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Zusammenfassung: Hintergrund: Die Ursachen für Burnout werden v.a. in prekären Arbeitsverhältnissen lokalisiert. Die Forschungslage zu personenbezogenen Risikofaktoren für Burnout ist bescheiden. Es gibt erheblichen Forschungsbedarf, der sich mit der Interaktion von Umwelt und Person auf das Burnout-Risiko beschäftigt. Methoden: Grundlage unserer Analyse ist die Zürich-Studie. Die Teilnehmer dieser Kohorte aus der Allgemeinbevölkerung wurden 1978 erstmals im Alter von 19 bis 20Jahren untersucht und bis ins Alter von 49 bis 50 nachverfolgt. In der letzten Nachuntersuchung 2008 wurden erstmals Burnout-Maße erhoben. Untersucht wurden die Zusammenhänge zwischen Burnout, Mastery und Selbstvertrauen einerseits und andererseits Persönlichkeitsvariablen, die 1988 mittels des Freiburger Persönlichkeitsinventars gemessen worden waren. Ergebnisse: In einem pfadanalytischen Modell konnten wir diverse Zusammenhänge zwischen den genannten Variablen aufzeigen. Unsere Ergebnisse weisen darauf hin, dass es eine komplexe Interaktion von dysfunktionaler, maladaptiver Persönlichkeit und Burnout gibt. Schlussfolgerungen: Um Burnout besser zu verstehen, braucht es Stichproben aus der Allgemeinbevölkerung, die sowohl aus personen- als auch umweltbezogener Perspektive untersucht werden

Background: Atypical depression (AD) exhibits distinct patterns of gender,bipolar-II disorder, genetic, and neuro-biological measures. Using prospective data from a community sample, this paper identifies criteria (and correlates) for an AD syndrome that maximizes the association with female sex and bipolar-II. Methods: The Zurich cohort study is composed of 591 subjects selected from a population-based cohort of young adults in the canton of Zurich in Switzerland, screened in 1978 and followed with six interviews through 1999. Seven definitions of atypical depression were tested, using varying combinations of vegetative symptoms and mood reactivity. Results: The atypical definitions using 2 of 3 (fatigue, overeating, oversleeping) or 2 of 2 (overeating, oversleeping) vegetative symptoms showed the strongest association with gender, bipolarity, and family history of mania. The 2/3 definition was chosen for further analysis due to its high sensitivity for identifying these characteristics. This syndrome had cumulated weighted prevalence of 16.4% (males 9.7%, females 23%); when associated with major depressive episodes, 8.2% (males 3.2%, females 15.1%). AD patients were characterized by high treatment rates, severity, and work impairment, early age of onset and long illness. AD was comorbid with social phobia, binge eating, neurasthenia, migraine headache, and subjective cognitive impairment

Our study sought to estimate the incidence rate of firstever ischemic stroke (FEIS) in the geographically well-defined population of the Canton Basle-City, Switzerland. An one-year prospective population-based study among the permanent residents of the Canton Basle-City (188015 inhabitants, census 2002) was carried out. Multiple overlapping sources of information were used. Stroke was defined according to the WHO criteria. The diagnosis of FEIS was based on clinical assessment and neuroimaging findings. 269 patients (114 males; mean age 72.8, standard deviation (SD) ± 12 and 155 females; mean age 78.4, SD ± 11) with FEIS were identified. The overall crude incidence of FEIS amounted to 143 per 100000 population (95% confidence interval (CI) 126 to 160) and it was higher among females (156; 95% CI 132 to 181) than in males (128; 95% CI 105 to 152). The age-specific incidence rates of FEIS approximately doubled with each decade of life, increasing from 17 (95 % CI 2 to 31) among 0-44 years old group to 1034 (95% CI 774 to 1293) for those aged 85 or more years. The overall incidence rate of FEIS adjusted for age to the European standard population was 76 per 100000 inhabitants (95% CI 66 to 86) and it was higher in males—89, 95% CI 72-106—than in females—66, 95 % CI 53-77. Moreover, in comparison with studies from other developed countries (e. g. Germany, Italy, Australia)—carried out in the middle of 1990s—the standardised incidence rates of FEIS were substantially lower in Switzerland. Our results indicate that the risk of ischemic stroke might be low in Switzerland. However, giving a major reduction in the age and gender specific stroke incidence over the past years our findings might—alternatively—mirror this favourable trend

At the end of the 19th century, male suicide rates in Switzerland were as high as the respective rates in recent decades, whereas female suicide rates were distinctly lower. An age-period-cohort analysis was performed to provide more information about the genderspecific changes over the last century. Suicide mortality has been reported in Switzerland since 1876 when the standardised registration of mortality data began. The analysed data cover the period 1881-2000. The statistical analyses were based on log-linear models and data aggregated by 10-year age-intervals and 10-year periodintervals. The results indicate similar age and period effects in males and females. The estimates representing age-specific risk increase steadily with age, with intermediate plateaus in the 20s and the 50s. The period-specific estimates follow the economic cycles. The birth cohort effects are stronger in males and weaker in females. In the males' estimates, there is a peak in cohorts born around 1840 and a low in cohorts born some 60-100 years later. The estimates increased again in generations born after World War II. In females, the birth cohort estimates are low in cohorts born in the first half of the 19th century and increase until the first half of the 20th century. Birth cohort effects remain an intriguing topic in epidemiology of suicide. A better understanding of birth cohort effects might open new doors to suicide prevention

Background This study aimed to identify the course of unmet needs by patients with a first episode of schizophrenia and to determine associated variables. Method We investigated baseline assessments in the European First Episode Schizophrenia Trial (EUFEST) and also follow-up interviews at 6 and 12 months. Latent class growth analysis was used to identify patient groups based on individual differences in the development of unmet needs. Multinomial logistic regression determined the predictors of group membership. Results Four classes were identified. Three differed in their baseline levels of unmet needs whereas the fourth had a marked decrease in such needs. Main predictors of class membership were prognosis and depression at baseline, and the quality of life and psychosocial intervention at follow-up. Depression at follow-up did not vary among classes. Conclusions We identified subtypes of patients with different courses of unmet needs. Prognosis of clinical improvement was a better predictor for the decline in unmet needs than was psychopathology. Needs concerning social relationships were particularly persistent in patients who remained high in their unmet needs and who lacked additional psychosocial treatment

Aims. Prevalence and covariates of subclinical psychosis have gained increased interest in the context of early identification and treatment of persons at risk for psychosis. Methods. We analysed 9829 adults representative of the general population within the canton of Zurich, Switzerland. Two psychosis syndromes, derived from the SCL-90-R, were applied: ‘schizotypal signs' and ‘schizophrenia nuclear symptoms'. Results. Only a few subjects (13.2%) reported no schizotypal signs. While 33.2% of subjects indicated mild signs, only a small proportion (3.7%) reported severe signs. A very common outcome was no ‘schizophrenia nuclear symptoms' (70.6%). Although 13.5% of the participants reported mild symptoms, severe nuclear symptoms were very rare (0.5%). Because these two syndromes were only moderately correlated (r=0.43), we were able to establish sufficiently distinct symptom clusters. Schizotypal signs were more closely connected to distress than was schizophrenia nuclear symptoms, even though their distribution types were similar. Both syndromes were associated with several covariates, such as alcohol and tobacco use, being unmarried, low education level, psychopathological distress and low subjective well-being. Conclusions. Subclinical psychosis symptoms are quite frequent in the general population but, for the most part, are not very pronounced. In particular, our data support the notion of a continuous Wald distribution of psychotic symptoms in the general population. Our findings have enabled us to confirm the usefulness of these syndromes as previously assessed in other independent community samples. Both can appropriately be associated with well-known risk factors of schizophrenia

Background To examine the effect of time on suicide after bereavement among widowed persons. Method The data were extracted from Swiss mortality statistics for the period 1987-2005. The time between bereavement and subsequent death, specifically by suicide, was determined by linkage of individual records of married persons. The suicide rates and the standardized mortality ratios in the first week/month/year of widowhood were calculated based on person-year calculations. Results The annualized suicide rates in widowed persons were highest in the first week after bereavement: 941 males and 207 females per 100 000. The corresponding standardized mortality ratios were approximately 34 and 19 respectively. In the first month(s) after bereavement, the rates and the ratios decreased, first rapidly, then gradually. Except in older widows, they did not reach the baseline levels during the first year after bereavement. Conclusions The suicide risk of widowed persons is increased in the days, weeks and months after bereavement. Widowed persons are a clear-cut risk group under the aegis of undertakers, priests and general practitioners

Background. Seasonal as well as weekly cycles in suicide have been described, replicated and poorly understood for a long time. In Western countries, suicides are typically least frequent on weekends and most frequent on Mondays and Tuesdays. To improve understanding of this phenomenon a strategy is required which focuses on anomalous findings beyond the regular patterns. Here, we focused on instances where the weekly suicide patterns disappear or are interrupted. Methods. We used data from Swiss and Austrian mortality statistics for the periods 1969-2010 and 1970-2010, respectively. First, the data were cross-tabulated by days of the week and the available socio-demographic information (sex, age, religious affiliation and region). Second, time series of cumulated daily frequencies of suicide were analysed by seasonal Autoregressive Integrated Moving Average (ARIMA) models which included intervention effects accounting for Easter and Pentecost (Whit) holidays. Results. First, the cross tabulations showed that weekly cycles may be smoothed above all in young persons and smoothed in drowning, jumping and car gas exhaustion suicides. Second, the ARIMA analyses displayed occasional preventive effects for holidays Saturdays and Sundays, and more systematic effects for holiday Mondays. There were no after effects on Tuesdays following holiday Mondays. Conclusions. In general, the weekend dip and the Monday backlog effect in suicide show striking similarities to the Advent season effect and are interpretable within the same template. The turning points between low and high frequencies possibly provide promising frames for the timing of prevention activities

Aims. Prevalence and covariates of subclinical psychosis have gained increased interest in the context of early identification and treatment of persons at risk for psychosis. Methods. We analysed 9829 adults representative of the general population within the canton of Zurich, Switzerland. Two psychosis syndromes, derived from the SCL-90-R, were applied: 'schizotypal signs' and 'schizophrenia nuclear symptoms'. Results. Only a few subjects (13.2%) reported no schizotypal signs. While 33.2% of subjects indicated mild signs, only a small proportion (3.7%) reported severe signs. A very common outcome was no 'schizophrenia nuclear symptoms' (70.6%). Although 13.5% of the participants reported mild symptoms, severe nuclear symptoms were very rare (0.5%). Because these two syndromes were only moderately correlated (r = 0.43), we were able to establish sufficiently distinct symptom clusters. Schizotypal signs were more closely connected to distress than was schizophrenia nuclear symptoms, even though their distribution types were similar. Both syndromes were associated with several covariates, such as alcohol and tobacco use, being unmarried, low education level, psychopathological distress and low subjective well-being. Conclusions. Subclinical psychosis symptoms are quite frequent in the general population but, for the most part, are not very pronounced. In particular, our data support the notion of a continuous Wald distribution of psychotic symptoms in the general population. Our findings have enabled us to confirm the usefulness of these syndromes as previously assessed in other independent community samples. Both can appropriately be associated with well-known risk factors of schizophrenia.

There is some evidence that fluid intelligence as well as empathy may be significantly related to personality disorders (PDs). To our knowledge, no study has addressed those issues simultaneously in all 10 DSM PDs in a sample of the general population. We analysed data from 196 participants aged 20-41 from the Epidemiology Survey of the Zurich Programme for Sustainable Development of Mental Health Services (ZInEP), a comprehensive psychiatric survey in the general population of Zurich, Switzerland. We assessed the digit symbol-coding test (DSCT), the "reading the mind in the eyes" test (RMET) and the interpersonal reactivity index (IRI). Both measures of cognitive empathy (i.e. RMET and IRI perspective taking) were not related to any PD trait-score. The total PD trait-score was significantly associated with low scores on DSCT and IRI empathic concern and high scores on IRI personal distress, which indicates a dose-response relationship in those measures. DSCT was particularly related to borderline PD, IRI empathic concern to schizoid and narcissistic PDs, and IRI personal distress to avoidant PD. The proportion of variance explained in the total PD trait-score accounted for by DSCT, IRI empathic concern and IRI personal distress was 2.6, 2.3 and 13.3 %, respectively. Symptomatology and severity of PDs are related to low fluid intelligence and reduced emotional empathy as characterized by low empathic concern and high personal distress towards emotional expressions of others. Further research is needed that examines the association between cognitive empathy and personality pathology as well as potential clinical applications.

PURPOSE: Quality of life (QoL) is considerably impaired in mental illness and especially in depression. In this study, we aimed to determine the demographic, personality-related and psychopathological associations with QoL. In addition, we studied how the associations with QoL differ depending on the burden of psychopathology. METHODS: We used a longitudinal observational cohort study, enriched for high levels of psychopathology, to examine data for QoL when the subjects were 34-35. We conducted a hierarchical linear regression analysis to determine how sex, personality, sociodemographics, somatic symptoms and psychopathology affect QoL. RESULTS: Once all the variables were included in the model, total psychopathology is strongly negatively associated with QoL, while mastery and income were shown to have positive associations with QoL. Sex, personality and somatic symptoms had no significant associations with QoL once the other variables had been introduced into the regression. Due to the outstanding association with psychopathology, we tested whether the relationship had any interaction with the other predictors, but none reached statistical significance. CONCLUSIONS: The most important association with QoL is psychopathology, regardless of sex, personality, coping resources, sociodemographics or the extent somatic symptoms. The relationship holds across the other variables included and the results are, thus, widely applicable.

This article takes four looks at the status of prevention in psychiatry. The first glance is critical, shaped by disappointment at the slow progress in the understanding of psychiatric diseases and the lack of promise in prevention. The second look is less humble. It characterizes and acknowledges the efforts made so far. The third and the fourth perspectives optimistically announce a new age in research and prevention. Breakthroughs, whose contours are already appearing on the horizon today, will transform the prevention of psychiatric diseases into a success story within the next 10-15 years.

Aims. To examine stigma- and knowledge-related barriers to help-seeking among members of the general population. Methods. In a representative survey of young to middle-aged Swiss adults (n = 8875), shame about a potential own mental illness, perceived knowledge about and satisfaction with one's mental health, psychiatric symptoms and attitudes towards help-seeking were assessed. Results. A latent profile analysis of all participants yielded two groups with different attitudes towards help-seeking. Relative to the majority, a one-in-four subgroup endorsed more negative attitudes towards seeking professional help, including psychiatric medication, and was characterized by more shame, less perceived knowledge, higher satisfaction with their mental health, younger age, male gender and lower education. Among participants with high symptom levels (n = 855), a third subgroup was reluctant to seek help in their private environment and characterized by high symptoms as well as low satisfaction with their mental health. Conclusions. Shame as an emotional proxy of self-stigma as well as poor subjective mental health literacy may be independent barriers to help-seeking. Interventions to increase mental health service use could focus on both variables and on those individuals with more negative views about professional help, in the general public as well as among people with a current mental illness.

BACKGROUND: This study aimed to identify the course of unmet needs by patients with a first episode of schizophrenia and to determine associated variables.MethodWe investigated baseline assessments in the European First Episode Schizophrenia Trial (EUFEST) and also follow-up interviews at 6 and 12 months. Latent class growth analysis was used to identify patient groups based on individual differences in the development of unmet needs. Multinomial logistic regression determined the predictors of group membership. RESULTS: Four classes were identified. Three differed in their baseline levels of unmet needs whereas the fourth had a marked decrease in such needs. Main predictors of class membership were prognosis and depression at baseline, and the quality of life and psychosocial intervention at follow-up. Depression at follow-up did not vary among classes. CONCLUSIONS: We identified subtypes of patients with different courses of unmet needs. Prognosis of clinical improvement was a better predictor for the decline in unmet needs than was psychopathology. Needs concerning social relationships were particularly persistent in patients who remained high in their unmet needs and who lacked additional psychosocial treatment.

OBJECTIVE: To determine the prevalence, impact, and stability of different subtypes of headache in a 30 year prospective follow-up study of a general population sample. DESIGN: Prospective cohort study. SETTING: Canton of Zurich, Switzerland. PARTICIPANTS: 591 people aged 19-20 from a cohort of 4547 residents of Zurich, Switzerland, interviewed seven times across 30 years of follow-up. MAIN OUTCOME MEASURES: Prevalence of headache; stability of the predominant subtype of headache over time; and age of onset, severity, impact, family history, use of healthcare services, and drugs for headache subtypes. RESULTS: The average one year prevalences of subtypes of headache were 0.9% (female:male ratio of 2.8) for migraine with aura, 10.9% (female:male ratio of 2.2) for migraine without aura, and 11.5% (female:male ratio of 1.2) for tension-type headache. Cumulative 30 year prevalences of headache subtypes were 3.0% for migraine with aura, 36.0% for migraine without aura, and 29.3% for tension-type headache. Despite the high prevalence of migraine without aura, most cases were transient and only about 20% continued to have migraine for more than half of the follow-up period. 69% of participants with migraine and 58% of those with tension-type headache manifested the same predominant subtype over time. However, the prospective stability of the predominant headache subtypes was quite low, with substantial crossover among the subtypes and no specific ordinal pattern of progression. A gradient of severity of clinical correlates and service use was present across headache subtypes; the greatest effect was for migraine with aura followed by migraine without aura, and then tension-type headache and unclassified headaches. CONCLUSIONS: These findings highlight the importance of prospective follow-up of people with headache. The substantial longitudinal overlap among subtypes of headache shows the developmental heterogeneity of headache syndromes. Studies of the causes of headache t

The interplay of psychotic and affective symptoms is a crucial challenge in understanding the pathogenesis of psychosis. In this study, we analyzed the interplay between two subclinical psychosis symptoms dimensions, and one depression symptoms dimension, using longitudinal data from Zurich. The Zurich study started in 1979 with a representative sample of 591 participants who were aged 20/21. Follow-up interviews were conducted at age 23, 28, 30, 35, and 41. The psychiatric symptoms were assessed with a semi-structured interview and the SCL 90-R. In this study, we analyzed three SCL-90-R subscales: the depression symptoms dimension and two distinct symptoms dimensions of subclinical psychosis, one representing a schizophrenia nuclear symptom dimension, the other representing a schizotypal symptoms dimension. Modeling was done with hybrid latent growth models, thereby including simultaneous and cross-lagged effects. The interplay between the two subclinical psychosis symptoms dimensions and the depression symptoms dimension includes several intertwined pathways. The schizotypal symptoms dimension has strong direct effects on the schizophrenia nuclear symptoms dimension, but also on the depression symptoms dimension. The latter has for its part an effect on the schizophrenia nuclear symptoms dimension. The main driving force within the dynamic interplay between depression and psychosis symptoms is a schizotypal symptoms dimension, which represents social and interpersonal deficiencies, ideas of reference, suspiciousness, paranoid ideation, and odd behavior. It does not only directly influence subclinical nuclear schizophrenia symptoms but also the symptoms of depression.

Die Schizophrenie, ursprünglich (1896) als Dementia praecox beschrieben und 1911 von Eugen Bleuler als Schizophrenie benannt, ist nach heutigem Kenntnisstand eine seltene Erkrankung, die weniger als 1% der Bevölkerung betrifft. Wir diagnostizieren die Schizophrenie im klinischen Alltag anhand bestimmter operationalisierter Kriterien. Die Diagnose soll nicht nur Auskunft über Art und Verlauf der Erkrankung geben, sondern auch handlungsleitend für die Therapie sein. Aus klinischer Sicht stellt sich deshalb bei jedem einzelnen Patienten die Frage, ob es sich um einen „Fall“ handelt oder nicht.

BACKGROUND: The objective of this longitudinal study was to assess the association between major depression and heart complaints in a population of young and healthy adults. METHODS: Starting at the age 20/21, participants of the Zurich Study underwent 6 structured, psychological interviews during a span of 20 years. We evaluated longitudinal data from 277 persons who participated in all 6 interviews including questions about heart complaints. RESULTS: Over 20 years, heart complaints were reported by two thirds of participants, and the frequency of depression was 11.4%. At the age of 40/ 41, heart complaints were significantly associated with earlier heart complaints and major depression, both more often in women. Recurrent brief depression showed a tendency, but neither minor depression nor depressive symptoms were predictive for later heart complaints. CONCLUSIONS: This study suggests that major depression is a predictor for heart complaints at the age of 40 and that the severity of depressive disorder in younger age has an effect on subsequent heart complaints. Follow-up data will help to elucidate whether these subjective heart complaints show any correlation with a later coronary heart disease.

BACKGROUND: Atypical depression (AD) exhibits distinct patterns of gender,bipolar-II disorder, genetic, and neuro-biological measures. Using prospective data from a community sample, this paper identifies criteria (and correlates) for an AD syndrome that maximizes the association with female sex and bipolar-II. METHODS: The Zurich cohort study is composed of 591 subjects selected from a population-based cohort of young adults in the canton of Zurich in Switzerland, screened in 1978 and followed with six interviews through 1999. Seven definitions of atypical depression were tested, using varying combinations of vegetative symptoms and mood reactivity. RESULTS: The atypical definitions using 2 of 3 (fatigue, overeating, oversleeping) or 2 of 2 (overeating, oversleeping) vegetative symptoms showed the strongest association with gender, bipolarity, and family history of mania. The 2/3 definition was chosen for further analysis due to its high sensitivity for identifying these characteristics. This syndrome had cumulated weighted prevalence of 16.4% (males 9.7%, females 23%); when associated with major depressive episodes, 8.2% (males 3.2%, females 15.1%). AD patients were characterized by high treatment rates, severity, and work impairment, early age of onset and long illness. AD was comorbid with social phobia, binge eating, neurasthenia, migraine headache, and subjective cognitive impairment.