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Psychotherapy of chronic depression has remained a challenge due to limited prognosis and high rates of recurrence. We present 5-year outcome data from a multicentre trial comparing psychoanalytic (PAT) and cognitive-behavioural (CBT) long-term treatments with randomized and preferred allocations analysing symptom (N = 227) and structural change (N = 134) trajectories.Self- and blinded expert ratings of depression symptoms were performed at yearly intervals using the Beck Depression Inventory-II (BDI-II) and Quick Inventory of Depressive Symptoms (QIDS-C). Blinded expert ratings of Operationalized Psychodynamic Diagnosis (OPD) and the Heidelberg Restructuring Scale (HRS) at baseline, 1, 3, and 5 years assessed structural change in a subsample.Lasting and comparable symptom changes were achieved by PAT and CBT. However, compared to CBT, PAT was more successful in restructuring, a major goal of long-term psychodynamic treatments with high frequency and duration.Due to practical reasons, the time criterion for chronic depression of an acute phase had to be defined for over 1 year in the present study, which does not correspond to the DSM-5 criterion of 2 years. Therapy duration and session frequency were not incorporated into the statistical models.Long-term psychotherapy helps patients with a yearlong history of depression and often multiple unsuccessful treatment attempts to achieve lasting symptom changes. Future follow-up will clarify whether restructuring promotes further sustainable improvements.

As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes.Individuals in psychosomatic inpatient treatment (After treatment (duration in days:The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.

Zusammenfassung Ziel der Studie Die Anzahl wissenschaftlicher Untersuchungen der Alexithymie ist in den letzten Jahrzehnten stark angewachsen, da das Konstrukt wichtige Implikationen für die psychische Gesundheit hat. Die bisher verwendeten Inventare sind in der epidemiologischen Forschung, der Primärversorgung und anderen klinischen Bereichen, in denen Zeit und Aufwand wichtige Faktoren für Screening und Diagnostik sind, nur von begrenztem Nutzen. Ziel der vorliegenden Studie war, auf der Grundlage von Items der autorisierten deutschen Version der Toronto Alexithymia Scale einen ultrakurzen Fragebogen zur komprimierten und eindimensionalen Erfassung von Alexithymie zu entwickeln (die Short Alexithymia Scale; SAS-3). Methodik Kriterien für die gekürzte Skala waren: (a) Eindimensionalität (notwendig zur Berechnung eines Summenscores), (b) ein Item aus jeder der ursprünglich postulierten Dimensionen und (c) keine invers kodierten Items (zur Vermeidung von Methodenartefakten). Die Daten stammen aus zwei bundesweiten, repräsentativen deutschen Bevölkerungsbefragungen: einer Befragung aus dem Jahr 1996 zur Entwicklung des SAS-3 (N=2,047) und einer Befragung aus dem Jahr 2013 (N=2,508) zur Auswertung und Berechnung der SAS-3 Perzentile. Ergebnisse Es wurden hypothesenkonforme, substantielle Korrelationen zwischen SAS-3 und PHQ-2, GAD-2 und GBB-8 festgestellt. Anhand einer konfirmatorischen Faktorenanalyse konnte die Eindimensionalität der SAS-3 bestätigt werden, wobei sehr gute Fit-Indizes erreicht wurden. Eine zusätzliche Messinvarianzanalyse hinsichtlich des Geschlechts und verschiedener Altersgruppen ergab eine (teilweise) strikte Invarianz für die verschiedenen Multigruppenanalysen. Perzentilränge des SAS-3-Summenscore sind nach Geschlecht und Altersgruppen stratifiziert angegeben. Schlussfolgerung Die SAS-3 erscheint geeignet für groß angelegte epidemiologische Forschungsvorhaben, die klinische (psychotherapeutische) Praxis und andere Kontexte, in denen eine ökonomische Erhebung der Alexithymie erforderlich ist.

Self-criticism is a stable personality trait identified as a serious risk factor for psychopathology and weight-related health problems. Therefore, it is relevant to epidemiological research, which requires a relatively brief instrument for measuring trait self-criticism in the general population. The current study introduces a brief measure of self-criticism and presents empirical results that inform on its reliability and validity. Based on the six-item version of the

Loneliness has been related to negative physical and mental health outcomes including suicidal ideation (SI). However, it is not clear whether loneliness is equally important for SI in women and men and in individuals of all age groups.Participants were a representative population sample (N=2,450) comprising the entire adult age range (18-95 years). Participants filled out established questionnaires (UCLA Three-Item Loneliness Scale, Beck Scale for Suicide Ideation, Patient Health Questionnaire-4). We tested a multiple linear regression model of SI (controlling for income, living alone, and mental distress) with interaction terms (loneliness x gender, loneliness x age, gender x age, loneliness x gender x age). We also investigated women and men separately.Women and men did not differ regarding mean levels of SI, but women reported more loneliness. Loneliness was related to SI regardless of participants' gender (β=.410; p.001). Gender-specific analyses showed that the association of loneliness and SI was especially strong among younger men (loneliness x age within the male sample: β=-.149; p=.014). Living in a shared household was negatively associated with SI in men (β=-.072; p=.019), but not in women.The cross-sectional study design does not allow for interpretations regarding the direction of effects.Besides similarities, the study indicated gender-specific potential risk- and protective factors, i.e. age and living together with others. Young men who report loneliness could be at particularly high risk for suicidal ideation. Gender- and age-specific approaches can contribute to a more precise identification of vulnerable groups in the population.

Krebserkrankungen konnen weitreichende und nachhaltige Folgen fur die psychische Gesundheit haben. Krebspatient*innen und -uberlebende sind deutlich haufiger als die Allgemeinbevolkerung von Suizidgedanken und -handlungen betroffen. Suizidpravention ist deshalb eine wichtige Aufgabe in der klinischen (psycho)onkologischen Praxis. Untersucht werden empirisch bestatigte und theoretisch abgeleitete Risiko- und Schutzfaktoren bei suizidalen Krisen im Kontext von Krebs. Die Zusammenfassung der Empirie basiert auf sechs aktuellen, internationalen Ubersichtsarbeiten. Erganzend werden ausgewahlte, praktisch relevante psychosoziale Faktoren dargestellt. Eine Fallvignette illustriert eine spezifische Gefahrdungslage und den Umgang damit im klinischen Alltag. Das Risiko fur Suizidgedanken und Tod durch Suizid variiert in Abhangigkeit von der Krebserkrankung (Entitat und Prognose) und Eigenschaften der Person (Alter und Geschlecht). Suizidversuche mit Todesfolge kamen eher bei Mannern als bei Frauen vor und fanden v. a. im ersten Jahr nach Diagnose statt. Soziale Unterstutzung schutzte vor Suizidalitat. Interventionen durch geschultes Fachpersonal – wie empathische Anteilnahme und strukturierte Hilfen wie Notfallplane – konnen stabilisierend wirken und damit Leben retten. Krebspatient*innen und -uberlebende konnen in seelische Krisensituationen geraten, in denen sie psychoonkologische Betreuung benotigen. Praktiker*innen sollten deshalb bereit sein, Suizidalitat im klinischen Alltag aktiv zu explorieren. Wissen uber Risiko- und Schutzfaktoren hilft dabei, gefahrdete Patient*innengruppen zu erkennen und sie gezielt zu unterstutzen.

The aim of this study was to investigate whether the three resource variables sense of coherence, resilience, and dispositional optimism become impaired when people are ill with cancer, whether there are sex and age differences in these variables, and how these variables are associated with quality of life (QoL).A sample of 1108 patients with mixed cancer diagnoses were examined using the Sense of Coherence Scale-3 (SOC-3), the Brief Resilience Scale (BRS), the Life Orientation Test (LOT-R), and the QoL questionnaire EORTC QLQ-C30.The three resource variables showed somewhat lower levels in the patients' sample in comparison with general population controls, with effect sizes between -0.10 and -0.23. While there were only small sex differences in the resource variables, significant age differences were found in these variables, with stronger detriments in younger patients. The correlations among the resource variables ranged between .53 and .61. Sense of coherence was more strongly correlated with QoL than resilience and optimism.Cancer patients with low levels of personal resources adapt to their disease more poorly than patients with high levels. In addition to limitations in QoL, health care professionals should also consider patients' resources for coping with the disease. Special attention should be given to young cancer patients.

Objective: As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes.Method: Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment.Results: After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (β = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge.Conclusion: The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.

The literature on alexithymia has multiplied in recent decades as the construct has important implications for mental health. The so far used inventories are of limited use in epidemiological research, primary care, and other clinical settings where time and effort are important factors in assessment. Based on items of the authorized German version of the Toronto Alexithymia Scale, the aim of this study was to develop an ultra-short questionnaire for a condensed and unidimensional assessment of alexithymia.Criteria for the abbreviated scale were: (a) one-dimensionality (necessary to calculate a global score), (b) one item from each of the originally postulated dimensions, and (c) no reverse-coded items (to avoid method artifacts). Data were drawn from two nationwide representative population surveys in Germany: a survey conducted in 1996 to develop the SAS-3 (N=2.047); and a survey conducted in 2013 (N=2.508) for the evaluation and calculation of SAS-3 percentiles.Reasonable correlations between the SAS-3 and the PHQ-2, the GAD-2, and the GBB-8 were observed. Based on a confirmatory factor analysis, the one-dimensionality of the SAS-3 could be confirmed, achieving very good fit indices. An additional invariance analysis regarding gender and different age groups resulted in (partial) strict invariance for the different multi-group analyses. Percentile ranks for SAS-3 sum score are reported stratified by gender and by age groups.The SAS-3 appears to be suitable in epidemiological research and other instances requiring an economical assessment of alexithymia.Die Anzahl wissenschaftlicher Untersuchungen der Alexithymie ist in den letzten Jahrzehnten stark angewachsen, da das Konstrukt wichtige Implikationen für die psychische Gesundheit hat. Die bisher verwendeten Inventare sind in der epidemiologischen Forschung, der Primärversorgung und anderen klinischen Bereichen, in denen Zeit und Aufwand wichtige Faktoren für Screening und Diagnostik sind, nur von begrenztem Nutzen. Ziel der vorliegenden Studie war, auf der Grundlage von Items der autorisierten deutschen Version der Toronto Alexithymia Scale einen ultrakurzen Fragebogen zur komprimierten und eindimensionalen Erfassung von Alexithymie zu entwickeln (die Short Alexithymia Scale; SAS-3).Kriterien für die gekürzte Skala waren: (a) Eindimensionalität (notwendig zur Berechnung eines Summenscores), (b) ein Item aus jeder der ursprünglich postulierten Dimensionen und (c) keine invers kodierten Items (zur Vermeidung von Methodenartefakten). Die Daten stammen aus zwei bundesweiten, repräsentativen deutschen Bevölkerungsbefragungen: einer Befragung aus dem Jahr 1996 zur Entwicklung des SAS-3 (N=2,047) und einer Befragung aus dem Jahr 2013 (N=2,508) zur Auswertung und Berechnung der SAS-3 Perzentile.Es wurden hypothesenkonforme, substantielle Korrelationen zwischen SAS-3 und PHQ-2, GAD-2 und GBB-8 festgestellt. Anhand einer konfirmatorischen Faktorenanalyse konnte die Eindimensionalität der SAS-3 bestätigt werden, wobei sehr gute Fit-Indizes erreicht wurden. Eine zusätzliche Messinvarianzanalyse hinsichtlich des Geschlechts und verschiedener Altersgruppen ergab eine (teilweise) strikte Invarianz für die verschiedenen Multigruppenanalysen. Perzentilränge des SAS-3-Summenscore sind nach Geschlecht und Altersgruppen stratifiziert angegeben.Die SAS-3 erscheint geeignet für groß angelegte epidemiologische Forschungsvorhaben, die klinische (psychotherapeutische) Praxis und andere Kontexte, in denen eine ökonomische Erhebung der Alexithymie erforderlich ist.

The aim of this umbrella review is to summarize and discuss the current state of research on information and other needs among migrant and ethnic minority cancer patients and survivors, as well as to provide a practical and comprehensive overview for medical personnel. In fact, although migrants and ethnic minorities with cancer show worse psychological and health-related quality of life outcomes, little is known about their needs during the different phases of cancer. Web of Science, PubMed, and PsycINFO databases were searched for systematic reviews on information and supportive care needs of ethnic minority and migrant cancer patients and survivors. From the 445 articles retrieved, 5 systematic reviews were included. During the diagnosis and therapy phase, almost all ethnic groups showed high needs for “cancer-specific”, “treatment-related”, and “prognosis” information. During the survivorship phase, high needs for “coping”, “rehabilitation”, and “prognosis” information were reported. Among mostly all migrant groups and ethnic minorities, information on the “general health care system” were among the most reported needs, especially on the topics of communication with medical personnel. Barriers towards the fulfillment of these needs were often reported in language and cultural differences. Supportive care needs concerning family and spirituality were not sufficiently met. Information needs on “body image/sexuality” were only present among certain minorities. Information and other needs are mostly similar among the various ethnic groups, as are the barriers towards them. However, some specific information or other needs are more present in some migrant groups or ethnic minority cancer patients and/or survivors than in others.

Ziel dieses Reviews ist es, den aktuellen Forschungsstand in Bezug auf Informations- und andere Unterstutzungsbedurfnisse von Krebspatienten und -uberlebenden mit Migrationshintergrund und/oder Zugehorigkeit zu einer ethnischen Minderheit zusammenzufassen, zu diskutieren und Behandelnden einen praxisnahen, umfassenden Uberblick zu bieten. Obwohl Migranten und ethnische Minderheiten mit Krebs haufig eine schlechtere Lebensqualitat angeben, ist wenig uber ihre Bedurfnisse in verschiedenen Erkrankungsphasen bekannt. Die Datenbanken Web of Science, PubMed und PsycINFO wurden nach systematischen Ubersichtsarbeiten zu Informations- und Unterstutzungsbedurfnissen von Krebspatienten ethnischer Minderheiten und Migranten durchsucht. Von 445 abgerufenen Artikeln entsprachen funf systematische Ubersichtsarbeiten den Einschlusskriterien. Wahrend der Diagnose- und Therapiephase berichteten fast alle ethnischen Gruppen grosen Bedarf an krebsspezifischen, behandlungsbezogenen und prognostischen Informationen. Wahrend der Nachsorgephase bestand ein groser Informationsbedarf zu „Bewaltigung“, „Rehabilitation“ und „Prognose“. Fast alle Gruppen benotigten Informationen uber das „Allgemeine Gesundheitssystem“, besonders zu Kommunikation mit medizinischem Personal. Barrieren waren sprachliche und kulturelle Unterschiede. Unterstutzungsbedurfnisse, die Familie und Spiritualitat betreffend, wurden nicht ausreichend befriedigt. Informationsbedarf zu „Korperbild/Sexualitat“ gab es nur bei wenigen Gruppen. Informations- und andere Unterstutzungsbedurfnisse verschiedener ethnischer Gruppen ahneln sich, ebenso deren Barrieren. Einige spezifische Bedurfnisse sind bei manchen Migrantengruppen und ethnischen Minderheiten starker ausgepragt als bei anderen.

Psychiatric disorders during pregnancy are common. Electroconvulsive therapy (ECT) can be indicated in severely affective or psychotic disorders with the necessity of a rapid response. Currently available review articles greatly differ in the methodology, leading to divergent conclusions concerning the use of ECT during pregnancy.Description of a new clinical case and interdisciplinary treatment suggestions for the safe application of ECT in pregnancy.Clinical case report and selective review of the literature with special consideration of existing systematic reviews.This case report shows the potentially high effectiveness and safe administration of ECT in pregnancy for both mother and fetus. The undesired adverse events associated with ECT described in the literature are largely qualitatively congruent with the risks of severe psychotic disorders in pregnancy per se. For a better risk-benefit analysis, larger case control studies would be desirable. Under the premise of a thorough evaluation of the indications, good interdisciplinary coordination and consideration of the specific practical requirements, ECT is a useful therapeutic option in pregnancy.HINTERGRUND: Psychische Störungen in der Schwangerschaft sind häufig. Besonders bei schweren affektiven oder psychotischen Störungen mit Notwendigkeit eines raschen Ansprechens kann eine Elektrokonvulsionstherapie (EKT) indiziert sein. Dazu vorliegende Übersichtsartikel unterscheiden sich methodisch stark, was zu unterschiedlichen Schlussfolgerungen hinsichtlich der Anwendung der EKT bei Schwangerschaft führt.Darstellung eines neuen klinischen Falls sowie interdisziplinärer Behandlungsvorschläge zur sicheren Anwendung der EKT bei Schwangerschaft.Fallbericht und selektive Literaturübersicht unter besonderer Berücksichtigung der existierenden systematischen Reviews.Die aktuelle Kasuistik zeigt die potenziell hohe Wirksamkeit sowie die für Mutter und Fetus sichere Anwendung der EKT während der Schwangerschaft. Die in der Literatur beschriebenen unerwünschten Ereignisse entsprechen qualitativ weitgehend den Risiken bei schwerer psychischer Störung in der Schwangerschaft. Zur besseren Nutzen-Risiko-Abwägung wären größere Fall-Kontroll-Studien wünschenswert. Bei sorgfältiger Indikationsstellung, guter interdisziplinärer Abstimmung und Beachtung der Besonderheiten in der praktischen Durchführung ist die EKT auch in der Schwangerschaft eine sinnvolle Behandlungsoption.

Low birth weight (LBW

Background Studies in immigrant youth have suggested differences in parenting patterns by immigration status. Knowledge of variation in recalled parenting pattern and its distinctive impact on mental health in adult immigrants, however, is limited. Therefore, the purpose of the current study was to investigate similarities and differences in recalled maternal and paternal rearing behavior and its association with depressiveness in adult 1st generation immigrants compared to non-immigrants. Methods Seven hundred and forty-three 1st generation immigrants (M = 57.4, SD = 10.1 years) and 6518 non-immigrants (M = 60.3, SD = 10.7 years) participated in a population-based study. Regarding countries of origin, the largest subgroups were immigrants from Eastern-Europe, Former-SU, and Arabic-Islamic countries. All participants completed the ultra-short version of The Recalled Parental Rearing Behavior-questionnaire and the PHQ-9 assessing depressiveness. Multiple linear regressions with depressiveness as outcome variable were analyzed separately for each facet of parental rearing behavior adjusting for socio-demographic and migration-related variables. Results In addition to differences in depressiveness and socioeconomic status, 1st generation immigrants recalled both their mothers and fathers as more controlling and overprotecting than non-immigrants. Parental emotional warmth was negatively associated with depressiveness across all groups. The relationship between parental control, respectively parental rejection and depressiveness, however, varied in direction and severity between the groups. Conclusion The results support the notion that parental warmth is a universal protective factor against depressiveness, whereas the impact of parental control on mental health might be more culturally influenced. Analyses point to the importance of considering the unique contribution of fathers’ rearing behavior on mental health, particularly in immigrant samples.

Introduction Long-term childhood cancer survivors (CCS) are at risk for physical and psychosocial late effects. Previous research has attested to increased rates of suicidal ideation (SI) in CCS, an especially dangerous indicator of distress. However, little was known about risk factors of SI among CCS which go beyond illness- and treatment related variables. Methods A registry-based sample of 916 adult long-term CCS (Mage=34.58 years [SD=5.53], Mage at diagnosis=6.15 years [SD=4.28]) underwent medical assessments and filled out questionnaires. We conducted a linear regression analysis on SI, testing predictors of different areas: sociodemographic, social, physical health and health behavior, and psychological distress symptoms. Results SI was reported by 73 (8.0%) CCS and previous suicide attempts were reported by 26 (2.8%) CCS. SI was most closely related to social and psychological factors, i.e. to concurrent distress symptoms (depression, anxiety, social phobia), previous suicide attempts, current loneliness, and the present living situation. Limitations SI and previous suicide attempts were assessed using short self-report instruments. The cross-sectional study design does not allow for causal inferences. Conclusions Long-term CCS are a previously understudied, vulnerable group. Decades after having survived cancer, a considerable percentage is affected by (recurrent) SI. CCS’ risk for SI is likely shaped by individual medical and psychological history, and by the current social environment and psychological comorbidities. There is a need for more interdisciplinary research and for screening efforts which take account of these factors. Interventions reducing CCS’ risk of suicide should foster social integration and counteract current stressors.

The COVID-19 pandemic and measures aimed at its mitigation, such as physical distancing, have been discussed as risk factors for loneliness, which increases the risk of premature mortality and mental and physical health conditions. To ascertain whether loneliness has increased since the start of the pandemic, this study aimed to narratively and statistically synthesize relevant high-quality primary studies. This systematic review with meta-analysis was registered at PROSPERO (ID CRD42021246771). Searched databases were PubMed, PsycINFO, Cochrane Library/Central Register of Controlled Trials/EMBASE/CINAHL, Web of Science, the World Health Organization (WHO) COVID-19 database, supplemented by Google Scholar and citation searching (cutoff date of the systematic search December 5, 2021). Summary data from prospective research including loneliness assessments before and during the pandemic were extracted. Of 6,850 retrieved records, 34 studies (23 longitudinal, 9 pseudolongitudinal, 2 reporting both designs) on 215,026 participants were included. Risk of bias (RoB) was estimated using the risk of bias in non-randomised studies-of interventions (ROBINS-I) tool. Standardized mean differences (SMD, Hedges' g) for continuous loneliness values and logOR for loneliness prevalence rates were calculated as pooled effect size estimators in random-effects meta-analyses. Pooling studies with longitudinal designs only (overall N = 45,734), loneliness scores (19 studies, SMD = 0.27 [95% confidence interval = 0.14-0.40], Z = 4.02, p.001, I 2 = 98%) and prevalence rates (8 studies, logOR = 0.33 [0.04-0.62], Z = 2.25, p = .02, I 2 = 96%) increased relative to prepandemic times with small effect sizes. Results were robust with respect to studies' overall RoB, pseudolongitudinal designs, timing of prepandemic assessments, and clinical populations. The heterogeneity of effects indicates a need to further investigate risk and protective factors as the pandemic progresses to inform targeted interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background Depression, the most frequent and harmful mental disorder, has been associated with specific somatic diseases as the leading cause of death. The purposes of this prospective study were to predict incident chronic diseases based on baseline depressive symptoms and to test sex-dependent effects. Methods In a representative German community sample of over 12 000 participants, baseline depressive symptoms (assessed using the Patient Health Questionnaire-9) were tested as a predictor of new onset of cardiovascular disease (CVD), chronic obstructive lung disease, diabetes, cancer, and migraine at 5-year follow-up. To study disease incidence, we created subsamples for each chronic disease by excluding participants who already had the respective disease at baseline. Potential confounders were included in logistic regression models and sex-specific analyses were performed. Results Controlling for demographic characteristics and loneliness, in men and women, baseline depressive symptoms were predictive of CVD, chronic obstructive lung disease, diabetes, and migraine, but not of cancer. When we additionally adjusted for metabolic and lifestyle risk factors, there was an 8% increase of chronic obstructive lung disease and migraine per point of depressive symptoms. There was a trend for CVD (4%; p = 0.053). Sex-sensitive analyses revealed trends for the relevance of depressive symptoms for CVD in men (p = 0.065), and for diabetes in women (p = 0.077). Conclusions These findings underscore the need to implement screening for depression in the treatment of major somatic illnesses. At the same time, depressed patients should be screened for metabolic and lifestyle risk factors and for somatic diseases and offered lifestyle interventions.

Suicidal ideation and behavior constitute important public mental health issues. In this study, we examined whether social integration prevents suicidal ideation over time and whether gender modifies this association.Data from the Gutenberg Health Study (population-based representative community sample in midwest Germany) and the Study of Health in Pomerania (population-based cohort study in northeast Germany) were used. Participants reporting low social support were compared to those receiving middle or high social support. Within a longitudinal study design, we calculated multiple logistic regression models including interaction terms and relevant covariates to test whether gender modified the association of social support and suicidal ideation.Suicidal ideation was present in 7.4% (N = 982) of the pooled cohorts' 13,290 participants. More women (8.6%, N = 565) than men (6.2%, N = 417) reported suicidal ideation. Middle or high social support was associated with a lower probability to report suicidal ideation five years later after controlling for sociodemographic factors, living situation, and cohort (OR = 0.42, 95%-CI = 0.34-0.52). Male gender was negatively related to suicidal ideation, but no statistically significant interaction of gender and social support was found (ratio of ORs = 1.00, 95%-CI = 0.73-1.35).The number of people reporting suicidal ideation in the SHIP study was small, especially for men. Suicidal ideation was measured using a single item.Social support is an important protective factor in preventing suicidal ideation for both women and men. Future research should further clarify gender-specific effects of family variables in suicidal ideation and test similar predictive models of suicidal behavior.

Research has described positive psychological outcomes after severe illness, including posttraumatic growth. The aim of the present research was to evaluate a short scale assessing posttraumatic growth within a sample of cancer survivors to provide an efficient instrument for research and care settings.Using data of a registry-based sample of N = 633 childhood cancer survivors (CCS) more than 25 years after diagnosis, we conducted an investigation of a five-item short form of the established Posttraumatic Growth Inventory (PTGI), the PPR-5 (PPR stands for "Posttraumatische Persönliche Reifung", the German expression for posttraumatic growth). We performed a confirmatory factor analysis, tested the PPR-5's internal consistency, and investigated associations with cancer-related, sociodemographic, and mental health variables (assessed using psychometrically tested screening instruments) using group comparisons and correlation analyses within a cross-sectional design.Findings supported a unidimensional structure of the PPR-5. It also showed good reliability (ω = 0.81). CCS especially endorsed Relating to others and Personal strength. The PPR-5's sum score was negatively associated with current depression, anxiety, and sleep disorder symptoms, intake of antidepressants, and lifetime diagnoses of depression and anxiety disorders. It showed positive associations with resilient coping, higher age at diagnosis, partnership, and parenthood.The PPR-5 allows for a brief assessment of posttraumatic growth. As it indicates aspects that support positive psychological adaptation to life as a (cancer) survivor, it could inform research and practice (e.g., as a screening measure, or in psychotherapy/counseling settings).

Child maltreatment is a risk factor for a range of mental disorders later in life, including dangerous self-harm and suicide attempts. A better understanding of the mechanisms underlying this association can inform prevention and intervention.To investigate personality functioning as a potential mediator of the association of childhood abuse and neglect and self-harm and suicide attempts in the general population.Data were drawn from a representative German population sample (N = 2510).Participants filled out the Childhood Trauma Questionnaire (CTQ), OPD Structure Questionnaire (OPD-SQS), and items of the Self-Injurious Thoughts and Behaviors Interview (SITBI). In structural equation models, we operationalized impaired personality functioning as the mediator between childhood abuse and neglect and self-harm.Individuals with a history of self-harm (combining suicide attempts, N = 47, and non-suicidal self-injury, N = 83) reported more childhood abuse and neglect (d = 1.39, p .001) and greater impairments in personality functioning (d = 1.64, p .001) than the rest of the population. The indirect effect via personality functioning accounted for 48.8 % of the total effect of childhood abuse and neglect on self-harm. In more differentiated analyses, emotional abuse showed the strongest association with self-harm. Only physical and sexual abuse had direct effects.The results specify the relationship between child maltreatment and self-harm by demonstrating that it is partly mediated by basic functions of personality assessed using a dimensional measure. These abilities constitute modifiable risk factors that can be addressed by psychotherapy.

Die Entgegnung auf den Beitrag von Kaiser et al. betrifft die erste kontrollierte Psychotherapiestudie, die psychoanalytische und kognitiv-verhaltenstherapeutische Langzeitpsychotherapien mit randomisierter und praferierter Zuweisung miteinander vergleicht. In 4 Behandlungszentren wurden 554 chronisch depressive Patienten interviewt, von denen 252 in die Studie aufgenommen werden konnten. In den Selbsteinschatzungen der Patienten (Beck-Depressions-Inventar, BDI) zeigten sich grose und stabile Veranderungen. Die vollstandige Remissionsrate betrug nach einem Jahr 34 % und stieg auf 45 % nach 3 Jahren. Die Effektstarken waren nach einem Jahr d = 1,17 und stiegen nach 3 Jahren auf 1,83. Analoge Ergebnisse zeigten sich in den Einschatzungen der unabhangigen, bezogen auf die Therapieverfahren verblindeten Rater (Quick Inventory of Depressive Symptoms [QIDS]: Remissionsraten nach einem Jahr: 39 %, nach 3 Jahren: 61 %, Effektstarken d = 1,56 nach einem Jahr, d = 2,08 nach 3 Jahren). Entgegen ihrer Hypothesen fanden die Autoren aber keinen statistisch signifikanten Unterschied zwischen den Verfahren bezuglich der Symptomreduktion und auch keine Effektunterschiede zwischen randomisierter Therapiezuweisung und Behandlung. Allerdings zeigten sich bezuglich der Strukturveranderung (gemessen mit der Operationalisierten Psychodynamischen Diagnostik 2, OPD‑2) durchaus Unterschiede. Drei Jahre nach Beginn der Behandlungen wiesen mehr Patienten in psychoanalytischer Therapie (PAT) Strukturveranderungen auf als in kognitiver Verhaltenstherapie (KVT). Zudem hatten diese Strukturveranderungen bei PAT im Vergleich zu KVT einen starkeren Einfluss auf die Symptomveranderung. Fruhere Publikationen betrafen T0-Daten sowie konzeptuelle und klinische Uberlegungen. Die Outcome-Ergebnisse wurden erst in den Hauptpublikationen 2019 in Englisch und Deutsch publiziert. Ein Alleinstellungsmerkmal der Studie betrifft die Auswertungen der Daten durch ein unabhangiges Methodenzentrum (Statistical Consulting Center, UnitStaBLab, Universitat Munchen), die methodische Einwande von Kaiser et al. in der Entgegnung entkraften. Wie jede Studie hat auch die LAC-Studie ihre Limitationen, wie die Autoren in den Hauptpublikationen ausfuhrlich diskutieren.

In this study, we aimed to identify the most important and sex-specific social, psychological, behavioral and somatic predictors of recurrent depressive symptoms. Data was obtained at two measurement points within five years by the Gutenberg Health Study (GHS). Out of N = 12,061 individuals, a sample of 877 (age 52.3 ± 9.9) who reported clinically relevant depressive symptoms at baseline was analyzed. Univariate analyses and multiple logistic regression analyses were conducted. Almost half of participants depressed at baseline also reported depressive symptoms five years later. Sex-stratified multivariate analyses revealed that solely social support remained a significant protective predictor against recurrence of depression in men (OR = 0.93; CI95% = 0.87–0.99), whereas in women smoking (OR = 1.97; CI95% = 1.23–3.22), and Type D personality (OR = 1.65; CI95% = 1.10–2.49) were significant risk factors. However, when analyzing the entire sample, no interaction effect between sex and each predictor turned out to be significant. Only social support was retained as an overall predictive factor. As depressive symptoms recur, depressive vulnerability is established involving personality, health behavior and social factors. Although no significant sex-specific interactions were observed, sex-stratified analyses point out different patterns for relevant predictors of recurrent depressive symptoms in men and women.

Objective A child's cancer diagnosis and treatment affect the whole family. While it has been recognized that parents are an important resource for their children, little is known about the specifics of parenting in the face of serious illness. Methods We used the Recalled Parental Rearing Behavior Questionnaire in a register-based cohort of adult childhood cancer survivors (CCS) (N = 951) and a representative population sample of the same age range (N = 2042). The questionnaire assesses behavior of mothers and fathers with three scales (emotional warmth, rejection/punishment, and control/overprotection) by querying the (former) child. We compared the two groups using general linear models. With a hierarchical linear regression analysis, we tested associations of recalled rearing behavior with disease- and treatment-related factors. Results Compared with the general population, CCS remembered both parents as emotionally warmer, more overprotective, and less punishing/rejecting and less ambitious. The regression analysis showed that having received radiotherapy (β = 0.092; P = .009) and chemotherapy (β = 0.077; P = .027) was positively related to memories of maternal emotional warmth. Conclusions CCS remembered parenting styles which are generally deemed more positive. The extent of recalled control and overprotection deviated from the population in different directions, suggesting that parenting in childhood cancer entails more complex adaptations than being affectionate and giving comfort. The results suggest an adaptation of parental behavior to particularly challenging treatments. They highlight potential vulnerability and resilience factors, some of which were sex-dependent.

Zusammenfassung. Die verschiedenen Formen der Kindesmisshandlung (körperlicher, sexueller oder emotionaler Missbrauch sowie emotionale und körperliche Vernachlässigung) gelten sowohl für die Entwicklung von Essstörungen als auch für einzelne Symptome pathologischen Essverhaltens (Essanfälle, Adipositas) als Risikofaktoren. Darüber hinaus ist bekannt, dass sich selbstregulatorische Fähigkeiten durch die Erfahrung von Kindesmisshandlung defizitär entwickeln können. Aus diesem Grund soll die Rolle von Selbstregulation für den Zusammenhang von erinnerter Kindheitsbelastung und Essverhalten eruiert werden, um Ansatzpunkte für Prävention und Behandlung von gestörtem Essverhalten zu erhalten. Eine hinsichtlich Geschlecht, Alter und Bildung bevölkerungsrepräsentative Stichprobe von 2508 Personen (1174 Männer und 1334 Frauen) im Alter von 14–92 Jahren ( M = 49.67, SD = 18.32) wurde im Rahmen eines umfassenden Gesundheits-Surveys zu Essverhalten, erinnerter Kindheitsbelastung und selbstregulatorischen Fähigkeiten befragt. Neben umfangreichen deskriptiven Analysen zu Essverhalten und Kindheitsbelastung wurde die Interaktion von Selbstregulation und Kindheitsbelastung unter Berücksichtigung von Geschlechtsunterschieden auf die Ausprägungen des Essverhaltens mittels einer moderierten Regressionsanalyse überprüft. Die Prävalenzraten für auffälliges Essverhalten liegen für Frauen höher als für Männer (14.7% vs. 6.5%). Frauen berichteten ebenfalls häufiger, dass sie eine Form der Kindesmisshandlung erlebt haben. Bei Betrachtung der einzelnen Formen von Kindesmisshandlung unterscheiden sich Männer und Frauen nur in der Häufigkeit von sexuellem Missbrauch, den Frauen häufiger berichteten. Die Interaktion aus höherer Kindheitsbelastung und Selbstregulationsdefiziten stellte sich lediglich für Männer als Risikofaktor für gestörtes Essverhalten heraus, nicht bei Frauen. Männer und Frauen zeigen unterschiedliche Risikoprofile, die weiter untersucht werden sollten. Bessere Kenntnisse geschlechtsspezifischer Unterschiede dienen der Prävention und Behandlung von Essstörungen sowie Adipositas.

Die Autoren berichten uber die erste kontrollierte Psychotherapiestudie, die psychoanalytische und kognitiv-verhaltenstherapeutische Langzeitpsychotherapien mit randomisierter und praferierter Zuweisung mit­einander vergleicht. In vier Behandlungszentren wurden 554 chronisch depressive Patienten interviewt, von denen 252 in die Studie aufgenommen werden konnten. In den Selbsteinschatzungen der Patienten zeigten sich grose und stabile Veranderungen. Die vollstandige Remissionsrate (fur BDI) lag nach einem Jahr bei 34 % und stieg auf 45 % nach drei Jahren. Analoge Ergebnisse zeigten sich in den Einschatzungen der unabhangigen, bezogen auf die Therapieverfahren verblindeten Rater (QIDS). Entgegen ihrer Hypothesen fanden die Autoren aber keinen statistisch signifikanten Unterschied zwischen den Verfahren und auch keine Effektunterschiede zwischen randomisierter Therapiezuweisung und Behandlung mit der praferierten Psychotherapie. Besser als in anderen Studien sind die erzielten Remissionsraten, die zeigten, dass chronisch depressive Patienten von Langzeitpsychotherapien profitieren.