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Richter F.,Jena University Hospital | Strauss B.,Jena University Hospital | Braehler E.,University of Leipzig | Braehler E.,Universal Medical Center Mainz | And 2 more authors.
Eating Behaviors | Year: 2016

Purpose: Disordered eating is common for all ages and sexes in the general population. However, only some individuals are known to develop clinically relevant eating disorders. There is a critical need of efficient, reliable and valid screening instruments to measure disordered eating for the general population. The Eating Attitudes Test was shortened into an 8-item-version to screen individuals at high risk of developing clinical eating disorders in a general population sample. Methods: Psychometric properties (Cronbach's α, construct and concurrent validity and factor structure), cutoff scores (with sensitivity, specificity, positive and negative predictive value) and norms were determined in a representative sample of the German population (N = 2527). Factorial validity was investigated using item response modeling. Results: Results confirmed reliability and validity of the questionnaire. Internal consistency and convergent validity were good. Analysis revealed different cutoff points for male and female participants. Values for sensitivity and specificity were satisfying and the positive predictive value was higher compared to other short screening instruments for disordered eating. Factorial analysis revealed a one-factor solution with an excellent model fit. The elimination of one item was discussed. Gender- and age-specific norms are reported. Conclusions: Overall results indicated that the EAT-8 is an efficient instrument suitable for screening purposes in large general population samples. © 2016 Elsevier Ltd.

Faller H.,University of Würzburg | Koch U.,University of Hamburg | Brahler E.,University of Leipzig | Brahler E.,Universal Medical Center Mainz | And 16 more authors.
Journal of Cancer Survivorship | Year: 2016

Purpose: Information needs in cancer patients are high but often not fulfilled. This study aimed to examine the level of perceived information, information satisfaction, and unmet needs in a large sample of cancer patients. Further, we explored associations with emotional distress and quality of life accounting for gender. Methods: In a multicenter, cross-sectional study in Germany, 4020 cancer patients (mean age 58 years, 51 % women) were evaluated. We obtained self-reports of information level, information satisfaction, and unmet needs, measured depressive symptoms with the Patient Health Questionnaire (PHQ-9), symptoms of anxiety with the Generalized Anxiety Disorder Scale (GAD-7), and health-related quality of life with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Results: Seventy-two to 88 % of participants reported to be well informed regarding various aspects of their disease, except of psychological support (38 %). However, unmet information needs were also prevalent in 36 to 48 %. Gender differences found were generally small. Although men felt less informed about psychological support, they expressed fewer needs for further information regarding this topic. Irrespective of gender, patients who were less satisfied with information received and had more unmet needs reported more anxiety, depression, and lower quality of life. Up to three quarters of those classified as most severely distressed reported unmet needs for information about psychological support. Conclusions: In this largest study to date, we found high levels of both information received and satisfaction with information, but also considerable amounts of unmet needs, particularly regarding psychological support. Implications for Cancer Survivors: Provision of information about psychosocial support seems important to increase utilization of support offers among distressed cancer survivors. © 2015, Springer Science+Business Media New York.

Richter F.,Jena University Hospital | Strauss B.,Jena University Hospital | Braehler E.,University of Leipzig | Braehler E.,Universal Medical Center Mainz | And 2 more authors.
Eating Behaviors | Year: 2016

The prevention of eating disorders and the identification of high-risk individuals are essential for the public health sector. There is need for sensitive and specific screening instruments of disordered eating that can be applied in universal samples as an initial step into disease prevention. The SCOFF is a screening instrument for disordered eating, frequently used in international and cross-cultural contexts to detect individuals at risk. The objective of this research is to evaluate whether the SCOFF can be used as a screening tool for disordered eating in universal samples. This is the first study which examined the psychometric properties of the German version of the SCOFF in a general population sample. A representative sample (N = 2527) of the German population, aged 14-95. years, was recruited. Psychometric properties were determined including reliability, concurrent and construct validity, and factor structure. The prevalence of disordered eating was assessed. The prevalence of disordered eating in the general population was 10%. Using the established cutoff point of ≥. 2, values for diagnostic accuracy were 26% (sensitivity), 97% (specificity), 80% (positive predictive value), and 74% (negative predictive value). Factorial analyses revealed an excellent model fit of a unidimensional model. Due to its low sensitivity and a high percentage of false negatives, there are limitations in using the German version of the SCOFF in general population samples with wide age ranges. © 2016 Elsevier Ltd.

Hauser W.,Klinikum Saarbrucken | Hauser W.,TU Munich | Schmutzer G.,University of Leipzig | Brahler E.,University of Leipzig | And 3 more authors.
Pain Medicine (United States) | Year: 2014

Objective: Low back pain (LBP), obesity, and depression are highly prevalent health conditions. We assessed the relative impact of body weight and depression on different types of LBP in a representative population sample. Design: This is a cross-sectional study. Setting and Patients: Two thousand five hundred ten subjects aged 14-90 years were randomly selected from the German general population in 2012. Measures: Pain sites and duration of pain were assessed by the Widespread Pain Index( WPI), depression by the Beck Depression Inventory Primary Care Questionnaire, disability by the European Organization for Research and Treatment of Cancer questionnaire, and current body mass index (BMI, kg/m2) by self-reported body weight and height. Widespread pain was defined by ≥7/19 pain sites in the WPI. Hierarchical logistic regression analyses were performed with different types of LBP as the dependent variable, and age, gender, lifetime employment status as a worker, number of pain sites, BMI, and depression as independent variables. Results: One thousand six hundred eighty-seven (67.1%) of participants reported no pain. Five hundred six (20.2%) reported chronic LBP and 84 (3.3%) reported disabling chronic LBP. Age (odds ratio [OR] 1.05 [95% confidence interval {CI} 1.04-1.06]), BMI (OR 1.08 [95% CI 1.05.-1.11]), and depression (OR 1.38 [95% CI 1.30-1.49]) independently predicted chronic LPB compared with persons without pain. Age (OR 1.07 [95% CI 1.05-1.09]), BMI (OR 1.07 [95% CI 1.03-1.13]), and depression (OR 1.71 [95% CI 1.55-1.88]) independently predicted disabling chronic LPB compared with persons without pain. Age (OR 1.03 [95% CI 1.01-1.05]), widespread pain (OR 5.23 [95% CI 3.04-9.00), and depression (OR 1.34 [95% CI 1.16-1.55]) independently predicted disabling chronic LPB compared with persons with nondisabling chronic LBP. Conclusion: BMI and depression are modifiable risk indicators for chronic disabling LBP. © 2014 American Academy of Pain Medicine.

Hund B.,Rhein Jura Klinik | Hund B.,Albert Ludwigs University of Freiburg | Reuter K.,Albert Ludwigs University of Freiburg | Harter M.,University of Hamburg | And 11 more authors.
Depression and Anxiety | Year: 2016

Background We aimed to investigate type and frequency of stressors, predominant symptom profiles, and predictors of adjustment disorders (AD) in cancer patients across major tumor entities. Methods In this epidemiological study, we examined 2,141 cancer patients out of 4,020 screened with the Composite International Diagnostic Interview, adaptation for oncology (CIDI-O). AD were operationalized as subthreshold disorders according to DSM-IV criteria. Results In our sample, 265 out of 2,141 patients (12.4%) met all criteria for AD (unweighted 4-week prevalence). The disclosure of the cancer diagnosis, relapse or metastases, and cancer treatments were most frequently described as stressors associated with depressive or anxious symptoms. With regard to AD symptom profiles, patients showed high prevalence rates of affective symptoms according to the DSM-IV criteria of Major Depression: The highest prevalence rates were found for cognitive disturbances (concentration and memory problems) (88%), sleeping disturbances (86%), and depressive mood (83%). We found sex, education, and metastasis as significant predictors for AD. Higher education was the most influential predictor. Men were half as likely to report symptoms fulfilling the AD criteria as women. Patients with metastasized tumors had a more than 80% higher risk of AD than those without metastasis. However, the explained variance of our model is very small (Nagelkerke's R2 = 0.08). Conclusions Patients with AD can be identified using a standardized instrument and deserve clinical attention, as they often show severe clinical symptoms and impairments. Improving the clinical conceptualization of AD by the adding-on of potential stress-response-symptoms is necessary to identify severe psychological strain. © 2015 Wiley Periodicals, Inc.

Kocalevent R.-D.,University of Hamburg | Klapp B.F.,Charité - Medical University of Berlin | Albani C.,University of Leipzig | Brahler E.,Universal Medical Center Mainz
BMC Public Health | Year: 2014

Background: The population-based study examined postulated effects, derived from a resources-demands-model about gender-related aspects of self-efficacy, optimism, chronic stress, and exhaustion. Methods: Data acquisition was carried out by a market research institute with a multi-topic questionnaire in the general population (N = 2,552). Instruments administered were the Questionnaire for Self-Efficacy and Optimism, the Trier Inventory for Chronic Stress, and the Chalder-Fatigue-Scale. Households and target persons were selected randomly. The analyses focused on structural equation modeling. Results: There were significant differences in structural relations among the resource paths. In particular, significant gender differences were found with respect to self-efficacy, and among the exhaustion paths, namely in the mental dimension of exhaustion. The observed measures of chronic stress were found to be operating equivalently for both genders. Results suggest that resources play an important role in the understanding of how chronic stress is preceded and may lead to exhaustion in both genders. Conclusion: Personal resources seem to be more expressed by men than by woman, for whom the relation of resources to health is of greater importance than for men. © 2014 Kocalevent et al.; licensee BioMed Central Ltd.

Korner A.,McGill University | Korner A.,Jewish General Hospital | Coroiu A.,McGill University | Copeland L.,McGill University | And 6 more authors.
PLoS ONE | Year: 2015

Self-compassion, typically operationalized as the total score of the Self-Compassion Scale (SCS; Neff, 2003b), has been shown to be related to increased psychological well-being and lower depression in students of the social sciences, users of psychology websites and psychotherapy patients. The current study builds on the existing literature by examining the link between self-compassion and depressive symptomatology in a sample representative of the German general population (n = 2,404). The SCS subscales of self-judgment, isolation, and over-identification, and the "self-coldness", composite score, which encompass these three negative subscales, consistently differed between subsamples of individuals without any depressive symptoms, with any depressive syndromes, and with major depressive disorder. The contribution of the positive SCS subscales of self-kindness, common humanity, and mindfulness to the variance in depressive symptomatology was almost negligible. However, when combined to a "self-compassion composite", the positive SCS subscales significantly moderated the relationship between "self-coldness" and depressive symptoms in the general population. This speaks for self-compassion having the potential to buffer self-coldness related to depression-providing an argument for interventions that foster self-caring, kind, and forgiving attitudes towards oneself. Copyright: © 2015 Körner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Gotze H.,University of Leipzig | Brahler E.,University of Leipzig | Brahler E.,Universal Medical Center Mainz | Gansera L.,University of Leipzig | And 2 more authors.
Supportive Care in Cancer | Year: 2014

Purpose Palliative patients and their family caregivers were interviewed at the beginning of home care in personal interviews at home in regard to their psychological distress as well as their quality of life. Methods Quality of life was collected with the palliative module EORTC QLQ-C15-PAL (patients) and the Short Form-8 Health Survey (caregivers). The psychological distress was assessed using the Hospital Anxiety and Depression Scale, the extent of social support with the Oslo 3-items social support scale. Two multiple regression models were employed to examine factors associated with psychological distress. Data from 106 palliative patients (39.6% female) and their family caregivers (67.9% female) were included in the analysis. Results Every fourth patient had clinically relevant anxiety levels and half of the palliative patients had clinically symptomatic depression scores. The main symptoms of the patients were: fatigue, loss of appetite, pain, and shortness of breath. Patients’ and caregivers’ anxiety and depression scores were significantly correlated (anxiety r=0.386, depression r= 0.416). Thirty-three percent of caregivers suffered from high anxiety and 28% from depression. Spousal caregivers had higher psychological distress than other caregivers. Other relevant factors for higher distress were high financial burden and low social support. There was hardly any family member receiving professional psychological support. Conclusions In palliative patients, depressive symptoms should not be judged as a normal attendant of the terminal illness situation. Instead, patients should be referred to appropriate support services for pharmacological or psychological treatment. Spousal caregivers and caregivers who are socially not well integrated are in particular need of support. Attention to the financial burden of family caregivers is also very important. Due to the existing correlation between the psychological situation of palliative patients and their caring relatives, couples must be considered an emotional system rather than just two individuals. © Springer-Verlag Berlin Heidelberg 2014.

Subic-Wrana C.,Universal Medical Center Mainz | Beutel M.E.,Universal Medical Center Mainz | Brahler E.,University of Leipzig | Stobel-Richter Y.,University of Leipzig | And 3 more authors.
PLoS ONE | Year: 2014

Objective: The Levels of Emotional Awareness Scale (LEAS) as a performance task discriminates between implicit or subconscious and explicit or conscious levels of emotional awareness. An impaired awareness of one's feeling states may influence emotion regulation strategies and self-reports of negative emotions. To determine this influence, we applied the LEAS and self-report measures for emotion regulation strategies and negative affect in a representative sample of the German general population. Sample and Methods: A short version of the LEAS, the Hospital Anxiety and Depression Scale (HADS) and the Emotion Regulation Questionnaire (ERQ), assessing reappraisal and suppression as emotion regulation strategies, were presented to N= 2524 participants of a representative German community study. The questionnaire data were analyzed with regard to the level of emotional awareness. Results: LEAS scores were independent from depression, but related to self-reported anxiety. Although of small or medium effect size, different correlational patters between emotion regulation strategies and negative affectivity were related to implict and explict levels of emotional awareness. In participants with implicit emotional awareness, suppression was related to higher anxiety and depression, whereas in participants with explicit emotional awareness, in addition to a positive relationship of suppression and depression, we found a negative relationship of reappraisal to depression. These findings were independent of age. In women high use of suppression and little use of reappraisal were more strongly related to negative affect than in men. Discussion: Our first findings suggest that conscious awareness of emotions may be a precondition for the use of reappraisal as an adaptive emotion regulation strategy. They encourage further research in the relation between subconsious and conscious emotional awareness and the prefarance of adaptive or maladaptive emotion regulation strategies The correlational trends found in a representative sample of the general population may become more pronounced in clinical samples. Copyright: © 2014 Subic-Wrana et al.

Kocalevent R.-D.,University of Hamburg | Zenger M.,University of Leipzig | Zenger M.,Magdeburg Stendal University of Applied Sciences | Heinen I.,University of Hamburg | And 4 more authors.
PLoS ONE | Year: 2015

Background The objectives of the study were to generate normative data for the RS-11 for different age groups for men and women and to further investigate the construct validity and factor structure in the general population. Methods Nationally representative face-to face household surveys were conducted in Germany in 2006 (n = 5,036). Results Normative data for the RS-11 were generated for men and women (53.7% female) and different age levels (mean age (SD) of 48.4 (18.0) years). Men had significantly higher mean scores compared with women (60.0 [SD = 10.2] vs. 59.3 [SD = 11.0]). Results of CFA supported a one-factor model of resilience. Self-esteem (standardized β = .50) and life satisfaction (standardized β =.20) were associated with resilience. Conclusions The normative data provide a framework for the interpretation and comparisons of resilience with other populations. Results demonstrate a special importance of self-esteem in the understanding of resilience. © 2015 Kocalevent et al.This is an open access article distributed under the terms of the Creative Commons Attribution License ,which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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