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Summary Background Systematic reviews indicated that home treatment is an effective and cost-saving alternative to conventional acute psychiatric treatment options. Treatment success has often been defined as a reduction of hospital admissions. In the current study, symptoms and well-being are assessed regularly during treatment as an indicator for treatment success. Patients’ characteristics such as diagnosis, age, substance use, and motivation for treatment were discussed as predictors for treatment success. A second focal point of the study lies in the examination of the therapeutic relationship in terms of the outcome, which has not yet been systematically investigated in home treatment. Methods This is an observational study with a prospective naturalistic design. Measurements are carried out at baseline, during and at the end of treatment as well as at the 3‑month follow-up. Patients’ characteristics as potential predictors for treatment success will be assessed at baseline. In addition, the perceived relationship between the patients and the team will be measured daily and weekly throughout the treatment. Treatment success is by the changes in symptoms and general well-being assessed weekly. We aim to include 82 participants assigned to home treatment. Variance analyses with repeated measurements will be conducted to evaluate treatment success. Conclusion By examining potential patient- and relationship-related predictors of treatment success, insights into relevant determining variables of treatment success in this setting are expected. The results might help to better identify who benefits the most from home treatment.

This study examined how patient characteristics concerning processing of emotions interact with common factors in psychotherapy. We focused on common factors of emotional processing in psychotherapy with regard to depression outcome. A total of 93 psychiatric outpatients were included. Patients completed preassessments and postassessments regarding depression symptoms and emotional processing style. In addition, the subjectively perceived activation of common factors related to emotional processing in therapy was assessed by the patients after each therapy session. Depending on patients' pretreatment characteristics in emotional processing, activation of the emotion-related common factor mindfulness in treatment had varying impact on depression outcome: The perceived activation of mindfulness had a positive impact on depression reduction only in patients with pretreatment deficits in cognitive representation and communication of emotions. In patients who did not show such deficits, the perceived activation of this common factor during treatment was negatively correlated with outcome. It appears that common factors in psychotherapy must match with patient characteristics to gain therapeutic significance. Examining the interplay of patient characteristics with common factors provides a promising approach to tailor psychotherapeutic procedures in the sense of a personalized psychotherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This paper presents the German adaptation and validation of the Religious and Spiritual Struggles Scale (RSSS) (Exline et al. 2014). Religious and spiritual (r/s) struggles consist of inner conflicts regarding supernatural, interpersonal and intrapersonal concerns, which in the RSSS are categorized into six struggles: Divine, Demonic, Doubt, Interpersonal, Moral and Ultimate Meaning. The prevalence of these as well as mental health correlates and associations with centrality of religiosity were explored in a sample of 1359 German-speaking participants, primarily university students from Switzerland. Inner r/s struggles have primarily been studied in samples from the United States, and data are lacking for more secular societies such as Switzerland, where these struggles are experienced as well. For the first time, the RSSS was translated into and administered in the German language and its six-factor structure confirmed with confirmatory factor analysis.

We studied the Amsterdam Sexual Pleasure Inventory’s (ASPI, Vol. 1.0) psychometric properties to present evidence regarding its intended interpretation and use. The ASPI is a theory-based and revised self-report battery which aims to assess different domains of state and trait sexual pleasure in survey-research in gender-diverse, sex-diverse, and relationship-diverse populations. We collected quantitative (n = 1371) and qualitative data (n = 637) using a cross-sectional multi-method design targeting the general (German-speaking) population. The theory-based 5-factor ESEM showed good and the PCA of the two general exploratory index-scales showed acceptable structural validity evidence. Measurement invariance of the 5-factor models was given for male and female (assigned-at-birth) participants and for sexually functional-scoring and dysfunctional-scoring people. Coefficient omega indicated that all scales, except those of one facet, showed acceptable to very good internal consistency reliability. The ASPI’s convergent and discriminant associations with sexological and psychological constructs demonstrated good overall construct validity evidence and the scales showed differential utility in differentiating known-groups. Participants understood the items as intended and felt that the ASPI covers relevant facets of sexual pleasure. The ASPI might help understand how individuals differ in experiencing sexual pleasure and how different contexts enable some people to experience pleasure while disadvantaging others.

There are indications for a raise in embitterment during the COVID-19 pandemic. As embitterment is related to felt social exclusion, pessimism, and a proneness toward COVID-19-related conspiracy beliefs, embitterment may be a key factor to consider in the current pandemic. However, perceived social support (PSS), which is associated with hope during the COVID-19 pandemic could serve as an important resilience factor for bitterness. We therefore investigated the effects of PSS on embitterment in aftermath of the second wave of the COVID-19 pandemic. 52 individuals participated in our follow-up online study in October 2020 (T1) and May 2021 (T2). Embitterment (measured with the Berne Embitterment Inventory) and PSS were repeatedly assessed at T1 and T2. A double moderation analysis was conducted, using the PROCESS macro to examine the effects of embitterment, PSS, and age on embitterment 6 months later. The results suggest that the prediction of embitterment at T2 by embitterment at T1 was altered by changes in PSS. Here, in particular participants with high embitterment at T1 and a gain in PSS had higher embitterment scores at T2, whereas participants with low embitterment were found to have lower embitterment scores. This interaction effect was further influenced by the age of the participants, where the effects were more pronounced among middle-aged participants than younger participants. As embittered individuals seem to grow in bitterness with a gain in PSS, support is found for the notion that embittered individuals seeking allies supporting their mindset.

Background After an acute myocardial infarction (MI 2 ), patients may develop posttraumatic stress disorder (PTSD 3 ). There is evidence for alterations in the hypothalamic–pituitary–adrenal axis in PTSD. An association between patients` cortisol level after experiencing an MI and subsequent PTSD symptoms has not been investigated yet. Therefore, the aim of this study was to examine whether serum cortisol measured in patients admitted to hospital for acute coronary care after MI is predictive of PTSD symptoms at three and 12 months post-MI, respectively. Methods Patients (N=106) with a verified MI and high risk for the development of MI-induced PTSD symptoms were included in the study within 48 hours of hospital admission for acute coronary intervention. Serum cortisol was measured from fasting venous blood samples the next morning. Hierarchical regression analysis was used to test for an independent contribution of cortisol levels from admission to the Clinician-Administered PTSD Scale sum score three and 12 months after discharge from the coronary care unit. Results Hierarchical regression analysis showed that lower serum cortisol levels were significantly associated with more severe PTSD symptoms three months (B=-0.002, p=0.042) and 12 months (B=-0.002, p=0.043) post-MI. Limitations The generalizability of the findings is limited to patients with high acute peri-traumatic distress and without an acute severe depressive episode. The study does not provide any information about the diurnal cortisol pattern. Conclusion Lower serum cortisol measured during MI hospitalization may predict more severe MI-induced PTSD symptoms three and 12 months after hospital discharge.

We thank Merkaš and Lakušić for commenting on our recently published paper; in the paper, we suggested that resources in a patient's social environment may moderate the benefit of one single-session trauma-focused counseling in the prevention of acute coronary syndrome (ACS)-induced posttraumatic stress disorder (PTSD) symptoms [...].

Separation and divorce are life events that might alter life satisfaction on the long term. Previous literature suggests a recovery of life satisfaction after marital dissolution for most individuals, simultaneously emphasizing considerable heterogeneity in the extent and timing of such adaptation. A new partnership seems to be a promising factor for a positive post-separation adjustment process. At the same time, the question arises whether people with beneficial characteristics, such as higher trait resilience, may have a double advantage by recovering faster and being more likely to find a new partner. However, little research has concurrently investigated the consequences of repartnering and favorable personal attributes on life satisfaction of middle- and older-aged people, especially not beyond the initial recovery period. Our data stem from a three-wave longitudinal questionnaire study including 199 participants after a separation, all single at the beginning of the study. Latent growth modeling was applied to investigate trajectories of life satisfaction, examining the role of a new intimate partnership, while controlling for trait resilience. Trait resilience represented a strong general predictor for inter-individual differences in the initial level of life satisfaction. However, an increase in life satisfaction over time was only observed in the group of participants who engaged in a new partnership. This increase occurred independently of preexisting differences in beneficial characteristics, such as high levels of trait resilience or life satisfaction. Thus, repartnering is associated with improvement of life satisfaction beyond the first adaptation phase after separation and is therefore important to prevent long-term negative consequences.

The superiority of early interventions for children with autism spectrum disorders (ASDs) compared to treatment as usual (TAU) has recently been questioned. This study was aimed to investigate the efficacy of early interventions in improving the cognitive ability, language, and adaptive behavior of pre-school children with ASDs through a systematic review of randomized controlled trials (RCTs). In total, 33 RCTs were included in the meta-analysis using the random effects model. The total sample consisted of 2581 children (age range: 12-132 months). Early interventions led to positive outcomes for cognitive ability (

Zusammenfassung. Theoretischer Hintergrund: Störungen der Emotionsverarbeitung gelten als transdiagnostisches Merkmal psychischer Probleme. Mit dem Modell „Emotionale Offenheit“ liegt ein Konzept vor, das therapierelevante Komponenten der Emotionsverarbeitung operationalisiert und mit Hilfe eines validierten Instruments (Dimensionen der Offenheit für Emotionen, DOE) erfasst. Fragestellung: Untersucht wird, ob bei depressiven Symptomen problematische Muster im DOE aufscheinen, sich diese in einer Psychotherapie verändern und mit einer Verringerung der Symptome verbunden sind. Methode: DOE und Symptombelastung wurden in einer klinischen Feldstudie erhoben. Mittels Prä-Post-Vergleichen und multiplen Regressionsanalysen wurden Zusammenhänge untersucht. Ergebnisse: Die erfassten Dimensionen der Emotionsverarbeitung waren mit den Symptomindikatoren assoziiert. Die ambulante psychotherapeutische Behandlung ging mit einer Zunahme der Repräsentation, Kommunikation und Regulation von Emotionen sowie mit einer Verringerung der Wahrnehmung körperlicher Emotionsindikatoren einher. Dieses Verlaufsmuster war mit einer Reduktion der depressiven Symptome verknüpft. Schlussfolgerungen: Die Untersuchung von Problemen der Emotionsverarbeitung über verschiedene Modelle hinaus kann zur Entwicklung personalisierter, transdiagnostischer psychotherapeutischer Strategien beitragen.

Elevated levels of C-reactive protein (CRP) are associated with both an increased risk of cardiovascular disease (CVD) and depression. We aimed to test the hypothesis that a self-report history of depression is associated with a smaller decrease in CRP levels from hospital admission to 3-month follow-up in patients with acute myocardial infarction (MI).We assessed 183 patients (median age 59 years; 84% men) with verified MI for a self-report history of lifetime depression and plasma CRP levels within 48 h of an acute coronary intervention and again for CRP levels at three months. CRP values were categorized according to their potential to predict CVD risk at hospital admission (acute inflammatory response: 0 tolt;5 mg/L, 5 tolt;10 mg/L, 10 tolt;20 mg/L, and ≥20 mg/L) and at 3 months (low-grade inflammation: 0 tolt;1 mg/L, 1 tolt;3 mg/L, and ≥3 mg/L). Additionally, in a subsample of 84 patients showing admission CRP levels below 20 mg/L, changes in continuous CRP values over time were also analyzed.After adjustment for a range of potentially important covariates, depression history showed a significant association with a smaller decrease in both CRP risk categories (r = 0.261,Self-reported history of depression may be associated with persistently elevated systemic inflammation three months after MI. This finding warrants studies to test whether lowering of inflammation in patients with an acute MI and a history of depression may improve prognosis.

A one-size-fits-all approach might explain why early psychological interventions are largely ineffective in preventing the development of posttraumatic stress disorder (PTSD) symptoms triggered by acute medical events. We examined the hypothesis that social and health care resources are moderators of an intervention effect.Within 48 h of hospital admission, 129 patients (mean age 58 years, 83% men) with acute coronary syndrome (ACS) self-rated their social support and were randomized to one single session of trauma-focused counseling (TFC) or stress-focused counseling (SFC) (active control intervention). Clinician-rated PTSD symptoms, use of cardiac rehabilitation (CR) and use of psychotherapy were assessed at 3 and 12 months. Random mixed regression multivariable models were used to analyze associations with PTSD symptoms over time.TFC did not prevent ACS-induced PTSD symptom onset better than SFC; yet, there were significant and independent interactions between "intervention" (TFC or SFC) and social support (Early psychological intervention after ACS with a trauma-focused approach to prevent the development of PTSD symptoms may be beneficial for patients who perceive high social support or participate in CR for several weeks.

After acute coronary syndrome (ACS), one in eight patients develops clinically significant symptoms of Post-traumatic stress disorder (PTSD). We hypothesized that changes in cardiac symptoms from 3 to 12 months after ACS are associated with changes in ACS-induced PTSD symptoms.At 3 (The onset of chest tightness/pain [estimate = 0.588, 95% confidence interval: 0.275, 0.090;Changes in cardiac symptoms between 3 and 12 months after hospitalization are associated with changes in ACS-induced PTSD symptoms. ClinicalTrials.gov #NCT01781247.

Psychiatric patients are particularly vulnerable to strong weather stimuli, such as foehn, a hot wind that occurs in the alps. However, there is a dearth of research regarding its impact on mental health. This study investigated the impact of foehn wind among patients of a psychiatric hospital located in a foehn area in the Swiss Alps. Analysis was based on anonymized datasets obtained from routine records on admission and discharge, including the Brief Symptom Checklist (BSCL) questionnaire, as well as sociodemographic parameters (age, sex, and diagnosis). Between 2013 and 2020 a total of 10,456 admission days and 10,575 discharge days were recorded. All meteorological data were extracted from the database of the Federal Office of Meteorology and Climatology of Switzerland. We estimated the effect of foehn on the BSCL items using a distributed lag model. Significant differences were found between foehn and non-foehn admissions in obsession-compulsion, Interpersonal Sensitivity, depression, Anxiety, Phobic Anxiety, Paranoid Ideation, and General Severity Index (GSI) (p

Psychological consequences of myocardial infarction (MI) are substantial, as 4% of all MI patients develop posttraumatic stress disorder (PTSD) and 12% clinically relevant posttraumatic stress symptoms (PTSS). The study investigated the course and development within 12 months of MI-induced PTSS to gain novel insights in potentially delayed response to early trauma-focused counseling aimed at preventing the incidence of MI-induced PTSS.In the MI-SPRINT two-group randomized controlled trial, 190 MI-patients were randomly allocated to receive a single-session intervention of either trauma-focused counseling or an active control intervention targeting the general role of stress in patients with heart disease. Blind interviewer-rated PTSS (primary outcome) and additional health outcomes were assessed at 12-month follow-up.12-month follow-up of outcomes were available for 106 (55.8%) of 190 participants: In the entire sample, one patient (0·5%, 1/190) who received trauma-focused counseling developed full PTSD. There was no significant difference between trauma-focused counseling and stress counseling regarding total score of interviewer-rated PTSS (No benefits were found for trauma-focused counseling after 12 months when compared with an active control intervention. PTSD prevalence in the present study was low highlighting a potential beneficial effect of both interventions. Further studies are needed to determine the most accurate approach of counseling.

First evidence suggests that internet-based self-help interventions effectively reduce COVID-19 related psychological distress. However, it is yet unclear which participant characteristics are associated with better treatment outcomes. Therefore, we conducted secondary analyses on data from a randomized controlled trial investigating the efficacy of a 3-week internet-based self-help intervention for COVID-19 related psychological distress. In this exploratory analysis, we examined several predictors ranging from sociodemographic variables to psychological distress, resource-related, and treatment-related variables. This includes, for example, age, motivation, and emotion regulation skills. Treatment outcomes were defined as post-treatment depressive symptoms and post-treatment resilience.In a total of 107 participants with at least mild depressive symptoms, possible predictor variables and treatment outcomes were assessed using self-report measures. For example, emotion regulation skills were assessed by the Self-report measure for the assessment of emotion regulation skills. In a first step, we performed a separate linear regression analysis for each potential predictor. In a second step, predictors meeting a significant threshold ofThe mean age of the participants was 40.36 years (SD = 14.59, range = 18-81 years) with the majority being female (The current study provides preliminary evidence regarding the relationship between participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related distress. Our results suggest that under the circumstances surrounding COVID-19 such interventions might be particularly beneficial for young adults regarding depressive symptoms. Moreover, focusing on participants' existing strengths might be a promising approach to promote resilience through internet-based self-help interventions. However, since this was an exploratory analysis in an uncontrolled setting, further studies are needed to draw firm conclusions about the relationship of participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related psychological distress.

Objectives: There is an ongoing debate as to whether job burnout and depression are over- lapping concepts or differ from each other, although this has not been scrutinized in in- patients. To further elucidate the robustness of this relationship, we used three different measurements of depression. We further examined the influence of psychological distress, perceived stress and sleep quality in the link between depressive symptoms and burnout. Methods: We investigated 723 consecutive inpatients, aged 23 to 82 years, 51.2% women, referred to a hospital specialized in the treatment of job stress-related disorders. Patients completed the Maslach Burnout Inventory, the Beck Depression Inventory, the Hospital Anxiety and Depression Scale, the Brief Symptom Inventory, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index. Results: We found significant correlations between burnout total scores as well as subscales (emotional exhaustion, depersonalization, lack of accomplishment) and depressive symp- toms, virtually independent of the applied depression measure. The shared variance ranged between 1.1 % and 19.4 %. Greater levels of burnout were directly associated with cognitive- affective symptoms and, although to a lesser extent, also with somatic-affective symptoms of depression. In the multivariable analysis, significantly more total burnout symptoms were revealed in more depressed and younger patients, in men than women, and in employ- ees with greater levels of psychological distress and perceived stress, respectively. Conclusions: The findings suggest that although burnout and depression do not represent the same psychopathology, there is considerable overlap between the two constructs; the extent of this overlap may vary depending upon the applied depression measure., Fragestellung: Es wird laufend diskutiert, ob Burnout und Depression sich überlappende Konstrukte sind oder sich von einander unterscheiden. Der Zusammenhang wurde zudem noch nicht bei stationären Patienten untersucht. Um die Robustheit der Beziehung weiter zu klären, wurden in der vorliegenden Untersuchung drei verschiedene Depressionsmessinstrumente verwendet. Es wurde der Einfluss von psychischem Distress, wahrgenommenem Stress und Schlafqualität auf die Beziehung von depressiven Symptomen und Burnout untersucht Methode: Untersucht wurden 723 konsekutive Patienten zwischen 23 und 82 Jahren, 51.2 % Frauen, welche in einer auf Stressfolgeerkrankungen spezialisierten Klinik hospitalisiert waren. Die Patienten beantworteten das Maslach Burnout Inventory, das Beck Depressions Inventory, die Hospital Anxiety und Depression Scale, das Brief Symptom Inventory, die Perceived Stress Scale und den Pittsburh Sleep Quality Index. Ergebnisse: Sowohl der Burnout Gesamtwert als auch die Subskalen (Emotionale Erschöpfung, Depersonalisation, Reduzierte Selbstwirksamkeit) korrelierten signifikant mit depressiven Symptomen, quasi unabhängig von verwendeten Depressionsmessinstrumenten. Die gemeinsame Varianz variierte zwischen 1.1 % und 19.4 %. Ein schwereres Burnout war direkt mit kognitiv-affektiven und, wenn auch in geringerem Ausmass, mit somatisch-affektiven Symptomen einer Depression verbunden. In der multivariablen Analyse zeigten sich deutlich mehr Burnout-Symptome bei depressiveren und jüngeren Patienten, bei Männern als bei Frauen und bei Mitarbeitern mit höherem psychischen Distress und wahrgenommenem Stress. Schlussfolgerung: Obwohl Burnout und Depression nicht die gleiche Psychopathologie darstellen, deuten die Ergebnisse auf eine beträchtliche Überschneidung zwischen den beiden Konstrukten hin; das Ausmass dieser Überlappung kann je nach angewandten Depressionsmessinstrument variieren.

Background Benzodiazepines and morphine are given during acute coronary syndromes (ACSs) to alleviate anxiety and pain, and β‐blockers may also reduce pain. ACS may induce posttraumatic stress disorder (PTSD) symptoms (PTSS). When taken during trauma other than ACS, benzodiazepines increase the risk of PTSS, but it is unknown if benzodiazepines increase the risk of PTSS in ACS. We examined the effects of drug exposure during ACS on the development of PTSS. Methods and Results Study participants were 154 patients with a verified ACS. Baseline demographics, clinical variables, and psychological measures were obtained through a medical history, through a psychometric assessment, and from patient records, and used as covariates in linear regression analysis. Three months after ACS, the severity of PTSS was assessed with the Clinician‐Administered PTSD Scale. During ACS, 37.7% of patients were exposed to benzodiazepines, whereas 72.1% were exposed to morphine and 88.3% were exposed to β‐blockers, but only 7.1% were exposed to antidepressants. Eighteen (11.7%) patients developed clinical PTSD. Adjusting for all covariates, benzodiazepine use was significantly associated with the Clinician‐Administered PTSD Scale total severity score (unstandardized coefficient B [SE], 0.589 [0.274]; partial r=0.18; P=0.032) and the reexperiencing subscore (B [SE], 0.433 [0.217]; partial r=0.17; P=0.047). Patients exposed to benzodiazepines had an almost 4‐fold increased relative risk of developing clinical PTSD, adjusting for acute stress disorder symptoms (odds ratio, 3.75; 95% CI, 1.31–10.77). Morphine, β‐blockers, and antidepressants showed no predictive value. Conclusions Notwithstanding short‐term antianxiety effects during ACS, benzodiazepine use might increase the risk of ACS‐induced PTSS with clinical significance, thereby compromising patients' quality of life and prognosis. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01781247.

To investigate the efficacy of a tailored counselling intervention for injured workers regarding different aspects of subjective well-being. Prospective randomized controlled trial with 192 mildly-to-moderately injured workers who were on sick leave for at least 18 weeks and showed a high-risk profile for a complicated rehabilitation process in a screening. Patients were assessed at baseline, 12 and 18 months post-injury. The outcome variables concerned five aspects of subjective well-being (negative feelings, life and job satisfaction, satisfaction related to family and health). Both the control and the experimental group received conventional case management. Participants in the intervention group additionally received tailored workplace interventions and/or mental health counselling sessions. Participants in the intervention group received an average of 2.23 (SD = 6.94) counselling sessions. Both groups showed a significant reduction (mean (95% CI) of negative feelings control group 2.6 (2.3–3.4), intervention group 2.4 (1.6–3.4)), with a significant difference in negative feelings between the groups (p = 0.01). Our results suggest that a tailored counselling intervention has a modest long-term effect (d = 0.74) on negative feelings for mildly-to-moderately injured workers. However, future studies should evaluate the feasibility of this study’s treatment approach.Implications for rehabilitationAccidents and the resulting injuries often cause a wide range of burdens including psychosocial and emotional distress as well as long-time sick leaves.Tailored counselling led to significant reductions of negative feelings in mildly-to-moderately injured workers over time.By showing that even conventional case management can have a beneficial effect on subjective wellbeing, the results of this study reaffirm the holistic biopsychosocial nature of injury rehabilitation. Accidents and the resulting injuries often cause a wide range of burdens including psychosocial and emotional distress as well as long-time sick leaves. Tailored counselling led to significant reductions of negative feelings in mildly-to-moderately injured workers over time. By showing that even conventional case management can have a beneficial effect on subjective wellbeing, the results of this study reaffirm the holistic biopsychosocial nature of injury rehabilitation.

BackgroundRefugees and asylum seekers are frequently exposed to violence, human rights violations and unstable living conditions before, during, and after their displacement. Elevated prevalence rates of psychiatric disorders in forcibly displaced persons are well documented. However, less is known about other problems related to common refugee experiences, such as embitterment, moral injury, and diminished self-efficacy, and how they are related to trauma exposure and post-migration living difficulties.MethodsA cross-sectional sample of 71 refugees and asylum seekers in treatment were examined regarding exposure to potentially traumatic events, post-migration living difficulties, moral injury appraisals, self-efficacy, and embitterment.ResultsElevated levels of embitterment were reported by 68% of participants. The regression analysis revealed that greater moral injury appraisals and low levels of self-efficacy were significantly associated with higher levels of embitterment.ConclusionThe results provide first insights into embitterment and associated factors in refugee populations. Furthermore, they highlight the significance of moral transgressions and low levels of self-efficacy emerging from displacement and traumatic experiences for the development of mental health problems in a clinical sample of refugees. The findings have implications for future research, policy development and clinical practice.

Acute coronary syndromes (ACS) induce post-traumatic stress symptoms (PTSS) in one out of eight patients. Effects of preventive interventions, the course and potential moderators of ACS-induced PTSS are vastly understudied. This study explored whether a preventive behavioral intervention leads to a decrease in myocardial infarction (MI)-induced PTSS between two follow-up assessments. Sociodemographic, clinical and psychological factors were additionally tested as both moderators of change over time in PTSS and predictors of PTSS across two follow-ups. Within 48 h after reaching stable circulatory conditions, 104 patients with MI were randomized to a 45-min one-session intervention of either trauma-focused counseling or stress counseling (active control). Sociodemographic, clinical, and psychological data were collected at baseline, and PTSS were assessed with the Clinician-Administered Post-traumatic Stress Disorder Scale 3 and 12 months post-MI. PTSS severity showed no change over time from 3 to 12 months post-MI, either in all patients or through the intervention [mean group difference for total PTSS = 1.6 (95% CI −1.8, 4.9), re-experiencing symptoms = 0.8 (95% CI −0.7, 2.2), avoidance/numbing symptoms = 0.1 (95% CI −1.6, 1.7) and hyperarousal symptoms = 0.6 (95% CI −0.9, 2.1)]. Patients receiving one preventive session of trauma-focused counseling showed a decrease from 3 to 12 months post-MI in avoidance symptoms with higher age (p = 0.011) and direct associations of clinical burden indices with total PTSS across both follow-ups (p's ≤ 0.043; interaction effects). Regardless of the intervention, decreases in re-experiencing, avoidance and hyperarousal symptoms from 3 to 12 months post-MI occurred, respectively, in men (p = 0.006), participants with low education (p = 0.014) and with more acute stress symptoms (p = 0.021). Peritraumatic distress (p = 0.004) and lifetime depression (p = 0.038) predicted total PTSS across both follow-ups. We conclude that PTSS were persistent in the first year after MI and not prevented by an early one-session intervention. A preventive one-session intervention of trauma-focused counseling may be inappropriate for certain subgroups of patients, although this observation needs confirmation. As predictors of the development and persistence of PTSS, sociodemographic and psychological factors could help to identify high-risk patients yet at hospital admission.

Der Verlust einer nahestehenden Person lost eine ganze Folge von Symptomen aus, die je nach Kultur und Kontext unterschiedlich gedeutet werden. Die Trauer ist die naturliche Folge der endgultigen Trennung von einer eng verbundenen Person. Die Forschung hat fur diverse Vorstellungen und Mythen, die mit der Trauer assoziiert werden, wenig Evidenz gefunden. Andererseits gibt es Faktoren, die eine akute Trauer chronifizieren lassen. Nur im Fall einer solchen persistierenden Trauer ist eine therapeutische Intervention indiziert.

BACKGROUND: Acute coronary syndrome (ACS) may cause clinically relevant posttraumatic stress disorder symptoms (PTSS). An inflammatory state might be one mechanism linking PTSS with poor prognosis after ACS. We tested the hypothesis that a change in C-reactive protein (CRP) between hospital admission and 3-month follow-up is an independent predictor of ACS-triggered PTSS. METHODS: We assessed 183 patients (median age 59 years; 84% men) with verified myocardial infarction (MI) within 48 h of an acute coronary intervention and three months post-MI for self-rated PTSS. 14 (7.7%) patients fulfilled definition criteria for PTSS caseness. CRP values were categorized according to the predicted risk of cardiovascular disease (CVD) at hospital admission (acute inflammatory response): 0 to

Abstract. Aim: In the research and treatment of Substance Use Disorders (SUDs), craving for alcohol, nicotine, and drugs is an important concept associated with addictive processes, including relapse after treatment. The 12-item Mannheimer Craving Scale (MaCS) has been proved to be an economic, reliable, and valid self-rating instrument across several substances in German samples. The aim of this study was to examine its psychometric characteristics in a Swiss German sample. Method: Overall, 166 patients were recruited from an inpatient SUD treatment program at the University Hospital of Psychiatry in Bern, Switzerland. Results: The internal consistency was high and the test-retest reliability was satisfactory. The total scale and three specific analogue craving measures were highly correlated. Principal component analysis extracted two factors, explaining 62 % of the total variance, and these factors were confirmed through confirmatory factor analysis. However, the two factors correlated highly, and several items loaded on both factors, so that the factor structure was inconclusive. Conclusions: The psychometric characteristics of the MaCS in a Swiss German sample are as good as those characteristics of the German version, suggesting that it is a valid and reliable measure. The MaCS factor structure must be examined on a larger sample that integrates a broader range of SUDs and their severities.

Background: Acute coronary syndrome (ACS)-induced posttraumatic stress disorder (PTSD) and clinically significant PTSD symptoms (PTSS) are found in 4 and 12% of patients, respectively. We hypothesized that trauma-focused counseling prevents the incidence of ACS-induced PTSS. Methods: Within 48 h of hospital admission, 190 patients with high distress during ACS were randomized to a single-session intervention of either trauma-focused counseling or an active control intervention targeting the general role of stress in patients with heart disease. Blind interviewer-rated PTSS (primary outcome) and additional health outcomes were assessed at 3 months of follow-up. Trial results about prevalence were compared with data from previous studies on the natural incidence of ACS-induced PTSS/PTSD. Results: Intention-to-treat analyses revealed no difference in interviewer-rated PTSS between trauma-focused counseling (mean, 11.33; 95% Cl, 9.23-13.43) and stress counseling (9.88; 7.36-12.40; p = 0.40), depressive symptoms (6.01, 4.98-7.03, vs. 4.71, 3.65-5.77; p = 0.08), global psychological distress (5.15, 4.07-6.23, vs. 3.80, 2.60-5.00; p = 0.11), and the risk for cardiovascular-related hospitalization/all-cause mortality (OR, 0.67; 95% CI, 0.37-1.23). Self-rated PTSS indicated less beneficial effects with trauma-focused (6.54; 4.95-8.14) versus stress counseling (3.74; 2.39-5.08; p = 0.017). The completer analysis (154 cases) confirmed these findings. The prevalence rates of interviewer-rated PTSD (0.5%, 1/190) and self-rated PTSS were in this trial much lower than in meta-analyses and observation studies from the same cardiology department. Conclusions: Benefits were not seen for trauma-focused counseling when compared with an active control intervention. Nonetheless, in distressed ACS patients, individual, single-session, early psychological counseling shows potential as a means to prevent posttraumatic responses, but trauma-focused early treatments should probably be avoided.

Self-rated health (SRH) is independently associated with all-cause mortality and adverse cardiovascular outcomes in individuals with and without cardiovascular disease. We examined whether SRH relates to haemostatic factors of a hypercoagulable state with prognostic impact in patients admitted with acute myocardial infarction (MI). We assessed 190 patients (median age: 59 years; all Caucasian; 83% men) within 48 hours of an acute coronary intervention in terms of demographic factors, medical and psychiatric comorbidity, health behaviours, cardiac-related variables and psychosocial characteristics. Patients rated their health state before MI retrospectively with the EuroQol Visual Analogue Scale ranging from 0 (‘worst imaginable health state’) to 100 (‘best imaginable health state’). Circulating levels of fibrinogen, fibrin D-dimer and von Willebrand factor (VWF) antigen were measured the morning after hospital referral. The median score of SRH was 75 (range: 20–100). SRH was inversely associated with fibrinogen (r = − 0.25, p = 0.001) and D-dimer (r = − 0.17, p = 0.021) levels in the bivariate analysis. Stronger relationships emerged for fibrinogen (r = − 0.33, p

Bei der Verarbeitung kritischer Lebensereignisse kommt der Regulation eigener Emotionen und der Emotion anderer Betroffener eine wichtige Funktion zu. Dies betrifft besonders auch das psychische Befinden nach dem Tod der Lebenspartnerin, resp. des Lebenspartners. Die Intensitat der Trauerreaktion wird stark von der Beziehung zur verstorbenen Person gepragt und kann zu kurz- oder langfristiger emotionaler und somatischer Dysregulation fuhren. Dauert dieser Zustand langer an, kann die Diagnose «anhaltende komplexe Trauerreaktion» vergeben werden. Die Forschung zeigt, dass ein solcher Zustand selten eintritt, haufiger zeigt sich, dass betroffene Person sich durchaus an die veranderte Situation anpassen konnen. Dabei spielt die Emotionsregulation eine wichtige Rolle. Sie fokussiert auf funf Bereiche, a) die Intensitat der Reaktion, b) der Dauer und c) Frequenz intrusiver Erlebnisse, auf d) unerwunschte Gefuhle und e) auf Aufmerksamkeitsprozesse. Aus transdiagnostischer Perspektive kann die anhaltende komplexe Trauerstorung wie eine Angststorung betrachtet werden, insofern Vermeidungsstrategien zur Aufrechterhaltung des problematischen Zustands beitragen und damit eine erfolgreiche Anpassung verhindern.

Objective: Pain and inflammation during acute myocardial infarction (AMI) have been associated with the development of posttraumatic stress disorder and may also impact negatively on somatic outcome. We investigated the relationship between pain during AMI and levels of circulating proinflammatory (tumor necrosis factor [TNF]-α, interleukin [IL]-6) and anti-inflammatory (IL-33 and tissue growth factor [TGF]-β1) cytokines. Methods: Data were collected as part of the Myocardial Infarction - Stress Prevention Intervention (MI-SPRINT) study. We included 140 patients (mean age 59.6 years, 82.1% male) with high acute psychological distress within 48 h after MI. Fasting blood samples were drawn thereafter to measure cytokine levels. Sociodemographic factors, psychological and medical data, as well as cardiometabolic markers were assessed with questionnaires and patient interviews. Results: Linear regression models showed a significant positive correlation of pain with TGF-β1 (b = 770.91, p = 0.031) and a significant inverse correlation of pain with IL-33 (b = -0.11, p = 0.015) after controlling for age, gender, body mass index, lifetime depression, acute stress disorder symptoms, and the prognostic Global Registry of Acute Coronary Events (GRACE) score. Pain was not associated with IL-6 but with the GRACE score (b = 0.01, p = 0.003). Pain showed no significant association with TNF-α. Conclusion: Pain during MI was associated with anti- but not proinflammatory cytokines. As IL-33 has been shown to be cardioprotective, lower IL-33 levels with more intense pain may suggest a pathway through which increased pain during MI may have an impact on the medical prognosis.

Abstract. There is a growing interest in embitterment as psychological concept. However, little systematic research has been conducted to characterize this emotional reaction. Still, there is an ongoing debate about the distinctiveness of embitterment and its dimensions. Additionally, a categorical and a dimensional perspective on embitterment have been developed independently over the last decade. The present study investigates the dimensions of embitterment by bringing these two different approaches together, for the first time. The Bern Embitterment Inventory (BEI) was given to 49 patients diagnosed with “Posttraumatic Embitterment Disorder (PTED)” and a matched control group of 49 patients with psychological disorders with other dominant emotional dysregulations. The ability to discriminate between the two groups was assessed by t-tests and Receiver Operating Characteristic Curves (ROC curve analysis). PTED patients scored significantly higher on the BEI than the patients of the control group. ROC analyses indicated diagnostic accuracy of the inventory. Further, we conducted Confirmatory Factor Analyses (CFA) to examine the different dimensions of embitterment and their relations. As a result, we found four characteristic dimensions of embitterment, namely disappointment, lack of acknowledge, pessimism, and misanthropy. In general, our findings showed a common understanding of embitterment as a unique but multidimensional emotional reaction to distressful life-events.

Purpose: The relationship between burnout and depression has been a major focus of burnout research, but personality factors might be equally important. Largely based on theoretical grounds, narcissism has repeatedly been proposed to contribute to burnout. Objective: The aim of this study was to examine empirically the relationship between burnout and narcissism. Methods: We investigated 723 consecutive in-patients, aged between 22 and 80 years (51.2% female), at a hospital specialized in the treatment of job stress-related disorders. Patients completed the 22-item Maslach Burnout Inventory and the 20-item Narcissism Inventory, the Beck Depression Inventory, the Pittsburgh Sleep Quality Index and the Perceived Stress Scale. Results: After controlling for sociodemographic factors, depressive symptoms, sleep quality, and perceived stress, narcissism explained 3.5% of the total burnout score (p

OBJECTIVE Acute myocardial infarction (MI) is a life-threatening condition, leading to immediate fear and distress in many patients. Approximately 18% of patients develop posttraumatic stress disorder in the aftermath of MI. Trait resilience has shown to be a protective factor for the development of posttraumatic stress disorder. However, whether this buffering effect has already an impact on peritraumatic distress and applies to patients with MI is elusive. METHODS We investigated 98 consecutive patients with acute MI within 48 hours after having reached stable circulatory conditions and 3 months thereafter. Peritraumatic distress was assessed retrospectively with three single-item questions about pain, fear, and helplessness during MI. All patients completed the Posttraumatic Diagnostic Scale (PDS) and the Resilience Scale to self-rate posttraumatic stress and trait resilience. RESULTS Multivariate models adjusting for sociodemographic and medical factors showed that trait resilience was not associated with peritraumatic distress, but significantly so with posttraumatic stress. Patients with greater trait resilience showed lower PDS scores (b = -0.06, p < .001). There was no significant relationship between peritraumatic distress scores and PDS scores; resilience did not emerge as a moderator of this relationship. CONCLUSIONS The findings suggest that trait resilience does not buffer the perception of acute MI as stressful per se but may enhance better coping with the traumatic experience in the longer term, thus preventing the development of MI-associated posttraumatic stress. Trait resilience may play an important role in posttraumatic stress symptoms triggered by medical diseases such as acute MI.

It was previously shown that forensic outpatient psychiatric treatment lowers recidivism and improves mental health. However, there is no data specifically from Switzerland, a fact that has been repeatedly criticized by local policymakers in the course of healthcare planning. The present study aimed to describe two groups of mentally ill offenders referred to a Swiss forensic outpatient clinic, namely those accepted for treatment and those who were left untreated because their treatment was rejected. The recidivism rates of the two groups were then compared, to determine whether differences in recidivism rates between the two groups might be related to socio-demographic characteristics and mental health. Finally, improvements regarding general functional level and severity of psychopathology were evaluated over the course of time. A total of n = 131 mentally ill offenders were studied. After an average time at risk of 42.6 months, our preliminary results show that 18% of those accepted for treatment relapsed into delinquent activities, while 38% of the rejected offenders did so. We found no sociodemographic variable that differentiated between reoffenders in the two samples. Likewise, the prevalence of personality disorders was similar in the two groups. Regarding comorbidity, the combination of any substance abuse disorder and any personality disorder was more prevalent in the treated sample. Over the course of therapy, the treated group showed improvements regarding their general functional level and the severity of their psychopathology. This is the first study to explore the effects of therapeutic outpatient treatment of mentally ill offenders on Swiss recidivism rates.

Background: The aim of this study was to investigate the relationship between illness perception and posttraumatic stress disorder (PTSD) symptoms at three months following acute myocardial infarction (MI). Methods: Patients (n = 96) were examined within 48 h and 3 months after the illness episode. The brief revised illness perception questionnaire (Brief-IPQ) was used to assess patients' cognitive representation of their MI. At 3-month follow-up, the Posttraumatic Diagnostic Scale (PDS) and the Clinician-Administered PTSD Scale (CAPS) were used to assess the level of PTSD symptoms. Results: The subjective perception of the illness, including higher harmful consequences (r > 0.35, p < 0.01), higher illness concerns (r > 0.24, p < 0.05) and more emotional impairment (r > 0.23, p < 0.05), was associated with both self-rated and clinician-rated PTSD symptoms. Beliefs regarding harmful consequences after acute MI were independently associated with levels of PTSD symptoms assessed with both the self-rated PDS and CAPS interview (standardized beta coefficient = 0.24; P < 0.05) adjusted for demographic factors, cognitive depressive symptoms, fear of dying during MI, factors related to study design, and illness severity. Conclusions: The findings suggest that initial perception of acute MI is significantly associated with PTSD symptoms attributable to MI at 3 months follow-up.

Independent of traditional risk factors, psychosocial risk factors increase the risk of cardiovascular disease (CVD). Studies in the field of psychotherapy have shown that the construct of incongruence (meaning a discrepancy between desired and achieved goals) affects the outcome of therapy. We prospectively measured the impact of incongruence in patients after undergoing a cardiac rehabilitation program. We examined 198 CVD patients enrolled in a 8-12 week comprehensive cardiac rehabilitation program. Patients completed the German short version of the Incongruence Questionnaire and the SF-36 Health Questionnaire to measure quality of life (QoL) at discharge of rehabilitation. Endpoints at follow-up were CVD-related hospitalizations plus all-cause mortality. During a mean follow-up period of 54.3 months, 29 patients experienced a CVD-related hospitalization and 3 patients died. Incongruence at discharge of rehabilitation was independent of traditional risk factors a significant predictor for CVD-related hospitalizations plus all-cause mortality (HR 2.03, 95% CI 1.29-3.20, p = .002). We also found a significant interaction of incongruence with mental QoL (HR .96, 95% CI .92-.99, p = .027), i.e. incongruence predicted poor prognosis if QoL was low (p = .017), but not if QoL was high (p = .74). Incongruence at discharge predicted future CVD-related hospitalizations plus all-cause mortality and mental QoL moderated this relationship. Therefore, incongruence should be considered for effective treatment planning and outcome measurement.

Background Myocardial infarction-triggered acute stress disorder (ASD) and subclinical inflammation associate with the development of posttraumatic stress disorder, and worsen the prognosis of myocardial infarction patients. We examined the relationship between ASD severity and C-reactive protein levels in patients with acute myocardial infarction. Methods We assessed 190 patients (median age 59 years; 83% men) with a verified myocardial infarction within 48 h of an acute coronary intervention. Circulating levels of C-reactive protein were categorized according to their prognostic risk for cardiovascular disease: 0 to Results The ASDS sum score was positively associated with C-reactive protein categories in the bivariate analysis ( r = 0.20, p Conclusions Higher levels of myocardial infarction-triggered ASD symptoms associate with a greater inflammatory response in patients with acute myocardial infarction independently of important covariates. The findings suggest a link between myocardial infarction-triggered ASD symptoms and a heightened acute phase response with a potential impact on cardiovascular disease prognosis.

Despite a long-standing need for patient-focused research on individuals with generalized anxiety disorder, there is little systematized knowledge about the in-session behaviors of these patients. The primary objective of this study was to describe the timing of expression of negative emotionality (level of explication) and the patients' focus on their own resources and how these indicators are associated with posttreatment outcome. Trained coders made minute-by-minute ratings of 1,100 min of video of 20 patient-therapist dialogues during Session 5. The results indicated that a higher level of explication generally observed at a later stage during the therapy sessions and the patients' focus on competencies (usually observed at an early stage) were positively associated with treatment outcome, independent of pretreatment distress, rapid response of well-being and symptom reduction, as well as the therapists' professional experience and treatment duration. However, positive reinterpretations and mentions of personal goals were negatively associated with outcome. If replicated, these results will highlight the importance of the in-session beginning phase in patients with generalized anxiety disorder.

Objective: Processes occurring in the course of psychotherapy are characterized by the simple fact that they unfold in time and that the multiple factors engaged in change processes vary highly between individuals (idiographic phenomena). Previous research, however, has neglected the temporal perspective by its traditional focus on static phenomena, which were mainly assessed at the group level (nomothetic phenomena). To support a temporal approach, the authors introduce time-series panel analysis (TSPA), a statistical methodology explicitly focusing on the quantification of temporal, session-to-session aspects of change in psychotherapy. TSPA-models are initially built at the level of individuals and are subsequently aggregated at the group level, thus allowing the exploration of prototypical models. Method: TSPA is based on vector auto-regression (VAR), an extension of univariate auto-regression models to multivariate time-series data. The application of TSPA is demonstrated in a sample of 87 outpatient psychotherapy patients who were monitored by postsession questionnaires. Prototypical mechanisms of change were derived from the aggregation of individual multivariate models of psychotherapy process. In a 2nd step, the associations between mechanisms of change (TSPA) and pre- to postsymptom change were explored. Results: TSPA allowed a prototypical process pattern to be identified, where patient's alliance and self-efficacy were linked by a temporal feedback-loop. Furthermore, therapist's stability over time in both mastery and clarification interventions was positively associated with better outcomes. Conclusions: TSPA is a statistical tool that sheds new light on temporal mechanisms of change. Through this approach, clinicians may gain insight into prototypical patterns of change in psychotherapy.

Der Beitrag untersucht Zusammenhänge zwischen sozialer Unterstützung und Suizidalität bei 615 homo- und bisexuellen Personen in der Schweiz. In einer Internetumfrage wurden dazu Suizidgedanken, Suizidpläne und Suizidversuche, sowie diverse Aspekte sozialer Unterstützung und die soziale Belastung erfragt. Obwohl homo- und bisexuelle Personen hohe Werte sozialer Unterstützung und niedrige Werte sozialer Belastung aufwiesen, zeigten sich hohe 12-Monats- und Lebenszeitprävalenzen bezüglich Suizidgedanken, -plänen und -versuchen. Alle Aspekte sozialer Unterstützung waren mit der Suizidalität in den letzten zwölf Monaten assoziiert, wobei die Zusammenhänge mit der sozialen Integration (r = -.34) und der sozialen Belastung (r = .39) am stärksten ausfielen. Selbst bei Kontrolle der depressiven Stimmung und des Alters teilnehmender Personen blieben die soziale Unterstützung (OR = .61) und die soziale Belastung (OR = 2.13) prädiktiv für die Suizidalität in den letzten zwölf Monaten. Personen, die viel soziale Unterstützung wahrnahmen (> 1 SD über dem Mittelwert) berichteten fünfmal weniger Suizidalität als solche mit geringer sozialer Unterstützung (> 1 SD unter dem Mittelwert). Personen, die viel soziale Belastung in ihrem Umfeld wahrnahmen (> 1 SD über dem Mittelwert), zeigten im vergangenen Jahr 14-mal häufiger Suizidalität als Personen, die geringe soziale Belastung erlebten (> 1 SD unter dem Mittelwert).

Emerging adulthood is a time of instability. This longitudinal study investigated the relationship between mental health and need satisfaction among emerging adults over a period of five years and focused on gender-specific differences. Two possible causal models were examined: (1) the mental health model, which predicts that incongruence is due to the presence of impaired mental health at an earlier point in time; (2) the consistency model, which predicts that impaired mental health is due to a higher level of incongruence reported at an earlier point in time. Emerging adults (N = 1,017) aged 18–24 completed computer-assisted telephone interviews in 2003 (T1), 2005 (T2), and 2008 (T3). The results indicate that better mental health at T1 predicts a lower level of incongruence two years later (T2), when prior level of incongruence is controlled for. The same cross-lagged effect is shown for T3. However, the cross-lagged paths from incongruence to mental health are marginally associated when prior mental health is controlled for. No gender differences were found in the cross-lagged model. The results support the mental health model and show that incongruence does not have a long-lasting negative effect on mental health. The results highlight the importance of identifying emerging adults with poor mental health early to provide support regarding need satisfaction.

Erhöhte Depressivität und Ängstlichkeit sowie ein erhöhtes subjektives Belastungserleben sind bei Angehörigen von Menschen mit einer Hirnverletzung häufig. Die vorliegende Pilotuntersuchung widmet sich der Evaluation einer neuartigen Intervention, dem OSCAR Online-Coaching, einer internetbasierten Mehrkomponentenintervention. In einer randomisierten, kontrollierten Pilotstudie mit 35 TeilnehmerInnen wurde ein 16-wöchiges therapeutengeleitetes Selbsthilfeprogramm mit einer Wartekontrollgruppe verglichen. Als primäre Ergebnismasse wurde der Perceived Stress Questionnaire und das Zarit Burden Interview eingesetzt. Intention-to-treat-Analysen der unmittelbaren Effekte direkt nach der Intervention zeigten keine signifikanten Gruppenunterschiede auf den primären und auf sekundären Ergebnismassen. Im 6-Monate Follow-up, nach Zugang der Kontrollgruppe zur Intervention, wurde in der Gesamtstichprobe eine signifikante Reduktion des Caregiver Burden, depressiver Symptome, der Angst, sowie eine Zunahme positiver Emotionen gefunden. Die Zufriedenheit mit dem Programm war gut.

Background: Alcohol craving is an essential construct in research and treatment of alcohol use disorders (AUD). Craving is mostly investigated in association with concurrent variables or distal treatment outcomes at follow-up. Objectives: The aim of this study is to examine craving at admission and its relevance for essential proximal outcomes at discharge from AUD treatment such as positive alcohol expectancy, abstinent-related self-efficacy, and substance-related coping, as well as patients’ demographic and AUD characteristics. Methods: In total, 36 patients were recruited within an inpatient treatment AUD program. Results: An association between craving and positive alcohol expectancies at discharge was found in the regression model even when the respective expectancies, age, gender, and severity of alcohol dependence at admission were controlled for (F(2,29)1⁄432.71, p50.001). Craving explained 2.3% of the variance of change in positive alcohol expectancy. Conclusion: The results suggest a low predictive value of craving for positive alcohol expectancy. In addition, we found significant associations between the craving and the severity of AUD and alcohol consumption before admission. Future studies should include proximal outcomes related to treatment efficacy as well as distal outcomes.

We investigated patients with a primary diagnosis of peripheral artery disease ( n = 69) and coronary heart disease (CAD; n = 520) at baseline and on changes in psychosocial risk factors (depression, anxiety, quality of life, negative and positive affect) during a cardiovascular rehabilitation program. Patients completed psychosocial questionnaires at the beginning and at discharge of a 12-week rehabilitation program. Depression and anxiety were measured with the Hospital Anxiety and Depression Scale (HADS), positive and negative affect with the Global Mood Scale, and health-related quality of life with the SF-36 Health Survey. Patients with PAD showed improvements in anxiety ( p < 0.001), negative affect ( p < 0.001) and bodily pain ( p < 0.001). Patients with CAD reported significant improvements in all measured dimensions (all p-values < 0.001).

ObjectiveAssessment and treatment of psychological distress in cancer patients was recognized as a major challenge. The role of spouses, caregivers, and significant others became of salient importance not only because of their supportive functions but also in respect to their own burden. The purpose of this study was to assess the amount of distress in a mixed sample of cancer patients and their partners and to explore the dyadic interdependence. MethodsAn initial sample of 154 dyads was recruited, and distress questionnaires (Hospital Anxiety and Depression Scale, Symptom Checklist 9-Item Short Version and 12-Item Short Form Health Survey) were assessed over four time points. Linear mixed models and actor-partner interdependence models were applied. ResultsA significant proportion of patients and their partners (up to 40%) reported high levels of anxiety, depression, psychological distress, and low quality of life over the course of the investigation. Mixed model analyses revealed that higher risks for clinical relevant anxiety and depression in couples exist for female patients and especially for female partners. Although psychological strain decreased over time, the risk for elevated distress in female partners remained. Modeling patient-partner interdependence over time stratified by patients' gender revealed specific effects: a moderate correlation between distress in patients and partners, and a transmission of distress from male patients to their female partners. ConclusionsOur findings provide empirical support for gender-specific transmission of distress in dyads coping with cancer. This should be considered as an important starting point for planning systemic psycho-oncological interventions and conceptualizing further research. Copyright (c) 2013 John Wiley & Sons, Ltd.

Objective To summarize empirical studies on the effectiveness of psychological interventions in long-term rehabilitation after an acquired brain injury (ABI) in reducing depressive symptoms. Data Sources A systematic literature search was conducted on MEDLINE, PsycINFO, Embase, and CINAHL to identify articles published between January 1990 and October 2011. Search terms included the 3 concepts (1) "brain injur*" or "stroke," (2) "psychotherap*" or "therapy" or "intervention" or "rehabilitation," and (3) "depress*." Study Selection Studies evaluating psychological interventions in patients after ABI were included. Time since injury was on average more than 1 year. Trials reported data on validated depression questionnaires before and after the psychological intervention. Data Extraction Two independent reviewers extracted information from the sample, the intervention, and the outcome of the included studies and calculated effect sizes (ESs) from depression questionnaires. Thirteen studies were included in a pre-post analysis. Seven studies were eligible for a meta-analysis of ESs in active interventions and control conditions. Data Synthesis Pre-post ESs were significant in 4 of 13 studies. The overall ES of .69 (95% confidence interval [CI], .29–1.09) suggests a medium effectiveness of psychological interventions on depressive symptoms compared with control conditions. Moderator analysis of the number of sessions and adequate randomization procedure did not show significant ES differences between strata. Studies with adequate randomization did not, however, suggest the effectiveness of psychological interventions on depressive symptoms after ABI. Conclusions Psychological interventions are a promising treatment option for depressive symptoms in long-term rehabilitation after ABI. Since only a few adequately randomized controlled trials (RCTs) exist, more RCTs are required to confirm this initial finding.