of the German general population (n = 2,037) were tested using the Hospital Anxiety and Depression Scale (HADS). RESULTS: While we confirmed a linear age trend of anxiety and depression in the general population, we observed an inverted U-shaped age dependency in the patient sample. Young patients are especially affected by anxiety and depression. Five items of the HADS that mainly contributed to the age differences were identified. Formal characteristics of these 5 items could not explain the age differences. Concerning the meaning of the items, however, most of the items refer to worrying about the future. CONCLUSIONS: The relatively low rates of anxiety and depression in older patients (compared with the general population) indicate that adaptation processes took place, which should be taken into account in studies concerning the psychological status of patients. Young patients need special attention when dealing with mental distress.

Gender and age differences in domain-specific life satisfaction and the impact of depressive and anxiety symptoms: a general population survey from Germany.

PURPOSE: Determine age and gender differences and interaction effects in domain-specific life satisfaction in the German population and examine to which degree depressive and anxiety symptoms are associated with life satisfaction in addition to sociodemographic variables, and which domains are affected. METHODS: Representative survey of the German population conducted 2006 with 5,036 participants (53.6% female). Mean age was 48.4 years (SD = 18.0). Measurements included domain-specific life satisfaction (FLZ(M)), anxiety (GAD-7), depressive symptoms (PHQ-2), and sociodemographic variables (e.g., marital status, income, employment, education, urbanity, part of Germany, religiousness, age and gender). RESULTS: Women were more satisfied with their family life, men showed greater satisfaction with their leisure activities. Age-group differences appeared in every life satisfaction domain. Age by gender interaction emerged in the field of satisfaction with health, income, and family life. Anxiety and depressive symptoms contributed significantly to the explained variance of domain-specific life satisfaction. CONCLUSIONS: Depressive and anxiety symptoms as two psychological variables have an additional impact on domain-specific life satisfaction. Further investigation is needed regarding the impact of psychological variables on domain-specific life satisfaction.

Calibrating Independence Goals and Partner Support: Couples Adjust to Functional Limitations after Tumor Surgery.

BACKGROUND: When patients recover from disease-related functional limitations, support received from partners may not always match patients' changing independence goals. The lines of defense (LoD) model proposes a hierarchy of independence goals (LoDs), ranging from minimising discomfort by disengagement (lowest LoD) to protection of self-reliance (highest LoD). Prostate cancer patients' LoDs were examined as moderators of the association between partner support and patients' and partners' affect during patients' recovery from postsurgical functional limitations. METHODS: Data from 169 couples were assessed four times within 7 months following patients' surgery. Patients reported on post-surgery functional limitations (i.e. incontinence), LoDs, affect, and received partner support. Partners reported on affect and support provided to patients. RESULTS: In patients endorsing lower LoDs, more received support was associated with less negative affect. Also, not endorsing high LoDs while receiving strong partner support was related to patients' lower negative and higher positive affect. Partners' support provision to patients tended to be associated with increases in partners' negative affect when patients had endorsed higher LoDs and with increases in positive affect when patients had endorsed lower LoDs. CONCLUSIONS: Matching patients' independence goals or LoDs with partners' support may be beneficial for patients' and partners' affect.

The Aging Males' Symptoms (AMS) scale: review of its methodological characteristics.

BACKGROUND: The current paper reviews data from different sources to get a closer impression on the psychometric and other methodological characteristics of the Aging Males' Symptoms (AMS) scale gathered recently. The scale was designed and standardized as self-administered scale to (a) to assess symptoms of aging (independent from those which are disease-related) between groups of males under different conditions, (b) to evaluate the severity of symptoms over time, and (c) to measure changes pre- and post androgen replacement therapy. The scale is in widespread use (14 languages). METHOD: Original data from different studies in many countries were centrally analysed to evaluate reliability and validity of the AMS. RESULTS: Reliability measures (consistency and test-retest stability) were found to be good across countries, although the sample size was sometimes small. VALIDITY: The internal structure of the AMS in healthy and androgen deficient males, and across countries was sufficiently similar to conclude that the scale really measures the same phenomenon. The sub-scores and total score correlations were high (0.8-0.9) but lower among the sub-scales (0.5-0.7). This however suggests that the subscales are not fully independent. The comparison with other scales for aging males or screening instruments for androgen deficiency showed sufficiently good correlations, illustrating a good criterion-oriented validity. The same is true for the comparison with the generic quality-of-life scale SF36 where also high correlation coefficients have been shown. Methodological analyses of a treatment study of symptomatic males with testosterone demonstrated the ability of the AMS scale to measure treatment effect, irrespective of the severity of complaints before therapy. It was also shown that the AMS result can predict the independently generated (physician's) opinion about the individual treatment effect. CONCLUSION: The currently available methodological evidence points towards a high quality of the AMS scale to measure and to compare HRQoL of aging males over time or before/after treatment, it suggests a high reliability and high validity as far as the process of construct validation could be pressed ahead yet. But certainly more data will become available, particularly from ongoing clinical studies.

Decreased Verbal Learning but not Recognition Performance in Alcohol-dependent Individuals During Early Abstinence.

OBJECTIVE: Alcoholism ultimately leads to impairment of memory and other cognitive functions. This can interfere with treatment, if cognitively impaired alcohol-dependent individuals have difficulties recalling and implementing skills acquired during therapy. We investigate if alcohol-dependent individuals without clinically apparent withdrawal symptoms may still be impaired in higher-order cognitive functions. METHODS: Thirty-four alcohol-dependent patients and 20 matched healthy controls were tested with the Verbal Learning and Memory Test which includes seven measurement points. The test comprises free recall, free recall after distraction and after 30 minute delay, and a word recognition task. Testing was performed between day seven and day 10 after the beginning of abstinence, when clinical withdrawal symptoms had ceased. RESULTS: Compared to healthy controls, alcohol-dependent patients performed worse in free recall after delay, but not in word recognition. Healthy controls showed a more linear progression of improvement in verbal memory performance. Overall, alcohol-dependent individuals showed reduced verbal learning efficiency. The extent of impaired recall after distraction was positively associated (one-tailed test) with history of delirium (r=0.34, p=0.04), seizures (r=0.46, p=0.01), and years since diagnosis for alcohol dependency (r=0.39, p=0.01). CONCLUSIONS: Our results provide evidence that unmedicated alcohol-dependent patients without obvious withdrawal symptoms had impaired verbal recall, but normal recognition performance, at seven to 10 days after onset of abstinence. This deficit may deteriorate treatment outcomes due to poorer implementation of skills newly-learned during this time period.

Low effective organizational strategies in visual memory performance of unmedicated alcoholics during early abstinence.

OBJECTIVE: Alcohol-dependent patients in early abstinence show an impairment of cognitive functions which can be seen in poor implementation of newly learned skills for avoiding relapse. Executive dysfunction may persist during abstinence in alcohol-dependent persons, thus mitigating long-term abstinence. This study assessed visual memory function and choice of organizational strategies in alcoholics, as these are major factors necessary to implement ongoing behavior changes which are required for maintaining abstinence. METHODS: We investigated 25 severely alcohol-dependent male patients between days 7 to 10 of abstinence, immediately after clinical withdrawal symptoms have ceased, compared to 15 healthy age, sex, and education matched controls. Pharmacological therapy had been terminated at least four half-lifes before inclusion into the study. Visual perceptual learning and organizational strategies were assessed with the Rey-Osterrieth Complex Figure Test (R-OCF). RESULTS: There were no group differences in copying or recalling the figure, but time differences occurred. Alcoholics and healthy controls performed worse in recalling than in copying. But, alcoholics used less effective organizational strategies. CONCLUSIONS: There was a deficit in choice of organizational strategy in newly abstinent and unmedicated alcohol-dependent patients. Due to the imperfect organizational strategies, alcoholics might need auxiliary therapeutic care to strengthen their cognitive ability.

[Associations between body dysmorphic symptoms, body image and self-consciousness in a representative population sample]. / Zusammenhang zwischen körperdysmorphen Beschwerden, Körperbild und Selbstaufmerksamkeit an einer repräsentativen Stichprobe.

This study investigates the association between body image and body dysmorphic symptoms in the population by taking different kinds of self-consciousness into account. Body dysmorphic symptoms are characterized by a distressing and impairing preoccupation with an imagined or slight defect in appearance. A representative sample of 1621 persons in Germany was examined with screening instruments for body image, body dysmorphic symptoms and self-consciousness. Women reported more body dysmorphic symptoms and higher self-consciousness than men. People with body dysmorphic symptoms reported a more negative body image and higher self-consciousness. Different aspects of self-consciousness moderated the association between body dysmorphic symptoms and negative body image. Results were discussed towards hypotheses of affect modulation and depression tendency of patients with body dysmorphic symptoms.

[Discrepancy between ideal and real body image: does it affect body-dysmorphic disorder symptoms?]. / Körperdysmorphe Beschwerden: Welche Rolle spielt die Diskrepanz zwischen Ideal- und Realkörperbild?

Body dysmorphic symptoms are characterized by a distressing and impairing preoccupation with an imagined or slight defect in appearance. It is assumed that a discrepancy between ideal and real body image is associated with body dysmorphic disorder symptoms. On the basis of a nationwide survey participants were analysed in terms of their body dysmorphic symptoms and specific aspects of their body image. The ideal and real body image differed significantly in both sexes and in age groups. On closer examination it was apparent that there were different factors for men and women which predicted the occurrence of body dysmorphic symptoms. The results are discussed against the background of existing body ideals and in terms of their gender specific relevance.