Background:
The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization of mental health care in the host countries. ...Mental health self-stigma, i.e., internalized stigma of having a mental disorder, could prevent individuals from seeking mental health care. Therefore, we aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. Moreover, we investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization.
Material and Methods:
Overall, 133 participants with mild to moderate posttraumatic stress symptoms were recruited in the metropolitan areas of Leipzig, Dresden and Halle, Germany, using a multimodal approach. Mental health self-stigma was assessed using the Self-Stigma of Mental Illness Scale – Short Form (SSMIS-SF), consisting of four subscales (
Stereotype awareness, Stereotype agreement, Application to self
,
Harm to self-esteem
), each scoring from 5 (low) to 45 (high) points. Linear regression analysis was used to test associations of sociodemographic and psychopathological variables with self-stigma subscales.
Results:
On average, self-stigma ratings ranged from 16.5 (SD = 6.6) points on
Application to self
to 28.3 (SD = 7.5) points on
Stereotype awareness
. Results showed higher scores on
Application to self
for individuals who were younger (
t
= 2.65,
p
= 0.009) and single (
F
= 5.70,
p
= 0.004). Regression analyses yielded statistically significant associations between having multiple comorbidities and a higher
Application to self
stigma (β = 0.18,
p
= 0.044), controlling for sociodemographic covariates.
Discussion:
Mental health self-stigma was increased among Syrian refugees in Germany. Correlates of increased self-stigma could inform efforts to improve access to mental health care among Syrian refugees with mental ill-health. Longitudinal studies following an intersectional approach by concurrently examining multiple forms of public and internalized stigma could provide helpful insights for developing tailored stigma reduction efforts in this context.
Abstract
Background
So far, previous research suggests positive effects of mental demands at the workplace. However, it may depend on how stressfull these demands are perceived on an individual ...level.
Objective
The aim was to build on previous research by investigating how mental demands are related to stress, overload, and work discontent and whether this relationship is mediated by individuals resources, such as resilience.
Method
A sub-sample of the LIFE Adult Cohort (n = 480) was asked to answer questions on sociodemographic characteristics, objective stress (using the Trier Inventory of Chronic Stress (TICS)), and perceptions of stress with regard to verbal and executive mental demands at work.
Results
According to generalized linear regression models, higher verbal as well as executive mental demands were associated with higher levels of chronic stress, work overload and discontent. Higher levels of resilience were associated with lower levels of these outcomes. Analyses regarding interaction effects revealed that the interaction between resilience and perceived stress of verbal mental demands was significant only in terms of work overload.
Conclusion
Higher perceived stressfulness of mental demands was associated with higher chronic stress, work overload and work discontent. Therefore, mental demands should be targeted by occupational interventions that aim to improve job conditions and employees‘ overall well-being. Besides resilience, other potential influencers or personal resources should be focused on in future studies to develop interventions.
Purpose The present study aimed to investigate age-group-specific incidence rates and risk factors for depressive symptoms in the highest age groups. Methods Data were derived from a prospective ...multicenter cohort study conducted in primary care – the AgeCoDe/AgeQualiDe study. In total, 2,436 patients 75 years and older were followed from baseline to ninth follow-up. To assess depressive symptoms, the short version of the Geriatric Depression Scale (GDS-15, cutoff score 6) was used. Age-specific competing risk regressions were performed to analyze risk factors for incident depressive symptoms in different age groups (75 to 79, 80 to 84, 85+ years), taking into account the accumulated mortality. Results The age-specific incidence rate of depression was 33 (95% CI 29-38), 46 (95% CI 40-52) and 63 (95% CI 45-87) per 1,000 person years for the initial age groups 75 to 79, 80 to 84 and 85+ years, respectively. In competing risk regression models, female sex, mobility as well as vision impairment, and subjective cognitive decline (SCD) were found to be risk factors for incident depression for age group 75 to 79, female sex, single/separated marital status, mobility as well as hearing impairment, and SCD for age group 80 to 84, and mobility impairment for age group 85+. Conclusion Depressive symptoms in latest life are common and the incidence increases with increasing age. Modifiable and differing risk factors across the highest age groups open up the possibility of specifically tailored prevention concepts.
Since the oldest-old population was identified as a high-risk group for a severe course of the coronavirus disease and higher mortality, it was assumed that they might be particularly psychologically ...burdened. The aim of the study is to analyze the development of anxiety and depressive symptoms over the course of the pandemic from 2020 to 2022, as well as psychosocial factors associated with these outcomes.
We analyzed data of
= 135 participants aged 78 to 97 years old (2020:
= 86.77,
= 4.54) with three points of measurement from May to June 2020 (t1), March to May 2021 (t2) and November to January 2022 (t3). Besides sociodemographic variables, worries about the Sars-Cov-2 virus, living situation, perceived social support (ESSI), resilience (BRS), anxiety and depressive symptoms (BSI-18) were assessed. We calculated multilevel mixed-effects generalized linear models with a negative binominal distribution to model anxiety and depressive symptoms over time.
While there is an increase in depressive and anxiety symptoms in the investigated oldest-old individuals in Germany from 2020 to 2021, there is no further increase in symptomatology from 2021 to 2022. Participants of older age reported higher levels of anxiety symptoms. Higher perceived social support was associated with both less depressive and less anxiety symptoms, while resilience was associated with less depressive symptoms only. More worries about the Sars-Cov-2 virus were associated with higher anxiety levels.
Overall, the oldest-old population appeared to show rather stable mental health after a slight increase in symptomatology within the first year of the pandemic. Social support is an important factor to target in mental health prevention programs for oldest-old individuals in times of future crises such as a pandemic.
Background Aim of this study was to detect predictors of better adherence to the AgeWell.de-intervention, a two-year randomized multi-domain lifestyle intervention against cognitive decline. Methods ...Data of 317 intervention group-participants comprising a risk group for dementia (Cardiovascular Risk Factors, Ageing and Dementia (CAIDE) score of greater than or equal to 9; mean age 68.9 years, 49.5% women) from the AgeWell.de intervention study were analysed. Regression models with four blocks of predictors (sociodemographic, cognitive and psychosocial, lifestyle factors and chronic conditions) were run on adherence to the components of nutrition, enhancement of social and physical activity and cognitive training. Adherence to each component was operationalised by assessing the degree of goal achievement per component at up to seven time points during the intervention period, measured using a 5-point Likert scale (mean score of goal achievement). Results Increasing age was negatively associated with adherence, while higher education positively predicted adherence. Participants with better mental state (Montreal Cognitive Assessment (MoCA)-score > 25) at baseline and higher self-efficacy adhered better. Diabetes and cardiovascular conditions were not associated with adherence, whereas smoking negatively affected adherence. Highest education and quitting smoking in the past were the only predictors associated with all four intervention components. Conclusion Results identified predictors for better and worse adherence. Particularly self-efficacy seems to be of considerable influence on adherence. This should be considered when designing future intervention trials. Trial registration German Clinical Trials Register (ref. number: DRKS00013555). Keywords: Dementia, Prevention, Lifestyle, Intervention, Adherence, Predictors
Although grief and its symptoms constitute a normal reaction to experiences of loss, some of those affected still report elevated levels of distress after an extended period, often termed complicated ...grief. Beneficial treatment effects of face-to-face therapies, for example, grief counseling or cognitive behavioral therapy against complicated grief, have been reported. Evaluations of internet- and mobile-based interventions targeting symptoms of grief in bereaved individuals with regard to objective quality criteria are currently lacking.
We aim to conduct a systematic review and meta-analysis on the effectiveness and feasibility of internet- and mobile-based interventions against symptoms of grief after bereavement.
We conducted systematic literature searches of randomized controlled trials or feasibility studies published before January 9, 2020, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, in PubMed, PsycINFO, Web of Science Core Collection, and the Cochrane Library. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations system. We further assessed aspects of feasibility and rated quality of interventions using criteria suggested by an expert panel on mental health care (German Association for Psychiatry, Psychotherapy, and Psychosomatics). A random-effects meta-analysis was conducted to assess between-group effect sizes.
In total, 9 trials (N=1349) were included. Of these, 7 studies were analyzed meta-analytically. Significant effects were found for symptoms of grief (g=0.54, 95% CI 0.32-0.77), depression (g=0.44, 95% CI 0.20-0.68), and posttraumatic stress (g=0.82, 95% CI 0.63-1.01). Heterogeneity was moderate for grief and depression (I
=48.75% and 55.19%, respectively) and low for posttraumatic stress symptoms (I
=0%). The overall quality of evidence was graded low (grief and depression) to moderate (posttraumatic stress). User satisfaction with the interventions was high, as was the quality of the interventions assessed using objective quality criteria.
Internet- or mobile-based interventions might constitute an effective treatment approach against symptoms of grief in bereaved adults. However, the small sample sizes and limited number of studies included in the review warrant further investigation.
International Prospective Register of Systematic Reviews (PROSPERO) CRD42012002100; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131428.
The death of a close person is a highly stressful, yet common life event in later life. While most individuals seem to cope well with bereavement, a substantial proportion of older individuals suffer ...from prolonged grief symptoms. E-mental health interventions have been shown to be efficient for a variety of psychological illnesses. Yet, there is a large research gap of studies with a special focus on older adults. This study protocol describes a randomized controlled trial for an internet-based self-help intervention addressing bereavement and loss in adults aged 60 years and over. The self-management intervention is based on techniques of cognitive behavioral therapy and consists of 8 modules. The objective of the AgE-health study is to evaluate the effectiveness and acceptability of this intervention in comparison to a bibliotherapy control group.
The AgE-health study aims at implementing a randomized controlled trial. Eligible participants aged 60+ years will be randomly allocated to an intervention group (access to the intervention) or to an active control group (access to bibliotherapy). Primary outcome is the reduction in grief symptoms (13-item Prolonged Grief Inventory); secondary outcomes are depression, social activity and network, quality of life, self-efficacy, satisfaction with the intervention/bibliotherapy, loneliness, acceptability, up-take and adherence. Assessments will take place before the intervention (baseline) as well as 4 months (follow-up 1) after the intervention.
This study addresses an under-recognized and understudied mental health burden in later life and may add valuable insight into our knowledge about the effectiveness of eHealth interventions for loss and bereavement in late life. To our knowledge, the AgE-health study will be the first randomized controlled trial to evaluate the effectiveness of an internet-based intervention targeting prolonged grief in adults aged 60 years and over.
The study has been registered at the German Clinical Trials Register (Identifier: DRKS00020595, Registered 30th July 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020595).
•Older adults seem under-recognized with regard to mental health care and eHealth.•First RCT on an eHealth intervention targeting prolonged grief in adults 60+ years.•The eHealth intervention was developed under participation of older adults.•The intervention is expected to improve mental health of adults 60+ years.
Background
Anxiety is a widespread phenomenon, and it is connected to disordered eating and obesity. We want to analyze the connection between anxiety and food addiction (FA) over two points in time ...to better understand the directionality of the association. Since there are gender differences with regard to anxiety and eating, we are also interested in differences between men and women.
Methods
We used data from the population-based LIFE-Adult-Study (
N
= 1,474) at time 1 (baseline) and time 2 (first follow-up) to analyze the connections between anxiety (GAD-7) and FA (YFAS) using a multiple group latent cross-lagged panel model with female and male participants as groups. We controlled for age, marital status, socioeconomic status and social support.
Results
Anxiety (women: β = 0.50,
p
≤ 0.001; men: β = 0.59,
p
≤ 0.001) as well as FA (women: β = 0.37,
p
≤ 0.001; men: β = 0.58,
p
≤ 0.001) exhibited stability over time for both genders. We found a significant association between anxiety at time 1 and FA at time 2 for women (β = 0.25,
p
≤ 0.001) but not for men (β = 0.04,
p
= 0.10), and significant associations between FA at time 1 and anxiety at time 2 for women (β = 0.23,
p
≤ 0.001) as well as men (β = 0.21,
p
≤ 0.001).
Conclusion
Food addiction longitudinally affects anxiety, independent of gender and other sociodemographic variables. In addition, anxiety affects subsequent FA as well, but only in women. Interventions that address FA could reduce anxiety in men and women, while interventions that mitigate anxiety could help prevent FA in women.
Late-life depression is a major public health concern, driving the development of complementary treatment options. This study investigates the effectiveness and acceptability of internet-based ...Cognitive Behavioral Therapy (iCBT) in older individuals (60+ years) compared to younger age groups.
Secondary analysis of a cluster-randomized controlled trial with 647 (18-82 years; mean 43.9) mild to moderately severe depressed primary care patients receiving either iCBT + treatment as usual (TAU) or TAU alone. Severity of depression was measured by the Beck Depression Inventory (BDI-II) at baseline, 6 weeks and 6 months. Intention-to-treat analysis in three age groups (18-39 years, n = 264; 40-59 years, n = 300; 60+ years, n = 83) was performed, using mixed-effects regression models to quantify treatment effect.
No age differences in the effectiveness of iCBT were found. Patients in the intervention group consistently showed a greater reduction in depression severity than controls in all three age groups and at both follow-ups. Effect sizes ranged from
= 0.30 (40-59 years, 6 weeks) to
= 1.91 (60+ years, 6 months). Uptake of the intervention was banded around 70% with no differences between age groups (
= 0.18,
= .915). The mean number of completed modules increased with age (
= 18.99,
= .040).
iCBT is equally effective in both younger and older individuals, thus providing a valuable complementary element of routine late-life depression care.
DRKS-ID: DRKS00005075 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005075.
The Patient Assessment of Chronic Illness Care (PACIC-5A) was developed to assess the satisfaction with patient-provider interaction based on the Chronic Care Model. The additional 5A approach ...(assess, advise, agree, assist, arrange) allows to score behavioral counseling. The aim of the study was to assess the psychometric properties of the German adaptation of the PACIC-5A questionnaire in a sample of general practitioners (GP) patients with obesity.
Analyses were based on data from the study "Five A's counseling in weight management of obese patients in primary care: a cluster randomized controlled trial (INTERACT)". Data were collected via standardized questionnaires containing the 26-item version of the PACIC-5A questionnaire. A total of 117 patients with obesity were included in the analyses. Statistical procedures comprised descriptive analyses, the calculation of Cronbach's alpha, test-retest analyses and factor analyses in order to assess the psychometric properties including reliability and validity of the PACIC-5A.
The patient's mean age was 43.4 years and the sample was mostly female (59%). Middle educational level was found for the majority (78%) and the mean Body Mass Index was 38.9 kg/m
. Descriptive analyses revealed a mean PACIC score of 2.33 and 5A sum score of 2.29. Notable floor effects were found. PACIC-5A showed high level of internal consistency (Cronbach's alphas > 0.9) and exploratory factor analyses resulted in a unidimensional structure.
The results of this study provide evidence regarding the psychometric properties of the German version of the PACIC-5A used in a sample of GP patients with obesity and make an important contribution to the reliable and valid assessment of the patient-GP interaction with regard to obesity counseling in primary care.
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