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Saarbrücken, Germany

Hauser W.,Klinikum Saarbrucken | Kosseva M.,TU Munich | Uceyler N.,University of Wurzburg | Klose P.,University of Duisburg - Essen | Sommer C.,University of Wurzburg
Arthritis Care and Research | Year: 2011

Objective: To systematically assess the potential association of fibromyalgia syndrome (FMS) with emotional, physical, and sexual abuse. Methods: The databases EMBase, Google Scholar, Medline, and PsycINFO (through April 2010) and the reference sections of original studies were searched for eligible studies. Eligible studies were cohort or case-control studies that assessed at least one type of emotional, physical, or sexual abuse in childhood or adulthood in patients with FMS and in controls. Two authors independently extracted descriptive, quality, and outcome data from included studies. Methodologic quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were pooled across studies by using the random-effects model. Heterogeneity was assessed by I 2 statistics. Results: The search identified 18 eligible case-control studies with 13,095 subjects. There were significant associations between FMS and self-reported physical abuse in childhood (OR 2.49 [95% CI 1.81-3.42], I 2 = 0%; 9 studies) and adulthood (OR 3.07 [95% CI 1.01-9.39], I 2 = 79%; 3 studies), and sexual abuse in childhood (OR 1.94 [95% CI 1.36-2.75], I 2 = 20%; 10 studies) and adulthood (OR 2.24 [95% CI 1.07-4.70], I 2 = 64%; 4 studies). Study quality was mostly poor. Low study quality was associated with higher effect sizes for sexual abuse in childhood, but not with other effect sizes. Conclusion: The association of FMS with physical and sexual abuse could be confirmed, but is confounded by study quality. © 2011, American College of Rheumatology. Source

Hauser W.,Klinikum Saarbrucken | Thieme K.,University of Heidelberg | Turk D.C.,University of Washington
European Journal of Pain | Year: 2010

We compared the methodology and the recommendations of evidence-based guidelines for the management of fibromyalgia syndrome (FMS) to give an orientation within the continuously growing number of reviews on the therapy of FMS. Systematic searches up to April 2008 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, the Association of the Scientific Medical Societies in Germany (AWMF) and Medline were conducted. Three evidence-based guidelines for the management of FMS published by professional organizations were identified: The American Pain Society (APS) (2005), the European League Against Rheumatism (EULAR) (2007), and the AWMF (2008). The steering committees and panels of APS and AWMF were comprised of multiple disciplines engaged in the management of FMS and included patients, whereas the task force of EULAR only consisted of physicians, predominantly rheumatologists. APS and AWMF ascribed the highest level of evidence to systematic reviews and meta-analyses, whereas EULAR credited the highest level of evidence to randomised controlled studies. Both APS and AWMF assigned the highest level of recommendation to aerobic exercise, cognitive-behavioral therapy, amitriptyline, and multicomponent treatment. In contrast, EULAR assigned the highest level of recommendation to a set of to pharmacological treatment. Although there was some consistency in the recommendations regarding pharmacological treatments among the three guidelines, the APS and AWMF guidelines assigned higher ratings to CBT and multicomponent treatments. The inconsistencies across guidelines are likely attributable to the criteria used for study inclusion, weighting systems, and composition of the panels. © 2009 European Federation of International Association for the Study of Pain Chapters. Source

Bernardy K.,Saarland University | Fuber N.,Saarland University | Kollner V.,MediClin Bliestal Clinics | Hauser W.,Klinikum Saarbrucken | Hauser W.,TU Munich
Journal of Rheumatology | Year: 2010

Objective. We performed the first systematic review with metaanalysis of the efficacy of cognitive-behavioral therapies (CBT) in fibromyalgia syndrome (FM). Methods. We screened Cochrane Library, Medline, PsychINFO, and Scopus (through June 2009) and the reference sections of original studies and systematic reviews for CBT in FM. Randomized controlled trials (RCT) comparing CBT to controls were analyzed. Primary outcomes were pain, sleep, fatigue, and health-related quality of life (HRQOL). Secondary outcomes were depressed mood, self-efficacy pain, and healthcare-seeking behavior. Effects were summarized using standardized mean differences (SMD). Results. A total of 14 out of 27 RCT with 910 subjects with a median treatment time of 27 hours (range 6-75) over a median of 9 weeks (range 5-15) were included. CBT reduced depressed mood (SMD -0.24, 95% CI -0.40, -0.08; p = 0.004) at posttreatment. Sensitivity analyses showed that the positive effect on depressed mood could not be distinguished from some risks of bias. There was no significant effect on pain, fatigue, sleep, and HRQOL at posttreatment and at followup. There was a significant effect on self-efficacy pain posttreatment (SMD 0.85, 95% CI 0.25, 1.46; p = 0.006) and at followup (SMD 0.90, 95% CI 0.14, 1.66; p = 0.02). Operant behavioral therapy significantly reduced the number of physician visits at followup (SMD -1.57, 95% CI -2.00, -1.14; p < 0.001). Conclusion. CBT can be considered to improve coping with pain and to reduce depressed mood and healthcare-seeking behavior in FM. The Journal of Rheumatology Copyright © 2010. All rights reserved. Source

Hilbert A.,University of Leipzig | Braehler E.,University of Leipzig | Haeuser W.,Klinikum Saarbrucken | Zenger M.,University of Leipzig
Obesity | Year: 2014

Objective Weight bias has strong associations with psychopathology in overweight and obese individuals. However, self-evaluative processes, as conceptualized in the process model of self-stigma, and implications for other health-related outcomes, remain to be clarified. Design and Methods In a representative general population sample of N = 1158 overweight and obese individuals, the impact of core self-evaluation as a mediator between weight bias internalization and mental and global health outcomes as well as between weight bias internalization and health care utilization, was examined using structural equation modeling. Results In overweight and obese individuals, greater weight bias internalization predicted lower core self-evaluation, which in turn predicted greater depression and anxiety, lower global health, and greater health care utilization. These mediational associations were largely stable in subsample analyses and after controlling for sociodemographic variables. Conclusions The results show that overweight and obese individuals with internalized weight bias are at risk for impaired health, especially if they experience low core self-evaluation, making them a group with which to target for interventions to reduce self-stigma. Weight bias internalization did not represent a barrier to health care utilization, but predicted greater health care utilization in association with greater health impairments. Copyright © 2013 The Obesity Society. Source

Hauser W.,Klinikum Saarbrucken | Hauser W.,TU Munich | Janke K.-H.,Baden Wurttemberg State Health Office | Klump B.,Universitatskliniken Tubingen | Hinz A.,University of Leipzig
Inflammatory Bowel Diseases | Year: 2011

Background: Studies on anxiety and depression in inflammatory bowel disease (IBD) yielded inconsistent results. We compared anxiety and depression of patients with Crohn's disease (CD) and ulcerative colitis (UC) controlled for sociodemographic and medical variables with age- and sex-matched controls. Methods: In all, 422 IBD patients (50% females, 314 CD, 108 UC) of different settings were compared with 140 age- and sex-matched patients with chronic liver diseases (CLD) of a tertiary care center and with 422 age- and sex-matched persons of a representative sample of the general German population (GP). Anxiety and depression and probable mental disorder were assessed by the German version of the Hospital Anxiety and Depression Scale. Comparisons between CD and UC were adjusted for medical (disease activity, number of IBD-associated diseases) and sociodemographic factors (age, gender, marital status). Results: CD and UC patients did not differ in the levels of anxiety and depression or in the frequency of a probable mental disorder. The levels of anxiety and depression of IBD patients with active disease were higher than that of the GP, but not of the IBD patients in remission. The depression score of the CLD sample was higher than that of the IBD sample (P < 0.001), but not the anxiety score. Mental disorders were more frequent in IBD patients with slight (27.7%) and moderate/severe disease activity (49.3%) compared to GP (10.4%) (P < 0.001), but not in IBD patients in remission (11.3%). Conclusions: Patients with active IBD should be screened for anxiety and depression. Inflamm Bowel Dis 2011 Copyright © 2010 Crohn's & Colitis Foundation of America, Inc. Source

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