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Background: Patient-centeredness and a strong working alliance are core elements of family medicine. Surveys in Germany showed that most people are satisfied with the quality of the family physician-patient relationship. However, factors that are responsible for the quality of the family physician-patient relationship remain unclear. This study aimed at identifying patient-related predictors of the quality of this relationship., Materials and Methods: Participants of a cross-sectional survey representative for the general German population were assessed using standardized questionnaires. The perceived quality of the family physician-patient relationship was measured with the German version of the Patient-Doctor Relationship Questionnaire (PDRQ-9). Associations of demographic and clinical variables (comorbidity, somatic symptom burden, psychological distress) with the quality of the family physician-patient relationship were assessed by applying hierarchical linear regression., Results: 2278 participants (91,9%) reported having a family physician. The mean total score of the PDRQ-9 was high (M=4,12, SD=0,70). The final regression model showed that higher age, being female, and most notably less somatic and less depressive symptoms predicted a higher quality of the family physician-patient relationship. Comorbidity lost significance when somatic symptom burden was added to the regression model. The final model explained 11% of the variance, indicating a small effect., Conclusions: Experiencing somatic and depressive symptoms emerged as most relevant patient-related predictors of the quality of the family physician-patient relationship., (© Georg Thieme Verlag KG Stuttgart · New York.)

As a consequence of earlier investigations, which have demonstrated that 20-25% of the students report psychological distress, the knowledge of the need and the utilization of help resulting from psychological or social problems have to be improved. Data from 366 students were collected to determine the need for advice, the utilization of help and the occurrence of psychological symptoms (SCL-27) and interpersonal problems (IIP-C). Comparisons between students and the total population as well as between students with and without need for advice were made. 23,3% of the persons surveyed, expressed the wish to receive professional help. In comparison to the total population, the students reported more psychological symptoms and consulted less frequently a general practitioner or a gynecologist. Students with need for advice experienced more psychological distress. To encourage more of the distressed students to utilize professional help, the access to professional help should be facilitated., (© Georg Thieme Verlag KG Stuttgart · New York.)

Facing the current political controversies concerning health care, the present study examines the question who is using outpatient psychotherapy in Germany. Using data drawn from a nationally representative survey of 5120 Germans 7% stated they had used oupatient psychotherapy in the former 6 years or being actually in outpatient psychotherapy. Comparisions of socio-economic variables between persons with and without use of outpatient psychotherapy showed, contrary to expectations, that psychotherapy is not utilised by so called "YARVIS" (young, attractive, rich, verbal, intelligent, successful) patients., (Copyright Georg Thieme Verlag KG Stuttgart. New York.)

Over these past years, German researchers have shown much interest for Costa and McCrae's five factor model as well as for their instrument: the NEO-Five-Factor Inventory . Nevertheless, results from a recent survey study using the German version of the NEO-FFI on a representative population sample (n = 1908) have reported problems to replicate the factor structure of the instrument. Insufficient psychometric indices of single items led to partly unsatisfactory scale values. A logical consequence of this was the development of a short version of the instrument with better psychometric properties. This article reports item and scale values of the NEO-FFI-30 for the German population sample. The five scales reach good internal consistency and are highly correlated with the original NEO-FFI scales. Furthermore, the influence of sociodemographic variables and correlations with the Giessentest appear to be very similar for both the original instrument and the short version. Moreover, the factor structure was replicated in an independent sample of 2508 adults. Results confirm the reliability, and factor and construct validity of this economic instrument without any significant loss in information.

The questionnaire "Profile of Mood States (POMS)" is recommended as a measure of mood states in patients and non-clinical samples. On the basis of a representative sample (2043 subjects) reference values for the four scales (DEPRESSION/ANXIETY, FATIGUE, VIGOR, ANGER) of the German short version of the "Profile of Mood States" (POMS--35 items, 7 point scale, instruction "How you have been feeling during the past 24 hours?") are presented. The scale ANGER was independent from variables gender, age, education and current residence. In contrast to the other three scales these differentiations were necessary and detailed reference values are reported.

Objectives and Methods: Medical doctors are especially burdened with psychological and social aspects of their occupation. These circumstances may lead to low life satisfaction and substance abusing behaviour and burn out symptoms are probable. In this paper we investigate, if alumni of medical sciences show lower life satisfaction compared to their peers. If so, we want to know, which factors influence this result. This survey is based on n = 671 alumni of medicine in seven German universities., Results: The life satisfaction of alumni differs significantly from the peer sample. Outstanding are the highly significant and powerful differences to the scale "leisure". It was evident by an iterative regression that the variables "extreme input at work", "instrumentality/masculinity", "effort-reward imbalance", "expressivity/femininity" as well as "career self-efficacy-expectation", clarify 43 % of the variance in the group of alumni working by the time of enquiry., Conclusions: The results point out, that already alumni of medical science are in the "circle of burn-out". Their life satisfaction is more affected, if the workload is perceived high and the perceived benefits are low. Individual as well as external aspects influence life satisfaction and can be a starting-point for prevention.

The psychometric properties of a newly developed short version of the "Unsicherheitsfragebogen" (Insecurity Questionnaire) by Ullrich & Ullrich de Muynck are examined using data drawn from a nationally representative survey of 652 former East and 1283 former West Germans. In addition, the questionnaire was tested on a clinical sample of 318 psychotherapy inpatients. The study demonstrates good test-theoretical features regarding parameters of items and subscales. In the population sample woman score higher on subscales fear of criticism and incapacity in saying NO and lower on scale being able to demand. Female psychotherapy patients score higher on scale fear of criticism and lower on scale being able to demand than male psychotherapy patients. When comparing psychotherapy patients to the population sample with respect to gender, male and female psychotherapy patients score higher on scales fear of criticism, fear of contact and incapacity in saying NO and lower on scale being able to demand. Scale means as reference values for the population sample as well as for the psychotherapy patients are reported.

The "Questionnaire for Assessing Subjective Physical Well-Being" by Kolip and Schmidt is examined using data drawn from a nationally representative survey of 573 former East and 1900 former West Germans. In this non-clinical sample the construct "subjective physical well-being" assessed by the "Questionnaire for Assessing Subjective Physical Well-Being" seems to have just one dimension. As women and probands with growing age score lower for "subjective physical well-being" a differentiated standardization was done for gender and age. Connections between "subjective physical well-being" and body-image assessed by the "Body Image Questionnaire" (FKB-20), quality of life ("EURO-HIS-QOL"), and questions for concerns about financial situation, family and health give hints for validity of the questionnaire.

The German short version of "Profile of Mood States" (POMS) was psychometrically tested in a representative sample (1009 subjects in Eastern Germany and 1034 subjects in Western Germany). The 35 items (7 point scale, instruction "How you have been feeling during the past 24 hours?") form the following scales: Depression/Anxiety, Fatigue, Vigor, Hostility. The POMS appears to be an internally consistent instrument (Cronbach's Alpha from 0.89 to 0.95). Replication of the postulated 4 factors was limited. There are hints for convergent validity of POMS-Scales using two questions: "1. Over the past two weeks, have you felt down, depressed, or helpless?" and "2. Over the past two weeks, have you felt little interest or pleasure in doing things?"

Since 1999, the statutory obligation of all German hospitals to establish an internal quality management system has resulted in an increase of patient surveys on inpatient care. Information on the subjective satisfaction of the patients is of particular interest because improvements may be realised. In the present paper, the objectives, the methodology and the choice of a tested survey instrument, the interpretation of the results and the practical problems in implementing a survey on patient satisfaction at the Leipzig University Hospital (a public institution comprising 1,464 beds in 2001) will be reported. This is intended to facilitate comparable projects in the future and to enable hospitals with fewer resources to organize and use such surveys. Altogether, 1,718 questionnaires (Hamburg questionnaires on patient stay in hospital, HFK) from 43 wards could be evaluated. The high satisfaction determined (mean values of the scores for 10 test parameters are between 1.72 and 2.02 on a 5-point scale) corresponds to the general tendency of patients to make socially desirable responses. Covert dissatisfaction was therefore analysed comparing the relative frequencies of complete and limited satisfaction at item level. Sociodemographic patient characteristics such as age and stay in hospital were of no substantial relevance. One important aim of the Leipzig survey project was to give detailed feedback within brief time periods. The project focussed on a differentiated and early monitoring of responses. If requested, an oral presentation of the results was made to each structural unit. This presentation included the spontaneous responses of the patient, which enhanced the acceptance of the investigation by the medical staff.

Several surveys of the German population concerning the attitude towards euthanasia in patients with terminal illness yielded contradictory results, ranging from high acquisition to high refusal rates. After a critical discussion of the methodological concepts of these investigations, we present the results of a representative study of 1957 German persons (age range: 14 - 96 years) which was performed by the institute USUMA in February 2001. Four different types of euthanasia were included in the study: active, passive, and indirect euthanasia as well as physician's assisted suicide. The affirmative response categories were "declared will and unbearable pain", "declared will", "referred will", and "in the responsibility of the physician". Additionally, we asked to state the personal preference in the case of an own incurable illness. The resulting frequency distributions stress the autonomy of the patients (declared will) and the legal forms of professional euthanasia (passive and indirect euthanasia), independent from the degree of pain. The rank order of the hypothetic personal preferences was: passive euthanasia (26.1 %), active euthanasia (21.1 %), indirect euthanasia (13.1 %) and assisted suicide (6.2 %). For each category the hypothetic personal will to utilize euthanasia personally is markedly lower than the consent to legalize euthanasia in the society. This points to a diminished readiness of the population to seek for euthanasia. Persons aged 60 years and above deny all types of euthanasia significantly more often than younger persons. Persons with subjectively bad health status prefer the category "in the responsibility of the physician" more often than healthy subjects. The representative study proves that there is no polarized public opinion concerning euthanasia, rather there is a picture of high complexity.

The basic principles dealing with euthanasia (1998) as expressed by the German Association of Doctors states that in advance written directives are of "substantial help for the doctor in his or her actions". This requires, however, wide proliferation of patient directives. Hence it was important to ascertain the prevalence of such directives in the German population, as well as the relationship to the wish for enlightenment in terminal illness and diseases in their final stages. This was accomplished in December 1998 using 2050 people obtained with the Random-Route-Procedure (1024 from the new German states, 1013 from the old German states). The sample was obtained from the opinion research institute USUMA with ages ranging between 14 - 92. The main results from this representative survey represent an important record of the status quo with respect to opinion shaping of patient autonomy. 16 % of this survey expressed the wish not to be fully enlightened in the case of a terminal illness or they wished for a clarification to be given to the family only. This result shows that part of the population still holds on to their right of no knowledge. 59.1 % expressed the wish for a complete and immediate enlightenment. The other 24.9 % desired a careful step-by-step presentation of information. The high percentage of those who desired information and enlightenment is in contradiction to the small 2.5 % of patients who have actually written advance directives. These empirical results are consistent with the clinical experience of many doctors and represents the decision of the "representational" doctors for the current ethical regulation of patient directives as an ideal idea. Since 71.9 % of those surveyed had never before thought about this issue conclusions are drawn regarding patient consultations. Gender and East/West differences are also shown.