Search

Background Following German reunification, physical health indicators in the formerly separated states (German Democratic Republic- East/ Federal Republic of Germany-West) have converged. However, it remains unclear how these societal changes have impacted somatic complaints, a major indicator of physical and mental health. Therefore, we investigated how somatic symptom reporting in men and women evolved regarding residency. Methods We administered cross-sectional surveys representative of the German population with comparable sample size in 1994 (N = 3047), 2001 (N = 2050), 2013 (N = 2508) and 2019 (N = 2531) following random route procedure. Men and women aged 14-99 reported demographics and filled the Gießen Complaint List, a standardized questionnaire, to assess major physical symptoms. Results Residency in the Eastern states was a determinant of higher symptom load in 2001 (β = 0.11, SE = 0.02, [95% CI = 0.07 to 0.15], p .001) where symptom reporting has been consistently higher compared to the West from 1994 through 2013. However, in 2019, the pattern reversed and residency in the East was associated with lower symptom load (β = -0.15, SE =0.02, [95% CI = -0.19 to -0.11], p .001). Predictors of high symptom load among all surveys were higher age, female sex, and low household income. Conclusions Symptom reporting did not converge, but reversed in 2019, with a higher symptom load in the Western states. This finding is particularly intriguing since other determinants, e.g., socioeconomic factors have converged, but have remained unfavorable in the East.

Background Surveys have indicated an increase of sexual activity in aging men; recently, however, a decrease of sexual activity has been reported in young men. Aim To assess (i) sexual activity and desire and their determinants across the age range in a population-based male sample and (ii) their changes over 11 years. Methods A representative survey of men (N = 1,095) 18 to 93 years old from 2016 was compared with a survey from 2005 (N = 1,106 men) with the same age range. Samples were drawn from the German population at random using standardized sampling procedures. Questions were filled out by participants in the presence of a trained interviewer. Sexual activity was compared using logistic regression with the factors survey (2005 vs 2016), living with a partner (yes vs no), and age. Frequency of sexual desire was compared using analysis of covariance with the factors survey (2005 vs 2016), living with a partner (yes vs no), and the covariate age. Outcomes Sexual activity was assessed as having been intimate with someone in the past year; frequency of sexual desire was evaluated within the past 4 weeks. Results The great majority of men cohabiting with a partner in 2016 was sexually active and indicated sexual desire until 70 years of age; half did so at an older age. Across the age range, men living without a partner reported considerably less sexual activity and desire. Compared with 2005, fewer men reported living with a partner. The overall proportion of men reporting sexual activity deceased from 81% to 73% in 2016 and absent sexual desire increased from 8% to 13%. Clinical Translation The findings highlight the relevance of living with a partner for sexual activity and desire. We advocate using a measure of sexual activity that encompasses many variants of intimate behavior. Strengths and Limitations Large and methodologically comparable population-based samples were compared. However, interpretations are limited by the absence of longitudinal data. We did not assess the effect of having a partner living elsewhere. Conclusion Sexual activity and desire decreased, especially in the young and middle-age groups. The decrease of men living with a partner contributed to this decreased sexual activity and desire. There was a generation effect, with younger and middle-age men living without a partner becoming less sexually active and experiencing less desire compared with the previous survey. The findings unveil changes in sexual activity and desire in a short time span.

The study determines how burden and patterns of somatic symptom reporting developed over almost four decades in the general German population. Additionally, we studied how socio-demographic factors affected the degree of somatic symptoms. Population-based samples representative for West Germany between 18 and 60 years of age were analyzed comparing three cross-sectional samples of 1975 (N = 1601), 1994 (N = 1416), and 2013 (N = 1290) by conducting a three-way analysis of variance (sex, age, survey). The prevalence rates for somatic symptoms in men and women were lower in the more recent surveys; this affected women most strongly. Exhaustion and musculoskeletal complaints remained leading symptoms (affecting 25%, resp. 11% of the men and 30%, resp. 19% of the women). There was a slight increase in women’s prevalence of exhaustion from 1994 (15%) to 2013 (19%). As determined by stepwise multiple regression, somatic symptoms were consistently associated with female sex and higher age. In the 2013 survey, education became an additional negative predictor of somatic symptom load, while the impact of age and sex on somatic symptoms reporting decreased. Somatic symptoms remain a major burden in the general population. Findings are interpreted with regard to improved living and health care conditions, different cohort experiences, and more public health information.

We estimate (1) sexual activity and sexual desire in women living with and without a partner across the age range in Germany and (2) changes over 11 years. A representative survey of 1345 (response rate: 65%) women between 18 and 99 years from 2016 was compared to a survey of 1314 women age 18–91 from 2005 (response rate: 53%). Sexual activity was assessed as having been physically intimate with someone in the past year; frequency of sexual desire was rated for the past 4 weeks. In 2016, the great majority of women living with a partner were sexually active and indicated sexual desire until the age of 60, which decreased thereafter. Compared to 2005, fewer women cohabited with a partner. Across the age range, women living without a partner reported considerably less sexual activity and desire. The overall proportion of women reporting partnered sexual activity decreased from 67% to 62% in 2016, and absent sexual desire increased from 24% to 26%. Declines of sexual activity and desire affected mostly young and middle-aged women. The decline of sexual activity and desire seems to be due to a reduced proportion of women living with a partner. There was also a generation effect with younger and middle-aged women without a partner becoming less sexually active and experiencing less desire compared to the previous survey. While surveys were methodologically comparable, interpretations are limited by the absence of longitudinal data.

Euroscepticism is associated with a new cleavage between the ‘losers’ and the ‘winners’ of globalisation. Current research also indicates that right-wing extremist, racist, and anti-democratic attitudes are more prevalent in lower status groups, particularly those struggling with societal change. These findings are combined with a unique data set covering both topics and thus add to the growing literature on Euroscepticism while also exploring the divide between the ‘losers’ and ‘winners’ of modernisation processes. The article introduces categories of occupational status groups, namely the ‘engaged’, the ‘skilled workers’, and the ‘legworkers’, which represent different levels of involvement in modernisation processes. It explores the differences in attitudes between these groups and how those differences correlate with citizens' professional status. It is concluded that perceived subjective alienation, which manifests in racist and anti-democratic attitudes, best explains EU-scepticism.

Whereas the number of marriages has decreased, alternatives such as cohabitation have increased in German society. The main goal of the present representative study was to specify the influ...

Objective To investigate the association between the quality of the family physician–patient relationship and frequent attendance of primary and specialist health care. Methods Cross-sectional survey of a representative German population sample ( N = 2.266). Family physician–patient relationship was assessed with the Patient Doctor Relationship Questionnaire (PDRQ-9). Determinants of frequent attendance were analyzed using logistic regression. Results Frequent attendance of family physicians was associated with lower income (OR 1.43, 95% CI 1.02–2.00), not being in paid work (OR 1.58, CI 1.08–2.30), psychological distress (OR 1.14, CI 1.07–1.22), somatic symptoms (OR 1.07, CI 1.04–1.11), and physical comorbidity (OR 1.54, CI 1.36–1.74) in the multivariate analysis. Frequent attendance of specialists was related to psychological distress (OR 1.12, CI 1.04–1.20), somatic symptoms (OR 1.08, CI 1.04–1.11), and physical comorbidity (OR 1.69, CI 1.48–1.93) in the multivariate analysis. Quality of the relationship was associated with frequent attendance only in the univariate analyses. A stronger relationship with the family physician was not associated with reduced contact with specialists. Conclusions The quality of the family physician–patient relationship is not independently associated with frequent attendance. Practice implications Family physicians should be aware that need factors, i.e. symptom burden and physical comorbidities, are main drivers of frequent attendance.

Einleitung: Patientenzentrierung und eine gute Arbeitsallianz sind zentrale Merkmale der hausarztlichen Behandlung. Umfragen zeigen, dass die meisten Deutschen mit der Beziehung zu ihrem Hausarzt zufrieden sind. Jedoch ist offen, welche Faktoren die Qualitat der Beziehung zum Hausarzt beeinflussen. Diese Studie hat daher zum Ziel, patientenbezogene Pradiktoren der Qualitat der Beziehung zwischen Hausarzt und Patient zu identifizieren. Material und Methoden: Personen einer reprasentativen Stichprobe der deutschen Allgemeinbevolkerung wurden im Rahmen einer Querschnittstudie mit standardisierten Fragebogen untersucht. Die Qualitat der Hausarzt-Patient-Beziehung wurde mit der deutschen Version des Patient-Doctor Relationship Questionnaire (PDRQ-9) erfasst. Mogliche Assoziationen von demografischen und klinischen Variablen (somatische Komorbiditat, korperliche und psychische Symptombelastung) mit der Qualitat der Hausarzt-Patient-Beziehung wurden mittels einer hierarchischen linearen Regressionsanalyse uberpruft. Ergebnisse: 2 278 Probanden (91,9%) gaben an, einen Hausarzt zu haben. Der Gesamtmittelwert im PDRQ-9 war hoch (M=4,12, SD=0,70). Das finale Regressionsmodell zeigte, dass hoheres Alter, weibliches Geschlecht und vor allem geringere somatische und depressive Symptombelastung als Pradiktoren einer guten Hausarzt-Patient-Beziehung fungierten. Der initiale Effekt der somatischen Komorbiditat verschwand, nachdem die korperliche Symptombelastung in die Regression aufgenommen wurde. Die erzielte Varianzaufklarung von 11% entspricht einem kleinen Effekt. Schlussfolgerung: Das subjektive Erleben von Beschwerden stellt den relevanten patientenseitigen Einflussfaktor fur die von Patienten wahrgenommene Qualitat der Beziehung zum Hausarzt dar.

As a result of a typesetting error, the number of participants in the study reported in this article was incorrectly stated in the article’s Abstract as originally published.

Introduction Up to 64% of the general population reports experiencing chronic pain, with the hip being one of the most frequent sites. An association has been shown between chronic back pain, obesity and depression. To date, a similar association has not been investigated with chronic hip pain. Methods A total of 2,515 subjects were chosen as a representative cross-section of the German population. Each was provided with a questionnaire that included the Regional Pain Scale, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Beck Depression Inventory-Primary Care and Winkler social class index. Participant height and weight values were obtained from self-reports. Using logistic regression methodology, we analysed the association between hip pain, obesity and increased depression scores. Results A total of 124 (4.9%) subjects reported chronic hip pain and an additional 39 (1.5%) reported chronic hip pain that was disabling. Hip pain affected 1-5 sites (oligolocular) in 47% of cases, and was widespread (6-19 sites) in 50%. Obesity and increased values on the depression scale were associated with an increased likelihood of chronic hip pain (odds ratio [OR] 2.55 and 8.53, respectively) compared with subjects without pain. Increased values on the depression scale (OR 28.22) increased the likelihood of experiencing disabling chronic hip pain in comparison with pain free individuals. Conclusions Hip pain is rarely the sole site of pain. Obesity and increased values on the depression scale are associated with chronic hip pain. Increased values on the depression scale are associated with disabling chronic hip pain.

Background Adverse childhood experiences (ACE) might predispose to and resilience might protect against chronic noncancer pain (CNCP). We studied whether ACE are positively associated with CNCP, whether resilience was negatively associated with CNCP and whether resilience buffered a potential association of ACE with CNCP. Methods A cross-sectional survey (N = 2,425) representative for the adult German general population was conducted in 2013. The following questionnaires were used: Chronic Pain Grade Questionnaire for CNCP stages; Childhood Trauma Screener for ACE; Brief Resilient Coping Scale for resilience; Patient Health Questionnaire 4 for psychological symptom burden; Giessen Subjective Complaints List for somatic symptom burden. To test the association of ACE and resilience with CNCP stages, logistic regression analyses including sociodemographic variables and psychological and somatic symptom burden as possible confounders were calculated. Results No statistically significant associations between any CNCP and disabling CNCP respectively with physical, emotional, and sexual abuse; emotional and physical neglect if compared to no chronic pain were found in uni- and multivariate analyses. There was a small effect of combined ACE and a small attenuating effect of resilience on any and disabling CNCP in univariate, but not in multivariate analysis. Large associations were found between age > 65 years with any CNCP (OR 6.51 [95% confidence interval 3.38 to 12.51)] and disabling CNCP (OR 9.33 [95% confidence interval 2.39 to 36.41]), respectively, if compared to no pain. Conclusions There was no pain-proneness by single and combined ACE for and no protection by resilience for any and for disabling CNCP in the general adult German population. Significance There is no pain-proneness due to adverse childhood experiences for any and disabling chronic noncancer pain. Resilience does not protect against any and disabling chronic noncancer pain. Older age is the strongest predictor of any and disabling chronic noncancer pain.

This study evaluated the prevalence of jaw pain as a local, regional, or widespread pain condition and its association with psychosocial variables in a large representative group of the general population from all regions in Germany. In two representative samples consisting of 2524 and 2515 subjects, respectively, the 7-day and 3-month pain prevalences were measured by using the Regional Pain Scale (RPS). Somatic symptom burden (somatization) and pain-related depression were assessed with the Patient Health Questionnaire and the Somatic Symptom Scale, respectively. Binary logistic regression was chosen to calculate the associations between demographic and psychological clinical predictor variables with jaw pain. The 7-day jaw pain prevalence was 4.0 % (95 % CI = 3.2–4.8). Of the subjects with jaw pain, only 9 % had local pain (1 pain site), while the remaining 91 % reported regional pain (2–5 pain sites), or widespread pain (6–19 pain sites). The 3-month prevalence of generally present jaw pain was 0.9 % (95 % CI = 0.6–1.0). Regional or widespread pain was present in 82 % of the participants. Jaw pain was predicted by somatic symptom burden (past 7 days, OR = 1.15 [95 % CI = 1.09–1.22]; past 3 months, OR = 1.13 [95 % CI = 1.02–1.25]), but not by depression. Most individuals with jaw pain have additional pain in other anatomical regions. They might also exhibit a greater risk for pain-associated somatic symptom burden. Assessment of pain distribution in the whole body and the use of a psychometric screening questionnaire for somatic symptom burden are recommended for individuals presenting with jaw pain in a clinical setting.

OBJECTIVES In population surveys, up to 30% of participants reported chronic pain. Reports of chronic pain do not necessarily imply disability associated with pain. We assessed the prevalence of chronic disabling noncancer pain and associated demographic and medical variables in a sample of the general German population. METHODS A cross-sectional survey was conducted with 4360 people aged 14 years and above, who were representative of the German population. Measures were obtained for demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (based on a chronic pain grade questionnaire), and disease load (based on the self-reported comorbidity questionnaire). RESULTS Responses were received from 2508 people. The prevalence of chronic pain was 28.3% (95% [confidence interval] CI, 26.5%-30.1%). In all, 7.3% (95% CI, 5.9%-8.7%) of participants met the criteria of chronic disabling noncancer pain. Chronic disabling noncancer pain was associated with age above 65 years (odds ratios [OR]=4.81 [95% CI, 1.57-14.79]), low family income (OR=2.54 [95% CI, 1.36-4.74]), obesity (OR=3.58 [95% CI, 2.21-5.79]), heart disease (OR=2.23 [95% CI, 3.69-11.40]), stomach disease (OR=4.24 [95% CI, 2.12-8.49]), and rheumatic disease (OR=3.67 [95% CI, 2.16-6.23]) when compared with no chronic pain. Chronic disabling noncancer pain was associated with low family income (OR=2.29 [95% CI, 1.23-4.27]), obesity (OR=2.14 [95% CI, 1.30-3.52]), and depression (OR=3.26 [95% CI, 1.90-5.66]) when compared with chronic nondisabling noncancer pain. CONCLUSIONS Prevalence rates of chronic disabling pain in the general population rather than prevalence rates of chronic pain might provide evidence in support of pain specialist care. The association of chronic disabling noncancer pain with mental disorders highlights the need for psychosocial services in chronic pain management.

Basierend auf Ergebnissen fruherer Studien, wonach 20–25% der Studierenden psychisch belastet sind, erhalten Kenntnisse zu Bedarf und Inanspruchnahme von fachlicher Hilfe bei psychischen und sozialen Problemen eine wesentliche Bedeutung. Im Rahmen einer Querschnittsstudie wurden 366 Studierende hinsichtlich ihres Beratungsbedarfs, der Inanspruchnahme von Hilfe und des Auftretens von Symptombelastung (SCL-27) und interpersonalen Problemen (IIP-C) befragt. Unterschiede zwischen Studierenden und der Allgemeinbevolkerung sowie zwischen Studierenden mit und ohne Beratungsbedarf wurden uberpruft. Insgesamt 23,3% der Befragten hatten einen Beratungswunsch aufgrund psychischer oder sozialer Probleme. Verglichen mit der Allgemeinbevolkerung war die Symptombelastung bei den Studierenden signifikant hoher, die Facharzte fur Allgemeinmedizin und Gynakologie wurden seltener in Anspruch genommen. Studierende mit Beratungsbedarf waren psychisch signifikant starker beeintrachtigt. Um mehr belastete Studierende zur Inanspruchnahme professioneller Hilfe zu animieren, sollte der Zugang zu professioneller Hilfe erleichtert werden.

Background There are only few data from representative samples of the general German population on the prevalence of a "pain disease" and on satisfaction with pain therapy of persons with chronic pain available. Methods A cross-sectional survey with people aged ≥ 14 years representative for the German population was conducted in 2013. Measures were obtained for presence of chronic pain (based on the definition of the International Association for the Study of Pain) and for "pain disease" by the presence of disabling pain in the Chronic Pain Grade Questionnaire and increased psychological distress in the Patient Health Questionnaire 4. In case of chronic pain reports, the satisfaction with current pain treatment and current treatment by a pain specialist were assessed. Results Responses were received from 2508 (57.5 %) of the 4360 people contacted. The prevalence of chronic pain was 26.9 % [95 % confidence interval (CI) 25.2-28.6 %]. A total of 7.4 % (95 % CI 5.0-9.9 %) met the criteria for chronic disabling nonmalignant pain, while 2.8 % (95 % CI 2.2-3.4 %) of participants met the criteria of a pain disease. In all, 31.9 % of persons with disabling pain reported current treatment by a pain specialist and 33.1 % of persons with disabling pain were (very) dissatisfied with current pain treatment. Treatment by a pain specialist was associated with higher health care use and lower treatment satisfaction. Conclusion There is a need to improve the care of persons with chronic disabling pain. Whether pain specialist treatment is (cost) effective in chronic disabling pain needs to be examined by longitudinal studies.

Hintergrund Aus Deutschland liegen keine Daten zur Pravalenz von beeintrachtigenden Bauchschmerzen und Menstruationsbeschwerden bei Erwachsenen vor.

Background There are no up to date data from representative samples of the general German population on the prevalence of debilitating pain and of pain diseases available. Methods A cross-sectional survey of a representative sample of the German general population including persons ≥ 14 years of age was conducted in 2012 based on face-to-face interviews using standardized questionnaires. Chronic pain was assessed by the widespread pain index (WPI), disability by the subscales physical functioning and role function of the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30) and psychological distress by the patient health questionnaire (PHQ-4). Chronic pain with associated physical and social impairments was defined by at least one pain site over 3 months in the WPI and at least one response of a moderate or severe impairment in both subscales of the EORTC 30 QLQ-C30. Chronic pain with associated physical, mental and social impairment (pain disease) required in addition a probable depressive and/or anxiety disorder in the PHQ-4. Results A total of 2,515 out of 4,480 (56.1 %) of contacted persons finished the study of which 32.9 % reported chronic pain, 5.4 % reported chronic pain with associated physical and social impairments and 2.3 % associated physical, mental and social impairments. No participants with local pain (only one pain site) but 24.0 % of participants with widespread pain (6-19 pain sites) met the criteria of a pain disease. Conclusions The reports of chronic pain in epidemiological studies do not necessarily imply a suffering (physical, psychological and social impairment) from pain.

Whether self-reported lifetime civilian and war-related potential traumatic events are associated with widespread pain (WP) and if so, whether the association is attributable to posttraumatic stress disorder (PTSD) and depression has not been studied in a representative sample of the general population. In a randomly selected sample of the German general population, persons aged 60-85 years answered validated self-rating instruments: Regional Pain Scale, trauma list of the Composite International Diagnostic Interview, Posttraumatic Diagnostic Scale, and Patient Health Questionnaire 2. Participants with WP were compared with participants with no or local or regional pain (controls). Stepwise hierarchical logistic regression analyses were performed with WP as the dependent variable and demographic data, potential traumatic events, PTSD, and depressive disorder as independent variables. Of 773 respondents, 147 (19.0%) reported WP. Participants with WP reported rape (4.1% vs 1.0%, P=0.01), life-threatening illness (11.6% vs 6.1%, P=0.02), witnessing trauma (19.2% vs 8.4%, P=0.001), and cumulative potential traumatic events (24.5% vs. 16.5%, P=0.004) more frequently than the 626 controls. The prevalence of full PTSD (10.9% vs 2.2%; P

While adverse childhood experiences have been shown to contribute to adverse health outcomes in adulthood, specifically distress and somatic symptoms, few studies have examined their joint effects with resilient coping style on adult adjustment. Hence, we aim to determine the association between resilient coping and distress in participants with and without reported childhood adversities. A representative German community sample (N = 2508) between 14-92 years (1334 women; 1174 men) was examined by the short form of the Childhood Trauma Questionnaire, the Brief Resilience Coping Scale, standardized scales of distress and somatoform symptoms. Childhood adversity was associated with reduced adjustment, social support and resilience. It was also strongly associated with increased distress and somatoform complaints. Resilient coping was not only associated with lower distress, it also buffered the effects of childhood adversity on distress. Our study corroborates the buffering effect of resilience in a representative German sample. High trait resilient subjects show less distress and somatoform symptoms despite reported childhood adversities in comparison to those with low resilient coping abilities.

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.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.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.Experiencing somatic and depressive symptoms emerged as most relevant patient-related predictors of the quality of the family physician-patient relationship.

Aus Deutschland liegen keine Daten zu Pravalenz und Pradiktoren von urogenitalen Schmerzen bei Mannern aus der allgemeinen Bevolkerung vor. Personen ≥14 Jahren aus einer reprasentativen Stichprobe der deutschen Gesamtbevolkerung wurden in einer Querschnittstudie mit standardisierten Fragebogen untersucht. Urogenitale Schmerzen wurden mit der deutschen Version des National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), Depressivitat mit dem Modul des Fragebogens zum Gesundheitszustand (PHQ-9) und die gesundheitsbezogene Lebensqualitat mit dem Fragebogen zum Gesundheitszustand (SF-36) erfasst. An der Studie nahmen 2066 Personen (66,5% der kontaktierten Personen) teil. In die Analyse wurden 960 Manner mit einem Durchschnittsalter von 47,2 Jahren eingeschlossen. Die 1-Wochenpravalenz von urogenitalen Schmerzen lag bei 9,6%. Ein Anteil von 2,4% erfullte die Kriterien milder und 1,9% die Kriterien schwerer prostatitisahnlicher Symptome. Der Gesamtschmerzscore des NIH-CPSI wurde durch ein hoheres Lebensalter, Einkommen und vermehrte Depressivitat pradiziert. Manner mit milden und schweren prostatitisahnlichen Symptomen gaben eine vermehrte Depressivitat und eine niedrigere gesundheitsbezogene Lebensqualitat an als Manner ohne prostatitisahnliche Symptome. Prostatitisahnliche Symptome in der allgemeinen Bevolkerung sind mit einer reduzierten gesundheitsbezogenen Lebensqualitat und vermehrter Depressivitat assoziiert.

This study analyzed the provision of outpatient psychotherapy services in Germany in typical practice settings. In a representative survey (from June 2008 to September 2009) 1,212 subjects who received outpatient psychotherapy during the past 6 years were questioned about their experiences with outpatient psychotherapy via telephone interviews. Socio-economic data, reasons for seeking treatment, access paths, financial resources and psychosocial support data were collected. Therapeutic settings and modalities and concomitant medication treatment are described. The findings illustrate the problem of multiple psychiatric morbidity in the clinical practice and confirm the urgent need for patient access to professional psychotherapeutic services. Improving access to these services requires close cooperation between care providers.

Aus Deutschland liegen keine Daten aus reprasentativen Stichproben der Gesamtbevolkerung zu Pradiktoren von Schmerzen in mehreren Korperregionen (WP) und des Fibromyalgiesyndroms (FMS) vor. Personen ≥14 Jahre aus einer reprasentativen Stichprobe der deutschen Gesamtbevolkerung wurden im Rahmen einer Querschnittsstudie mit standardisierten Fragebogen untersucht. Schmerzorte, das Vorliegen eines WP und FMS wurden mit der Regionalen Schmerzskala RPS, korperliche Symptombelastung bzw. Depressivitat mit den Modulen des Fragebogens zum Gesundheitszustand PHQ 15 bzw. PHQ 9 und der subjektive Gesundheitszustand mit der Kurzform des Fragebogens zum Gesundheitszustand SF-12 erfasst. Die Studie beendeten 2524/4064 (62,1%) der kontaktierten Personen. Die Pravalenz des CWP war 8,6%, des FMS 3,8%. Das Geschlechtsverhaltnis Frauen zu Manner war bei WP und FMS 1:1; 52,4% der Varianz der Zahl der Schmerzorte wurden durch hoheres Alter, niedrigen sozialen Schichtindex, hohe korperliche Symptombelastung, geringe Depressivitat und subjektiv niedrigen korperlichen Gesundheitszustand pradiziert (p

Das von Borkenau und Ostendorf uebersetzte "NEO-Fuenf-Faktoren-Inventar" (NEO-FFI) zur Erfassung fuenf robuster Persoenlichkeitsfaktoren nach Costa und McCrae hat sich in den letzten Jahren auch im deutschen Sprachraum etabliert. Die Ergebnisse einer Untersuchung mit einer 1908 Personen umfassenden repraesentativen Bevoelkerungsstichprobe zeigten allerdings Probleme bei der Replikation der Faktorenstruktur. Ungenuegende Kennwerte einzelner Items fuehrten zu teilweise unbefriedigenden Skalenkennwerten. Als Konsequenz erfolgte die Entwicklung einer oekonomischen Kurzversion mit besseren psychometrischen Eigenschaften. Es werden Item- und Skalenwerte des NEO-FFI-30 anhand der deutschen Bevoelkerungsstichprobe berichtet, wobei alle Items ihre hoechste Trennschaerfe auf der jeweils zugeordneten Skala aufweisen. Die Skalen erreichten akzeptable interne Konsistenzen und korrelierten hoch mit den originalen NEO-FFI-Skalen. Es zeigten sich nahezu identische Abhaengigkeiten von soziodemografischen Variablen und Korrelationen mit dem "Giessen-Test". Des Weiteren liess sich die Faktorenstruktur in einer unabhaengigen Pruefstichprobe von 2508 Erwachsenen bestaetigen. Damit sprechen die Ergebnisse fuer die Reliabilitaet, faktorielle und Konstruktvaliditaet des NEO-FFI-30.

Zusammenfassung. Theoretischer Hintergrund: Interpersonelle Schuldgefühle sind klinisch relevant, bisher aber kaum empirisch untersucht. Fragestellung: Es soll zur Validierung des “Fragebogens zu interpersonellen Schuldgefühlen“ (FIS) beigetragen werden. Methode: Zusammenhänge zwischen interpersonellen Schuldgefühlen (FIS) und psychischer Beeinträchtigung (Beck-Depressions-Inventar, SCL-90-R, U-Bogen-24, IIP-D) wurden an 308 PsychotherapiepatientInnen untersucht. Ergebnisse: Auf den Skalen Überlebensschuldgefühl, Schuldgefühl aus Verantwortung und Gesamtwert zeigten PsychotherapiepatientInnen höhere Werte als ProbandInnen einer repräsentativen Bevölkerungsstichprobe. Frauen gaben mehr Schuldgefühle an als Männer. Interpersonelle Schuldgefühle standen in positivem Zusammenhang mit psychischer Beeinträchtigung. PatientInnen gaben zum Therapieende niedrigere Werte für Trennungsschuldgefühl, Schuldgefühl aus Verantwortung und den Gesamtwert an als zu Therapiebeginn. Schlussfolgerungen: Der “Fragebogen zu interpersonellen Schuldgefühlen“ scheint eine klinisch relevante, valide und zeitökonomische Erfassung interpersoneller Schuldgefühle zu erlauben.

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.

Innerhalb einer reprasentativen Mehrthemenbefragung in der deutschen Bevolkerung wurden im Rahmen von Sekundaranalysen anhand von zwei Fragen („Wo sind Sie uberwiegend aufgewachsen – altes Bundesgebiet oder neues Bundesgebiet?“ und „Wo leben Sie jetzt?“) innerdeutsche Binnenmigranten (54 West-Ost- und 68 Ost-West-Migranten) ermittelt und bezuglich verschiedener Variablen zur Einschatzung der psychischen Befindlichkeit mit Nichtmigranten (1136 Westdeutsche und 294 Ostdeutsche) verglichen. Verglichen mit Nichtmigranten gaben Migranten erhohten Stress, eingeschranktes korperliches Wohlbefinden und verstarkte korperliche Symptome an. Probanden, die von Westdeutschland nach Ostdeutschland ubergesiedelt waren, schatzten ihre Lebensqualitat niedriger als alle anderen Gruppen ein.

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 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 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?"

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. Language: de

Objective Low back pain (LBP), obesity, and depression are highly prevalent health conditions. We assessed the relative impact of body weight and depression on different types of LBP in a representative population sample. Design This is a cross-sectional study. Setting and Patients Two thousand five hundred ten subjects aged 14–90 years were randomly selected from the German general population in 2012. Measures Pain sites and duration of pain were assessed by the Widespread Pain Index( WPI), depression by the Beck Depression Inventory Primary Care Questionnaire, disability by the European Organization for Research and Treatment of Cancer questionnaire, and current body mass index (BMI, kg/m2) by self-reported body weight and height. Widespread pain was defined by ≥7/19 pain sites in the WPI. Hierarchical logistic regression analyses were performed with different types of LBP as the dependent variable, and age, gender, lifetime employment status as a worker, number of pain sites, BMI, and depression as independent variables. Results One thousand six hundred eighty-seven (67.1%) of participants reported no pain. Five hundred six (20.2%) reported chronic LBP and 84 (3.3%) reported disabling chronic LBP. Age (odds ratio [OR] 1.05 [95% confidence interval {CI} 1.04–1.06]), BMI (OR 1.08 [95% CI 1.05.–1.11]), and depression (OR 1.38 [95% CI 1.30–1.49]) independently predicted chronic LPB compared with persons without pain. Age (OR 1.07 [95% CI 1.05–1.09]), BMI (OR 1.07 [95% CI 1.03–1.13]), and depression (OR 1.71 [95% CI 1.55–1.88]) independently predicted disabling chronic LPB compared with persons without pain. Age (OR 1.03 [95% CI 1.01–1.05]), widespread pain (OR 5.23 [95% CI 3.04–9.00), and depression (OR 1.34 [95% CI 1.16–1.55]) independently predicted disabling chronic LPB compared with persons with nondisabling chronic LBP. Conclusion BMI and depression are modifiable risk indicators for chronic disabling LBP.

Body dysmorphic disorder (BDD) is a psychosomatic disease associated with reduced quality of life and suicidal ideations. Increasing attention to beauty and the development of beauty industries lead to the hypothesis that BDD is increasing. The aim of this study was to test this hypothesis in two representative samples of Germans, assessed in 2002 and 2013. In 2002, n = 2,066 and in 2013, n = 2,508 Germans were asked to fill in the Dysmorphic Concern Questionnaire (DCQ), which assesses dysmorphic concerns. Subclinical and clinical dysmorphic concerns increased from 2002 to 2013 (subclinical from 0.5% to 2.6%, OR = 5.16 (CI95% = 2.64; 10.06); clinical from 0.5% to 1.0%, OR = 2.20 (CI95% = 1.03; 4.73). Women reported more dysmorphic concerns than men, with rates of 0.7% subclinical and 0.8 clinical BDD in women and 0.3% subclinical and 0.1% clinical BDD in men in 2002. In 2013, 2.8% subclinical and 1.2% clinical BDD were found in women and 2.4% subclinical and 0.8% clinical BDD in men. Further studies should assess predictors for developing a BDD and evaluate factors determining the efficacy of disease-specific psychotherapeutic and psychotropic drug treatments.

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.

Background Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses. Results 2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]). Conclusion Chronic pain stages, but also disease load and societal inequalities contributed to societal burden. Pain measurements in epidemiology research of chronic pain should include chronic pain grades and disease load.

A link between fibromyalgia syndrome (FMS) and posttraumatic stress disorder (PTSD) has been suggested because both conditions share some similar symptoms. The temporal relationships between traumatic experiences and the onset of PTSD and FMS symptoms have not been studied until now. All consecutive FMS patients in 8 study centres of different specialties were assessed from February 1 to July 31, 2012. Data on duration of chronic widespread pain (CWP) were based on patients' self-reports. Potential traumatic experiences and year of most burdensome traumatic experience were assessed by the trauma list of the Munich Composite International Diagnostic Interview. PTSD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders IV symptom criteria by the Posttraumatic Diagnostic Scale. Age- and sex-matched persons of a general population sample were selected for controls. Three hundred ninety-five of 529 patients screened for eligibility were analysed (93.9% women, mean age 52.3 years, mean duration since chronic widespread pain 12.8 years); 45.3% of FMS patients and 3.0% of population controls met the criteria for PTSD. Most burdensome traumatic experience and PTSD symptoms antedated the onset of CWP in 66.5% of patients. In 29.5% of patients, most burdensome traumatic experience and PTSD symptoms followed the onset of CWP. In 4.0% of patients' most burdensome traumatic experience, PTSD and FMS symptoms occurred in the same year. FMS and PTSD are linked in several ways: PTSD is a potential risk factor of FMS and vice versa. FMS and PTSD are comorbid conditions because they are associated with common antecedent traumatic experiences.

Innerhalb von internationalen Studien, die auf Populationsdaten basierten, berichteten bis zu 30 % der Teilnehmer von chronischen Schmerzen. W. Hauser et al. haben nun am Beispiel der deutschen Allgemeinbevolkerung die Pravalenz von chronischen, invalidisierenden, nicht krebsbedingten Schmerzen sowie assoziierte Faktoren untersucht.

Maltreatment in childhood and adolescence constitutes a major social problem and a health risk throughout the world (1). In the USA, the Centers for Disease Control and Prevention (CDC) define child maltreatment as “Any act or series of acts of commission or omission by a parent or other caregiver (e.g., clergy, coach, teacher) that results in harm, potential for harm, or threat of harm to a child.” Acts of commission are divided into physical, sexual, and psychological abuse. Acts of omission are classified as physical, emotional, medical, or educational neglect or failure to supervise. Neglect is defined as “failure to provide for a child’s basic physical, emotional, or educational needs or to protect a child from harm or potential harm,” while abuse is “words or overt actions that cause harm, potential harm, or threat of harm to a child.” Maltreatment can be characterized in terms of severity (from mild to severe) and frequency (from an isolated occurrence to repeated acts over a number of years) (2). The frequency of child maltreatment can be estimated from externally registered cases of maltreatment, e.g., cases recorded by the Federal Criminal Police Office or case series from pediatric hospitals. However, this method probably underestimates the true prevalence of child maltreatment because of the high proportion of cases assumed to go unreported (3). Alternatively, the frequency of child maltreatment can be ascertained by retrospective population surveys. Previous studies on the frequency of maltreatment in childhood that have been based on surveys (by questionnaire or interview) of samples of the general population have focused mainly on one type of maltreatment, i.e., sexual abuse (4). To our knowledge, only one study of a representative sample of the population on the frequency of maltreatment in childhood using a questionnaire designed by the investigators has been carried out in Germany to date. This study, conducted in 1992 and published in 1998, surveyed 3289 people aged 16 to 59 years. Of those questioned, 75% reported experiencing physical violence before the age of 16 and 6% stated they had been sexually abused (5). A review of European studies on maltreatment in childhood and adolescence found that sexual abuse was commoner among girls and physical maltreatment more frequent among boys (6). The German study mentioned above revealed an association between social class and physical abuse, but not between class and sexual abuse (5). The goal of the present study was to ascertain retrospectively the frequency, severity and associations of maltreatment (abuse and neglect) of children and adolescents in a representative sample of the German general population. A validated questionnaire was used for this purpose. Furthermore, we investigated the possible associations of demographic variables (sex, age at time of study, social class) with maltreatment in childhood and adolescence.

There are no up-to-date, representative studies on the frequency of maltreatment (abuse or neglect) among children and adolescents in Germany.In a cross-sectional study, standardized questionnaires were administered to persons aged 14 and older in a representative sample of the German population. Statistics on maltreatment in childhood and adolescence were collected with the German version of the Childhood Trauma Questionnaire. Regression analysis was used to detect potential associations of maltreatment with demographic variables including sex, age, place of birth, and social class.2504 of the 4455 persons contacted (56%) completed the study. Severe emotional abuse in childhood and/or adolescence was reported by 1.6% of persons in the overall sample, severe physical abuse by 2.8%, and severe sexual abuse by 1.9%. Severe emotional neglect was reported by 6.6% and severe physical neglect by 10.8%. Female sex was a predictor for severe sexual abuse, while belonging to a low or middle social stratum was a predictor for severe physical abuse and neglect. Being older at the time of the survey was a predictor for severe physical neglect. All types of maltreatment were significantly correlated with each other (p0.001).The frequencies of various types of abuse and neglect of children and adolescents that were retrospectively determined in this up-to-date study by questionnaire of a representative sample of the German population, and the correlations between them, correspond to those found in a German population-based study in 1995 and in recent American studies.

Background Disgust sensitivity is defined as a predisposition to experiencing disgust, which can be measured on the basis of the Disgust Scale and its German version, the Questionnaire for the Assessment of Disgust Sensitivity (QADS). In various studies, different factor structures were reported for either instrument. The differences may most likely be due to the selected factor analysis estimation methods and the small non-representative samples. Consequently, the aims of this study were to explore and confirm a theory-driven and statistically coherent QADS factor structure in a large representative sample and to present its standard values. Methods The QADS was answered by N = 2473 healthy subjects. The respective households and participants were selected using the random-route sampling method. Afterwards, the collected sample was compared to the information from the Federal Statistical Office to ensure that it was representative for the German residential population. With these data, an exploratory Promax-rotated Principal Axis Factor Analysis as well as comparative confirmatory factor analyses with robust Maximum Likelihood estimations were computed. Any possible socio-demographic influences were quantified as effect sizes. Results The data-driven and theoretically sound solution with the three highly interrelated factors Animal Reminder Disgust, Core Disgust, and Contamination Disgust led to a moderate model fit. All QADS scales had very good reliabilities (Cronbach's alpha) from .90 to .95. There were no age-differences found among the participants, however, the female participants showed remarkably higher disgust ratings. Conclusions Based on the representative sample, the QADS factor structure was revised. Gender-specific standard percentages permit a population-based assessment of individual disgust sensitivity. The differences of the original QADS, the new solution, and the Disgust Scale - Revised will be discussed.

Objective.We tested the hypothesis that “fibromyalgia syndrome” is a biopsychosocial continuum disorder.Methods.A cross-sectional survey of a representative sample of the German general population with persons ≥ 14 years of age was conducted based on face-to-face contacts. Physical distress was measured by the regional pain scale (RPS) and the Patient Health Questionnaire 15 (PHQ-15), psychological distress by the PHQ-9, and social distress by the Oslo Social Support Scale. Health-related quality of life (HRQOL) was measured by the 12-item form of the Medical Outcome Study Short Form Health Survey. A k-means clustering procedure with 2–8 clusters preset was used to classify the scores of the RPS, PHQ-9, and PHQ-15. The number of clusters retained was based on the stability and interpretability of the clusters. The cluster analysis was first performed with a randomly selected half of the sample and then cross-validated on the second half of the total sample.Results.A 4-cluster solution produced the most stable and meaningful results. Cluster 1 was very low on all symptom scores. Cluster 2 was low on pain sites, somatic symptoms, and depression. Cluster 3 was high on pain scores, moderate on somatic symptoms, and low on depression. Cluster 4 was high on all symptom scores. The centroids of cluster 4 met the survey criteria of fibromyalgia syndrome. Cluster 4 reported a lower HRQOL and less social support compared to the other 3 groups.Conclusion.A cluster within the continuum of biopsychosocial distress can be labeled fibromyalgia syndrome.

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.

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.