An investigation into the role of thought suppression in the retrieval of autobiographical memories

This program of research was designed to examine the role of thought suppression in the retrieval of autobiographical memories (ABMs). The principal theory proposed here is that thought suppression is an important mechanism in explaining certain ABM retrieval patterns relevant to trauma and self-harm. Study 1 examined the role of thought suppression as a correlate of ABM retrieval in a nonclinical student sample, and showed that higher levels of thought suppression were significantly correlated with the faster recall of negative episodic ABMs as well as the recall of fewer personal semantic memories. Study 2 used a suppression manipulation procedure designed to examine whether this was a causal relationship, and revealed that induced thought suppression directly led to a significant enhancement in the retrieval of negative episodic ABMs as well as significantly fewer overgeneral first responses to negative cues. Furthermore, the induced thought suppression also resulted in the recall of significantly fewer personal semantic memories. Together these results support the theory that thought suppression is an important factor in ABM recall. The enhanced recall of negative memories could be particularly important in individuals who are self-harming, suicidal and/or suffering from PTSD, as enhanced negative recall has previously been observed in these populations. In order to further examine how thought suppression affects ABM retrieval and whether the enhanced negative recall observed in Study 2 was a result of mood-congruent recall, Study 3 used a similar suppression manipulation paradigm to examine the effects of induced thought suppression on mood. The results suggested that the enhanced negative ABM recall was unlikely to have been a by-product of the suppression manipulation resulting in a more negative mood state. Finally, Study 4 examined the role of thought suppression and ABM recall in a clinical sample of self-harming adolescents (who also reported high levels of post-traumatic stress symptoms). The results showed that levels of thought suppression were significantly higher in the self-harmers than the control group, indicating that thought suppression is an important coping mechanism in self-harmers. Furthermore, in terms of the autobiographical memory retrieval, it was found that the self-harmers were significantly faster in their retrieval of negative episodic ABMs and recalled fewer personal semantic memories than the control group. Multiple regression analysis of the data revealed that thought suppression remained as the most important predictor of variability in negative episodic ABM retrieval and personal semantic memory retrieval, even when variability explained by symptoms of depression and PTSD was considered. This program of research extends current theories of ABM retrieval by identifying thought suppression as a cognitive mechanism that directly affects the retrieval of both episodic as well as personal semantic ABMs. The theoretical importance and clinical relevance of this program of research are discussed

Barriers and drivers to vaccination among healthcare workers in Germany

Vaccine hesitancy is a major threat to global public health. Reasons not to vaccinate are multifaceted. Healthcare workers (HCWs) are key figures in the vaccination system – both as vaccine providers and vaccine recipients. This dissertation project aimed to (i) investigate barriers and drivers to vaccination among HCWs in Germany and (ii) identify vaccination gaps among HCWs. It further aimed to (iii) investigate whether HCWs favor vaccine mandates as an intervention to increase vaccine uptake. Survey data was collected from family physicians (FPs), hospital staff and primary care physicians. HCWs’ vaccination coverage for various vaccines and recommendation behavior were assessed. Further, we assessed psychological determinants of vaccination and additional barriers to vaccination. Lastly, we assessed psychological determinants of physician attitudes towards vaccine mandates. In all studies, associations between outcomes and determinants were examined using linear and logistic regression analysis. The surveys revealed that there are relevant vaccination gaps among FPs and hospital staff. These vary by vaccine (measles, influenza, hepatitis B), by setting (hospital, private practice) and by target group (nurses, physicians). The majority of FPs claimed to actively recommend vaccines to patients. Of the psychological determinants, vaccine confidence was associated with FPs’ own vaccination status and recommendation behavior. Collective responsibility, constraints and complacency were associated with own vaccination status. Among hospitals staff, constraints and lack of confidence were the main reasons not to get vaccinated against influenza. Regarding the newly introduced measles vaccine mandate, 86% of physicians expressed being in favor of it. The attitude towards the mandate was associated with its projected consequences, e.g., believing that it will increase vaccination coverage. The higher physicians scored on confidence and collective responsibility and the lower on complacency and calculation, the stronger they were in favor of vaccine mandates. These findings have several policy implications. In hospital settings access to vaccines should be made more convenient. Private physicians were predominantly in favor of the newly implemented measles vaccine mandate. However, some reservations can be found, e.g., with regards to the effectiveness of such a mandate. The introduction of the mandate should be evaluated with regards to its outcomes. Furthermore, we found that psychological determinants for vaccination behavior and attitude towards vaccine mandates overlap. Hence, interventions addressing confidence, collective responsibility and complacency will both motivate vaccination behavior and foster a friendly reception of a mandate.Eine geringe Impfbereitschaft ist eine relevante Bedrohung für die weltweite Gesundheit. Die Gründe nicht zu impfen sind divers. Beschäftigte im Gesundheitswesen spielen eine zentrale Rolle als impfende Akteure und als Empfänger von Impfungen. Diese Dissertation hatte zum Ziel (i) hemmende und fördernde Faktoren für das Impfen bei Gesundheitspersonal in Deutschland zu untersuchen und (ii) Impflücken bei Gesundheitspersonal zu identifizieren. Weiterhin sollte untersucht werden, (iii) ob das Gesundheitspersonal Impfpflichten als Mittel zur Steigerung von Impfquoten positiv gegenübersteht. Es wurden Befragungsdaten von Hausärzt*innen, Krankenhauspersonal und Ärzt*innen der Primärversorgung erhoben. Die Impfquoten für verschiedene Impfungen und das Impfempfehlungsverhalten bei Gesundheitspersonal wurden erfragt. Weiterhin wurden psychologische Determinanten des Impfverhaltens und weitere Barrieren für das Impfen erfasst. In allen Studien wurden die Zusammenhänge zwischen den Prädiktoren und den Zielvariablen in linearen und logistischen Regressionsanalysen untersucht. Die Befragungsdaten zeigen, dass es relevante Impflücken bei Hausärzt*innen und Krankenhauspersonal gibt. Diese variieren je nach Impfung (Masern, Influenza, Hepatitis B), Umfeld (Krankenhaus, Arztpraxis) und Zielgruppe (Pflege, Ärzteschaft). Der Großteil der Hausärzt*innen empfiehlt den Patient*innen Impfungen aktiv. Von den psychologischen Determinanten des Impfverhaltens war das Vertrauen in die Impfung (Confidence) bei Hausärzt*innen mit dem eigenen Impfstatus und dem Empfehlungsverhalten assoziiert. Gemeinsinn (Collective Responsibility), praktische Barrieren (Constraints) und eine niedrige Risikowahrnehmung (Complacency) waren mit dem eigenen Impfstatus assoziiert. Bei Krankenhauspersonal waren praktische Barrieren und fehlendes Vertrauen die Hauptgründe, sich nicht gegen Influenza impfen zu lassen. 86% der Ärzt*innen befürworteten die neu eingeführte Masernimpfpflicht. Die Einstellung zur Impfpflicht war mit den erwarteten Konsequenzen assoziiert, bspw. der Überzeugung, die Impfquote würde dadurch steigen. Je größer Confidence und Collective Responsibility der Ärzt*innen, je höher die Risikowahrnehmung (niedrige Complacency) und je geringer das Bedürfnis nach Informationen und Abwägung (Calculation), umso mehr befürworteten die Befragten Impfpflichten. Die Ergebnisse haben strategische Implikationen. In Krankenhäusern sollte der Zugang zu Impfungen erleichtert werden. Ärzt*innen befürworten die neue Masernimpfpflicht überwiegend. Dennoch finden sich einige Bedenken, bspw. ob eine solche Impfpflicht ihr Ziel erreicht. Die Einführung der Masernimpfpflicht sollte in Bezug auf das Erreichen der Ziele evaluiert werden. Die psychologischen Determinanten sind sowohl für das Impfverhalten als auch die Einstellung zur Impfpflicht relevant. Daher können Interventionen, die Confidence, Collective Responsibility und Complacency adressieren, sowohl eigenes Impfverhalten motivieren als auch das Wohlwollen gegenüber einer neuen Impfpflicht erhöhen

Determinants of physician attitudes towards the new selective measles vaccine mandate in Germany

Background In Germany, a mandatory policy on measles vaccination came into effect in March 2020. Physicians, as the main vaccine providers, have a crucial role in implementing it. Mandatory vaccination changes the preconditions under which patient-provider communication on vaccines occurs. Physicians might or might not favor vaccine mandates depending on, among other factors, their attitudes towards vaccines and capabilities as vaccine providers. The aim of this study was to investigate in different subgroups of physicians the association between various factors and their attitudes towards a mandatory policy. Methods In total, 2229 physicians participated in a mixed-mode online/paper-pencil survey. Respondents were general practitioners, pediatricians, gynecologists, and internists. Primary determinants were the 5C psychological antecedents of vaccination, communication self-efficacy, patient clientele, projected consequences of the mandate and sociodemographic characteristics. Associations between outcomes and determinants were examined using linear regression analysis. Results Approximately 86% of physicians were in favor of the measles vaccine mandate for children. Regarding the 5C model, physicians were more in favor of vaccine mandates when they scored higher on confidence and collective responsibility, and lower on complacency and calculation. They were more in favor of vaccine mandates when they had higher communication self-efficacy and a more vaccine-positive patient clientele. Pediatricians were less in favor of mandates for children (80.0%) than other physician subgroups (87.1%). They were also less convinced that a mandate would result in more children getting vaccinated (59.3%) than other physician subgroups (78.3%). When controlled for these expected consequences, being a pediatrician no longer lowered the attitude towards the mandate. Conclusions Physicians in Germany are predominantly in favor of a measles vaccine mandate. Whether or not physicians believe the mandate to be effective in increasing vaccine coverage affects their attitude towards the mandate. In pediatricians, this belief explains their less positive attitude towards the mandate. In addition, physicians need adequate support to communicate well with patients, especially those who are hesitant, to booster their communication self-efficacy. To increase acceptance of vaccine mandates, the 5C model can be used, e.g., collective responsibility can be communicated, to avoid anger stemming from a negative attitude to mandates.Peer Reviewe

How a generally well-accepted measles vaccine mandate may lead to inequities and decreased vaccine uptake: a preregistered survey study in Germany

Additional file 1: Supplementary Figure 1. Directed acyclic graph (DAG) on hypothesis 2: Higher reactance to the measles mandate among parents decreases uptake of other vaccines and the intention to vaccinate children against other diseases. Supplementary  Table 1. ANCOVA results for socio-economic status (income) and for knowledge about the measles vaccine mandate and the measles vaccine. Supplementary Table 2. ANCOVA results for socio-economic status (education) and for knowledge about the measles vaccine mandate and the measles vaccine. Supplementary  Table 3. Parental vaccination decisions for vaccines that had just become due or were soon to come. Supplementary  Table 4. Relationship between reactance and vaccination behavior. Results from multiple logistic regression model with hexavalent and pneumococcal vaccination status as outcomes, reactance as predictor and the 5C model, age, gender, region and institutional trust included as covariates. Supplementary  Table 5. Relationship between reactance and vaccination intention. Results from multiple linear regression models with intention to get vaccinated against HPV, Tdap, Men C as outcomes, reactance as predictor and the 5C model, age, gender, region and institutional trust included as covariates. Supplementary  Table 6. Mediation analyses: Effect of institutional trust (X) on attitude towards the mandate (Y) via reactance (M)

Engagement in an e-Health Tool (ORION) predicts opioid-dependent patient likelihood of behavioural change

Background: An eHealth computer-based tool named ORION was constructed to assist patients in the clinic to appreciate the factors responsible for risks of drug overdose. The aim of this study was to investigate the associations between risk perception of overdose, engagement in the ORION tool and willingness to alter overdose risk factors. Methods: 194 opioid dependent patients participated from 4 countries (UK, N=39; Germany, N=99; Italy, N=40 and Denmark, N=16).A structural equation model was fitted (AMOS version 17) to summarise the predicted associations between perceived risk and willingness to change risks of opioid overdose. The degree of engagement with the tool (time spent and number of changes to overdose risk factors) was explored. Results: A variety of models were fitted and the most parsimonious model provided a non-significant difference between the raw data and the specified model: Chi Sq = 16.87, df10, p = .077chi sq/df = 1.688. The fit indices: CFI = .991, RMSEA = .066. Pre and post self-assessments of risk towards known factors linked with overdose were highly correlated. A significant path was found between engagement in the tool and the willingness to change one or more risk factors (stand. coeff. = 0.16, p = .04). In addition, the final assessment of the risk factors was associated with engagement (stand. coeff. = 0.18, p = .02). Conclusion: The encouragement of drug users to engage in exploring changes to their overdose risk when presented on a computer screen appears to increase willingness to change risky behaviour.Publisher PDFPeer reviewe

The effect of influenza and pneumococcal vaccination in the elderly on health service utilisation and costs: a claims data-based cohort study

Background: To date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care. Methods: Retrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias. Results: Influenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of − €178.87 [95% CI − €240.03;− €117.17] per individual (2015: − €50.02 [95% CI − €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [− €9.43; 95% CI − €17.56;− €1.30] and 2016 [− €12.93; 95% CI − €25.37;− €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out. Conclusion: Influenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.Peer Reviewe

Beschluss der STIKO zur 9. Aktualisierung der COVID-19-Impfempfehlung und die dazugehörige wissenschaftliche Begründung

Die STIKO empfiehlt auch für alle 12- bis 17-jährigen Kinder und Jugendliche die Impfung gegen COVID-19 mit einem der beiden zugelassenen mRNA-Impfstoffe (Comirnaty von BioNTech/Pfizer und Spikevax von Moderna). Verabreicht werden sollen jeweils zwei Dosen Comirnaty oder Spikevax im Abstand von 3-6 bzw. 4-6 Wochen. Die Aktualisierung der Empfehlung zur COVID-19-Impfung von 12- bis 17-Jährigen basiert auf der Bewertung neuer quantitativer Daten zur Sicherheit der Impfung und zur Krankheitslast sowie einer Modellierung von direkten Effekten der Impfung auf diese Altersgruppe wie auch indirekten Effekten auf andere Altersgruppen. Die STIKO spricht sich jedoch explizit dagegen aus, dass der Zugang von Kindern und Jugendlichen zur Teilhabe an Bildung, Kultur und anderen Aktivitäten des sozialen Lebens vom Vorliegen einer Impfung abhängig gemacht wird.Peer Reviewe

Wissenschaftliche Begründung der STIKO für die Modifizierung der COVID-19-Impfempfehlung für Kinder im Alter von 5 – 11 Jahren

Die STIKO empfiehlt Kindern mit Vorerkrankungen weiterhin eine Grundimmunisierung mit 2 Impfstoffdosen sowie eine Auffrischimpfung. Gesunde Kinder sollen eine Grundimmunisierung mit 2 Impfstoffdosen bekommen, wenn sich in deren Umfeld Personen mit hohem Risiko für einen schweren COVID-19-Verlauf befinden, die durch eine Impfung selbst nicht sicher geschützt werden können. Allen anderen Kindern empfiehlt die STIKO zunächst nur eine COVID-19-Impfstoffdosis.Peer Reviewe

Beschluss der STIKO zur 9. Aktualisierung der COVID-19-Impfempfehlung und die dazugehörige wissenschaftliche Begründung

Die STIKO empfiehlt auch für alle 12- bis 17-jährigen Kinder und Jugendliche die Impfung gegen COVID-19 mit einem der beiden zugelassenen mRNA-Impfstoffe (Comirnaty von BioNTech/Pfizer und Spikevax von Moderna). Verabreicht werden sollen jeweils zwei Dosen Comirnaty oder Spikevax im Abstand von 3-6 bzw. 4-6 Wochen. Die Aktualisierung der Empfehlung zur COVID-19-Impfung von 12- bis 17-Jährigen basiert auf der Bewertung neuer quantitativer Daten zur Sicherheit der Impfung und zur Krankheitslast sowie einer Modellierung von direkten Effekten der Impfung auf diese Altersgruppe wie auch indirekten Effekten auf andere Altersgruppen. Die STIKO spricht sich jedoch explizit dagegen aus, dass der Zugang von Kindern und Jugendlichen zur Teilhabe an Bildung, Kultur und anderen Aktivitäten des sozialen Lebens vom Vorliegen einer Impfung abhängig gemacht wird.Peer Reviewe