Cancer as a risk factor for distress and its interactions with sociodemographic variables in the context of the first wave of the COVID-19 pandemic in Germany

The COVID-19 pandemic poses a psychological challenge, especially for individuals with chronic illnesses. The aim of this study was to investigate associations of cancer with distress, including its interplay with further risk and protective factors. We conducted a representative survey of the German population (N = 2503, including N = 144 with a cancer diagnosis) during the first wave of the pandemic. In multiple linear and logistic regression analyses, we tested associations of cancer with depression and anxiety symptoms and suicidal ideation. We also investigated moderating effects of age, gender, income, living situation, marital status, and loneliness. Individuals with cancer were more likely to report anxiety symptoms (φ = .061), suicidal ideation (φ = .050), and loneliness (φ = .044) than other participants. In regression analyses that controlled for sociodemographic differences, cancer was still associated with anxiety symptoms. We also observed interaction effects, indicating that this relation was especially strong in men with cancer and that cancer survivors with a low income were particularly likely to report anxiety symptoms. The findings demonstrate that cancer survivors are a vulnerable group and that factors of different life domains interact in shaping well-being in the population, necessitating comprehensive risk assessment and support offers during the pandemic and beyond

The Berlin inventory of gambling behavior – screening (BIG-S) : validation using a clinical sample

Background: Published diagnostic questionnaires for gambling disorder in German are either based on DSM-III criteria or focus on aspects other than life time prevalence. This study was designed to assess the usability of the DSM-IV criteria based Berlin Inventory of Gambling Behavior Screening tool in a clinical sample and adapt it to DSM-5 criteria. Methods: In a sample of 432 patients presenting for behavioral addiction assessment at the University Medical Center Mainz, we checked the screening tool’s results against clinical diagnosis and compared a subsample of n=300 clinically diagnosed gambling disorder patients with a comparison group of n=132. Results: The BIG-S produced a sensitivity of 99.7% and a specificity of 96.2%. The instrument’s unidimensionality and the diagnostic improvements of DSM-5 criteria were verified by exploratory and confirmatory factor analysis as well as receiver operating characteristic analysis.3 Conclusions: The BIG-S is a reliable and valid screening tool for gambling disorder and demonstrated its concise and comprehensible operationalization of current DSM-5 criteria in a clinical setting. Keywords: Gambling disorder - Diagnostic tool - Screening - Validation - Usability - DSM

Bipolar spectrum disorders in a clinical sample of patients with Internet addiction: Hidden comorbidity or differential diagnosis?

Background and aims Behavioral addictions and bipolar disorders have a certain probability of co-occurrence. While the presence of a manic episode has been defined as an exclusion criterion for gambling disorder, no such exclusion has been formulated for Internet addiction. Methods A clinical sample of 368 treatment seekers presenting with excessive to addictive Internet use was screened for bipolar spectrum disorders using the Mood Disorder Questionnaire. Psychopathology was assessed by the Symptom Checklist 90R and a clinical interview was administered to screen for comorbid disorders. Results Comorbid bipolar disorders were more frequent in patients meeting criteria for Internet addiction (30.9%) than among the excessive users (5.6%). This subgroup showed heightened psychopathological symptoms, including substance use disorders, affective disorders and personality disorders. Further differences were found regarding frequency of Internet use regarding social networking sites and online-pornography. Discussion Patients with Internet addiction have a heightened probability for meeting criteria of bipolar disorders. It is not possible to draw conclusions regarding the direction of this association but it is recommended to implement screening for bipolar disorders in patients presenting with Internet addiction. Conclusion Similar to gambling disorder, it might prove necessary to subsume bipolar disorders as an exclusion criterion for the future criteria of Internet addiction

Validation of the Personal Attributes Questionnaire-8 : gender expression and mental distress in the German population in 2006 and 2018

Objectives: Mental health differences between men and women can be attributed to sex or gender. Due to absence of brief assessments, contributions of gender expressions to the mental health gap between men and women have been understudied. The purpose of this study is to develop and validate a short screening measure of gender expression and test its associations with mental distress.Methods: German representative survey data from 2006 (N = 2,507) and 2018 (N = 2,516) were analysed. A short form of the Personality Attributes Questionnaire with 8 items (PAQ-8) was assessed to measure femininity and masculinity. Validity of the PAQ-8 was tested and associations between femininity, masculinity and mental health were examined.Results: PAQ-8 was a valid screening measure to assess gender expression. Compared to 2006, femininity increased in women and decreased in men in 2018. Higher levels of femininity and masculinity were associated with lower distress. Sex was no longer predictive for mental distress when femininity, masculinity, age and equivalised income were considered.Conclusion: Our findings support the use of gender measures, which may be more predictive of mental health than sex

Psychoanalytic and cognitive-behavior therapy of chronic depression : study protocol for a randomized controlled trial

Background: Despite limited effectiveness of short-term psychotherapy for chronic depression, there is a lack of trials of long-term psychotherapy. Our study is the first to determine the effectiveness of controlled long-term psychodynamic and cognitive-behavioral (CBT) treatments and to assess the effects of preferential vs. randomized assessment. Methods/design: Patients are assigned to treatment according to their preference or randomized (if they have no clear preference). Up to 80 sessions of psychodynamic or psychoanalytically oriented treatments (PAT) or up to 60 sessions of CBT are offered during the first year in the study. After the first year, PAT can be continued according to the ‘naturalistic’ usual method of treating such patients within the system of German health care (normally from 240 up to 300 sessions over two to three years). CBT therapists may extend their treatment up to 80 sessions, but focus mainly maintenance and relapse prevention. We plan to recruit a total of 240 patients (60 per arm). A total of 11 assessments are conducted throughout treatment and up to three years after initiation of treatment. The primary outcome measures are the Quick Inventory of Depressive Symptoms (QIDS, independent clinician rating) and the Beck Depression Inventory (BDI) after the first year. Discussion: We combine a naturalistic approach with randomized controlled trials(RCTs)to investigate how effectively chronic depression can be treated on an outpatient basis by the two forms of treatment reimbursed in the German healthcare system and we will determine the effects of treatment preference vs. randomization

Is that me in the mirror? Depersonalisation modulates tactile mirroring mechanisms

Our sense of self is thought to develop through sensory-motor contingencies provided, not only by observing one's own body, but also by mirroring interactions with others. This suggests that there is a strong link between mirroring mechanisms and the bodily self. The present study tested whether this link is expressed at early, implicit stages of the mirroring process or at later, more cognitive stages. We also provide, to the best of our knowledge, the first demonstration of how inter-individual differences in our sense of bodily self may affect mirroring mechanisms. We used somatosensory event-related potentials (SEPs) to investigate the temporal dynamics of mirroring highly self-related information (viewed touch on one's own face) compared to other-related information (viewed touch on a stranger's face), in individuals with low and high levels of depersonalisation, a mental condition characterised by feeling detached or estranged from one's self and body. For the low-depersonalisation group, mirroring for self-related events (P45) preceded mirroring for other-related events (N80). At later stages (P200), mirroring was stronger for other-related than self-related events. This shows that early, implicit and later, more cognitive processes play different relative roles in mirroring self- and other-related bodily events. Critically, mirroring differed in the high-depersonalisation group, specifically for self-related events. An absence of early, implicit mirroring for self-related events over P45 suggests that the associated processes may be the neural correlates of the disembodiment experienced in depersonalisation. A lack of differential mirroring for self- and other-related events over P200 may reflect compensatory mechanisms that redress deficiencies in mirroring at earlier stages, which may break down to give rise to symptoms of depersonalisation. Alternatively, or in addition, they may represent an attenuation of processes related to self-other distinction. Our study thus shows that mirroring, especially for events on one's own face, can be strongly affected by how connected the observer feels to their own bodily self

Gender differences in the prevalence of mental distress in East and West Germany over time : a hierarchical age-period-cohort analysis, 2006–2021

Purpose Mental distress has become a major public health concern. Temporal trends in psychological distress are complex and depend on numerous factors. In this study, we examined age-period-cohort effects for mental distress including gender and German region over a 15 years’ time span. Methods Data on mental distress from ten cross-sectional surveys of the general German population, covering the years from 2006 to 2021, was used. Hierarchical age-period-cohort analyses including gender and German region as predictors were performed to disentangle age, period, and cohort effects. The Patient Health Questionnaire-4 was used as a brief screener for mental distress. Results We found significant period and cohort effects, with peek values for mental distress in the years 2017 and 2020 and for the oldest birth cohort (born before 1946). Age did not affect mental distress when cohort- and period effects as well as gender and German region were considered. An interaction effect for gender and the German region was found. Women in West Germany reported significantly higher mental distress compared to women in East Germany. Compared to men, women reported the highest prevalence in both regions. Conclusion Important political events as well as major crises can lead to an increase of mental distress in societies. Furthermore, an association between birth cohort and mental distress could be linked to socialization effects of that certain time, causing traumatic experiences or a specific coping style within this cohort group. Prevention and intervention strategies could benefit from acknowledging structural differences linked to period and cohort effects