Publications by authors named "Andres Schneeberger"

44 Publications

Perceptions and Attitudes of Correctional Staff Toward ADHD-A Challenging Disorder in Everyday Prison Life.

Front Psychiatry 2020 28;11:600005. Epub 2021 Jan 28.

Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is associated with risk-taking behaviors, poor self-control, and interpersonal difficulties. Affected individuals have an increased probability of involvement with the criminal justice system, contributing to a higher rate of arrest, and imprisonment compared with the general population; they are also inadequately treated once sentenced. Because prison staff play a central role in the identification of inmates with mental disorders, they could well be key to improving provision of care. There is however little knowledge of the conceptions, perceptions, and attitudes of prison staff toward ADHD. Such information could help to identify starting points for awareness training and further implementation of specific ADHD treatment. To bridge this gap, we undertook a study based on a qualitatively-driven mixed methods design, combining qualitative data collection in the form of narrative interviews with 19 prison staff from a Swiss correctional facility with quantitative data collection in the form of a survey that included the Attitudes toward Prisoners scale. The interviews were analyzed with QSR NVIVO 11 and a qualitative content analysis approach was used to evaluate findings. Prison staff were generally aware of ADHD and its symptomology, believing it to a be "real," but "fashionable" disorder and favoring hereditary-genetic or biological explanatory models for its development. They viewed inmates with ADHD rather negatively, as complicating correctional efforts, and perceived them as sticking out, as tying up more resources and as frequently being involved in confrontations. Our findings suggest that difficulties in pragmatic aspects of communication and language comprehension may be perceived "as not listening or following instructions," creating additional tensions. Consequently, inmates with ADHD are more often exposed to disciplinary sanctions, such as solitary confinement-an intervention deemed "necessary" by staff. Therefore, staff training on ADHD might need to cover evidence on adverse effects. Non-pharmacological interventions for treatment were preferred and considered to be highly efficacious. Skepticism toward pharmacological treatment prevailed, even when benefits from stimulant medication were described. Interestingly, this skepticism was not the result of negative experiences with the misuse and diversion of stimulants. Acceptance of multimodal treatment among prison staff may require customized strategies.
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http://dx.doi.org/10.3389/fpsyt.2020.600005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901975PMC
January 2021

[Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept].

Praxis (Bern 1994) 2021 Jan;110(1):30-36

Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern.

Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept Entrustable Professional Activities (EPAs) are competency-based learning goals derived from observable clinical activities. In undergraduate medical education, they have now been adopted throughout Switzerland as part of the so-called PROFILES catalog (Principal Relevant Objectives and Framework for Integrated Learning and Education in Switzerland). The nine core EPAs to be mastered in undergraduate medical education can serve as a basis for introducing EPAs in graduate medical education as well. We will discuss this approach in the context of graduate medical education in psychiatry and psychotherapy from the perspective of different training contexts and a pilot example. In this position paper, we describe a promising opportunity to improve graduate medical training through the implementation of EPAs, both in terms of the quality of training and thus of patient care, as well as in terms of the attractiveness of the specialty for future residents.
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http://dx.doi.org/10.1024/1661-8157/a003601DOI Listing
January 2021

Fifteen years of heroin-assisted treatment in a Swiss prison-a retrospective cohort study.

Harm Reduct J 2020 10 13;17(1):67. Epub 2020 Oct 13.

Swiss Research Institute for Public Health and Addiction ISGF, University of Zurich, Zurich, Switzerland.

Background: In the context of the current US opioid crisis and the compelling fact that a quarter to a third of all those addicted to heroin pass through its prisons and jails each year, the care of incarcerated opioid-using individuals (OUI) needs to be improved.

Aims: Little has been published on the effectiveness or outcomes of heroin-assisted treatment (HAT), a treatment option for severely dependent OUI delivered in a prison setting. The aim of this study was therefore to evaluate such treatment since its implementation. The primary objective was to investigate whether heroin-assisted treatment was associated with severe detrimental health outcomes. The secondary objective was to compare the heroin-assisted treatment group with the general prison population in terms of occupational functioning.

Design: Retrospective cohort study SETTING: An open prison with 120 places SUBJECTS: Data on 1885 male prisoners with a total of 2239 imprisonment periods between 2000 and 2015 was available. Ninety-seven inmates in heroin-assisted treatment were compared with 1788 inmates from the general prison population (reference group).

Measurements: Mortality, medical complications (including overdoses), and work performance (days worked, sick days, and monthly wages earned).

Findings: Inmates receiving HAT were on average 1 year younger (33.8 vs. 34.9 years), had longer prison stays (7.3 vs. 3.0 months), were more often of Swiss nationality (68.0% vs. 28.9%), and had committed more drug- and property-related offenses (49.5% vs. 23.2% and 63.9% vs. 38.3%, respectively) compared to the reference group. No serious heroin-related medical complication occurred during the 15-year window of observation among inmates with heroin-assisted treatment. Their work performance was comparable to that of the reference group.

Conclusions: This study shows that heroin-assisted treatment can be a valuable treatment option for severely dependent OUI during imprisonment, can be delivered safely by prison health staff over extended periods of time, and allows OUI in treatment to achieve work performance rates comparable to that of the general prison population.
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http://dx.doi.org/10.1186/s12954-020-00412-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552491PMC
October 2020

The Accessibility of Opioid Agonist Treatment and Its Forced Discontinuation in Swiss Prisons-Attitudes, Perceptions and Experiences of Defense Lawyers in Dealing With Detained Persons Using Opioids.

Front Psychiatry 2020 14;11:395. Epub 2020 May 14.

Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.

Background: Opioid agonist treatment (OAT) is an important pillar in the treatment of individuals using opioids and its continuation during imprisonment is recommended. Despite this knowledge access to and continuation of OAT is still limited in many countries. The forced discontinuation during pre-trial detention can cause severe withdrawal symptoms, which in turn may significantly impair the defendant's ability to exercise granted procedural participation rights. Furthermore, it can be argued that forced discontinuation of a desired treatment represents a form of a compulsory intervention.

Aims: The present study was developed against the backdrop of a recent ruling by the European Court of Human Rights (Wenner vs. Germany). It intended to examine how defense lawyers dealing with detained persons using opioids view and assess the accessibility of OAT in pre-trial detention as well as during imprisonment in different parts of Switzerland.

Methods: Using a qualitative approach, we interviewed 11 defense lawyers from three different cantons of Switzerland with multiple years of experience in providing legal representation to more than 220 defendants using heroin. The interviews were analyzed with QSR NVIVO 11 for Windows. A qualitative content analysis approach was used to evaluate findings.

Results: Defenders who had been exposed to the opioid crisis during the course of their legal career had adopted a positive attitude towards OAT and associated it with a stabilizing influence on their clients, an improvement in criminal prognosis, and a reduction in recidivism. They were generally of the opinion that access to OAT had improved, however identified a considerable variance in different penitentiaries, which were mediated by attitudes of staff and authorities. Based on the assessments of the defense lawyers, it can be estimated that the initiation of OAT especially during pre-trial detention is challenging. The predominant aim of OAT in a variety of Swiss prisons still seems to focus on a discontinuation, mediated by a forced reduction of medication. Some of the interventions reported are not in line with the principle of equivalence and strongly contrast the recommendations of the Council of Europe.
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http://dx.doi.org/10.3389/fpsyt.2020.00395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240251PMC
May 2020

Reducing recidivism using the Reasoning and Rehabilitation program: a pilot multi-site-controlled trial among prisoners in Switzerland.

Int J Public Health 2020 Jul 21;65(6):801-810. Epub 2020 Apr 21.

Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.

Objectives: This study evaluated whether the Reasoning and Rehabilitation (R&R2) program was effective in reducing recidivism, minimizing dropout rates, and improving outcomes related to attitudes, behaviors, and personality among people living in detention.

Methods: Data were collected in eight Swiss German-speaking prisons among males detained for violent offenses using a quasi-experimental controlled design (R&R2: n = 129, treatment as usual [TAU]: n = 84). Measures included recidivism, dropout rate, and self-report questionnaires (hostile attribution bias, aggressiveness, interpersonal problems, and willingness to accept responsibility). Data were analyzed using mixed-effect models.

Results: Participants in the R&R2 group were less likely to reoffend in comparison with the TAU group in the intention-to-treat (n = 51, odds ratio = 0.75, p = .060) and the per-protocol (excluding dropouts; n = 38, odds ratio = 0.65, p = .068) analyses. They also had lower self-reported scores of spontaneous and reactive aggressiveness (p = .047 and p = .070) and excitability (p = .086).

Conclusions: The findings of this pilot project were promising, with the R&R2 program leading to reduced recidivism and dropout rate. Even though these results should be considered preliminary, the R&R2 program appeared to be a relevant approach in reducing recidivism after prison.
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http://dx.doi.org/10.1007/s00038-020-01372-9DOI Listing
July 2020

[In the Same Boat: How to Support Relatives of Patients with Dementia Using Diverse Interventions].

Praxis (Bern 1994) 2020 ;109(4):265-269

Klinik Susenberg, Zürich.

In the Same Boat: How to Support Relatives of Patients with Dementia Using Diverse Interventions Caring for people with dementia has great psychological, physical, social, financial and spiritual effects on relatives. Support and counseling can contribute to an improved health of the relative, to the relationship with the dementia patient, as well as to better treatment (through shared decision-making/care planning) of the patient. This article reviews data from Switzerland and international studies.
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http://dx.doi.org/10.1024/1661-8157/a003392DOI Listing
July 2020

Deciding to End One's Life Because of a Psychiatric Illness-A Decision Without Second Thoughts?

Front Psychiatry 2020 18;11:58. Epub 2020 Feb 18.

Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland.

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http://dx.doi.org/10.3389/fpsyt.2020.00058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040838PMC
February 2020

An Effective Treatment for Tinnitus and Hyperacusis Based on Cognitive Behavioral Therapy in an Inpatient Setting: A 10-Year Retrospective Outcome Analysis.

Front Psychiatry 2020 7;11:25. Epub 2020 Feb 7.

Department of Adult Psychiatry, Psychiatric Services of Grisons, Chur, Switzerland.

Aim: Tinnitus and hyperacusis are phenomena with a considerable prevalence in the general population, leading to high levels of suffering. It is a symptom that can present itself comorbidly with a variety of psychiatric and medical illnesses. We established a treatment of tinnitus and hyperacusis, which is based on a multimodal approach including a specific cognitive behavioral therapy (CBT) method in an inpatient setting. This approach includes education on tinnitus and hyperacusis, applying coping strategies and techniques of relaxation, directed attention, and music therapy. We aim to evaluate the efficacy of this treatment approach.

Materials And Methods: We included retrospective data of 268 patients who underwent tinnitus treatment throughout the 10-year existence of the treatment program. We assessed routine clinical data pretreatment and posttreatment with parameters concerning tinnitus-distress, hyperacusis, and psychological well-being. To determine these variables, we used validated instruments including the Tinnitus Questionnaire (TQ), Questionnaire on Hypersensitivity to Sound (QHS), Brief Symptom Inventory (BSI), and the Beck Depression Inventory (BDI-II).

Results: Patients showed highly significant reduction in all of the examined clinical outcomes. Reduction of TQ, the primary outcome measure, was 15.39 (SD 21.88) from a mean baseline value of 35.72 (p < 0.001). The QHS showed a reduction of 6.72 (SD 8.23) from a mean baseline value of 18.98 (p < 0.001). Moreover, psychological strain was also reduced with high significance, as illustrated in reduction of BSI and BDI-II; reduction in BSI from 49.63 by 24.41 (SD 26.88; p < 0.001) and BDI-II from 16.89 by 7.47 (SD 8.76; p < 0.001).

Discussion: The multimodal treatment program for tinnitus and hyperacusis including a specific CBT method proves to be a highly effective means of significantly reducing not only tinnitus and hyperacusis but also accompanying distress. Furthermore, it also enables considerable reduction of concomitant psychiatric symptoms such as depression.

Conclusions: Our results underline the importance of intensive and multimodal approaches to the treatment of tinnitus and hyperacusis.
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http://dx.doi.org/10.3389/fpsyt.2020.00025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020229PMC
February 2020

An Effective Treatment for Tinnitus and Hyperacusis Based on Cognitive Behavioral Therapy in an Inpatient Setting: A 10-Year Retrospective Outcome Analysis.

Front Psychiatry 2020 7;11:25. Epub 2020 Feb 7.

Department of Adult Psychiatry, Psychiatric Services of Grisons, Chur, Switzerland.

Aim: Tinnitus and hyperacusis are phenomena with a considerable prevalence in the general population, leading to high levels of suffering. It is a symptom that can present itself comorbidly with a variety of psychiatric and medical illnesses. We established a treatment of tinnitus and hyperacusis, which is based on a multimodal approach including a specific cognitive behavioral therapy (CBT) method in an inpatient setting. This approach includes education on tinnitus and hyperacusis, applying coping strategies and techniques of relaxation, directed attention, and music therapy. We aim to evaluate the efficacy of this treatment approach.

Materials And Methods: We included retrospective data of 268 patients who underwent tinnitus treatment throughout the 10-year existence of the treatment program. We assessed routine clinical data pretreatment and posttreatment with parameters concerning tinnitus-distress, hyperacusis, and psychological well-being. To determine these variables, we used validated instruments including the Tinnitus Questionnaire (TQ), Questionnaire on Hypersensitivity to Sound (QHS), Brief Symptom Inventory (BSI), and the Beck Depression Inventory (BDI-II).

Results: Patients showed highly significant reduction in all of the examined clinical outcomes. Reduction of TQ, the primary outcome measure, was 15.39 (SD 21.88) from a mean baseline value of 35.72 (p < 0.001). The QHS showed a reduction of 6.72 (SD 8.23) from a mean baseline value of 18.98 (p < 0.001). Moreover, psychological strain was also reduced with high significance, as illustrated in reduction of BSI and BDI-II; reduction in BSI from 49.63 by 24.41 (SD 26.88; p < 0.001) and BDI-II from 16.89 by 7.47 (SD 8.76; p < 0.001).

Discussion: The multimodal treatment program for tinnitus and hyperacusis including a specific CBT method proves to be a highly effective means of significantly reducing not only tinnitus and hyperacusis but also accompanying distress. Furthermore, it also enables considerable reduction of concomitant psychiatric symptoms such as depression.

Conclusions: Our results underline the importance of intensive and multimodal approaches to the treatment of tinnitus and hyperacusis.
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http://dx.doi.org/10.3389/fpsyt.2020.00025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020229PMC
February 2020

Compulsory Admission to Psychiatric Wards-Who Is Admitted, and Who Appeals Against Admission?

Front Psychiatry 2019 9;10:544. Epub 2019 Aug 9.

Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland.

When persons with a mental illness present a danger to themselves or others, involuntary hospital admission can be used to initiate an immediate inpatient treatment. Often, the patients have the right to appeal against compulsory admission. These processes are implemented in most mental health-care systems, but regulations and legal framework differ widely. In the Swiss canton of Basel-Stadt, a new regulation was implemented in January 2013. While the current literature holds some evidence for factors associated with involuntary admission, knowledge on who uses the right to appeal against admission is sparse. The study aims to examine if specific sociodemographic and clinical characteristics are associated with involuntary admission and with an appeal against the compulsory admission order. Routine clinical data of all inpatient cases admitted during the period from January 2013 to December 2015 at the Psychiatric University Hospital Basel were extracted. Generalized estimating equation (GEE) analyses were used to examine the association of sociodemographic and clinical characteristics with "involuntary admission" and "appeal against compulsory admission order." Of the 8,917 cases included in the present study, 942 (10.6%) were admitted involuntarily. Of these, 250 (26.5%) lodged an appeal against the compulsory admission order. Compared with cases admitted on a voluntary legal status, cases admitted involuntarily were older and were admitted more often during the nighttime or weekend. Moreover, involuntarily admitted cases had more often a principal diagnosis of a schizophrenia spectrum disorder. Patients from cases where an appeal was lodged were more often female, had more often Swiss nationality, and were more often diagnosed with schizophrenia spectrum disorder. Despite legal changes, the frequency of involuntary admissions in the observed catchment area seems to be relatively stable across the last 20 years. The percentage of appeals has decreased from 2000 to 2015, and only comparably few patients make use of the possibility to appeal. Better knowledge of the regulations, higher social functioning, and lower insight into illness might be associated with a higher probability of lodging an appeal. Future research should examine if specific patient groups are in need of additional assistance to exert their rights to appeal.
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http://dx.doi.org/10.3389/fpsyt.2019.00544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695555PMC
August 2019

[Six years of open-door policy at the University Psychiatric Hospital Basel].

Nervenarzt 2019 Jul;90(7):705-708

Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Kornhausgasse 7, 4051, Basel, Schweiz.

Background: Coercive measures in psychiatry have well-known negative consequences for the patients and their treatment. They are considered ethically problematic and must only be used as a last resort. Locked wards may promote a threatening atmosphere leading to more aggression and a subsequent higher use of coercive measures. The aim of this was to investigate the frequency of seclusion and forced medication during clinic-wide implementation of an open-door policy.

Material And Methods: In this 6‑year longitudinal observational study (2010-2015) the frequencies of seclusion and forced medication were investigated on the basis of 17,359 cases treated in the University Psychiatric Hospital Basel. During the observational period, six formerly permanently locked wards were opened.

Results: The examined data showed a clinically relevant decrease in the frequency of seclusion (from 8.2% to 3.5%) and forced medication (from 2.4% to 1.2%) during the observational period.

Conclusion: These results underline the potential of a less restrictive policy in psychiatry to reduce the frequency of coercive measures.
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http://dx.doi.org/10.1007/s00115-019-0733-3DOI Listing
July 2019

Is it the moon? Effects of the lunar cycle on psychiatric admissions, discharges and length of stay.

Swiss Med Wkly 2019 Apr 23;149:w20070. Epub 2019 Apr 23.

Psychiatrische Dienste Graubuenden, Chur, Switzerland / Psychiatrische Universitätsklinik Zürich, Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Universität Zürich, Switzerland / Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA.

Background: There is an ongoing debate concerning the connection between lunar cycle and psychiatric illness.

Aims Of The Study: The purpose of the present study was to evaluate the rates of admission to and discharge from psychiatric inpatient treatment, as well as the length of stay, in relation to the lunar cycle, including 20 different categories of phases of the moon.

Methods: The data of 17,966 cases of people treated in an inpatient setting were analysed. Routine clinical data and data about admission and discharge were used. The lunar calendar was obtained from the website of the US Naval Observatory and was used to calculate the dates of the full moon according to the geographic location of the clinics. The clinics are located in the Canton Grisons in Switzerland. The following phases of the moon throughout the lunar cycle were defined: (a) full moon, (b) quarter waxing moon, (c) new moon, and (d) quarter waning moon. In addition, we coded one day and two days preceding every lunar phase as well as the two days following the respective phases of the moon.

Results: The lunar cycles showed no connection with either admission or discharge rates of psychiatric inpatients, nor was there a relationship with the length of stay.

Conclusions: Despite the widespread belief that the moon impacts peoples’ mental health and subsequently psychiatric treatment, this study provides no evidence that our celestial neighbour influences our mental well-being.
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http://dx.doi.org/10.4414/smw.2019.20070DOI Listing
April 2019

The impact of depression on adherence to organized and opportunistic breast cancer screening.

Eur J Cancer Prev 2020 01;29(1):53-59

Psychiatric University Hospital (UPK), University of Basel, Basel.

One in five women will experience depression over her lifetime, and one out of eight will develop breast cancer. We evaluated the effect of depression on adherence to mammography in Switzerland, where opportunistic and organized screening programs coexist. We analyzed data from 3206 women aged 50-69 who participated in the Swiss Health Survey 2012. We compared mammographic rates among women with no to mild versus moderate to severe depressive symptoms. The effect of the type of screening on the odds of undertaking a mammography was calculated using multivariable logistic regression analysis. Women with moderate to severe major depressive symptoms were more likely to have had a mammography in the previous 2 years than their nondepressed or less-depressed counterparts (51 vs. 39.2%, respectively, P = 0.005). In the multivariable analysis, women with no to mild major depression living in cantons with an organized screening program had an adjusted odds ratio of 2.7 (95% confidence interval: 2.30-3.17, P < 0.001) of having had a mammography within the past 24 months compared with those living in the regions with an opportunistic screening. The adjusted odds ratio for women with moderate to severe major depression was 4.21 (95% confidence interval: 2.13-8.33, P < 0.001). In Switzerland. adherence to mammographic screening among women with moderate to severe major depression is higher than among women with no or minimal major depressive symptoms. This increased adherence is even more pronounced in regions with organized screening.
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http://dx.doi.org/10.1097/CEJ.0000000000000520DOI Listing
January 2020

Differences in Insomnia Symptoms between Immigrants and Non-Immigrants in Switzerland attributed to Emotional Distress: Analysis of the Swiss Health Survey.

Int J Environ Res Public Health 2019 01 21;16(2). Epub 2019 Jan 21.

Universitaere Psychiatrische Kliniken Basel, Universitaet Basel, Switzerland (UPK), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland.

Migration can be a stressful experience and may lead to poor health and behavioral changes. The immigrant population in Switzerland is disproportionately burdened by several negative health outcomes, chief among these is mental health issues. The aim of the study was to investigate whether sleep disturbances are more prevalent among immigrants compared to non-immigrants and whether emotional distress might explain sleep differences. Based on the Swiss Health Survey 2012 dataset, we analyzed the data of 17,968 people, of which 3406 respondents were immigrants. We examined variables including insomnia symptoms, emotional distress and clinical and socio-demographic data using unadjusted and adjusted generalized linear models. Compared to non-immigrants, immigrants suffer significantly more often from insomnia symptoms. Immigrants also endured higher levels of emotional distress. Higher values of emotional distress are related to other symptoms of sleep disorders. Immigrants with emotional distress were at significant risk of sleep disturbances. Sleep disparities between immigrants and non-immigrants may be influenced by emotional distress. Migration health care should address emotional distress, a more proximal and modifiable factor, as a possible cause of insomnia symptoms in immigrants.
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http://dx.doi.org/10.3390/ijerph16020289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352062PMC
January 2019

Second Opinions in Psychiatry: A Review.

J Psychiatr Pract 2018 Nov;24(6):434-442

HEUSS: Department of Communication and Marketing, University of Applied Sciences Northwestern Switzerland FHNW, Olten, Switzerland SCHWARTZ: Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY SCHNEEBERGER: Psychiatric Services Grisons, Chur, Switzerland and Albert Einstein College of Medicine, Bronx, NY.

Background: Although second opinions are rather restricted to the surgical disciplines, they have become more and more important to the health system in the last 20 years. The demand has been triggered by rising health costs and the economization of the field. The Internet has also made a considerable contribution to the demand for patient-initiated second opinions. Given these developments, it is surprising that second opinions have not become more important in the field of psychiatry. This article highlights the special situation of second opinions in psychiatry, discusses possible barriers to the adoption of second opinions in psychiatry, and the potential for greater use of second opinions in this field.

Objective: In psychiatry, second opinions have been neglected by the typical drivers of innovations in health care, including insurers and other commercial drivers as well as psychiatrists and patients themselves. This review identifies current barriers to widespread adoption of second opinions in psychiatric practice, discusses the benefits of second opinions that have been demonstrated in other disciplines, and outlines the potential gains to be realized through use of second opinions in psychiatry.

Methods: Literature in the area was reviewed through a search of the main medical databases. This literature review was supported by in-depth interviews with health care personnel and insurers.

Conclusions: Second opinions are rarely obtained in psychiatry and there is little literature on this subject. The stigmatization of psychiatric disorders and patients and the uniqueness of the patient-doctor relationship in psychiatry, especially in psychotherapeutic care, may pose considerable obstacles to the use of second opinions in this field. In addition, more stakeholders, such as social workers, government agencies and regulators, health care and disability insurers, and social security agencies, are involved in the mental health compared with the somatic health sector, which may make it more difficult to achieve a coordinated approach in psychiatric care. However, we have found no convincingly good reason why second opinions have not been at least discussed in psychiatry. Psychiatry could benefit from ongoing discussions concerning the outcomes of second opinions in other medical disciplines.
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http://dx.doi.org/10.1097/PRA.0000000000000343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372222PMC
November 2018

Mediating effects of body mass index, physical activity, and emotional distress on the relationship between short sleep and cardiovascular disease.

Medicine (Baltimore) 2018 Sep;97(37):e11939

NYU Langone Health, Department of Population Health, New York Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY Departments of Psychiatry, Psychology, and Medicine, Sleep & Health Research Program, University of Arizona College of Medicine, Tucson, AZ Universitaere Psychiatrische Kliniken, Universitaet Basel, Basel Psychiatrische Dienste Graubuenden, St. Moritz, Switzerland Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx NYU Langone Health, Department of Psychiatry, New York, NY.

The current study investigated the mediating effects of body mass index (BMI), physical activity, and emotional distress on the association between short sleep duration (<7 hours per 24-hour period) and cardiovascular disease (CVD) and risk factors.We used data from the National Health Interview Survey, an ongoing nationally representative cross-sectional study of noninstitutionalized US adults (≥18 years) from 2004 to 2013 (N = 206,049). Participants provided information about anthropometric features (height and weight), sociodemographic factors, health behaviors (smoking and physical activity), emotional distress, and physician-diagnosed health conditions, including hypertension, coronary heart disease, diabetes, heart attack, stroke, kidney disease, and cancer. Structural equation modeling was used to assess the mediating effects of physical activity, BMI, and emotional distress on the relationship between short sleep and CVDs and risk factors (coronary heart disease, hypertension, diabetes, chronic kidney disease, heart attack, and stroke).Of the sample, 54.7% were female, 60.1% identified as white, 17.7% as Hispanic, and 15.4% as black. The mean age of the respondents was 46.75 years (SE = 0.12), with a mean BMI of 27.11 kg/m (SE = 0.02) and approximately 32.5% reported short sleep duration. The main relationship between short sleep and CVD and risk factors was significant (β = 0.08, P < .001), as was the mediated effect via BMI (indirect effect = 0.047, P < .001), emotional distress (indirect effect = 0.022, P < .001), and physical activity (indirect effect = -0.022, P = .035), as well as after adjustment for covariates, including age, race, sex, marital status, and income: short sleep and CVD (B = 0.15; SE = 0.01; P < .001), BMI (B = 0.05; SE = 0.00; P < .001), emotional distress (B = 0.02; SE = 0.00; P < .001), and physical activity (B = 0.01; SE = 0.00; P < .001).Our findings indicate that short sleep is a risk factor for CVD and that the relationship between short sleep and CVD and risk factors may be mediated by emotional distress and obesity, and negatively mediated by physical activity.
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http://dx.doi.org/10.1097/MD.0000000000011939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6156068PMC
September 2018

TARPSY: A New System of Remuneration for Psychiatric Hospitalization in Switzerland.

Psychiatr Serv 2018 10 3;69(10):1056-1058. Epub 2018 Aug 3.

Dr. Schneeberger and Mr. Felber are with Psychiatric Services Grisons, Chur, Switzerland. Dr. Schneeberger is also with the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, where Dr. Schwartz is affiliated. Dr. Schwartz is also with the Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, New York. Dr. Spring and Dr. Hölzer are with SwissDRG, Inc., Berne, Switzerland. Mr. Peter is with eonum, Inc., Berne. Dr. Seifritz is with the Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.

As financing mental health care is becoming more challenging, governments are progressively introducing new remuneration systems. At the beginning of 2018, Switzerland introduced TARPSY, a new tariff system based on diagnosis-related psychiatric cost groups that takes into consideration ratings of severity and complexity. TARPSY is expected to provide incentives for medically and economically meaningful treatment, increase transparency, and improve the quality of the provided services by triggering competition between hospitals. Yet some fear that TARPSY will lead to an economization of mental health, encouraging a reduction in length of stay and medically indicated treatment.
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http://dx.doi.org/10.1176/appi.ps.201800233DOI Listing
October 2018

Cross-Cultural Notions of Risk and Liberty: A Comparison of Involuntary Psychiatric Hospitalization and Outpatient Treatment in New York, United States and Zurich, Switzerland.

Front Psychiatry 2018 19;9:267. Epub 2018 Jun 19.

Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, United States.

Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which involuntary hospitalization generally is enacted. This paper aims at analyzing the regulation and process of involuntary hospitalization in New York (United States) and Zurich (Switzerland). Comparing the respective historical, political, and economic backgrounds shows how notions of risk and liberty are culture-bound and consequently shape legislation and local practices. It is highly relevant to reconsider which criteria are required for involuntary hospitalization as this might shape the view of society on psychiatric patients and psychiatry itself. Furthermore, this article discusses the impact that training and experience of the person authorized to conduct and maintain an involuntary hospitalization has on the outcome.
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http://dx.doi.org/10.3389/fpsyt.2018.00267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020767PMC
June 2018

Machine Learning: An Approach in Identifying Risk Factors for Coercion Compared to Binary Logistic Regression.

Front Psychiatry 2018 12;9:258. Epub 2018 Jun 12.

Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.

Although knowledge about negative effects of coercive measures in psychiatry exists, its prevalence is still high in clinical routine. This study aimed at define risk factors and test machine learning algorithms for their accuracy in the prediction of the risk to being subjected to coercive measures. In a sample of involuntarily hospitalized patients ( = 393) at the University Hospital of Psychiatry Zurich, we analyzed risk factors for the experience of coercion ( = 170 patients) using chi-square tests and Mann Whitney U tests. We trained machine learning algorithms [logistic regression, Supported Vector Machine (SVM), and decision trees] with these risk factors and tested obtained models for their accuracy via five-fold cross validation. To verify the results we compared them to binary logistic regression. In a model with 8 risk-factors which were available at admission, the SVM algorithm identified 102 out of 170 patients, which had experienced coercion and 174 out of 223 patients without coercion (69% accuracy with 60% sensitivity and 78% specificity, AUC 0.74). In a model with 18 risk-factors, available after discharge, the logistic regression algorithm identified 121 out of 170 with and 176 out of 223 without coercion (75% accuracy, 71% sensitivity, and 79% specificity, AUC 0.82). Incorporating both clinical and demographic variables can help to estimate the risk of experiencing coercion for psychiatric patients. This study could show that trained machine learning algorithms are comparable to binary logistic regression and can reach a good or even excellent area under the curve (AUC) in the prediction of the outcome coercion/no coercion when cross validation is used. Due to the better generalizability machine learning is a promising approach for further studies, especially when more variables are analyzed. More detailed knowledge about individual risk factors may help to prevent the occurrence of situations involving coercion.
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http://dx.doi.org/10.3389/fpsyt.2018.00258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005877PMC
June 2018

Quality of Life in Transitioned Trans Persons: A Retrospective Cross-Sectional Cohort Study.

Biomed Res Int 2018 12;2018:8684625. Epub 2018 Apr 12.

Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.

Background: Medical gender-affirming interventions (GAI) are important in the transition process of many trans persons. The aim of this study was to examine the associations between GAI and quality of life (QoL) of transitioned trans individuals.

Methods: 143 trans persons were recruited from a multicenter outpatient Swiss population as well as a web-based survey. The QoL was assessed using the Short Form (36) Health Survey questionnaire (SF-36). Depressive symptoms were examined using the Short Form of the Center for Epidemiologic Studies-Depression Scale (ADS-K). Multiple interferential analyses and a regression analysis were performed.

Results: Both transfeminine and transmasculine individuals reported a lower QoL compared to the general population. Within the trans group, nonbinary individuals showed the lowest QoL scores and significantly more depressive symptoms. A detailed analysis identified sociodemographic and transition-specific influencing factors.

Conclusions: Medical GAI are associated with better mental wellbeing but even after successful medical transition, trans people remain a population at risk for low QoL and mental health, and the nonbinary group shows the greatest vulnerability.
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http://dx.doi.org/10.1155/2018/8684625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925023PMC
October 2018

Gender Minority Stress and Depressive Symptoms in Transitioned Swiss Transpersons.

Biomed Res Int 2018 19;2018:8639263. Epub 2018 Apr 19.

Department of Psychiatry and Psychotherapy, University of Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.

Compared to the general population, transpersons are exposed to higher levels of discrimination and violence. The stigmatization of transpersons can lead to physical and psychological problems. In particular, transindividuals exhibit a higher prevalence of depression compared to the cispopulation. The gender minority stress model (GMSM) provides a comprehensive theoretical basis to interpret these biopsychosocial interactions. Using the GMSM, this study aimed to identify associations between experience of stigmatization and the mental health of transitioned transpersons using correlational analyses and multiple regression models. In total, 143 transpersons were recruited. Multivariate analyses identified three variables (i.e., unemployment, nonaffirmation of gender identity, and internalized transphobia) to explain variance of depressive symptoms. Furthermore, a mediation of the proximal factors between distal factors and depressive symptoms was found. However, the moderating effect of resilience factors was not demonstrated. The results confirmed the importance of distal and proximal minority stressors for the mental health of transpersons. At the same time, the protective influence of resilience factors seemed to be surprisingly minor. In the treatment of transpersons, practitioners should not only focus on somatic aspects, but also consider the person's previous experiences of stigmatization.
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http://dx.doi.org/10.1155/2018/8639263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933055PMC
October 2018

Clinical course and prevalence of coercive measures: an observational study among involuntarily hospitalised psychiatric patients.

Swiss Med Wkly 2018 26;148:w14616. Epub 2018 Apr 26.

Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland.

Aims Of The Study: In daily clinical work, coercion continues to be highly prevalent, with rates differing between countries and sometimes even within countries or between wards of the same hospital. Previous research found inconsistent characteristics of individuals who underwent coercive measures during psychiatric treatment. Furthermore, there continues to be a lack of knowledge on the clinical course of people after being involuntarily committed. This study aimed to describe the rate and duration of different coercive measures and characterise a cohort of involuntarily committed patients regarding sociodemographic and clinical variables.

Methods: In this observational cohort study, we analysed clinical data from the patients' medical files, the use of coercive measures (seclusion, restraint, coercive medication) and other procedural aspects in involuntarily hospitalised patients (n = 612) at the University Hospital of Psychiatry Zurich. For analysis, we used cross-tabulation with chi-square tests for categorical variables and, owing to a non-normal distribution, the Mann-Whitney U-test for interval variables.

Results: Coercive measures were documented in 170 patients (28% of those who were involuntarily hospitalised). The total number of seclusions was 344, with a mean duration of 9 hours per seclusion. A total of 89 patients (15%) received 159 episodes of coercive medication (oral and intramuscular). Also, 11 episodes of restraint were recorded in 7 patients (1%) with a mean duration of 12 hours per restraint. Patients subjected to coercion were significantly more often male, violent prior to admission, diagnosed with psychosis or personality disorder, and had a history of frequent hospitalisations with long durations of hospitalisation.

Conclusions: The prevalence of coercive measures is still high in involuntarily hospitalised patients. Seclusion was the most frequently used coercive measure, which may be based on cultural and clinical aspects and differs from findings in other countries where restraint is more frequently used. Some sociodemographic and clinical characteristics were associated with the use of coercion. This underlines the importance of developing treatment strategies for patients at risk to prevent situations in which the use of coercion is necessary. To enable comparison between different study sites, standardised protocols should be used to document frequency and duration of coercive measures.
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http://dx.doi.org/10.4414/smw.2018.14616DOI Listing
October 2018

The Swiss Mental Health Care System.

Psychiatr Serv 2018 02 15;69(2):126-128. Epub 2017 Dec 15.

Dr. Schneeberger is with Psychiatric Services Grisons, St. Moritz, Switzerland. He is also with the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, where Dr. Schwartz is affiliated. Dr. Schwartz is also with the Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, New York. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.

The United States and Switzerland are among the world's wealthiest countries. Both are highly innovative and entrepreneurial, ranking high in global competitiveness and innovation and with similar liberal economies. This column highlights features of the health care system in Switzerland, a country with an exclusively private health insurance system, with federally mandated universal health insurance. Residents can choose from about 58 insurance companies. Switzerland regulates these companies and negotiates reimbursement rates. The Swiss model of health care and its provision of comprehensive psychiatric and substance abuse treatment could inform policy as the United States considers major changes to its health care laws. Switzerland could serve as an example for developing a mental health care model that ensures appropriate services, with a high density of psychiatric inpatient facilities and mental health care providers, while maintaining affordable care.
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http://dx.doi.org/10.1176/appi.ps.201700412DOI Listing
February 2018

Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study.

J Psychiatr Res 2017 12 26;95:189-195. Epub 2017 Aug 26.

Universitäre Psychiatrische Kliniken Basel, Universität Basel, Wilhelm-Klein-Str. 27, CH-4012 Basel, Switzerland.

Aggressive behavior and violence in psychiatric patients have often been quoted to justify more restrictive settings in psychiatric facilities. However, the effects of open vs. locked door policies on aggressive incidents remain unclear. This study had a naturalistic observational design and analyzed the occurrence of aggressive behavior as well as the use of seclusion or restraint in 21 German hospitals. The analysis included data from 1998 to 2012 and contained a total of n = 314,330 cases, either treated in one of 17 hospitals with (n = 68,135) or in one of 4 hospitals without an open door policy (n = 246,195). We also analyzed the data according to participants' stay on open, partially open, or locked wards. To compare hospital and ward types, we used generalized linear mixed-effects models on a propensity score matched subset (n = 126,268) and on the total dataset. The effect of open vs. locked door policy was non-significant in all analyses of aggressive behavior during treatment. Restraint or seclusion during treatment was less likely in hospitals with an open door policy. On open wards, any aggressive behavior and restraint or seclusion were less likely, whereas bodily harm was more likely than on closed wards. Hospitals with open door policies did not differ from hospitals with locked wards regarding different forms of aggression. Other restrictive interventions used to control aggression were significantly reduced in open settings. Open wards seem to have a positive effect on reducing aggression. Future research should focus on mental health care policies targeted at empowering treatment approaches, respecting the patient's autonomy and promoting reductions of institutional coercion.
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http://dx.doi.org/10.1016/j.jpsychires.2017.08.017DOI Listing
December 2017

Length of Involuntary Hospitalization Related to the Referring Physician's Psychiatric Emergency Experience.

Adm Policy Ment Health 2018 03;45(2):254-264

Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, Postfach 1931, 8032, Zurich, Switzerland.

Although involuntary commitment (IC) is a serious intervention in psychiatry and must always be regarded as an emergency measure, the knowledge about influencing factors is limited. Aims were to test the hypothesis that duration of involuntary hospitalization and associated parameters differ for IC's mandated by physicians with or with less routine experience in psychiatric emergency situations. Duration of involuntary hospitalization and duration until day-passes of 508 patients with IC at the University Hospital of Psychiatry Zurich were analyzed using a generalized linear model. Durations of involuntary hospitalization and time until day-passes were significantly shorter in patients referred by physicians with less routine experience in psychiatric emergency situations than compared to experienced physicians. Shorter hospitalizations following IC by less-experienced physicians suggest that some IC's might be unnecessary. A specific training or restriction to physicians being capable of conducting IC could decrease the rate of IC.
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http://dx.doi.org/10.1007/s10488-017-0819-9DOI Listing
March 2018

Patient Satisfaction and Quality of Life in People with Schizophrenia-Spectrum Disorders in a Rural Area.

Adm Policy Ment Health 2018 03;45(2):245-253

Psychiatrische Dienste Graubünden, Plazza Paracelsus 2, 7500 St., Moritz, Switzerland.

People suffering from schizophrenia-spectrum disorders often endorse a reduced quality of life (QoL) as compared to the general population. There appears to be a lack of studies for rural catchment areas for this patient population. We conducted a cross-sectional study with 94 people with schizophrenia-spectrum disorders in a mainly rural alpine area. We used multilevel models controlled for covariates to analyze the data. Total service satisfaction was associated with psychological aspects of subjective QoL and physical well-being in our model. Variables characterizing autonomy and empowerment of the person seem crucial concerning the QoL in this population.
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http://dx.doi.org/10.1007/s10488-017-0820-3DOI Listing
March 2018

[Influence of an "Open Door Policy" on Ward Climate: Impact on Treatment Quality].

Psychiatr Prax 2018 04 3;45(3):133-139. Epub 2017 Apr 3.

Universitäre Psychiatrische Kliniken (UPK) und Universität Basel, Schweiz.

Objective: To compare the ward atmosphere, safety, therapeutic hold, and patients' coherence on recently opened (1 year), opened (4 years) and open (> 20 years) psychiatric wards in a longitudinal naturalistic study design. The question was if a patient shift from formerly locked to open wards might deteriorate the ward atmosphere on the open and opened wards.

Methods: Ward atmosphere on two recently opened (n = 2), opened (n = 2) and open (n = 2) wards was examined using the Essen Climate Evaluation Schema (EssenCES) in a follow-up study after 4 years. Structural as well as clinical data were extracted.

Results: Global ward atmosphere, safety, and patients' coherence on the recently opened wards was significantly increased; on always opened wards and long-term opened wards it remained unchanged. Coercive measures and discharges against medical advice decreased during the open door process.

Conclusion: Opening locked psychiatric wards can help to establish a positive therapeutic atmosphere without changing the therapeutic climate on the other already open wards. A better ward atmosphere might be connected with a better therapeutic quality.
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http://dx.doi.org/10.1055/s-0042-121784DOI Listing
April 2018

Facilitators and barriers influencing the readiness to receive dental implants in a geriatric institutionalised population-A randomized non-invasive interventional study.

Gerodontology 2017 Sep 28;34(3):306-312. Epub 2017 Mar 28.

Universitaere Psychiatrische Kliniken, Universitaet Basel, Basel, Switzerland.

Objective: Although elderly people have many serious dental issues and are in need of prosthesis, few opt for dental implants. The aim of this study was to investigate barriers that prevent elderly people from receiving dental implants. Specifically, we examined (i) whether the message was delivered before or after the interview had an impact, and (ii) whether it did matter who delivered the message.

Materials And Methods: Sixty-six residents from seven residential homes in the Canton of Grisons, Switzerland were included. The sample was randomized to a treatment group that received comprehensive education about dental implants before the interview and a control group that received education after completing the questionnaire.

Results: The sample consisted of 54 women (81.8%) and 12 males (18.2%) with an average age of 86.2 years. Education before the interview did not show any impact on the attitude towards dental implants. Main reasons for a negative attitude towards implants were old age and high costs. Participants who received information about implants from their relatives and their own dentist and not from the study dentist were significantly more willing to receive implants.

Conclusion: Providing an adequate education about benefits and risks of receiving dental implants does not change the attitude towards dental implants. The source of information/messenger does influence attitudes towards implants. If the person delivering the education and information is a relative or a known medical person, the person's attitude is more likely to change as compared to people receiving the information from an unrelated person.
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http://dx.doi.org/10.1111/ger.12264DOI Listing
September 2017

Differences in short and long sleep durations between blacks and whites attributed to emotional distress: analysis of the National Health Interview Survey in the United States.

Sleep Health 2017 02 13;3(1):28-34. Epub 2016 Dec 13.

NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change.

Objectives: The current study examined the role of emotional distress in explaining racial/ethnic differences in unhealthy sleep duration.

Design: Data from the 2004-2013 National Health Interview Survey were analyzed using SPSS 20.

Setting: Data were collected through personal household interviews in the United States.

Participants: Of the total 261,686 participants (age≥18 years), 17.0% were black, 83.0% were white, and the mean age was 48 years (SE=0.04).

Measurements: To ascertain total sleep duration, participants were asked, "How many hours of sleep do you get on average in a 24-hour period?" Sleep duration was coded as short sleep (<7hours), average sleep (7-8hours), or long sleep (>8hours). Emotional distress-feeling sad, nervous, restless, hopeless, worthless, and burdened over a 30-day period-was measured using Kessler-6, a 6-item screening scale.

Results: Of the participants reporting significant emotional distress (4.0% black, 3.5% white), χ analyses revealed that a higher percentage of blacks, compared with whites, reported unhealthy sleep durations. Relative to Whites, Blacks had increased prevalence of short sleep (prevalence ratio=1.32, P<.001) or long sleep (odds ratio =1.189, P<.001). The interaction between race/ethnicity and emotional distress was significantly associated with short (prevalence ratio=0.99, P<.001) and long sleep (odds ratio=0.98, P<.001) durations.

Conclusions: Individuals of the black race/ethnicity or those reporting greater levels of emotional distress are more likely to report short or long sleep duration. Emotional distress might partially explain racial/ethnic differences in unhealthy sleep duration between blacks and whites.
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http://dx.doi.org/10.1016/j.sleh.2016.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911358PMC
February 2017