Current major depressive syndrome measured with the Patient Health Questionnaire-9 (PHQ-9) and the Composite International Diagnostic Interview (CIDI): results from a cross-sectional population-based study of adults in Germany.

BACKGROUND: Prevalence estimates for depression vary considerably by the type of assessment instrument, and there is limited information on their overlap in population-based samples. Our aim was to compare the Patient Health Questionnaire-9 (PHQ-9) with the Composite International Diagnostic Interview (CIDI) as measures for current major depressive syndrome (MDS) in a large population-based sample. METHODS: Data derived from the mental health module of the nationwide cross-sectional German Health Interview and Examination Survey for Adults (DEGS1-MH) (n = 4483; age 18-79 years). MDS in the past two weeks was assessed (a) using the PHQ-9 diagnostic algorithm (PHQ-MDS) and (b) based on CIDI information about the latest symptom occurrence (recency) (CIDI-MDS). Prevalences, overall concordance and percentages of overlap of both MDS measures were determined. Prevalences of affirmed PHQ-9 depression symptoms and the mean and median PHQ-9 sum scores were analyzed per measure. RESULTS: Prevalence of current MDS was 2.7% (95% CI: 2.0-3.6) for PHQ-MDS and 3.9% (95% CI: 3.1-5.0) for CIDI-MDS. The overall agreement between both measures was moderate (kappa: 0.43). Of all the participants, 1.5% (95% CI: 1.0-2.2) were classified as MDS cases by both measures, with 54.5% (95% CI: 42.7-65.9) of PHQ-MDS cases and 37.9% (95% CI: 27.8-49.1) of CIDI-MDS cases also being classified as MDS by the respective other MDS measure. However, 94.8% (95% CI: 93.6-95.8) of the participants were classified as non-MDS by both measures, with 97.5% (95% CI: 96.6-98.1) of non-PHQ-MDS and 98.7% (95% CI: 98.2-99.1) of non-CIDI-MDS being classified as non-MDS by the respective other MDS measure. The mean and median PHQ-9 sum score was higher in those with PHQ-MDS than in those with CIDI-MDS. CONCLUSIONS: Both measures have a high level of agreement for ruling out current MDS, but the overlap in their classification of cases is moderate. Our results indicate that they cannot be interpreted as equal measures of the same construct, suggesting limited comparability of their prevalence estimates. However, further exploration of algorithms and correlates and a proper labeling of measures in epidemiological studies are required.

Hypertension and exposure to noise near airports: the HYENA study.

BACKGROUND: An increasing number of people are exposed to aircraft and road traffic noise. Hypertension is an important risk factor for cardiovascular disease, and even a small contribution in risk from environmental factors may have a major impact on public health. OBJECTIVES: The HYENA (Hypertension and Exposure to Noise near Airports) study aimed to assess the relations between noise from aircraft or road traffic near airports and the risk of hypertension. METHODS: We measured blood pressure and collected data on health, socioeconomic, and lifestyle factors, including diet and physical activity, via questionnaire at home visits for 4,861 persons 45-70 years of age, who had lived at least 5 years near any of six major European airports. We assessed noise exposure using detailed models with a resolution of 1 dB (5 dB for United Kingdom road traffic noise), and a spatial resolution of 250 x 250 m for aircraft and 10 x 10 m for road traffic noise. RESULTS: We found significant exposure-response relationships between night-time aircraft as well as average daily road traffic noise exposure and risk of hypertension after adjustment for major confounders. For night-time aircraft noise, a 10-dB increase in exposure was associated with an odds ratio (OR) of 1.14 [95% confidence interval (CI), 1.01-1.29]. The exposure-response relationships were similar for road traffic noise and stronger for men with an OR of 1.54 (95% CI, 0.99-2.40) in the highest exposure category (> 65 dB; p(trend) = 0.008). CONCLUSIONS: Our results indicate excess risks of hypertension related to long-term noise exposure, primarily for night-time aircraft noise and daily average road traffic noise.

[Prevalence and Comorbidity of Self-Reported Diagnosis of Burnout Syndrome in the General Population - Results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Häufigkeit und psychiatrische Komorbiditäten von selbstberichtetem diagnostiziertem Burnout-Syndrom.

Objective: To determine the prevalence and comorbid mental disorders of self-reported diagnosis of burnout syndrome in the general population of Germany. Methods: In the German Health Interview and Examination Survey (DEGS1) self-reported diagnosis of a burnout syndrome made by a physician or psychotherapist was assessed in a standardized interview (N = 7987). For N = 4483 mental disorders were determined with the Composite International Diagnostic Interview (CIDI). Weighted lifetime and 12-month prevalences were calculated. Results: Lifetime prevalence of diagnosed burnout syndrome was 4.2 % (women 5.2 %, men 3.3 %), 12-month prevalence was 1.5 % (women 1.9 %, men 1.1 %). Highest prevalences were found in 40 - 59 year olds, in people with middle and high socio-economic status and in women with low and men with high social support. Among the 12-month cases, 70.9 % had at least one DSM-IV disorder. Associations were found for the diagnosis of burnout syndrome with somatoform, affective and anxiety disorders. Conclusion: The diagnosis of burnout syndrome is less frequently given and reported than expected. People with a burnout diagnosis often have a manifest mental disorder.

[Prevalence and Comorbidity of Self-Reported Diagnosis of Burnout Syndrome in the General Population]. / Häufigkeit und psychiatrische Komorbiditäten von selbstberichtetem diagnostiziertem Burnout-Syndrom.

OBJECTIVE: To determine the prevalence and comorbid mental disorders of self-reported diagnosis of burnout syndrome in the general population of Germany. METHODS: In the German Health Interview and Examination Survey (DEGS1) self-reported diagnosis of a burnout syndrome made by a physician or psychotherapist was assessed in a standardized interview (N = 7987). For N = 4483 mental disorders were determined with the Composite International Diagnostic Interview (CIDI). Weighted lifetime and 12-month prevalences were calculated. RESULTS: Lifetime prevalence of diagnosed burnout syndrome was 4.2 % (women 5.2 %, men 3.3 %), 12-month prevalence was 1.5 % (women 1.9 %, men 1.1 %). Highest prevalences were found in 40 - 59 year olds, in people with middle and high socio economic status and in women with low and men with high social support. Among the 12-month cases, 70.9 % had at least one DSM-IV disorder. Associations were found for the diagnosis of burnout syndrome with somatoform, affective and anxiety disorders. CONCLUSION: The diagnosis of burnout syndrome is less frequently given and reported than expected. People with a burnout diagnosis often have a manifest mental disorder.

Twelve-months prevalence of mental disorders in the German Health Interview and Examination Survey for Adults - Mental Health Module (DEGS1-MH): a methodological addendum and correction.

We recently published findings in this journal on the prevalence of mental disorders from the German Health Interview and Examination Survey for Adults Mental Health Module (DEGS1-MH). The DEGS1-MH paper was also meant to be the major reference publication for this large-scale German study program, allowing future users of the data set to understand how the study was conducted and analyzed. Thus, towards this goal highest standards regarding transparency, consistency and reproducibility should be applied. After publication, unfortunately, the need for an addendum and corrigendum became apparent due to changes in the eligible reference sample, and corresponding corrections of the imputed data. As a consequence the sample description, sample size and some prevalence data needed amendments. Additionally we identified a coding error in the algorithm for major depression that had a significant effect on the prevalence estimates of depression and associated conditions. This addendum and corrigendum highlights all changes and presents the corrected prevalence tables. Copyright © 2015 John Wiley & Sons, Ltd.

Self-reported utilization of mental health services in the adult German population--evidence for unmet needs? Results of the DEGS1-Mental Health Module (DEGS1-MH).

This paper provides up-to-date data on service use for mental health problems and disorders among adults aged 18-79 years in Germany derived from the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH; N=4483). Data are based exclusively on self-report. Respondents were examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview DIA-X/M-CIDI to assess diagnoses according to the criteria of DSM-IV-TR. Service use, i.e. contact to mental health care services, due to mental health problems was assessed for the past 12 months and lifetime, by type of sector and type of institution. Among respondents with a 12-month diagnosis of a mental disorder, 23.5% of the women and 11.6% of the men reported any service use in the past 12 months. Service use depends on type of diagnosis, comorbidity and socio-demographic characteristics. Lowest 12-month utilization rates were found for substance use disorders (15.6%; lifetime use 37.3%), highest for psychotic disorders (40.5%; lifetime 72.1%). Further, a considerable time lap was found between disorder onset and subsequent service use among the majority of cases with anxiety and mood disorders. This paper provides self-reported epidemiological data on mental health service use in Germany, complementing administrative statistics and the predecessor mental health module of the German Health Interview and Examination Survey (GHS-MHS) from 1998. Despite considerable changes in the mental health field in Germany and the existence of a comprehensive mental health care system without major financial barriers, we find no indications of substantially higher utilization rates for mental disorders as compared to other comparable European countries. Further, no indications of major overall changes in utilization rates are apparent. To pinpoint areas with unmet needs, more detailed analyses of the data are needed taking into account type, frequency, and adequacy of service use and treatment of mental disorders. Appropriately matched comparisons with the GHS-MHS are needed to identify changes in patterns of utilization and interventions by type of disorder.

Twelve-month prevalence, comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH).

This paper provides up to date prevalence estimates of mental disorders in Germany derived from a national survey (German Health Interview and Examination Survey for Adults, Mental Health Module [DEGS1-MH]). A nationally representative sample (N = 5318) of the adult (18-79) population was examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview (DEGS-CIDI) to assess symptoms, syndromes and diagnoses according to DSM-IV-TR (25 diagnoses covered). Of the participants 27.7% met criteria for at least one mental disorder during the past 12 months, among them 44% with more than one disorder and 22% with three or more diagnoses. Most frequent were anxiety (15.3%), mood (9.3%) and substance use disorders (5.7%). Overall rates for mental disorders were substantially higher in women (33% versus 22% in men), younger age group (18-34: 37% versus 20% in age group 65-79), when living without a partner (37% versus 26% with partnership) or with low (38%) versus high socio-economic status (22%). High degree of urbanization (> 500,000 inhabitants versus < 20,000) was associated with elevated rates of psychotic (5.2% versus 2.5%) and mood disorders (13.9% versus 7.8%). The findings confirm that almost one third of the general population is affected by mental disorders and inform about subsets in the population who are particularly affected.

Saliva cortisol and exposure to aircraft noise in six European countries.

BACKGROUND: Several studies show an association between exposure to aircraft or road traffic noise and cardiovascular effects, which may be mediated by a noise-induced release of stress hormones. OBJECTIVE: Our objective was to assess saliva cortisol concentration in relation to exposure to aircraft noise. METHOD: A multicenter cross-sectional study, HYENA (Hypertension and Exposure to Noise near Airports), comprising 4,861 persons was carried out in six European countries. In a subgroup of 439 study participants, selected to enhance the contrast in exposure to aircraft noise, saliva cortisol was assessed three times (morning, lunch, and evening) during 1 day. RESULTS: We observed an elevation of 6.07 nmol/L [95% confidence interval (CI), 2.32-9.81 nmol/L] in morning saliva cortisol level in women exposed to aircraft noise at an average 24-hr sound level (L(Aeq,24h)) > 60 dB, compared with women exposed to L(Aeq,24h) < or = 50 dB, corresponding to an increase of 34%. Employment status appeared to modify the response. We found no association between noise exposure and saliva cortisol levels in men. CONCLUSIONS: Our results suggest that exposure to aircraft noise increases morning saliva cortisol levels in women, which could be of relevance for noise-related cardiovascular effects.