Publications by authors named "Katja Petrowski"

130 Publications

Patient's and the Therapist's Attachment Representations, Attachment to Therapists, and Self-Esteem-Change Through Psychotherapy.

Front Psychol 2021 2;12:711296. Epub 2021 Nov 2.

Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria.

The present naturalistic study aims to investigate the differential effects of the patient's and the therapist's attachment representations on the attachment to the therapist as perceived by the patient, and their impact on self-esteem-change through psychotherapy. Attachment variables of = 573 patients as well as = 16 therapists were assessed. Attachment representations were measured for therapists and patients via the Bielefelder Questionnaire for Client Attachment Exploration, the Relationship Specific Attachment to Therapist Scales and the Adult Attachment Interview. The patient's attachment to therapists was evaluated and patients' self-esteem was measured via the Frankfurter Selbstkonzeptskalen at the beginning and end of psychotherapy. Although there were significant effects of the patient's attachment representations on the perceived attachment to the therapist as well as between the perceived attachment to the therapist and the amount of self-esteem-change, the therapist's attachment style had no significant influence on the perceived attachment to the therapist. Self-esteem-change through psychotherapy is influenced by the actually formed attachment relationship as perceived by the patient. The patient's attachment representations but not the therapist's attachment style contributes to the actual patient's attachment to the therapist.
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http://dx.doi.org/10.3389/fpsyg.2021.711296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8593375PMC
November 2021

How acute physical and psychological stress differentially influence the kynurenine pathway: A randomized cross-over trial.

Psychoneuroendocrinology 2021 Sep 25;134:105433. Epub 2021 Sep 25.

Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.

Psychological stress is associated with the pathogenesis of several neuropsychiatric disorders. In contrast, physical stress, as provoked by exercise, counteracts symptoms and potentially also disease progression. The kynurenine pathway, which is imbalanced in neuropsychiatric disorders, responds to both psychological and physical stress. Here, we compared the acute effects of psychological versus physical stress on the kynurenine pathway and inflammatory mediators. Thirty-five healthy males (mean age: 24.09±3.39 years) underwent both the Trier Social Stress Test (psychological stressor) and the Wingate-Test (physical stressor). The kinetics of tryptophan and its metabolites as well as cytokines IL-6, IFN-γ, TNF-α, and IL-10 were measured before and after the two stress conditions. After both stressors, there was a significant change over time for the kinetics of tryptophan metabolites and for cytokines. Furthermore, the reactivity of kynurenine pathway metabolite ratios and cytokines was statistically greater after physical stress than after psychological stress. The increased metabolic flux towards kynurenic acid following acute physical stress suggests an exercise-induced neuroprotective mechanism. Despite the paradoxical influence of both stressors on neuropsychiatric diseases, the acute kynurenine pathway reactivity appears to be similar, although effects were more pronounced in response to physical stress.
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http://dx.doi.org/10.1016/j.psyneuen.2021.105433DOI Listing
September 2021

A New Routine for Analyzing Brief Symptom Inventory Profiles in Chronic Pain Patients to Evaluate Psychological Comorbidity.

Front Psychol 2021 30;12:692545. Epub 2021 Sep 30.

Division of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.

Comorbidity, i.e., additional psychological distress in patients already suffering from chronic somatic diseases (e.g., orthopedic conditions) is of growing importance. The quality of analyzing and interpreting the often used Brief Symptom Inventory (BSI) used with orthopedic patients should improve by employing a new "case definition" of four groups (instead of two) of differentially psychologically distressed patients instead of two groups as before. Four groups with the different psychological distress definitions of "no," "mild," "remarkable," and "severe" were to be analyzed from a group of 639 orthopedic patients in inpatient rehabilitation clinics. The BSI is transformed into T values (=50, SD=10). There is "no" distress if no T [two scales] is ≥60 and "mild" distress if T [two scales] and/or T [GSI] is ≥60 and <63. If T [two scales] and/or T [GSI] is ≥63 and <70, it is "remarkable," and if T [two scales] and/or T [GSI] ≥70, it speaks for "severe" psychological distress. The new tool for analyzing psychological distress based on the T-scores of the BSI resulted in the following four groups: No psychological distress (41.9%): unspecific health-related information stands for a useful intervention. About 13.3% demonstrated low psychological distress: shorter diagnostic interviews and a few more diagnostic examinations led to a low-level outpatient group program to improve health and well-being in a preventive sense; one repeated measurement in 4weeks is advised. Remarkable psychological distress (26%): in-depth exploration using interviews, tests, and questionnaires to choose specific interventions in a single and/or group setting, outpatient or inpatient treatment; repeated measurements and process control. About 18.8% reported severe psychological distress: in-depth exploration led to specific interventions in a single and/or group setting, almost an inpatient setting; immediately crisis intervention and high-frequent process control. The new evaluation strategy of the BSI should improve practice and research; further investigation is necessary.
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http://dx.doi.org/10.3389/fpsyg.2021.692545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515025PMC
September 2021

Effect of a biofeedback intervention on heart rate variability in individuals with panic disorder: A randomized controlled trial.

Psychosom Med 2021 Oct 12. Epub 2021 Oct 12.

Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany Clinic for Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany Department of Psychosomatic Medicine und Psychotherapy, University Bonn, Bonn, Germany.

Objective: Some individuals with panic disorder (PD) display reduced heart rate variability, which may result in an increased risk of cardiovascular mortality. Heart rate variability-biofeedback (HRV-BF) training has been shown to improve the modulation of the autonomic activity. Therefore, this randomized controlled trial was conducted to investigate the effect of a four-week HRV-BF intervention in individuals with PD. Heart rate variability-biofeedback (HRV-BF) training improved the modulation of the autonomic activity. Therefore, with this randomized controlled trial we aimed to investigate the effect of a four-week HRV-BF intervention in people with PD.

Methods: Thirty-six women and sixteen men with PD (mean age: 35.85 ± 15.60 years) were randomly allocated either to HRV-BF with 0.1 Hz breathing as intervention group or to HRV-Sham-BF as active control group. HRV-BF was performed over four weeks while HRV was measured both during a short-term resting condition as well as during a paced breathing condition before and after intervention.

Results: HRV-BF with 0.1 Hz breathing increased HRV and reduced panic symptoms in individuals with PD. HRV-BF with 0.1 Hz breathing demonstrated an increase in the time and frequency domain parameters of HRV during the short-term resting condition (ΔPost-Pre RMSSD: 5.87 ± 14.03 ms; ΔPost-Pre SDNN: 11.63 ± 17.06 ms; ΔPost-Pre Total Power: 464.88 ± 1825.47 ms2; ΔPost-Pre LF: 312.73 ± 592.71 ms2), a decrease in the heart rate during the paced breathing condition (ΔPost-Pre: -5.87 ± 9.14 b/min), and a decrease in the Panic & Agoraphobia Scale (ΔPost-Pre: -3.64 ± 6.30). There was no intervention effect in the HRV-Sham-BF group.

Conclusions: HRV-BF as a non-invasive and non-pharmacological treatment seems to be an important intervention option to improve reduced HRV and decrease panic symptoms in individuals with PD. Future studies are needed to establish whether these effects translate to reductions in the risk of cardiovascular disease in PD.
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http://dx.doi.org/10.1097/PSY.0000000000001031DOI Listing
October 2021

Examining air pollution (PM), mental health and well-being in a representative German sample.

Sci Rep 2021 09 16;11(1):18436. Epub 2021 Sep 16.

Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.

There is a growing debate on the role of the physical environment and what constitute risk and protective factors for mental health. Various forms of air pollution have shown links to physical and mental health concerns and considering that Germany does not meet the WHO air quality standards-poor air quality affects a large proportion of Germans and is more important now than ever. This study investigates the physical environmental factor, air pollution, measured by particulate matter of particles with an aerodynamic diameter smaller than 10 µm (PM) and effects on determinants of mental health and well-being (life satisfaction, stress resilience, anxiety, depression, and self-esteem). A representative sample of N = 3020 German adults with 54% females (46% males) and an age range between 18 and 92 years (M = 49.04, S.D. ± 17.27) was used. Multivariate linear regression analyses show that higher life satisfaction, more self-esteem and higher stress resilience are predicted by less air pollution (PM). Individual income, age, and gender were taken into account for each regression model. Gender specific sub-analyses revealed similar predictions for PM and stress resilience whereas PM and self-esteem were only significantly associated for females. Associations between mental health or well-being determinants and air pollution (PM) are found in the representative German sample.
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http://dx.doi.org/10.1038/s41598-021-93773-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445943PMC
September 2021

Emergency Treatment of Anaphylactic Reactions in Air Rescue Missions: An Eight-Year Analysis of a German Rescue Helicopter Base.

Prehosp Disaster Med 2021 Oct 24;36(5):586-592. Epub 2021 Aug 24.

Wissenschaftlicher Arbeitskreis der DRF Stiftung Luftrettung Gemeinnützige AG, Filderstadt, Germany.

Introduction: Anaphylactic reactions can lead to a life-threatening situation. In the event of anaphylaxis, rapid and targeted emergency treatment is indicated.

Study Objective: The study sought to determine the emergency therapy administered for anaphylaxis in children and adults. Focus was placed on therapy with adrenaline. In addition, the study aimed to investigate demographic data, triggers, and hospitalization rates of the different severities of anaphylaxis.

Methods: A retrospective analysis of anaphylactic reactions was conducted using data from prehospital emergency missions performed by the Air Rescue Dresden/Germany from 2008 through 2015 using the standardized application protocol EPRO-5.0 (MIND 3) anonymized. Data from 152 adults and 29 children were evaluated, focusing especially on the acute treatment as well as demographic information, triggers, and symptoms of anaphylactic reactions.

Results: In total, 152 adults (73 female, 79 male) from 18 to 87 years (mean 50.5 years) and 29 children (9 female, 20 male) from 1 to 16 years (mean 7.5 years) with anaphylactic reactions were analyzed. The most common trigger for severe anaphylactic reactions (Grade II-IV; classification modified according to Ring and Messmer) was food in children (33%) and insect venom in adults (59%). The data show that 19% of adults with Grade II-IV anaphylactic reactions (classification modified according to Ring and Messmer) received adrenaline. Regarding children, the appliance of adrenaline was only administered in seven percent of the cases of Grade II-IV anaphylactic reactions. Adults with Grade II or higher anaphylactic reactions were hospitalized in 92%. Three percent refused hospitalization and five percent were not transferred to hospital. One-hundred percent of the children with Grade II-IV anaphylaxis were hospitalized.

Conclusions: Analysis of data from the Air Rescue Dresden/Germany shows that despite existing recommendations, only 19% of adults with severe anaphylaxis received adrenaline. Among children, only in seven percent was a treatment with adrenaline performed.On the other hand, all patients survived the acute emergency treatment without apparent adverse outcomes. Thus, further studies are needed to determine the proper use of adrenaline in anaphylactic reactions.
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http://dx.doi.org/10.1017/S1049023X2100087XDOI Listing
October 2021

Psychological and Socio-Economical Determinants of Health: The Case of Inner German Migration.

Front Public Health 2021 29;9:691680. Epub 2021 Jun 29.

Research Group Medical Psychology and Medical Sociology, Division of Psychological and Social Medicine and Developmental Neurosciences, Technische Universität Dresden, Dresden, Germany.

A substantial body of research has shown worse health conditions for East- vs. West-Germany in the wake of reunification. In the present study, we investigate how these differences between the two formerly divided regions developed and what maintains them. Specifically, we consider the associations between health status, income satisfaction, and health-related locus of control. In a quasi-experimental and longitudinal study design, we are particularly interested in the differences between individuals who stayed in East-Germany and those who were born in the East but migrated to West-Germany. To this end, we examined data from seven waves of the Saxony Longitudinal Study (2003-2009). Specifically, we tested a cross-lagged panel model with random effects, which evinced very good model fit. Most parameters and processes were equivalent between individuals who stayed in East-Germany vs. moved to West-Germany. Crucially, there was the expected pattern of positive correlations between health, income, and locus of control. In addition, we found substantially lower values for all three of these variables for the individuals who stayed in East-Germany (vs. moved to West-Germany). A possible explanation is the increase in socio-economic status that the internal migrants experienced. These findings present an important contribution of research in order to foster a better understanding on the social dynamics in Germany related to internal/domestic migrants and implications in the context of health outcomes (e.g., significantly more unemployment in East vs. West-Germany), especially since almost 20-25% of East-German citizens migrated to West-Germany. Until now, there are no similar studies to the Saxony longitudinal project, since the data collection started in 1987 and almost every year an identical panel has been surveyed; which can be particularly useful for health authorities. The study mainly focuses on social science research and deals with the phenomenon of reunification, approaching several subjects such as mental and physical health, quality of life and the evaluation of the political system. Yet even though many people have experienced such a migration process, there has been little research on the subjects we approach. With our research we deepen the understanding of the health consequences of internal migration.
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http://dx.doi.org/10.3389/fpubh.2021.691680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275934PMC
August 2021

Lamotrigine Reduces Stress Symptoms of Chronic Anxiety in the Times of the Covid-19 Natural Catastrophe-A Case Report.

Front Psychiatry 2021 21;12:655079. Epub 2021 Jun 21.

Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Leipzig, Germany.

The SARS-CoV-2 pandemic has been a worldwide chronic, stress-inducing natural catastrophe associated with increased emotional challenging. Patients with Post-traumatic stress disorder (PTSD), self-injury behavior, and obesity are predisposed to aggravation of their symptoms at this time, requiring new therapeutic approaches to balance their disrupted neuro-hormonal stress axis. Here we present our observations of an off-label treatment with lamotrigine in an adolescent girl with PTSD, self-injury behavior, and obesity. Lamotrigine was an efficacious pharmaceutical intervention that helped the patient deal with chronic stress and associated anxiety. The results are discussed based on our previous basic research outcomes in animals and humans that focused on the glutamate-cortisol circuits within the limbic brain.
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http://dx.doi.org/10.3389/fpsyt.2021.655079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255466PMC
June 2021

Revised Short Screening Version of the Profile of Mood States (POMS) From the German General Population.

Front Psychol 2021 31;12:631668. Epub 2021 May 31.

Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

The present study was conducted with the aim of constructing and validating a short form of the Profile of Mood States (POMS). The POMS is a widely-applied measure for the assessment of an individual's mood. Thus, it is of great relevance for many research questions in clinical and social psychology. To develop the short scale, we first examined psychometric properties and found the optimal 16-item solution among all valid combinations of the full POMS in an exploratory subsample ( = 1,029) of our complete representative sample of the German general population. We then validated this model in a confirmatory subsample ( = 977). Additionally, we examined its invariance across age groups and sex, as well as its reliability. Our results indicate that the POMS-16 is a valid and reliable measure of mood states with minimal losses compared to the 35-item version. Particularly where brevity and an economical assessment is desired, the POMS-16 should be considered.
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http://dx.doi.org/10.3389/fpsyg.2021.631668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200627PMC
May 2021

The effective group size for teaching cardiopulmonary resuscitation skills - A randomized controlled simulation trial.

Resuscitation 2021 08 6;165:77-82. Epub 2021 Jun 6.

Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; ERC ResearchNET; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria.

Aim Of The Study: The ideal group size for effective teaching of cardiopulmonary resuscitation is currently under debate. The upper limit is reached when instructors are unable to correct participants' errors during skills practice. This simulation study aimed to define this limit during cardiopulmonary resuscitation teaching.

Methods: Medical students acting as simulated Basic Life Support course participants were instructed to make three different pre-defined Basic Life Support quality errors (e.g., chest compression too fast) in 7 min. Basic Life Support instructors were randomized to groups of 3-10 participants. Instructors were asked to observe the Basic Life Support skills and to correct performance errors. Primary outcome was the maximum group size at which the percentage of correctly identified participants' errors drops below 80%.

Results: Sixty-four instructors participated, eight for each group size. Their average age was 41 ± 9 years and 33% were female, with a median [25th percentile; 75th percentile] teaching experience of 6 [2;11] years. Instructors had taught 3 [1;5] cardiopulmonary resuscitation courses in the year before the study. A logistic binominal regression model showed that the predicted mean percentage of correctly identified participants' errors dropped below 80% for group sizes larger than six.

Conclusion: This randomized controlled simulation trial reveals decreased ability of instructors to detect Basic Life Support performance errors with increased group size. The maximum group size enabling Basic Life Support instructors to correct more than 80% of errors is six. We therefore recommend a maximum instructor-to-participant ratio of 1:6 for cardiopulmonary resuscitation courses.
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http://dx.doi.org/10.1016/j.resuscitation.2021.05.034DOI Listing
August 2021

Anxiety is associated with unfulfilled information needs and pain at the informed consent consultation of spine surgery patients: a longitudinal study.

Eur Spine J 2021 08 5;30(8):2360-2367. Epub 2021 Jun 5.

Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.

Purpose: Meeting the information needs of patients adequately is of high importance in informed consent consultations in surgery. However, information needs often remain unmet in the informed consent consultation. The aim of this study was to assess anxiety and pain in relation to the patients' information needs fulfillment perioperatively.

Methods: We applied a question prompt list (QPL) for patients undergoing spine surgery (SN-QPL) before (t1) and a question answering list (SN-QAL) after (t2) the informed consent consultation. The patients additionally completed the "State-Trait Anxiety Operation Inventory" (STOA, cognitive and affective scale) at t1, as well as a pain numerical rating scale (NRS) at t2 and postoperative (t3). We analyzed (1) the association between anxiety, information needs and pain and (2) anxiety and pain scores regarding information needs fulfillment after the consent consultation.

Results: A total of n = 118 patients was included. Affective and cognitive state anxiety was only reduced postoperatively (affective p < .001, cognitive p < .05). The higher trait anxiety was, the more patients longed for information at t1-t3 (t1: r = .58/r = .74, each p < .001), (t2: r = .38/r = .49, each p < .001) and (t3: r = .29, p < .01/r = 34, p < .001). Higher grades of trait anxiety resulted in lower information needs fulfilment. Higher state anxiety levels were associated with higher pain levels. Information needs more often remained unfulfilled in high trait and state anxiety patients.

Conclusion: Patients' anxiety was associated with (un)fulfilled information needs. Meeting information needs should be optimized in the process of surgeon-patient communication. Adapting the information to the patients' anxiety levels seem to be an effective way to reduce anxiety.
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http://dx.doi.org/10.1007/s00586-021-06824-1DOI Listing
August 2021

Do patients suffering from chronic diseases retrospectively overestimate how healthy they were before they fell ill?

Int J Clin Health Psychol 2021 Sep-Dec;21(3):100230. Epub 2021 Apr 21.

Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Mainz, Germany.

: To examine the impact of a disease on a person's subjective health state, patients are often asked to assess their current health state and to retrospectively assess how healthy they were before they fell ill. The objective of this study was to test whether patients generally overestimated the quality of their pre-disease health. : Six samples of patients with chronic diseases (cancer patients, cardiovascular patients, and patients diagnosed with sarcoidosis, between 197 and 1,197) were analyzed. The patients assessed their current health states and their health states at the time before diagnosis. The retrospective scores were compared with matched data from general population studies. : In three of the six studies, the retrospective health ratings of the patients were significantly higher than the general population norms (effect sizes between 0.24 and 0.46), two studies yielded nonsignificant effects, and in one study there was an opposite trend. The general overestimation of pre-disease health was more pronounced in older patients as compared with younger ones, and it was more pronounced when global health/quality of life was to be assessed. : Retrospective assessments of pre-disease health states are not appropriate for assessing disease-related changes in a person's health state.
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http://dx.doi.org/10.1016/j.ijchp.2021.100230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091885PMC
April 2021

Association between the experience of violence and burnout among paramedics.

Int Arch Occup Environ Health 2021 Oct 22;94(7):1559-1565. Epub 2021 Apr 22.

Medical Psychology and Medical Sociology, Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

Purpose: Similar to many occupational groups in the rescue service, paramedics show increased mental health problems. Both situational and work-organizational factors play a role in the development of mental illnesses. The aim of the study is to investigate the connection of experienced violence and the development of burnout in the paramedical profession.

Methods: To analyze this association, 358 paramedics working for a German metropolitan fire brigade were examined using the Hamburg burnout inventory and a questionnaire on the history of violence, using one-factorial variance analyses, t tests and regression analyses.

Results: The examined sample did not show elevated burnout rates, but 97.5% reported that they had already been insulted or spit on while in service. The experience of feeling threatened proved to be a significant predictor for emotional exhaustion and an aggressive response to emotional stress. Also, the experience of being jailed or insulted and the number of years of service are associated with the burnout score. All other experiences showed no significant association with the burnout burden.

Conclusion: It can be concluded that specific experiences with violence in the service of paramedics can particularly be associated with burnout symptoms. In general, however, violence seems to play a minor role.
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http://dx.doi.org/10.1007/s00420-021-01693-zDOI Listing
October 2021

Correction: Cortisol reactivity in patients with anorexia nervosa after stress induction.

Transl Psychiatry 2021 Apr 8;11(1):208. Epub 2021 Apr 8.

Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

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http://dx.doi.org/10.1038/s41398-021-01326-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032664PMC
April 2021

Autonomic Nervous System Response to Psychosocial Stress in Anorexia Nervosa: A Cross-Sectional and Controlled Study.

Front Psychol 2021 17;12:649848. Epub 2021 Mar 17.

Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes-Gutenberg University Mainz, Mainz, Germany.

To foster understanding in the psychopathology of patients with anorexia nervosa (P) at the psychological and physiological level, standardized experimental studies on reliable biomarkers are needed, especially due to the lack of disorder-specific samples. To this end, the autonomic nervous system (ANS) response to a psychosocial stressor was investigated in = 19 P (BMI: 18.7 ± 3.3 kg/m), age, and gender-matched to = 19 healthy controls (HC; BMI: 24.23 ± 3.0 kg/m). For this purpose, heart rate (HR) and heart rate variability (HRV) parameters were assessed in a cross-sectional study design under two experimental conditions: (1) rest and (2) stress (Trier Social Stress Test). In addition, psychological indicators of stress were assessed. An 2 × 2 × 8 ANOVA demonstrated similar HR and HRV patterns (except LF-HRV) between P and HC at rest. Under stress, P (vs. HC) demonstrated a blunted HR [conditiontimegroup: = 9.326, = 0.000, η = 0.206] and an attenuated HRV response (reduced SNS/PNS reactivity). Significant effects of stress appraisal (SA) and BMI on HRV-reactivity were revealed. SA on SDNN = ConditiontimeSA = = 2.676, = 0.033, η = 0.073. BMI on LF/HF-Ratio = ConditiontimeBMI = = 3.339, = 0.019, η = 0.164. Psychological indices suggested higher levels of chronic and appraised stress in P relative to HC. Additional analyses demonstrated that ED-symptoms are highly correlated with the latter constructs, as well as with psychological burden, but not with weight. Further, it was shown that abnormalities in reactivity persisted despite normalized ANS activity. Overall, we suggested that besides weight recovery, improvement in stress appraisal could be beneficial for cardiac health. In this light, a combination of therapy (e.g., development and activation of coping skills, cognitive reappraisal) and biofeedback training may improve treatment outcomes and regulate stress reactivity.
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http://dx.doi.org/10.3389/fpsyg.2021.649848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011538PMC
March 2021

Psychometric Properties of the German Version of the Self-Regulation of Eating Behavior Questionnaire.

Front Psychol 2021 12;12:649867. Epub 2021 Mar 12.

Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.

The Self-Regulation of Eating Behavior Questionnaire (SREBQ) is an economical way of assessing an individual's self-regulatory abilities regarding eating behavior. Such scales are needed in the German population; therefore, the purpose of the present study was the translation and validation of a German version of the SREBQ. First, we conducted a pilot study (Study 1; = 371) after the translation procedure. Second, we assessed the final scale in a representative sample of the German population (Sample 2; = 2,483) and its underlying factor structure. Further, we tested for measurement invariance and evaluated the SREBQ's associations with related scales to explore convergent and discriminant validity. Finally, we considered differences in SREBQ based on sociodemographic variables and provided derived reference scores (norm values). Factor analysis revealed deficiencies in the original model. Thus, we shortened the scale based on statistical considerations and the adapted version showed improved fit in Confirmatory Factor Analysis and reliability. We also found evidence for partial strict invariance, which means the measure is equivalent for the tested groups of age and gender. Item and scale psychometric properties of the shortened version were satisfactory. In terms of diagnostic validity, it was shown that individuals with higher body mass index (kg/m) have worse self-regulation of eating behavior than those with lower. In sum, the SREBQ evidenced good validity and reliability and is suitable for application in medical, psychological, and nutritional research.
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http://dx.doi.org/10.3389/fpsyg.2021.649867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994521PMC
March 2021

Effects of stress on chewing and food intake in patients with anorexia nervosa.

Int J Eat Disord 2021 07 9;54(7):1160-1170. Epub 2021 Mar 9.

Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

Objective: The present study investigates the impact of psychosocial stress on chewing and eating behavior in patients with anorexia nervosa (P ).

Method: The eating and chewing behavior of P were examined in a standardized setting by means of a chewing sensor. These procedures encompassed n = 19 P , age, and gender matched to n = 19 healthy controls (HC). Food intake and chewing frequency were assessed in two experimental conditions: rest versus stress (via Trier Social Stress Test). To verify stress induction, two appraisal scales were employed. In addition, chronic stress, psychological distress and eating disorder symptoms were assessed.

Results: In terms of food intake and chewing frequency, the results of the 2x2 ANOVA demonstrated a significant effect of condition and group. During stress, all participants demonstrated a higher chewing frequency and a decreased ingestion. In general, patients ate less at a lower chewing frequency (vs. HC). However, sample specific analyses demonstrated that the eating and chewing behavior of P remained unchanged regardless of the condition, except for their drinking. Food choices were comparable between the groups, but appetite values significantly differed.

Discussion: The increase in chewing frequency in all participants during stress suggests that chewing might impact affect regulation, however, not specifically in P . Future research should clarify to what extent the normalization of chewing behavior could ameliorate ED-symptoms (incl. food intake) in P . The application of a chewing sensor could support this aim and future interventions.
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http://dx.doi.org/10.1002/eat.23500DOI Listing
July 2021

Traumatic brain injury as vulnerability factor for the development of psychological disorders in a prospective single-event trauma traffic accident sample.

Brain Inj 2021 04 10;35(5):604-608. Epub 2021 Mar 10.

Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine, Mainz, Germany.

: Traumatic brain injuries (TBIs) present a relevant problem among individuals involved in traffic accidents. The aim of this study was to investigate the impact of TBI on the development of psychological symptoms after a traffic accident. This cohort study investigates, whether individuals involved in traffic accidents with TBI are more likely to develop psychological illness than those without TBI. 59 men (patients: = 19, controls: = 40) and 64 women (patients: = 21, controls = 43) participated in the study (Mean age: = 40.23; = 13.19; Injury severity score ISS: = 6.48, = 5.99). The psychological distress was compared between the two groups using t-tests. The impact of ISS, number and duration of surgeries were regarded using regression analyses. No indications for a heightened risk of psychological disorders in patients with TBI were found. The treatment at the hospital had no measurable influence on the development of psychological disorders. Nevertheless, in the Dexamethasone-suppression-test there was an increased stress load of patients with TBI caused by injury severity and operations. TBIs do not seem to cause psychological illness directly but the number of surgeries and the injury severity can influence the stress load which is associated with psychological symptoms.
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http://dx.doi.org/10.1080/02699052.2021.1894480DOI Listing
April 2021

Movement and Emotional Facial Expressions during the Adult Attachment Interview: Interaction Effects of Attachment and Anxiety Disorder.

Psychopathology 2021 Feb 24:1-12. Epub 2021 Feb 24.

Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.

Introduction: Adult attachment is commonly associated with emotion regulation. Less is known about the nonverbal embodiment of adult attachment.

Objective: We hypothesized that dismissing attachment is related to less movement and fewer facial expressions of emotions, whereas preoccupied attachment is associated with more negative emotional facial expressions. Moreover, the interaction of attachment and the presence of an anxiety disorder (AD) was explored.

Methods: The sample included 95 individuals, 21 with AD without comorbidity, 21 with AD and comorbid major depression (AD-CD), and 53 healthy controls. We analyzed nonverbal behavior during a part of the Adult Attachment Interview (AAI) asking about the family and parental figures. The movements of the interviewees were captured via Motion Energy Analysis. Facial expressions were coded according to the Facial Action Coding System using the OpenFace software. We compared individuals with secure, dismissing, and preoccupied states of mind (assessed with the AAI) with regard to the frequency and complexity of movements and the frequency of the facial expressions such as happy, sad, and contemptuous.

Results: As expected, dismissingly attached individuals moved less often and with lower complexity than securely attached. For emotional facial expressions, a main effect of the disorder group and interaction effects of attachment by disorder were found. In the AD-CD group, dismissingly attached patients showed comparatively fewer happy facial expressions than securely attached individuals.

Conclusions: Reduced movement specifically seems to be related to dismissing attachment when interviewees talk about significant parental figures. Facial expressions of emotions related to attachment occurred when maladaptive emotion regulation strategies were intensified by a psychological disorder.
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http://dx.doi.org/10.1159/000512127DOI Listing
February 2021

Hormonal and Subjectively Perceived Stress of the Emergency Physicians of the Airborne Rescue Service.

J Clin Psychol Med Settings 2021 12 17;28(4):771-780. Epub 2021 Feb 17.

Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Mainz, Germany.

Due to their work activities, emergency physicians are regularly exposed to exceptional mental and physical situations. In order to prevent stress-related illnesses, the triggers of hormonal and subjectively perceived stress must be understood better. On a sample of emergency physicians from two air rescue services (N = 80), the cortisol awakening response (CAR) was determined on flight rescue days, clinic days, and days off. Pearson correlations showed significant connections between the CAR on flight rescue days and individual scales of the Trier Inventory for Chronic Stress (TICS) and the Perceived Stress Scale (PSS). The results indicate that a lower subjective stress level is associated with higher levels of hormonal stress. Stepwise regression analyses showed a significant influence of the number of professional years, subjectively perceived stress, pressure to succeed, and social isolation. The results suggest that the hormonal stress burden of emergency physicians is in a complex relationship with perceived strain.
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http://dx.doi.org/10.1007/s10880-021-09767-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590658PMC
December 2021

Hormonal responsiveness in the Trier Social Stress Test and the dexamethasone-corticotropin releasing hormone test in healthy individuals.

Psych J 2021 Apr 28;10(2):305-317. Epub 2021 Jan 28.

Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Dresden, Germany.

A number of different laboratory procedures investigate the hormonal response in a standardized pharmacological challenge test (dexamethasone-corticotropin releasing hormone; DEX-CRH) or in a psychosocial stress induction on the hypothalamic-pituitary-adrenocortical axis by the Trier Social Stress Test (TSST). However, the magnitude of the response related to the different stressors and the interaction of the responsiveness between the two tests is still unclear. Fifty-two participants underwent both the DEX-CRH test and the TSST on two separate days. The cortisol and the plasma adrenocorticotropic hormone (ACTH) release were assessed before and after the stress tests. For a specification of the cortisol response to both conditions, subgroups of high- and low-cortisol responders to the TSST and the DEX-CRH test were formed. The healthy participants showed a substantial increase in the ACTH and the cortisol concentration after the two tests. This increase was 3 times greater in the TSST than the DEX-CRH test. High responders in both tests demonstrated a higher factor of the cortisol reactivity ratio (TSST/DEX-CRH test). Psychosocial stress as induced by the TSST was associated with a significantly greater increase in cortisol compared to the DEX-CRH test, even though the ACTH response displayed no differences. Our findings indicate an interaction of the hormonal responsiveness between the two tests with regard to the cortisol patterns.
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http://dx.doi.org/10.1002/pchj.424DOI Listing
April 2021

Evaluation of a digitized physician-patient-communication course evaluated by preclinical medical students: a replacement for classroom education?

GMS J Med Educ 2020 3;37(7):Doc85. Epub 2020 Dec 3.

Universitätsmedizin Mainz, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Medizinische Psychologie und Medizinische Soziologie, Mainz, Germany.

The limitations in teaching resulting from the Covid-19 epidemic were the rational for transferring the course in Medical Psychology and Medical Sociology (doctor-patient communication) into an asynchronous e-learning course. For this purpose, ten exercises were developed to be downloaded by the students and the solutions returned to the course lecturer on a weekly basis. In addition, two students individually recorded via video one of eight doctor-patient exercise conversations, which were then evaluated by four other students and the respective lecturer. For evaluation, the students filled out an exercise and an effect-related questionnaire with 21 items. The questionnaire was completed by n=203 (98%) students (59% female, 41% male). The video-based situation analyses (91%) helped most of them to become rather closely or very well acquainted with medical conversation practice. 76% rated the exercise "Enlightenment Conversation/SPIKES Protocol" as fairly helpful or very helpful in respect to the practicing concepts of medical conversation. When asked about the effects, most of them found the idea of patient orientation in medicine to be quite helpful or very helpful (83%). About a quarter of them (24%) stated that the online course could not, or only slightly, replace face-to-face teaching. This assessment was less pronounced among female students than among male students (Wilcoxon test p<.01). Our online course concept of physician-patient conversation found good overall response among pre-clinical medical students. However, the participants expressed different opinions about the extent to which the concept can replace face-to-face teaching.
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http://dx.doi.org/10.3205/zma001378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7740042PMC
January 2021

A Brief Assessment of Body Image Perception: Norm Values and Factorial Structure of the Short Version of the FKB-20.

Front Psychol 2020 1;11:579783. Epub 2020 Dec 1.

Integrated Research and Treatment Center (IFB) Adiposity Diseases - Behavioral Medicine, Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany.

The Body Image Questionnaire-20 (FKB-20) is one of the most applied self-report measures in the context of body image assessment in German-speaking regions. A version of the FKB-20 capturing an ideal concept of body image is also available. A special property of the scale is its high sensitivity for individuals suffering from anorexia nervosa. The present research provided a short version of this scale (for both variants) and examined its validity in a representative sample ( = 2,347) of the German population. We utilized factor analysis methods to identify the optimal short scale of the measure, finding excellent model fit and reliability for a two-factor model (FKB-6) for both real and ideal body image. Both versions of the FKB-6 can be considered invariant across sex and age groups. Good reliability indices were shown for both versions of the FKB-6. The reliability indices were similar to those mentioned in previous studies. Our study also revealed, that large discrepancies between the real and an ideal body image are correlated with somatic and body dysmorphic symptoms. Finally, we provided norm values for comparisons of individual scores with the general population. The FKB-6 is a valid and a reliable measure that economizes assessments by clinicians and researchers.
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http://dx.doi.org/10.3389/fpsyg.2020.579783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7736636PMC
December 2020

Retraction Note: Psychometric properties of a short version of the Job Anxiety Scale.

BMC Med Res Methodol 2020 Nov 30;20(1):285. Epub 2020 Nov 30.

Technische Universität Dresden, University Hospital Carl Gustav Carus, Clinic of Psychotherapy and Psychosomatic Medicine, Fetscherstraße 74, 01307, Dresden, Germany.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12874-020-01166-w .
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http://dx.doi.org/10.1186/s12874-020-01166-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702677PMC
November 2020

Effect of acute psychosocial stress on the brain-derived neurotrophic factor in humans - a randomized cross within trial.

Stress 2021 07 10;24(4):442-449. Epub 2020 Dec 10.

Medical Psychology and Medical Sociology, University Medicine Mainz, Mainz, Germany.

The brain-derived neurotrophic factor (BDNF) is involved in the plasticity and development of the central nervous system. Thereby the protein synthesis is highly related to neuronal activity, and its signaling pathways are associated with several substances like, e.g. glucocorticoids, which seem to be able to activate BDNF-Tropomyosin receptor kinase B (TrkB). While there is evidence that acute physical stress can result in advantageous physiological outcomes like an enhanced BDNF level, outcome parameters in response to psychosocial stress are primarily focused on psychological parameters. The existing literature pointing on the impact of acute psychosocial stress on physiological parameters is controversial and differs depending on the species, the stressor used, and the study methodology. It was hypothesized that an acute standardized psychosocial stressor would increase the BDNF level and therefore show beneficial physiological outcome parameters through psychosocial stress. The serum BDNF levels of 32 healthy young males ( = 24.31 years of age,  = 3.35), who performed the Trier Social Stress Test (TSST), were assessed and compared to a control condition. To prove the stress-generating effect of the TSST, additional cortisol levels were measured. Acute psychosocial stress significantly increased the serum BDNF- and the cortisol-level, whereby no alteration was found during the control. This study expands the rare literature focusing on the effect of an acute standardized psychosocial stressor on the BDNF level in healthy humans, including a control condition. Implications for future studies are being discussed.
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http://dx.doi.org/10.1080/10253890.2020.1854218DOI Listing
July 2021

The effect of restrained eating on acute stress-induced food intake in people with obesity.

Appetite 2021 04 21;159:105045. Epub 2020 Nov 21.

Medical Psychology & Medical Sociology, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Mainz, Germany.

Restrained eating, defined as a form of intense dieting or restrictive food intake of specific macronutrients or types of food with sporadic episodes of overeating, results in an increased risk of overweight and obesity. Acute stress situations cause irregular eating patterns and are connected to restrained eating. Therefore, the present study investigates the effect of high/low restrained eating on eating behavior in people with obesity after standardized acute stress induction as well as resting condition. Fifty men and women with obesity (BMI: 33.62 ± 3.93 kg/m) were categorized into high restrained eaters (HRE) and low restrained eaters (LRE). The total energy intake was measured during a standardized laboratory meal after a resting and stress condition (Trier Social Stress Test) on two separate days. HRE and LRE showed differences in the total energy intake in response to acute stress but not after resting condition (F = 9.188, p = .004, η2 = 0.164). Lower total energy intake after stress compared to resting condition could be observed in HRE (t (23) = -2.617, p = .015). LRE showed higher total energy intake after stress than after resting condition (t (25) = 2.155, p = .041). The present data suggest that restrained eating behavior might be an influencing factor for stress-induced eating in obesity. It is highly necessary to understand the association between restrained eating behavior, acute stress and obesity for the improvement of the behavioral intervention of dietary restriction.
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http://dx.doi.org/10.1016/j.appet.2020.105045DOI Listing
April 2021

Cortisol reactivity in social anxiety disorder: A highly standardized and controlled study.

Psychoneuroendocrinology 2021 01 15;123:104913. Epub 2020 Oct 15.

Clinic of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Germany.

In order to understand the psychopathology of the social anxiety disorder (SAD) at the neuroendocrine level, standardized experimental studies on endocrine and physiological markers are necessary, especially since empirical data are still ambiguous. Hence, differences in both, the autonomic nervous system (ANS) and the endocrine stress responses (ACTH, salivary and plasma cortisol) were investigated in a particularly homogenous sample after a standardized stressor (Trier Social Stress Test). The sample consisted of n  = 35 patients with SAD, age, and gender matched to n  = 35 healthy controls (HC). In terms of the heart rate, the response pattern was comparable in both groups. Concerning ACTH, no significant group differences in the response pattern nor in the total output (AUC) were exhibited. Significant differences were noticeable only in the plasma cortisol response pattern with less total output (AUC) in patients suggesting a blunted response. The salivary cortisol response indicated comparable patterns between groups. However, the patients' total output (AUC) was significantly smaller relative to the controls. In sum, evidence for a hypo-responsiveness of the HPA-axis in SAD by means of blood cortisol was observed, with no differences in ACTH between the two groups. This reduced reactivity of the HPA-axis might be associated with an inability to elicit an adequate hormone release, possibly accompanied by an enhanced perception of the stress stimulus. This might be explained by an adaptation of the adrenocortical system due to prolonged repeated stress exposure such as social evaluation.
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http://dx.doi.org/10.1016/j.psyneuen.2020.104913DOI Listing
January 2021

Blood endocannabinoid levels in patients with panic disorder.

Psychoneuroendocrinology 2020 12 6;122:104905. Epub 2020 Oct 6.

Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany.

Background: The development and maintenance of anxiety disorders is not fully understood. There is consensus in the literature that in addition to genetic factors, social, psychological and neurobiological factors are of crucial importance. The present exploratory study investigates the influence of the endocannabinoids (EC) and related N-acylethanolamines (NA) on the maintenance of panic disorder (PD).

Methods: A total of n = 36 PD and n = 26 healthy controls (HC) were included in the study. Baseline characteristics showed no differences between the two groups. The participants were exposed to the Trier Social Stress Test (TSST) for reliable laboratory stress induction. Blood samples were taken during the TSST by an intravenous catheter to examine the endocannabinoid (EC) stress response. Repeated measures ANOVA was conducted to test for main effects of time and group as well as the respective interaction.

Results: Participants with PD consistently had significantly higher EC and NA blood levels than HC. The consistently high EC and NA levels barely showed any reactivity as indicated by a lack of statistical variance. In line with these findings no reaction to the psychosocial stressor TSST could be detected.

Conclusion: Our main results show significant differences in EC concentrations between participants with PD and HC. These findings suggest that an imbalance in the ECS contributes to the maintenance of PD. Increased endocannabinoid levels may have important implications for organic diseases such as cardiovascular disorders. The limitations of the study as well as implications for further investigations are discussed.
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http://dx.doi.org/10.1016/j.psyneuen.2020.104905DOI Listing
December 2020

Perceived Stress Scale (PSS-10) psychometric properties in migrants and native Germans.

BMC Psychiatry 2020 09 11;20(1):450. Epub 2020 Sep 11.

Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.

Background: With the increasing diversity of the German population, it is important to test the psychometric validity and reliability of the German version Perceived Stress Scale (PSS-10) specifically between German natives and residents with a migration background.

Methods: Using nationally representative data (N = 2527), this study conducted an Exploratory Factor Analysis (EFA) to determine the most appropriate factor structure, a Multi-Group Confirmatory Factor Analysis (MGCFA) to compare the validity of the two-factor structure and tested the PSS-10 measurement invariance between the German native and migrant sub-samples. Lastly, reliability of the PSS-10 was examined via Cronbach's alpha, omega and individual item analyses across the two sub-samples.

Results: The EFA results support a two-factor structure in the migrant sample. The MGCFA showed adequate model fit for both sub-samples and the PSS-10 is strict invariant between German natives and migrants. Cronbach's alpha and omega for Perceived Helplessness (PHS: factor 1) and Perceived Self-Efficacy (PSES: factor 2) demonstrate good internal consistency in both German and migrant sub-samples.

Conclusions: The key conclusions are: (1) the German version PSS-10 is suitable for German residents with a migration background. (2) Despite good internal consistency for the total scale, the PSS-10 measures two aspects: (a) perceived helplessness and (b) perceived self-efficacy. Future research would profit from analyzing the two subscales separately, not only using the total score.
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http://dx.doi.org/10.1186/s12888-020-02851-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488568PMC
September 2020

Recalled parental rearing behavior in adult women and men with depressive and anxiety symptoms: Findings from a community study.

Z Psychosom Med Psychother 2020 Sep;66(3):243-258

Department of Psychosomatic Medicine and Psychotherapy University Medical Center of the Johannes Gutenberg University Mainz Germany.

Addressing the lack of population-based data, the purpose of this representative study was to assess sex- and age-specific associations of maternal and paternal rearing behavior with depressiveness and anxiety controlling for sociodemographic and somatic variables. 8,175 subjects participating in a population-based study completed standardized questionnaires measuring Recalled Parental Rearing Behavior and distress. Women recalled their fathers as more controlling and warmer, and their mothers as more rejecting than men. Comparisons between age groups (≤ 60 vs. > 60 years) revealed that younger participants recalled more parental control and emotional warmth. In addition to sociodemographic and somatic risk factors, paternal rejection and maternal control were associated with depressiveness and anxiety both for women and men (OR 1.58-1.96; OR 1.37-1.66). Maternal warmth was negatively related to distress (OR 0.66-0.69). Findings suggested sex- and age-specific differences in recalled maternal and paternal rearing behavior. The current results highlighted the important role of recalled parental rearing behavior besides sociodemographic factors and somatic diseases for the occurrence of depression and anxiety symptoms across the age groups.
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http://dx.doi.org/10.13109/zptm.2020.66.3.243DOI Listing
September 2020
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