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Our study examined whether potentially critical indications from depression questionnaires, interviews, and single items on suicidal ideation among partici-pants in a large prospective population-based study are related to short-term sui-cides within one year. For this purpose, we studied the association between (a) the severity of depressive symptoms according to the M-CIDI and the PHQ-9, BDI-II, and CID-S depression screening and (b) elevated scores on single sui-cidal ideation items and mortality according to claims databases.
In the baseline cohort, the frequency of depressive symptoms measured by CID-S was 12.90% (SHIP-START-0). The frequency for “Moderate” to “Severe de-pression” measured by the PHQ-9 (≥ 10 points) and BDI-II (≥ 20 points) ques-tionnaires ranged from 5.40% (SHIP-LEGENDE) to 8.80% (SHIP-TREND Morbid-ity follow-up). The 1-month prevalence of unipolar depression, measured by the M-CIDI in SHIP LEGENDE, was 2.31%.
Between 5.90% (SHIP-TREND Morbidity follow-up) and 6.60% (SHIP-LEGENDE) of respondents showed a certain degree of suicidal ideation in the two weeks preceding the assessment, according to BDI-II and PHQ-9.
Our results show the high frequency of depressive symptoms in the study region, with women being affected more frequently than men, especially in the higher categories. Furthermore, women were more frequently affected by suicidal idea-tion, although this difference was not evident in the highest categories.
There was one potential suicide in the year after a SHIP examination.
From our results, we cannot conclude that severe self-reported symptoms from depression questionnaires should be reported back to participants of an obser-vational population-based study to prevent suicide deaths within one year.
Objective
Alexithymia is associated with various mental and physical disorders. Some rare evidence also suggested high alexithymia to affect the HPA axis based on small and selective samples. It was aimed to investigate the impact of alexithymia on basal cortisol levels in a large population-based cohort.
Methods
In a sample of N = 3444 individuals from the Study of Health in Pomerania (SHIP-TREND-0), the effect of alexithymia on basal serum cortisol levels was investigated in a cross-sectional design.
Multiple linear regressions utilizing cortisol levels as the response variable and alexithymia as the predictor of interest were calculated, while adjusting for conven-tional confounding covariates including depression. Multiple stratified, moderation and mediation analyses were performed to validate the results.
Results
Alexithymia was not significantly associated with basal cortisol levels (b = 0.23, 95 percent confidence interval (CI) of [-0.24, 0.69]; sr2 = 0.00, CI: [-0.00, 0.00]).
Sex- and age-stratified regression analyses as well as dichotomized models of non-alexithymic and alexithymic individuals substantiated the non-significance.
Additional mediation analyses with (1) depression and (2) physical health (R2 > 1 in both cases) and moderation analysis regarding the interaction of physical health and alexithymia (b = -1.45, 95 percent confidence interval (CI) of [-6.13, 3.32]; sr2 = 0.00, CI: [-0.00, 0.00]) corroborated the results.
Conclusion
This study does not support previous findings as it shows no association between alexithymia and basal cortisol; however, a consideration of the circadian rhythm, stress exposure or specific sample compositions heeding the methodological design should be the subject of further research.
Background
Only about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy).
Method
All variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R).
Results
Altogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16).
Conclusion
The Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses.
Trial registration
German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.
Zur Messqualität des Beck-Depressionsinventars (BDI-II) in
unterschiedlichen klinischen Stichproben
(2022)
Theoretischer Hintergrund: Das BDI-II ist ein Selbstbeurteilungsinstrument zur Erfassung des Schweregrads einer Depression. Es liegen kaum Analysen mit Modellen aus der Item-Response-Theorie (IRT) vor. Fragestellung: Wie hoch ist die Messgenauigkeit des BDI-II über die unterschiedlichen Ausprägungen des latenten Traits (Depressivität) hinweg und sind die Kategorien der Items jeweils aufsteigend geordnet? Methode: Anhand von sechs großen Datensätzen aus verschiedenen klinischen Bereichen wurden psychometrische Analysen mit dem Graded Response Model durchgeführt. Ergebnisse: In allen Stichproben fand sich eine hohe interne Konsistenz. Die Schwellenwerte waren mit Ausnahme von Item 6 („Bestrafungsgefühle“) geordnet. Gemäß Testinformationsfunktion misst das BDI-II im mittleren bis hohen Depressionsbereich sehr gut (Reliabilität > .90) und im unteren Bereich gut. Schlussfolgerung: Für das BDI-II ergibt sich eine hohe und relativ gleichbleibende Messpräzision über einen weiten Bereich des latenten Traits, weshalb es insbesondere im klinischen, aber auch im nicht klinisch relevanten Wertebereich zur Erhebung des Schweregrades einer Depression gut geeignet ist.
The experience of abuse in the period of childhood and youth is a key stressor that has con-sequences on the developing brain and is associated with the genesis of mental disorders. Childhood abuse and depression often cooccur together and have both been associated with cortical thickness resulting in a difficulty to detangle the influence of each factor. In prior studies, childhood abuse and depression were inconsistently related to whole-brain cortical thickness. Thus, this thesis aims to investigate the link between childhood abuse, depres-sive symptoms, and alterations of the cortex.
Therefore, this study analyses 1,551 individuals of the general population. A significant in-teraction effect of childhood abuse and depressive symptoms is observed for whole-brain cortical thickness. Yet, the results indicate no influence of childhood abuse or depression alone. A thinner cortex was associated with more severe depressive symptoms in the abused, but not in the non-abused group. In non-depressed participants, an increased whole-brain cortex was found in the abused, compared to the non-abused group. Similar interaction effects were observed in 12 out of 34 cortical regions.
The results suggest, in line with prior findings, that depressed individuals with a history of childhood abuse are a specific ecophenotype which is also reflected in specific brain altera-tions. Cortical regions that are distinct associated with the interaction of depressive symp-toms and childhood abuse are involved in various fields such as sensory processing, self-conception, and memory. Greater cortical thickness in subjects with childhood abuse and without depressive symptoms might act compensatory and thus reflect resilience against depressive symptoms.
Practical implications concern the treatment and diagnostic system as well as the im-portance of early prevention programs. An individualised treatment is necessary as various studies found a less favourable outcome in depressive patients with a history of maltreat-ment. Therefore, it seems urgent to assess experiences of childhood abuse at the beginning of psychiatric and psychotherapeutic treatment. In addition, early prevention programs are in need to support vulnerable family systems and thereby strengthening the economic, health and social system.
Background: Depressive disorders are highly prevalent and disabling diseases. Epidemiological studies have shown that they often co-occur with addictive behaviors, which in part might be explained by common risk factors. Rumination might be such a risk factor. Comorbidity can have substantial adverse effects for those affected. Thus, combined treatment approaches are needed. These should not be restricted to individuals with clinical disorders. In light of an apparent treatment gap, new treatment approaches that provide widespread access to evidence-based treatments need to be explored. In recent years, e-health interventions received a lot of attention. With their potential to be widely disseminated, they might be suitable to provide population-based intervention approaches. Developing population-based interventions might present special challenges to intervention developers, for example, in terms of intervention design or the selection of samples to preliminary test interventions. This thesis explored the application of e-health interventions in the treatment and prevention of depressive symptoms and addictive behaviors. Its first aim was to provide an overview on publicly accessible evidence-based e-health interventions for the treatment and prevention of depressive symptoms (study 1). The second aim was to test the feasibility, acceptability and potential effectiveness of a newly developed computer-based expert system intervention simultaneously targeting hazardous alcohol consumption and depressive symptoms and to investigate the importance of the sample selection when preliminary testing interventions (study 2). The third aim was to further investigate rumination with its subfactors brooding and reflection as a common cause of depression and addictive behaviors and thus as a potential target for combined interventions by analyzing its associations with symptoms of pathological gambling (SPGs; study 3).
Methods: This thesis provides a summary of different working steps in the process of developing and testing a computer-based intervention for health care patients (HCPs) with comorbid hazardous alcohol consumption patterns and depressive symptoms. In study 1, a systematic literature search was conducted to identify evidence-based e-health interventions for depressive symptoms. Interventions were considered for further inspection if studies provided evidence for at least small intervention effects and if the interventions were accessible to at least selected groups of individuals. For study 2, 2773 consecutive HCPs were screened for hazardous drinking and depressive symptoms. Of the 41 HCPs who were offered to participate in the study, 27 (65.9%) consented. To investigate the importance of the sample selection when preliminary testing interventions, HCPs were compared to media recruited volunteers (MVs). Over a period of 6 months, study participants received 6 individualized counselling letters and weekly short messages. Pre-post data were analyzed for 30 participants (15 HCPs, 15 MVs). Intervention acceptability was assessed in post-intervention interviews conducted with 32 study participants. In study 3, cross-sectional data of 506 (80.4% male) individuals aged 14 to 64 years with a history of gambling problems were analyzed. Associations between the rumination subfactors and SPGs across different levels of problem gambling severity were investigated by means of sequential quantile regression.
Results: In study 1, 37 publicly accessible evidence-based e-health interventions for depressive symptoms were identified. Most interventions (81.1%) were available in English. For the German language area, only 3 interventions were identified. In study 2, HCPs and MVs reduced regular binge drinking (HCPs: p = 0.016; MVs: p = 0.031) and depressiveness (HCPs: p = 0.020; MVs: p < 0.001). MVs further reduced average daily consumption (p = 0.034). Both subsamples rated the intervention positive. Compared to HCPs, MVs rated the alcohol module more favorably (p = 0.012). Intervention usage was higher in MVs than in HCPs (p = 0.013). Study 3 showed that at the median, ruminative brooding was positively associated with the severity of problem gambling after controlling for covariates (p = 0.005). Along the distribution of problem gambling severity, findings did hold for all but the lowest severity level. Ruminative reflection was not associated with problem gambling severity at the median (p = 0.347).
Conclusions: E-health interventions show great potential in the treatment and prevention of depressive symptoms and addictive behaviors. However, more research is needed to clarify how to make the most of this potential. Important questions that remain to be answered include, for example, how to best provide e-health interventions to those in need or how to design interventions in order to maximize their reach and thus their public health impact. This thesis showed that 1) publicly accessible evidence-based e-health interventions for depressive symptoms were available. However, the supply in the German language area was low. 2) The computer-based expert system intervention targeting hazardous alcohol consumption and depressive symptoms was technically and logistically feasible, acceptable, and may have the potential to reduce hazardous drinking and depressive symptoms in different populations, including populations unselected in terms of their motivation to change. To avoid biased conclusions about the potential of interventions, intervention developers should preliminary test interventions on intended target populations. 3) Rumination might be important in the development and maintenance of addictive behaviors. With its relations to depression and addictive behaviors, it should be considered as a target for future combined interventions.
Patient-reported outcomes (PROs) refer to any report coming directly from patients about how they function or feel in relation to a health condition or its therapy. PROs have been applied in medicine for the assessment of the impact of clinical phenomena. Self-report scales and procedures for assessing physical pain in adults have been developed and used in clinical trials. However, insufficient attention has been dedicated to the assessment of mental pain. The aim of this paper is to outline the implications that assessment of mental pain may entail in psychiatry and medicine, with particular reference to a clinimetric index. A simple 10-item self-rating questionnaire, the Mental Pain Questionnaire (MPQ), encompasses the specific clinical features of mental pain and shows good clinimetric properties (i.e., sensitivity, discriminant and incremental validity). The preliminary data suggest that the MPQ may qualify as a PRO measure to be included in clinical trials. Assessment of mental pain may have important clinical implications in intervention research, both in psychopharmacology and psychotherapy. The transdiagnostic features of mental pain are supported by its association with a number of psychiatric disorders, such as depression, anxiety, eating disorders, as well as borderline personality disorder. Further, addressing mental pain may be an important pathway to prevent and diminish the opioid epidemic. The data summarized here indicate that mental pain can be incorporated into current psychiatric assessment and included as a PRO measure in treatment outcome studies.
Weltweit leiden 4,4% der Weltbevölkerung an einer Depression. Das variable Erscheinungsbild dieser Erkrankung erschwert deren Erforschung. Dass ein besseres Verständnis und die Entwicklung optimaler Therapiemöglichkeiten dieser Erkrankung sehr wichtig sind, zeigen die starke Einschränkung des gesamten Lebensalltags Betroffener (DALYs) und auch die hohe Suizidalität. Es existieren verschiedene ätiologische Theorien zur Depression, wie zum Beispiel die Monoaminmangel-Hypothese, die auf einen Mangel an Neurotransmittern im synaptischen Spalt und deren sekundären Effekte beruht. Neuroendokrine Theorien verweisen auf einen Hyperkortisolismus mit Störung der HPA-Achse und eine Stress-bezogene Ätiologie. Ein andauernder Hyperkortisolismus führt laut der Neutrophin-Hypothese zu Neurotoxizität, zu einer verminderten Neurogenese, Atrophie und Volumenminderung. Bildmorphologische Untersuchungen mittels PET-CT oder fMRT verweisen auf strukturelle und funktionelle Veränderungen bestimmter Hirnregionen bei depressiven Probanden. Auf zellulärer Ebene kann eine veränderte Zellaktivität mittels immunhistochemischer Methoden wie der C-Fos-Färbung dargestellt werden.
Für die vorliegende Untersuchung wurden Hirne von 8 männlichen Ratten untersucht, die zuvor einen Verhaltensversuch der Erlernten Hilflosigkeit zugeführt wurden. Dieser von M. Seligman entwickelte Verhaltensversuch gilt als tierexperimentelles Modell der Depressionsforschung. Durch Selektion wurden Tiere mit angeborener Erlernter Hilflosigkeit gezüchtet (congenitally Learned Helplessness, cLH) und von nicht-hilflosen Tieren unterschieden (congenitally Non Learned Helplessness, cNLH). Tiere mit Erlernter Hilflosigkeit zeigen ein mit dem Menschen vergleichbares depressives Verhalten.
Die Rattenhirne von je 4 cLH- und cNLH-Tieren wurden mit indirekter Immunhistochemie auf ihre C-Fos-Expression untersucht. Dabei wurden die Hirne in 40 μm dicke Scheiben geschnitten und nach Anwendung eines standardisierten Färbeprotokolls 11 Hirnregionen unter Rhodaminfilter mikroskopiert. In einem 200 x 200 μm großen Rahmen wurden die C-Fos-positiven Zellen ausgezählt. Im Vergleich der cLH und cNLH-Hirne ergab sich hierbei eine signifikant geringere C-Fos-Expression der cLH-Tiere in der hippocampalen Regionen CA1 und CA3, dem medialen und centralen Amygdalakern und der Substantia nigra. Kein signifikanter Unterschied fand sich in den hippocampalen Regionen CA2 und dem Gyrus dentatus, dem basolateralen und lateralen Amygdalakern, dem Nucleus accumbens und dem prälimbischen Kortex. Die signifikanten Ergebnisse verweisen auf eine Hypoaktivität bei Depression in bestimmten Hirnregionen. Eine Hypotrophie und Hypoaktivität bestimmter Regionen (z. B. dem Hippocampus) wurde bereits in weiteren Studien beschrieben, während in anderen Regionen (z.B. den Amygdalakernen) eher Hyperaktivität vorbeschrieben wurde. Zusammenfassend konnte gezeigt werden, dass in einigen Hirnregionen eine verminderte Aktivität in Zusammenhang mit der depressiven Erkrankung steht.
The first part of my work comprises empirical findings and theoretical foundations on stress in its historical development and socio-emotional and behavioural factors.
The first study of my dissertation focuses on the relationship between perceived stress in adolescence, the context variables of perceived helpfulness and competition and socio-emotional and behavioural strengths and difficulties (i.e., emotional problems, symptoms of hyperactivity, problems with peers, prosocial behaviour and conduct problems) from early to middle adolescence. I postulated a moderation or mediation of the effect of perceived stress on socio-emotional and behavioural strengths and difficulties through the two context variables. My hypotheses were tested using a latent moderating structural equation model (moderation analysis) and a multi-group structural equation model taking into account the gender and age of the students (mediation analysis). The theoretical basis of my first study is the transactional stress model by Lazarus and Folkman (1984).
The second study of my dissertation is dedicated to the question whether perceived stress is a moderator in the relationship between depressive symptoms in early adolescence and socio-emotional and behavioural strengths and difficulties in middle adolescence. Based on the cognitive vulnerability-transactional stress theory of Hankin and Abramson (2001), which assumes reciprocal and dynamic relationships between the individual and the environment, I investigated this question and tested the relationships using a latent moderating structural equation model.
The third study of my dissertation is based on Bronfenbrenner’s socio-ecological model (1975). Using a cross-lagged panel design, I investigate the within time and longitudinal relationships between variables of emotional (in-)stability (i.e., depressive symptoms, perceived stress and loneliness) and socio-environmental factors (i.e., sense of belonging, student-student and teacher-student-relationship) from early to middle adolescence.
At the end of my work there is a summary of all results, a discussion and an outlook for future research.
In den Jahren 1990 und 2000 wurde bereits von Kroll et al. (2003) die Wissensvermittlung via deutsche Printmedien zur Erkrankung Depression untersucht. Danach wurden in Deutschland verschiedene Aufklärungskampagnen, unter anderem im Jahr 2001 das „Nürnberger Bündnis gegen Depression“ ins Leben gerufen. Inwiefern Tageszeitungen in Deutschland das in Fachkreisen propagierte Bild der Depression den Zeitungslesern in den Jahren 1999 bis 2009 nähergebracht haben, wurde in der vorliegenden Arbeit untersucht. Um eine möglichst breite Abbildung zu erreichen wurden die Bild Zeitung, Frankfurter Allgemeine Zeitung, Süddeutschen Zeitung sowie die Ostsee Zeitung und der Spiegel in den Jahren 1999/2000, 2002/03, 2008/09 analysiert. Zur Untersuchung der Artikel wurde ein für diese Arbeit entwickeltes Kategoriensystem genutzt, welches verschiedene Aspekte sowohl der formalen wie auch der inhaltlichen Auswertung aufgreift. Der Begriff „depress“ wurde im Untersuchungszeitraum in den Jahren 2008/09 häufiger verwendet als noch in den Jahren 1999/2000, dabei blieb der Anteil der Verwendung als Krankheits- und Symptombezeichnung bei etwa 44% konstant. Die Anzahl der Artikel, welche Gesundheit als Hauptthema haben und in denen Depression behandelt wird, hat jedoch von 128 auf 117 abgenommen. Daraus kann sowohl auf eine quantitative als auch qualitative Abnahme bei der Berichterstattung über Depressionen geschlossen werden, wenn man speziell diesen Artikeln eine informierende und aufklärende Funktion zuweist. Bei der genaueren inhaltlichen Betrachtung zeigt sich keine wesentliche Änderung in den untersuchten Jahren. In Artikeln, die sich hauptsächlich mit Gesundheitsthemen befassen, dominiert ein rein biologisches Modell der Krankheitsentwicklung, während in der Gesamtheit der Artikel überwiegend auf die psychosozialen Aspekte der Krankheitsentstehung eingegangen wird. Insgesamt spiegelt sich die in Fachkreisen propagierte Vielfalt der Ursachen und Therapiemöglichkeiten kaum bis gar nicht in den Artikeln wieder. Lediglich bei dem Thema Suizid ist eine Veränderung zu verzeichnen. Im Verhältnis zur Gesamtzahl der Artikel hat die Rate der Publikationen, welche sich hiermit befassen, abgenommen. Dies kann durchaus auf Empfehlungen von Fachkreisen bezüglich dem Umgang von Journalisten mit dem Thema Suizid zurückgeführt werden. Insgesamt wird über die deutschen Printmedien in dem Untersuchungszeitraum kein ausgewogenes, wissenschaftlich adäquates Bild der Depression vermittelt.