Stress, Stressverarbeitung und Beeinträchtigung im Alltag bei adulter Aufmerksamkeitsdefizits-/Hyperaktivitätsstörung (ADHS)

Bei erwachsenen ADHS-Patienten kommt es aufgrund der Symptomatik häufig zu Problemen in der Alltagsbewältigung. Alltägliche Stressoren dürften aufgrund von Störungen der Wahrnehmungsfunktionen übersteigert wahrgenommen und wegen fehlender Kompetenzen im Coping nicht adäquat verarbeitet werden. Dadurch ist von einer erhöhten Stressbelastung mit entsprechenden körperlichen und psychischen Symptomen auszugehen, was wiederum zu einer hohen Beeinträchtigung im Alltag führen dürfte. Ausgangspunkt für die vorliegende Studie war die Hypothese, dass ADHS-Patienten generell mit Stresssymptomen stärker belastet sind, mehr inadäquate wie adäquate Stressverarbeitungsmechanismen verwenden und im Alltag dadurch stärker beeinträchtigt sind. Zur Klärung der Fragestellung wurde eine Stichprobe von 94 ADHS-Patienten aus der laufenden Sprechstunde der ADHS-Ambulanz des Instituts für Gerichtliche Psychologie und Psychiatrie des Universitätsklinikums Homburg (Saar) in Deutschland gebildet und mit 107 Kontrollpersonen verglichen. Die Probanden mussten eine Selbstbeurteilung anhand eines vorgegebenen Fragebogenkatalogs abgeben. Mittels ADHS-SB und WURS-k erfolgte die Zuteilung zur ADHS-Gruppe mit Unterscheidung in den ADHS-Subtyp nach DSM-IV oder zur Kontrollgruppe. Anhand der SCL-90-R, des SVF und der Sheehan-Skala wurden die aktuelle Belastung mit körperlichen und psychischen Symptomen, die Stressverarbeitung und die Beeinträchtigung im alltäglichen Leben erfasst. Die Ergebnisse der vorliegenden Untersuchung zeigen, dass ADHS-Patienten deutlich stärker von körperlichen und psychischen Symptomen betroffen sind, was sich auch in der gesamten psychischen Belastung (global severity index der SCL-90-R) abbildet. Bei allen maladaptiven Copingstrategien kann bei ADHS eine eindeutig stärkere Ausprägung festgestellt werden. Unterschiede zwischen den ADHS-Subtypen finden sich nur bei Pharmakaeinnahme und Aggressivität, wo besonders der kombinierte und der vorwiegend hyperaktiv-impulsive Subtyp betroffen sind. In den funktionellen Stressverarbeitungsmechanismen zeigt sich kein generelles Defizit bei ADHS, sondern lediglich eine geringere Ausprägung von Bagatellisierung, Herunterspielen, Situationskontrolle und positiver Selbstinstruktion. Im Alltag sind ADHS-Patienten deutlich beeinträchtigter. Der Ausprägungsgrad der ADHS, gemessen am Summenscore im ADHS-SB, spielt eine bedeutende Rolle für die Defizite in der Stressverarbeitung, den Grad der psychischen Belastung und die Beeinträchtigung im Alltag. Eine inadäquate Stressverarbeitung steht eindeutig im Zusammenhang mit hoher Stressbelastung und starker Beeinträchtigung im Alltag. Insofern könnte eine gezielte Schulung von ADHS-Patienten in Stressverarbeitung im Rahmen der psychotherapeutischen Behandlung die festgestellte Belastung und Beeinträchtigung deutlich reduzieren und somit die Lebensqualität verbessern.The symptoms of adult ADHD patients often lead to problems in coping with everyday life. Due to a disturbance of cognitive functions, everyday stressors are likely to be excessively perceived. Furthermore, it can be assumed that a lack of coping skills prevents their adequate processing. As a consequence, an increased stress level with corresponding physical and psychological symptoms can be expected, which in turn leads to a high impairment in everyday life. The aim of the study was to explore the hypothesis that ADHD patients are generally more affected by stress symptoms, use more inadequate than adequate coping mechanisms and are therefore more affected in everyday life. 94 ADHD patients from the ADHD outpatient clinic of the University Hospital Homburg (Saar) in Germany as well as a control group of 107 healthy members were included in the present study. Both the ADHD patients and the control group were asked to take part in self- and observer rating assessments. The study participants were allocated to the ADHD group (with distinction between the ADHD subtype according to DSM-IV) or to the control group using the ADHD-SB and WURS-k. With the help of the SCL-90-R, the SVF and the Sheehan disability scale, the current extent of physical and mental symptoms, the coping and the impairment in everyday life were recorded. The results of the study showed that ADHD patients are significantly more affected by physical and psychological symptoms, which is also reflected in the total psychological distress (global severity index of SCL-90-R). All maladaptive coping strategies are more pronounced with ADHD. Differences between ADHD subtypes can only be found among those taking drugs or with aggression issues. Here it is in particular the combined and predominantly hyperactive-impulsive subtypes who are affected. Among the functional coping mechanisms, no general deficit in ADHD could be found. There is only a reduced amount of trivialization, downplaying, situation control and positive self-instruction. In everyday life ADHD patients are significantly impaired. The severity of ADHD, as measured on the sum score in the ADHD-SB, plays an important role in the deficits in coping, the degree of psychological distress and impairment in everyday life. Based on the results I hypothesize that inadequate stress management is connected to a high degree of stress and severe impairment in everyday life. The targeted training of ADHD patients with a focus on coping strategies and in the context of psychotherapeutic treatment could significantly reduce the observed stress and impairment observed, thus improving the quality of life of ADHD patients

The role of stress coping strategies for life impairments in ADHD

Attention-deficit/hyperactivity disorder (ADHD) is commonly accompanied by functional impairments within personal, professional, and social context as well as further psychological distress. The role of perceived stress has been examined in this regard, although little is known about the influence of stress coping strategies. We examined the dynamics between ADHD symptomatology, stress coping strategies, and life impairments in a sample of 230 clinical and non-clinical adult individuals. ADHD was associated with low probability of choosing adaptive but high probability of implementing maladaptive stress coping strategies as well as with increased life impairments. Adaptive stress coping showed little effects beyond the associations between ADHD and life impairments, whereas some maladaptive coping strategies increased current life impairments over and above the effects of ADHD and further psychological distress. The present findings emphasize the need of professional support in adults with ADHD and the necessity to include stress coping strategies in respective treatment approaches aimed at reducing life impairments

Men's Psychotherapy Use, Male Role Norms, and Male-Typical Depression Symptoms: Examining 716 Men and Women Experiencing Psychological Distress

Men as compared to women are half as often affected by depressive and anxiety disorders and seek significantly less help for mental health issues than women. Adherence to traditional male role norms (AtTMRN) may hinder men from describing prototypical depression symptoms and from seeking psychotherapy. The current study compared whether AtTMRN, gender role identity, or the experience of prototypical or male-typical externalizing mental health symptoms were associated with psychotherapy use in men and women. In an anonymous online survey, 716 participants (37% men) reporting to currently experience psychological distress were examined. Information was obtained on psychotherapy use, depression and anxiety symptoms, gender role identity, and traditional male role norms. Although experiencing similar levels of depression, men compared to women showed a reduction in psychotherapy use by 29%. Masculine role identity was directly associated with reduced psychotherapy use in men (β = -0.41, p = 0.029), whereas AtTMRN was not (men: β = -0.04, p = 0.818; women: β = -0.25, p = 0.064). Higher externalizing depression symptomatology (β = -0.68, p = 0.005), but not prototypical depression symptomatology (β = -0.02, p = 0.499), was associated with reduced psychotherapy use in men but not women (p > 0.05). Interactions revealed that men, but not women, with high AtTMRN use psychotherapy only when exhibiting elevated symptom levels. The results corroborate previous reports showing reduced psychotherapy use in men as compared to women and identify elevated masculine role identity and male-typical externalizing depression symptomatology as direct factors associated with reduced psychotherapy use in psychologically distressed men. AtTMRN interacts with mental health symptoms to predict psychotherapy use, indicating that men with high AtTMRN only use psychotherapy when exhibiting high symptomatology

Male depression risk, psychological distress, and psychotherapy uptake: Validation of the German version of the male depression risk scale

Background Screening for depressive disorders in men may be complicated by traditional male role norms. The Male Depression Risk Scale (MDRS) was developed to aid screening for depression in men adhering to traditional male role norms and to facilitate identification of depression in men in general and to promote treatment uptake. Aims Validation of a German version of the MDRS and examination of its potential to predict clinical characteristics. Methods In an anonymous online survey comprising of 1605 participants (male: N = 671; 42%), information was obtained on psychological distress, diagnosed psychological disorders, psychotherapy and psychopharmacological treatment. Additional measures included a German version of the MDRS as further mental-health-related constructs. Results The German version of the MDRS showed good validity and reliability. The previously identified 6-factor structure could be replicated for the German version. Compared to the Patient Health Questionnaire 9, the MDRS showed similar detection performance in identifying men who self-reported psychological distress, psychological disorders, depression, psychotherapy usage, or usage of psychopharmacological therapy. Conclusions The German version of the MDRS shows good psychometric validity and represents a valid screening instrument for the identification of psychological distress specifically in men

Status loss due to COVID-19, traditional masculinity, and their association with recent suicide attempts and suicidal ideation

The COVID-19 pandemic is causing extensive job loss leading to a loss of social status in many men. Endorsement of traditional masculinity ideology may render some men particularly sensitive to status loss and thereby to an increased risk for suicidality. In this anonymous online survey conducted in German-speaking European countries, 490 men completed questionnaires regarding loss of social status due to the COVID-19 pandemic, past-month and lifetime suicide attempt and suicidal ideation. Furthermore, endorsement of traditional masculinity ideology and prototypical and male-typical externalizing depression symptoms were measured. Out of a total of 490 men, 14.7% of men reported experiencing status loss due to the pandemic. These men were more than four times as likely to have attempted suicide in the past month (OR = 4.48, 95% CI [1.72, 11.67]) and more than twice as likely to report suicidal ideation during the past 2 weeks (OR = 2.47, 95% CI [1.42, 4.28]), than men not reporting status loss. Status loss, but not endorsement of traditional masculinity ideology, was associated with suicide outcomes. However, when male-typical externalizing depression symptoms and prototypical depression symptoms were included in the models, they exhibited the only direct associations with suicide outcomes (e.g., for past-month suicide attempt: male-typical externalizing depression symptoms OR = 2.18, 95% CI [1.31, 3.62], prototypical depression symptoms OR = 2.41, 95% CI [1.13, 5.12]). A significant interaction between status loss and endorsement of traditional masculinity ideology further suggests an enhancing moderating effect of traditional masculinity on the relationship between status loss and past-month suicide attempts (OR = 3.27, 95% CI [1.16, 9.27]). Status loss due to the COVID-19 pandemic emerges as risk factor for suicide in men. Men who experience status loss due to the COVID-19 pandemic while concomitantly exhibiting strong endorsement of traditional masculinity ideology have an additional increased risk of suicide

Andromind Self-Test (AST)

The primary aim of the anonymous online study is to facilitate a self-assessment of individual mental well-being through a specialized self-test hosted on the Andromind.ch platform. This platform is a dedicated online resource specifically designed to promote and support men's mental health, providing vital tools and resources tailored to their unique needs. Unlike other self-tests commonly available for depression screening, the self-test on Andromind.ch is uniquely focused on men. It incorporates male-specific instruments, such as the Male Depression Risk Scale, to capture the symptom profiles typically seen in men. These tools have been calibrated to recognize and assess symptoms that may manifest differently in men, offering a more accurate and relevant insight into male mental health. A significant objective of this study is to offer men who may be under mental strain an opportunity to gain a comprehensive understanding of their own mental health condition. Those who utilize the self-test on the Andromind.ch webpage will receive feedback on a wide array of symptoms. This information can then be used as a solid foundation for deciding whether to seek therapy or not and help them identify possible points of contact or resources to support their mental health. The self-test explores various facets of mental health. Alongside the traditional areas such as depression, anxiety, trauma, suicidality, and alcohol or drug use, it also delves into aspects of mental health like aggression and violence, and sexual function. This comprehensive approach ensures that the feedback provided to the individuals covers a broad spectrum of their current situation, allowing for a nuanced understanding of their mental health status. While providing invaluable personal insights to individuals, this study also serves a broader purpose. The anonymous data generated from the self-tests will be collected and analyzed to gain further information about the stress profiles commonly seen in men. This data serves as a crucial resource for advancing our understanding of male mental health. It allows researchers to further examine the connections between societal gender roles and the stigma often associated with mental health issues in men, paving the way for more effective strategies and interventions in the future. Therefore, the data consists of cross-sectional questionnaire data

Gender role norms and mental health: an anonymous online study in the German-speaking part of Europe

The aim of the anonymous online study is to examine the adherence to traditional gender role norms in the general German-speaking population of Central Europe and to analyze its association with mental health. Our focus lies on the adherence to traditional male gender role norms and the experience of gender role conflict in men in relation to different mental health (e.g. depression, anxiety, and mental illness stigma) and related outcomes (e.g. self-esteem, shame, resilience, personality, perceived social status, or need to belong). Studies suggest that high adherence to traditional male gender role norms is associated with worse mental health and reduced help-seeking. Importantly, such studies examining female gender role norms are still insufficient in number and scope, why we also include a measure of traditional female gender role norms in the current study. Whether and how gender role norms are related to positive psychological constructs is insufficiently studied. With the present study, we aim to examine both, potentially positive and negative aspects of adhering to traditional gender role norms in a differentiated manner. The complex interactions between the adherence to traditional gender role norms, gender role orientation, gender role conflict, mental health symptoms, self-reported psychological distress, suffering from mental disorders, use of psychotherapy, use of pharmacological medication will be further examined. In addition, potential moderators and mediators of these associations such as multidimensional self-esteem, shame proneness, internalized stigma of mental illness, need to belong or general belongingness, perceived social status, socio-sexuality, optimism/pessimism, resilience, and the Big Five personality traits will be examined. Finally, since the Aging Men’s Masculinity Ideologies Inventory, the Femininity Ideology Scale, the Need to Belong Scale, and the General Belongingness Scale were never translated and validated in German, this study examines a German translation of these scales

Endorsement of Traditional Masculinity Ideologies is Associated With Differences in Psychotherapy Use Among Heterosexual-Identified but not Non-Heterosexual-Identified Men

Background: Heterosexual-identified men, as compared to non-heterosexual-identified men, are less likely to seek out psychotherapy when experiencing psychological distress. Stronger endorsement of traditional masculinity ideologies (TMI) has been reported to be associated with reduced psychotherapy use among men. However, the relationship between psychotherapy use, TMI, and sexual identity needs to be explored. Methods: A total of 728 psychologically distressed men (59.9% heterosexual-identified, 40.1% non-heterosexual-identified) from German-speaking parts of Europe completed an online questionnaire asking about current psychotherapy use, endorsement of TMI, experienced gender role conflict, depression symptoms, and externalizing depression symptoms. Results: In total 34.5% (N = 251) of the men were currently using psychotherapy, of which 47.4% (N = 119) identified as heterosexual and 52.6% (N = 132) as non-heterosexual. Heterosexual-identified men used psychotherapy significantly less than gay- and bisexual- identified men, while showing comparable psychological distress. Additionally, heterosexual-identified men exhibited higher endorsement of TMI across all domains and experienced more masculine gender role conflict, especially in the domains Success, Power, Competition and Restrictive Affectionate Behavior Between Men. In heterosexual- but not non-heterosexual-identified men, stronger endorsement of TMI was associated with reduced psychotherapy use. Conclusion: Higher endorsement of TMI is linked to reduced psychotherapy use among psychologically distressed heterosexual-identified men. Thus, challenging TMI and advocating for alternative masculinities that include health promoting behavior can especially help heterosexual-identified men

Association between psychotherapy use, sexual orientation, and traditional masculinity among psychologically distressed men

Heterosexual-identified men, as compared to non-heterosexual-identified men, are less likely to seek out psychotherapy when experiencing psychological distress. Stronger endorsement of traditional masculinity ideologies (TMI) has been reported to be associated with reduced psychotherapy use among men. However, the relationship between psychotherapy use, TMI, and sexual orientation needs to be explored. A total of 728 psychologically distressed men (59.9% heterosexual-identified, 40.1% non-heterosexual-identified) from German-speaking parts of Europe completed an online questionnaire asking about current psychotherapy use, endorsement of TMI, experienced gender role conflict (GRC), prototypical depression symptoms, and externalizing depression symptoms. In total 34.5% (n = 251) of the men were currently using psychotherapy, of which 47.4% (n = 119) identified as heterosexual and 52.6% (n = 132) as non-heterosexual. Heterosexual-identified men used psychotherapy less than non-heterosexual-identified men, while exhibiting lower prototypical depression symptoms but comparable externalizing depression symptoms. Additionally, heterosexual-identified men exhibited higher endorsement of TMI across all domains and experienced more masculine GRC, especially in the domains Success Concerns and Restricted Affection. Endorsement of TMI was associated with increased externalizing depression symptoms only among heterosexual-identified men. Logistic regression analyses showed stronger endorsement of TMI, increased externalizing depression symptoms, and identifying as heterosexual to be associated with reduced psychotherapy use. Men identifying as heterosexual with strong endorsement of TMI, and high externalizing depression symptoms have a reduced likelihood to use psychotherapy. Thus, challenging TMI and advocating for alternative masculinities that include health promoting behavior can especially help heterosexual-identified men with strong TMI