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Objective: Health anxiety (HA) is frequently observed in patients suffering from a severe disease such as cancer. This study aimed to test the psychometric properties of the Whiteley Index-7 (WI-7) measuring HA and to identify prognostic factors for heightened HA in cancer patients., Methods: A sample of 1723 cancer patients, treated in a German rehabilitation clinic, completed the Whiteley Index-7, the Generalized Anxiety Disorder screener GAD-7, the Patient Health Questionnaire PHQ-9, the Fear of Progression questionnaire FoP-Q-12, the Concerns About Cancer Recurrence questionnaire CARQ-4, and two subscales of the EORTC QLQ-SURV100., Results: The internal consistency of the WI-7 was good (Cronbach's α = 0.85), and the correlations between the WI-7 and other scales were as follows: 0.64 (GAD-7), 0.63 (PHQ-9), 0.75 (FoP-Q-12), 0.71 (CARQ-4), 0.66 (SURV-HD), and 0.75 (SURV-NHO). Women showed markedly higher levels of HA than men (effect size: d = 0.40), and patients aged 60 years and above reported lower levels of HA than younger patients (d = -0.32). Melanoma patients showed the highest HA mean score (M = 10.9), and patients receiving antibody therapy showed heightened levels of HA (M = 10.7). When considering age and sex, the effects of tumor type and treatment become smaller than in the univariate analyses., Conclusion: The WI-7 is a suitable instrument for assessing HA in cancer patients. When evaluating the effects of cancer type or treatment on HA, one has to take into account the age and sex distribution. Younger patients and women deserve special attention regarding HA., Competing Interests: Declaration of competing interest The authors have no competing interests to report., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The early 2020s witnessed an unprecedented overlap of multiple global crises. This longitudinal study examined the compounded effects of multiple intersecting global crises on mental health outcomes in a representative cohort of East German adults. We investigated how perceived threats (PT) from climate change (PT-CLC), COVID-19 (PT-COV), the Russia-Ukraine War (PT-RUW), and rising costs of living (PT-RCL) will impact various aspects of mental health from 2021 to 2022. This research question addresses whether these crises exacerbate mental health issues and how their effects differ across various mental health outcomes. Methods: We conducted a longitudinal study with 319 participants (mean age 49.9 years, 54.5% female) from the Saxony Longitudinal Study. Data were collected in two waves: March-July 2021 and September-December 2022. We used linear mixed-effects models to analyze both unadjusted group trends and adjusted individual-level effects on physical complaints, mental distress, sleep problems, life satisfaction, and self-rated health. Results: Unadjusted analyses revealed significant increases in mental distress and sleep problems over time, whereas physical complaints, life satisfaction, and self-rated health remained stable at the group level. Adjusted analyses showed that higher PT-RCL and PT-COV were significantly associated with increased physical complaints, mental distress, sleep problems, and decreased life satisfaction, even when group-level changes were not significant. Conclusions: This study highlights the complex impact of intersecting global crises on mental health, emphasizing the importance of considering both population-level trends and individual perceptions. The findings suggest that economic and pandemic-related stressors have more immediate effects on mental health outcomes compared to more distant threats, such as climate change or geopolitical conflicts.

Background : The COVID-19 outbreak necessitated physical distancing, as part of secondary prevention, at a personal and professional level. Working from home (WFH) became increasingly important. In this study, the impact of the COVID-19 pandemic restrictions on physical and mental health is investigated, compared with pre-pandemic data, and with employees who WFH and are on-site. Methods : Data from the German Saxon longitudinal study population were used. Attitudes towards WFH as well as mental and physical health assessments during the COVID-19 pandemic were examined. Comparisons were made with corresponding pre-pandemic scores and between employees WFH and on-site in 2022. Results : In total, 319 participants with equal gender distribution were included. Of those, 86 worked from home stating better organizability of their work, more time for partnership, less stress, and greater work satisfaction. Compared to pre-pandemic data, the D-score, PHQ-4, G-Score, and PHQ-SSS-8 showed a significant increase. No difference in physical or mental health between employees WFH and on-site was observed. Conclusion : In general, COVID-19 restrictions had a negative impact on mental and physical health. Although WFH is well accepted, it did not show significant health benefits.

Objective: The objective of the study was to investigate whether psychological distress increased in a German community sample from Saxony during the course of the Corona pandemic., Methods: In 2017/2018 and 2022, N=289 participants (54.7% female) of the Saxon Longitudinal Study were interviewed about their psychological well-being using questionnaires (PHQ-4, SSS-8)., Results: There is a significant increase in complaints (anxiety, depression, psychological distress, physical complaints) compared to 2017/2018 to 2022 with effect sizes in the small and medium range (Cohens d=0.26-0.62)., Conclusion: Data collection was not due to the pandemic but was routine as part of an ongoing long-term study. The Covid-19 pandemic led to an increase in psychological distress and physical complaints in a Saxonian, age-homogeneous population sample., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht, (Thieme. All rights reserved.)

Background: Oral health-related self-efficacy (OH-SE) is pivotal for oral health and is associated with other oral-health related variables, such as dental fear and anxiety (DF/A) and dental hygiene behaviors (DHB). This study attempts to analyze associations between OH-SE and oral healthrelated variables in a German population to extend previous research by analyzing whether OH-SE can be predicted by these variables, as this might contribute to the development of treatment interventions., Methods: OH-SE, DF/A, oral health-related quality of life (OHRQoL), self-perceived dental condition, satisfaction with general health, DHB, and socioeconomic status were assessed as a part of the Saxon Longitudinal Study in an adult sample (n = 309, 56.3% female, all Saxon secondary school 8th graders in 1987). The associations of OH-SE with these variables were examined by means of correlation, multiple linear regression analyses, and group comparisons. Significance (p), standardized regression coefficients (β), and effect size (Cohen's d) were calculated., Results: The correlation analyses revealed increased OH-SE to be accompanied by low levels of DF/A, high levels of OHRQoL, high levels of self-perceived dental condition, increased satisfaction with general health and socioeconomic status (all r ≥ 0.142; all p ≤ 0.013). In the regression analysis, OH-SE was mainly predicted by self-perceived dental condition and satisfaction with general health (R 2  = 0.157) as well as by daily frequency of toothbrushing, OHRQoL, and socioeconomic status on a trend-level basis. In the group comparisons OH-SE was lower in participants with moderate for manifest DF/A and higher in individuals with higher OHRQoL, better self-perceived dental condition, increased satisfaction with general health, increased daily frequency of toothbrushing, more dental appointments, and above-average socioeconomic status (trend level; all t ≥ 1.57; p ≤ 0.059)., Conclusions: In this cross-sectional study, high levels of OH-SE were mainly predicted by general health as well as self-perceived dental condition. It was also associated with decreased DF/A, increased DHB, higher OHRQoL, and higher socioeconomic status. Future research should analyze these associations in longitudinal designs to address whether interventions focusing on adherence to good DHB improve (dental) health and thus OH-SE. This might be a promising approach, particularly in relation to the treatment of DF/A., (© 2023. The Author(s).)

Objective/background: Despite its high prevalence, little information is available about the course of insomnia symptoms over the life span. In this study, we analyzed the self-reported insomnia symptoms of the general population over more than 20 years, covering young up to middle adulthood., Patients/methods: Data from waves 12 to 32 of the Saxon Longitudinal Study (1996-2021), were analyzed. Based on data from the 12th wave, n = 115 adults (48 men (41.7%), 67 women (58.3%), M age  = 23.59, SD = 0.59) completed the G-Score Item #3 in the following 18 waves, thus forming the basis for our analyses. The G-Score Item #3 reads "In the last 12 months, have you had the following complaints? Please indicate how often they occurred - Insomnia". The G-Score Item #3 was dichotomized using a cut-off score of 2, and prevalence and incidence rates were calculated by gender., Results: The minimum prevalence rate was 23.48% (M age  = 32.11, SD = 0.40), and the maximum was 47.83% (M age  = 48.43, SD = 0.64), indicating an increase in insomnia symptoms with age. In most cases, no evidence was found for gender differences in prevalence rates. The incidence rates were 10.43% for the 1st year of follow-up and 8.7% for the 5th year and 6th year of follow-up, respectively., Conclusions: This study provides further evidence for the high prevalence rates of insomnia symptoms in the general population. As this study is the first epidemiological study of insomnia symptoms based on a single-item (screening) instrument, it should be rather seen as an extension than a replication of previous study findings., Competing Interests: Declaration of competing interest Franziska Klimt, Clara Jacobi, Elmar Brähler, Yve Stöbel-Richter, Markus Zenger and Hendrik Berth declare no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Aim: The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health., Subject and Methods: To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802)., Results: Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning-with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude., Conclusion: We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded., (© The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Sleep disturbances are one of the most prevalent health complaints in the general population. Thus, the need for validated screening instruments and prevention measures is high. The aim of the current study is to evaluate a potential single-item screening instrument and therefore, contribute to an improved early detection., Methods: Data from Saxony Longitudinal Study (SLS) is being analyzed. Based on data of 32nd wave (n=321, 172 women, 149 men, M age=48.42, SD=0.64), the G-Score Item #3 ("Have you had the following complaints in the last 12 months? Please indicate how often they occurred. - sleeplessness"), a potential screening instrument, is psychometrically evaluated. A Receiver Operating Characteristic (ROC)-Analysis is calculated to assess the predictive validity of the G-Score Item #3., Results: Retestreliability for the G-Score Item #3 is 0.70 (p<0.001). Correlation with the Jenkins Sleep Scale (JSS) was r=0.79 (p<0.01). The area under the curve (AUC) is 0.92, providing evidence for a very good predictive validity., Discussion and Conclusion: This study provides evidence for the use of the G-Score Item #3 as a screening instrument for sleep disturbances by showing good psychometric properties and brevity., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: It is well-known that patients with cancer frequently experience sleep problems, and that sleep quality is associated with general quality of life (QoL). The aims of this study were to analyze the relationship between sleep problems and other components of QoL in more detail and to investigate sex and age differences in sleep quality in cancer patients in comparison with the general population., Method: This study comprised one general population sample ( n  = 4,476) and eight samples with cancer patients ( n between 323 and 4,020). Sleep Quality was measured using the QoL questionnaire EORTC QLQ-C30., Results: All of the cancer patient groups reported more sleep problems than the general population. Sleep problems were associated with all facets of QoL both in cancer patients and in the general population. The highest associations were found in cancer patients for fatigue ( r  = 0.52) and emotional functioning ( r  = -0.47). The association between sleep quality and general QoL was lower in the cancer samples ( r  = -0.37) than in the general population ( r  = -0.46). Female cancer patients reported markedly more sleep problems than male patients did ( d  = 0.45), while this sex difference was lower in the general population ( d  = 0.15). In contrast to the general population, younger cancer patients had greater trouble sleeping than older patients did ( d  = -0.17)., Conclusion: The results underline the significance of the role mental factors play in sleep problems. Health care providers should pay special attention to female patients and younger patients concerning this issue., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hofmeister, Schulte, Mehnert-Theuerkauf, Geue, Zenger, Esser, Götze and Hinz.)

In this paper, we investigate the relationship between a person's psychological distress, subjective physical health and their attitudes towards the COVID-19 pandemic. The evaluation was performed on the basis of data from two waves of the Saxon Longitudinal Study, carried out in 2019 (pre-pandemic) and 2021. The number of study participants in both waves was 291. We tested in autoregressive cross-lagged models the stability of the respondents' health status before and during the pandemic and reviewed their influence on attitudes towards COVID-19. Our results show that COVID-19-related concerns are controlled by subjective physical health, while pandemic denial is linked to psychological distress. In an unknown and critical situation, with limited control over the situation, the strategy of avoidance or suppression may be used by individuals for protection by psychologically downplaying the stressor and danger.

Objective: The literature on alexithymia has multiplied in recent decades as the construct has important implications for mental health. The so far used inventories are of limited use in epidemiological research, primary care, and other clinical settings where time and effort are important factors in assessment. Based on items of the authorized German version of the Toronto Alexithymia Scale, the aim of this study was to develop an ultra-short questionnaire for a condensed and unidimensional assessment of alexithymia., Methods: Criteria for the abbreviated scale were: (a) one-dimensionality (necessary to calculate a global score), (b) one item from each of the originally postulated dimensions, and (c) no reverse-coded items (to avoid method artifacts). Data were drawn from two nationwide representative population surveys in Germany: a survey conducted in 1996 to develop the SAS-3 (N=2.047); and a survey conducted in 2013 (N=2.508) for the evaluation and calculation of SAS-3 percentiles., Results: Reasonable correlations between the SAS-3 and the PHQ-2, the GAD-2, and the GBB-8 were observed. Based on a confirmatory factor analysis, the one-dimensionality of the SAS-3 could be confirmed, achieving very good fit indices. An additional invariance analysis regarding gender and different age groups resulted in (partial) strict invariance for the different multi-group analyses. Percentile ranks for SAS-3 sum score are reported stratified by gender and by age groups., Conclusions: The SAS-3 appears to be suitable in epidemiological research and other instances requiring an economical assessment of alexithymia., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objectives: Quality of life (QoL) has been the focus of increasing interest in oncology. QoL assessment instruments implicitly assume that each QoL domain has the same meaning for each patient. The objective of this study was to analyze the importance of and the satisfaction with QoL domains and to analyze the relationship between the two., Methods: A sample of 308 breast cancer survivors was examined twice with a three-month time interval. The women completed the two QoL questionnaires Questions of Life Satisfaction (FLZ-M), which measures participants' satisfaction with eight QoL domains and the subjective importance of those domains to them, and the EORTC QLQ-C30. A sample of 1,143 women from the general population served as controls., Results: Compared with the general population sample, the patients were less satisfied with their health and more satisfied with all other QoL domains. The subjective importance of health was lower in the patients' sample (Effect size: d = 0.38). Satisfaction with health and importance of health were slightly positively correlated ( r between 0.05 and 0.08). The effect of QoL domain importance on general QoL was small (beta between -0.05 and 0.11), and interaction effects between domain importance and satisfaction on the prediction of global QoL were negligible., Conclusion: In addition to satisfaction with QoL dimensions, the subjective importance of these dimensions is relevant for psychooncological research and treatment. Health is not the only relevant QoL domain in breast cancer survivors, other domains such as finances also deserve health care providers' attention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hinz, Zenger, Schmalbach, Brähler, Hofmeister and Petrowski.)

Objective: The aim of this study was to examine psychometric properties of the Life Orientation Test-Revised (LOT-R)., Design and Main Outcome Measures: The LOT-R was administered in five clinical samples, three samples of the adult general population, and one sample of adolescents. Seven of the studies were performed in Germany and two in Colombia. All of the sample sizes were above 300., Results: Cronbach's alpha coefficients were between .57 and .75 for the eight adult samples, the correlations between the scales optimism and pessimism ranged from -.05 to -.37, and the coefficients of temporal stability (test-retest correlations) of the scales ranged from .43 to .69. There were no systematic age and gender effects observed in the nine studies. While the one-factor model of confirmatory factor analyses showed clearly insufficient fit indices among all of the samples, the two-factor model fit was markedly better., Conclusions: The LOT-R proved to be a suitable instrument for measuring dispositional optimism in patients and in the general population, though the sum score should be viewed with caution. Studies comparing the LOT-R mean scores of different samples need not take age and gender distributions into account.

Aim The aim of the present study was to determine the relevant factors in the mental health of people who experienced internal migration in comparison with people who did not. Methods Data from a longitudinal study in Saxony were used to compare the psychological distress of individuals who migrated internally with that of those who did not in 2010 and 2020. Bootstrapping-based mediation analysis was applied to examine possible mediators between internal migration and mental health.Results Individuals who experienced internal migration reported less mental distress compared to those who did not in 2010, but not in 2020, but these effects disappeared after including covariates and mediators. Important mediators in 2010 were life situation, political solidarity with FRG, winner of German Unification and job security; in 2020, these were threat of old-age poverty and experiences with system.Discussion Internal migration influences mental distress through different factors. Especially the current life circumstances play a crucial role., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The aim of the present study was the construction and psychometric evaluation of a shortened version of the Burnout Screening Scales II (BOSS II), a measure for exhaustion and burnout., Methods: To this end, among a representative sample of the German general population (N = 2429, 52.9% women), we shortened the scale from 30 to 15 items applying ant-colony-optimization, and calculated item statistics of the short version (BOSS II-short). To estimate its reliability, we used McDonald's Omega (ω). To demonstrate validity, we compared the correlation between the BOSS II-short and the BOSS II, as well as their associations with depression, anxiety, and quality of life. Furthermore, we evaluated model fit and measurement invariance across respondent age and gender in confirmatory factor analyses (CFA). Finally, we present adapted norm values., Results: The CFA showed an excellent model fit (χ 2  = 223.037, df = 87, p < .001; CFI = .975; TLI = .970; RMSEA [90%CI] = .036 [.031;.040]) of the BOSS II-short, and good to very good reliability of the three subscales: 'physical' (ω = .76), 'cognitive' (ω = .89), and 'emotional' (ω = .88) symptoms. There was strict measurement invariance for male and female participants and partial strict invariance across age groups. Each subscale was negatively related to quality of life ('physical': r = -.62; 'cognitive': r = -.50; 'emotional': r = -.50), and positively associated with depression ('physical': r = .57; 'cognitive': r = .67; 'emotional': r = .73) and anxiety ('physical': r = .50; 'cognitive': r = .63; 'emotional': r = .71)., Conclusions: Overall, the BOSS II-short proved to be a valid and reliable instrument in the German general population allowing a brief assessment of different symptoms of exhaustion. Norm values can be used for early detection of exhaustion., (© 2022. The Author(s).)

Background: The present study investigated the psychometric properties of the newly developed English version of the Giessen Subjective Complaint List-8 (GBB-8), a questionnaire assessing psychosomatic symptoms with regard to exhaustion, gastrointestinal, musculoskeletal and cardiovascular., Methods: A U.S. sample of 638 participants (47.6% female) was recruited by MTurk to participate in this cross-sectional online survey. Validation instruments included the Patient Health Questionnaire-4, Perceived Stress Scale, short version of the Trier Inventory for Chronic Stress., Results: Reliability was high with ω's between .80 and .86 for all subscales. Confirmatory factor analyses yielded comparable good model fit for a four-dimensional model as well as a higher order model. Multi-group confirmatory factor analyses confirmed measurement invariance of the GBB-8 across sex and age. Regarding convergent validity, correlations with other instruments were highly significant and of large magnitude as expected., Conclusion: The English version of the GBB-8 has shown excellent psychometric properties. Therefore, it can be recommended for the assessment of psychosomatic complaints in contexts where short screening instruments are necessary., (© 2022. The Author(s).)