Publications by authors named "Stephan Zipfel"

320 Publications

[Twin research in Germany].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021 Oct 15;64(10):1298-1306. Epub 2021 Sep 15.

Innere Medizin VI, Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen, Osianderstr. 5, 72076, Tübingen, Deutschland.

The worldwide development of twin cohorts began after World War II. These cohorts now include around 1.5 million twins, and more than 2748 twin studies have been published between 1950 and 2012. Each year, the number of twin publications increases by another 500 to 1000. The underrepresentation of German twin studies cannot be solely explained by the abuse of medical research under National Socialism. Developing and expanding large twin cohorts is a challenge in terms of both ethics and data protection. However, twin cohorts enable long-term and real-time research on many medical issues and contribute to answer the question of predisposition or environment as possible disease triggers - even after the sequencing of the human genome.There are currently two German twin cohorts: the biomedical cohort HealthTwiSt, with around 1500 pairs of twins, and TwinLife, a sociological-psychological cohort with around 4000 pairs of twins. There are also disease-specific cohorts. The TwinHealth Consortium in the Faculty of Medicine at the University of Tübingen was established in 2016 with the aim of enabling open-ended and sustainable twin research in Tübingen to answer various scientific questions.With the help of systematic literature research and medical history, this article gives an overview of the worldwide development of twin studies and databases over the last 100 years. The example of the Tübingen TwinHealth Initiative illuminates the structure of a twin cohort and its legal, ethical, and data protection aspects.
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http://dx.doi.org/10.1007/s00103-021-03400-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8441034PMC
October 2021

Attitude Matters! How Attitude towards Bariatric Surgery Influences the Effects of Behavioural Weight Loss Treatment.

Obes Facts 2021 14;14(5):531-542. Epub 2021 Sep 14.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.

Introduction: Multidisciplinary obesity services at university hospitals usually treat patients with more complex and severe obesity. In addition, patients with Class 3 obesity, in particular, have different attitudes regarding the choices of therapy.

Methods: This explorative study investigated the effect of patient attitudes towards bariatric surgery on body weight change (primary outcome) and psychological improvement (secondary outcomes: quality of life, depression, anxiety, and eating behaviour) in a 6-month moderate behavioural weight loss (BWL) programme in a university outpatient setting.

Results: 297 patients with mostly Class 3 obesity participated in the programme. The patients did not yet have any indications for bariatric surgery. Of the participants, 37% had a positive attitude towards bariatric surgery (POS), whereas 38% had a negative attitude (NEG). The drop-out rate was 8%. NEG participants lost significantly more body weight than the POS participants (intention-to-treat population: 4.5 [SD: 6.3] kg versus 0.4 [SD: 5.8] kg; p < 0.001). In both subgroups, anxiety, depression, the mental score for quality of life, and eating behaviour improved.

Conclusion: A BWL treatment in a clinical setting identified 2 distinct groups with different attitudes towards bariatric surgery that were associated with different body weight change outcomes. These groups may require differently targeted programmes to achieve the best body weight loss results.
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http://dx.doi.org/10.1159/000517850DOI Listing
September 2021

Patients With Somatoform Disorders Are Prone To Expensive and Potentially Harmful Medical Procedures.

Dtsch Arztebl Int 2021 06;118(25):425-431

Institute of General Practice and Health Services Research, TUM School of Medicine, Klinikumrechts der Isar, Technical University MunichDepartment of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen.

Background: Patients with functional somatic syndromes (FSS) might be prone to potentially harmful medical investigations in ambulatory care. The primary aim was to investigate whether patients with FSS are more likely to undergo diagnostic examinations such as radiography, computed tomography (CT), magnetic reso - nance imaging (MRI), and outpatient surgical procedures. The secondary aim was to evaluate the extent to which coordination of care by primary care physicians reduces healthcare utilization.

Methods: Retrospective cohort study using longitudinal regression analysis of routine data. FSS patients were weighted in the regression model to allow a representative comparison with the Bavarian population. The observation period was from 5 years before until 10 years after the diagnosis of FSS.

Results: The cohort comprised 43 676 patients with FSS and a control group of 50 003 patients without a diagnosis of FSS. The FSS patients exhibited continuously increased healthcare utilization over the 15-year period. The relative risk (RR) for FSS patients was up to 1.48 (95% confidence interval [1.46; 1.50]) for radiography, 2.01 [1.94; 2.08] for CT, 1.91 [1.87; 1.96] for MRI, and 1.30 [1.27; 1.34] for outpatient surgery. Compared with patients whose treatment was coordinated by their primary care physician, patients with no such coordination showed higher service utilization. The ambulatory care costs were up to 1.37 [1.36; 1.38] times greater.

Conclusion: Patients with FSS more frequently undergo potentially harmful and costly diagnostic testing and outpatient surgery. Coordination of care by the primary care physician is associated with lower healthcare utilization.
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http://dx.doi.org/10.3238/arztebl.m2021.0135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381614PMC
June 2021

Impact of Childhood Obesity and Psychological Factors on Sleep.

Front Psychiatry 2021 9;12:657322. Epub 2021 Jul 9.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany.

The aim of the study was to analyze sleep duration and behaviors in relation to psychological parameters in children and adolescents with obesity seeking inpatient weight-loss treatment in comparison to normal-weight children, and whether or not these variables would improve during the time course of treatment. Sixty children or adolescents with overweight and obesity (OBE) and 27 normal-weight (NW) peers (age: 9-17) were assessed for subjective sleep measures through self-reported and parent-reported questionnaires, as well as body weight, body composition, and psychological questionnaires. The OBE participants were assessed upon admission and before discharge of an inpatient multidisciplinary weight-loss program. NW participants' data were collected for cross-sectional comparison. In comparison to NW, children and adolescents with OBE had a shorter self-reported sleep duration and had poorer sleep behaviors and more sleep-disordered breathing as reported by their parents. No change in sleep measures occurred during the inpatient treatment. Psychological factors including higher anxiety, depression, and destructive-anger-related emotion regulation were moderate predictors for unfavorable sleep outcomes, independent of weight status. Children with obesity had less favorable sleep patterns, and psychological factors influenced sleep in children, independent of weight. More research is needed on the relationship and direction of influence between sleep, psychological factors, and obesity, and whether they can be integrated in the prevention and management of childhood obesity and possibly also other pediatric diseases.
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http://dx.doi.org/10.3389/fpsyt.2021.657322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298750PMC
July 2021

Medical education in times of COVID-19: survey on teachers' perspectives from a German medical faculty.

GMS J Med Educ 2021;38(5):Doc93. Epub 2021 Jun 15.

University Hospital Tuebingen, Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany.

Clinicians in their role as teachers and medical faculties were struggling to address the medical students' needs regarding their medical education in times of COVID-19. They were especially confronted with several challenges regarding what medical training should look like and how to transfer medical training to integrate relevant skills like interpersonal or practical competencies. This study aimed to investigate the teachers' perspectives on medical education and COVID-19 in general, including their distress level. This quantitative questionnaire study was distributed online among responsible lecturers of medical training at the Medical Faculty of Tuebingen. Teachers answered questions about the medical training, COVID-19 in general (on a seven point- Likert scale from "not at all" to "completely") and their mental well-being (STAI). Descriptive data analysis and t-tests were performed. The teachers reported being significantly (p<.01) more distressed regarding the medical training (=4.63, =1.24) in comparison to their private lives (=3.58, =1.38) or the clinical context (=3.33, =1.95). They also felt significantly less informed about the medical training in times of COVID-19 (p<.001). They wished for more support and information from their medical faculty. When teachers were asked which teaching should be implemented in future, they reported the most the online lectures (87.5%), followed by collaborative working (75.5%), live broadcast (62.5%) and online chats (58.3%). Teachers also saw the current situation of COVID-19 as a chance for a digital transformation of the medical education (=5.92, =0.95). Teachers of the Medical Faculty of Tuebingen saw online-based teaching formats as a chance to meet the medical students' needs regarding the medical education. Video-based formats like online lecturers and online chats with teachers might play a relevant role in order to impart knowledge. Furthermore, medical students should also be taught in digital formats like telehealth, including patient-physician distance interactions.
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http://dx.doi.org/10.3205/zma001489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256125PMC
August 2021

Illness perception and health care use in individuals with irritable bowel syndrome: results from an online survey.

BMC Fam Pract 2021 07 19;22(1):154. Epub 2021 Jul 19.

Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.

Background: Individual illness perception is known to influence a range of outcome variables. However, little is known regarding illness perception in irritable bowel syndrome (IBS) and its relation to the use of the health care system. This study hypothesised a relationship between illness perception and inappropriate health care use (under-, over- and misuse).

Methods: An internet-based, cross-sectional study in participants affected by IBS symptoms was carried out (April - October 2019) using open questions as well as validated standardized instruments, e.g. the illness perception questionnaire revised (IPQ-R) and its subscales. Sub-group comparisons were done non-parametrically and effect sizes were reported. Potential predictors of (1) conventional health care utilisation and (2) utilisation of treatment approaches with lacking or weak evidence regarding effectiveness in IBS were examined with logistic regression analyses and reported as odds ratio (OR) and 95% confidence interval.

Results: Data from 513 individuals were available. More than one-third (35.7%) of participants were classified as high utilisers (> 5 doctor visits during the last year). Several indicators of inappropriate health care use were detected, such as a low proportion of state-of-the-art gynaecological evaluation of symptoms (35.0% of women) and a high proportion of individuals taking ineffective and not recommended non-steroidal antirheumatic drugs for IBS (29.4%). A majority (57.7%) used treatment approaches with lacking or weak evidence regarding the effectiveness in IBS (e.g. homeopathy). Being a high utiliser as defined above was predicted by the perceived daily life consequences of IBS (IPQ-R subscale "consequences", OR = 1.189 [1.100-1.284], p ≤ 0.001) and age (OR = 0.980 [0.962-0.998], p = 0.027). The use of treatment approaches with lacking or weak evidence was forecasted by the perceived daily life consequences (OR = 1.155 [1.091-1.223], p ≤ 0.001) and gender (reference category male: OR = 0.537 [0.327-0.881], p = 0.014), however effect sizes were small.

Conclusions: Daily life consequences, perceived cure and personal control as aspects of individual disease perception seem to be related to individuals' health care use. These aspects should be a standard part of the medical interview and actively explored. To face inappropriate health care use patients and professionals need to be trained. Interdisciplinary collaborative care may contribute to enhanced quality of medical supply in IBS.
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http://dx.doi.org/10.1186/s12875-021-01499-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287688PMC
July 2021

Diminished prefrontal cortex activation in patients with binge eating disorder associates with trait impulsivity and improves after impulsivity-focused treatment based on a randomized controlled IMPULS trial.

Neuroimage Clin 2021 19;30:102679. Epub 2021 Apr 19.

Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Germany. Electronic address:

Background: Behavioral and cognitive control are vital for healthy eating behavior. Patients with binge eating disorder (BED) suffer under recurrent binge eating episodes accompanied by subjective loss of control that results, among other factors, from increased impulsivity.

Methods: In the current study, we investigated the frontal network using functional near-infrared spectroscopy (fNIRS) during a food specific go/nogo task to assess response inhibition in 24 patients with BED (BMI range 22.6-59.7 kg/m) compared to 12 healthy controls (HC) (BMI range 20.9-27 kg/m). Patients with BED were invited to undergo fNIRS measurements before an impulsivity-focused cognitive behavioral group treatment, directly after this treatment and 3 months afterwards. As this was a planned subgroup analysis of the randomized controlled IMPULS trial, patients with BED were randomized either to the treatment group (n = 14) or to a control group (n = 10). The treatment group received 8 weekly sessions of the IMPULS treatment.

Results: We found a significant response inhibition effect (nogo minus go), in terms of an increased oxygenated hemoglobin response in the bilateral prefrontal cortex in both groups. The greatest response was observed when participants were instructed to go for healthy and withhold their response to unhealthy high caloric food cues. The healthy nogo condition failed to show a significant prefrontal inhibitory response, which was probably related to the task design, as the condition was considered more demanding. BED patients, especially those with higher trait impulsivity, showed a weaker activation of the prefrontal cortex during response inhibition, predominantly in the right hemisphere. Interestingly, three months after the treatment, patients of the treatment group increased their right prefrontal cortex activity during response inhibition. Likewise, increased prefrontal cortex activation correlated with decreased trait impulsivity after treatment.

Conclusions: Our results suggest that patients with BED have limited resources to activate the prefrontal cortex when asked to inhibit a reaction onto food-specific stimuli. However, this effect could be partly driven by differences in BMI between the HC and BED group. Cognitive-behavioral therapy targeting impulsive eating behavior may improve prefrontal cortex recruitment during response inhibition.
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http://dx.doi.org/10.1016/j.nicl.2021.102679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102655PMC
July 2021

The Role of Dishware Size in the Perception of Portion Size in Children and Adolescents with Obesity.

Nutrients 2021 Jun 16;13(6). Epub 2021 Jun 16.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany.

Purpose: The influence of dishware on portion size perception in children and adolescents is inconclusive. This study investigated how children and adolescents with both obesity and a normal weight perceived portion size in different sized and shaped dishware items.

Methods: The study included 60 children and adolescents with overweight and obesity (OBE) and 27 children and adolescents with normal weight (NW) aged from 9 to 17 years. The participants estimated quantities in three pairs of drinking glasses, one pair of bowls and two pairs of plates which varied in size and shape. The children were instructed to state intuitively which portion they would choose for big or small thirst/hunger. Thereafter they were asked to determine the exact amount by answering which dishware item contained the larger/smaller portion (cognitive evaluation).

Results: There were no substantial differences in the intuitive evaluation of portion sizes between OBE and NW. During the cognitive evaluation, OBE estimated the amount of water in the glasses more correctly compared to NW (61% vs. 43%; = 0.008); OBE estimated the amount of lentils in the bowls and on the plates significantly less correctly (39%) compared to NW (56%; = 0.013).

Conclusions: Habit formation and environmental stimuli might play a greater role in estimating food amounts in dishware than the child's and adolescent's body weight.
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http://dx.doi.org/10.3390/nu13062062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235649PMC
June 2021

The Role of Dishware Size in the Perception of Portion Size in Children and Adolescents with Obesity.

Nutrients 2021 Jun 16;13(6). Epub 2021 Jun 16.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany.

Purpose: The influence of dishware on portion size perception in children and adolescents is inconclusive. This study investigated how children and adolescents with both obesity and a normal weight perceived portion size in different sized and shaped dishware items.

Methods: The study included 60 children and adolescents with overweight and obesity (OBE) and 27 children and adolescents with normal weight (NW) aged from 9 to 17 years. The participants estimated quantities in three pairs of drinking glasses, one pair of bowls and two pairs of plates which varied in size and shape. The children were instructed to state intuitively which portion they would choose for big or small thirst/hunger. Thereafter they were asked to determine the exact amount by answering which dishware item contained the larger/smaller portion (cognitive evaluation).

Results: There were no substantial differences in the intuitive evaluation of portion sizes between OBE and NW. During the cognitive evaluation, OBE estimated the amount of water in the glasses more correctly compared to NW (61% vs. 43%; = 0.008); OBE estimated the amount of lentils in the bowls and on the plates significantly less correctly (39%) compared to NW (56%; = 0.013).

Conclusions: Habit formation and environmental stimuli might play a greater role in estimating food amounts in dishware than the child's and adolescent's body weight.
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http://dx.doi.org/10.3390/nu13062062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235649PMC
June 2021

Long Haulers-What Is the Evidence for Post-COVID Fatigue?

Front Psychiatry 2021 21;12:677934. Epub 2021 May 21.

Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany.

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http://dx.doi.org/10.3389/fpsyt.2021.677934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175784PMC
May 2021

Longitudinal Changes in Posttraumatic Stress Disorder After Resettlement Among Yazidi Female Refugees Exposed to Violence.

JAMA Netw Open 2021 May 3;4(5):e2111120. Epub 2021 May 3.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.

Importance: Posttraumatic stress disorder (PTSD) is highly prevalent among refugees surviving mass atrocities, especially among women. Longitudinal studies investigating factors associated with PTSD course are essential to enable adequate treatment yet widely lacking.

Objective: To identify longitudinal changes in PTSD severity and posttraumatic coping among severely traumatized female refugees as well as risk and protective factors for PTSD course.

Design, Setting, And Participants: This prospective cohort study took place in 14 German cities in the context of a humanitarian admission program that resettled 1000 especially vulnerable women and children from northern Iraq to Germany. Approximately 400 adult beneficiaries of the humanitarian admission program were eligible for the study. At baseline, a total of 116 of the 400 beneficiaries (29.0%) participated, with 96 (82.8%) of these women participating in the follow-up assessment. The study included a baseline assessment conducted 2 years after resettlement (September 1, 2017, to January 12, 2018) and a 1-year follow-up (August 29, 2018, to January 15, 2019).

Exposures: Violence and/or captivity during the 2014 genocide in northern Iraq by the so-called Islamic State.

Main Outcomes And Measures: Posttraumatic stress disorder severity and coping strategies were assessed in interpreter-aided interviews using the Impact of Event Scale-Revised.

Results: A total of 116 women (mean [SD] age, 32.2 [8.2] years; 115 [99.1%] Yazidi; 1 [0.9%] Christian) participated at baseline. According to the Impact of Event Scale-Revised, a high PTSD severity was found (mean [SD] raw sum score, 60.88 [15.75] of 88, with higher scores indicating greater distress), with no significant change over time. Helpful coping strategies included prayer, belief in collective strength, and belief in personal strength. Earlier symptoms of intrusions (β = 0.389, P = .007) and longer captivity (β = 0.218, P = .02) were identified as being associated with PTSD severity 1 year later. Longer captivity was associated with PTSD aggravation over time (β = 0.227, P = .04). Posttraumatic strengthening in faith (β = -0.206, P = .05) and in social relationships (β = -0.221, P = .03) were associated with a reduction in PTSD symptoms.

Conclusions And Relevance: These findings suggest that female refugee survivors of genocide are at high risk for severe and chronic PTSD beyond the initial years of resettlement. The findings provide suggestions for mental health care specialized for particularly vulnerable populations.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.11120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164098PMC
May 2021

Mental Health Applications for Primary and Secondary Prevention of Common Mental Disorders: Attitudes of German Employees.

Front Psychiatry 2021 4;12:508622. Epub 2021 May 4.

Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany.

Web-based and mobile mental health applications for the prevention and treatment of common mental disorders (CMDs) are on the rise. Under certain circumstances they have proved to be effective for a range of conditions (e.g., depression). There is not sufficient evidence regarding the benefits and barriers especially for mobile phone apps and for programs in the field of primary prevention. Studies on the acceptance of potential users of mental health apps yielded mixed outcomes. In a large survey we investigated the attitudes of employees toward mental health apps and various traditional mental health services. Our main research question in this contribution focuses on the acceptance of apps compared to other measures and the moderating influence of individual characteristics. The standardized survey was completed by members of an online access panel with different job types. A set of 33 self-developed items, including three questions on e-health, captured the perceived relevance of prevention at the (A) occupational, (B) individual, and (C) societal level. On the basis of an exploratory factor analysis, mean scores for mapping seven (sub-)dimensions were constructed and compared using the Wilcoxon test. The influence of potential predictors was analyzed in linear regression models. The data of 610 respondents were analyzed (response rate 75%). Support from mental health applications was rated significantly less important compared to all other dimensions at the levels (A) to (C). Respondents were more likely to use mental health apps if they felt literate with electronic devices, perceived a high relevance of work-related demands as causal factors for CMDs, stated they would be ashamed of having a CMD, and would be willing to begin psychotherapy if recommended. The results confirm the critical attitudes of potential mental health app users found in other studies. Since users with a negative attitude toward e-health might have a higher risk for dropout and non-adherence as well as lower intervention effects, well-designed educational strategies should be carried out beforehand.
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http://dx.doi.org/10.3389/fpsyt.2021.508622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130826PMC
May 2021

Specialized post-inpatient psychotherapy for sustained recovery in anorexia nervosa via videoconference - study protocol of the randomized controlled SUSTAIN trial.

J Eat Disord 2021 May 19;9(1):61. Epub 2021 May 19.

Department of Psychosomatic Medicine und Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.

Background: A major barrier to long-term recovery from anorexia nervosa (AN) are early and frequent relapses after inpatient treatment. There is an urgent need for enhanced continuity of specialized care involving effective aftercare interventions and relapse prevention strategies in order to improve the long-term outcome for patients with AN.

Methods: SUSTAIN is a multi-center, prospective, randomized-controlled trial investigating the efficacy of a novel post-inpatient aftercare intervention for patients with AN as compared to optimized treatment-as-usual (TAU-O). The SUSTAIN aftercare intervention is based on the cognitive-interpersonal maintenance model of AN and specifically tailored to achieve sustained recovery in AN following inpatient treatment. The SUSTAIN aftercare intervention comprises 20 treatment sessions over eight months and will be predominantly delivered via videoconference to overcome discontinuity of care. TAU-O refers to routine outpatient psychotherapy as generally offered in the German health care system. A total number of 190 patients receiving inpatient or day-hospital treatment for AN will be randomized and assessed over a 14-month period following randomization including a 6 months follow-up. Minimum Body Mass Index (BMI) is 15 kg/m at trial inclusion. The primary efficacy endpoint is the change in BMI between baseline (T0) and end of treatment (T2) adjusted for baseline BMI. Key secondary outcomes comprise eating disorder and general psychopathology, quality of life, proportion of relapse and of weight restoration, and cost-effectiveness.

Discussion: The results of the present trial will provide evidence if the novel aftercare intervention fosters sustained recovery in patients affected by severe courses of AN.

Trial Registration: The SUSTAIN trial was prospectively registered on November 18, 2020, under the registration number DRKS00023372 at the German Clinical Trials Register ( https://www.drks.de/drks_web/ ) which is an acknowledged primary register of the World Health Organization ( http://apps.who.int/trialsearch/ ). Protocol version: 1.2.
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http://dx.doi.org/10.1186/s40337-021-00416-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132489PMC
May 2021

Eating behaviour and symptom trajectories in patients with a history of binge eating disorder during COVID-19 pandemic.

Eur Eat Disord Rev 2021 07 6;29(4):657-662. Epub 2021 May 6.

Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.

Objective: A history of an eating disorder (ED) might constitute a risk for symptom deterioration and relapse during COVID-19 pandemic. This longitudinal study investigates ED symptom trajectories until the first COVID-19 lockdown in Spring 2020 in patients with a history of binge eating disorder (BED).

Method: Participants of the randomised-controlled BED treatment trial IMPULS participated in a re-assessment directly after the first COVID-19 lockdown in Germany. We used expert-rated clinical interviews and self-report to investigate binge eating (BE) frequency, ED and general psychopathology, distress, emotion regulation and sense of coherence. Symptom trajectories were analysed for baseline when entering the trial, end of trial participation and the time point directly after lockdown. BE frequency was assessed on a recall basis for 4 weeks directly before lockdown and 4 weeks during lockdown.

Results: BE frequency, general ED pathology and depressive symptoms markedly increased after as compared to before the COVID-19 outbreak. Individuals scoring high on reappraisal as emotion regulation strategy and sense of coherence scored lower on general ED pathology.

Conclusion: Individuals with a history of an ED are at risk for symptom deterioration and relapse during the pandemic. Intervention and service dissemination strategies are needed to support vulnerable groups throughout the pandemic.
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http://dx.doi.org/10.1002/erv.2837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206923PMC
July 2021

Food-related impulsivity assessed by longitudinal laboratory tasks is reduced in patients with binge eating disorder in a randomized controlled trial.

Sci Rep 2021 04 15;11(1):8225. Epub 2021 Apr 15.

Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany.

Food-related impulsivity, i.e. a food-related attentional bias proposed to be due to increased reward sensitivity and diminished inhibitory control, has been cross-sectionally associated with binge eating disorder. To analyze changes in food-related impulsivity, we implemented longitudinal analyses of objective laboratory tasks in a randomized controlled trial called IMPULS. Patients who attended an impulsivity-focused group intervention (IG N = 31) and control patients who did not take part in the intervention (CG N = 25) were compared before (T0) and after the intervention period (T1) and at three months follow-up (T2). Patients' impulsive gaze behavior towards food vs. neutral stimuli was measured in two eye tracking paradigms, one addressing reward sensitivity and another addressing inhibitory control. Initial fixations of food vs. neutral stimuli were increased at T0 (IG: p = .014, CG: p = .001), but not at T1 and T2 in IG (T1: p = .178, T2: p = .203) and in CG after Bonferroni correction only at T2 (T1: p = .031, T2: p = .002). Patients from IG increased dwell time on neutral stimuli at T1 contrary to patients from CG (p = .016) and rated the presented food stimuli as less positive (e.g. pleasantness p < .001 at T1 and T2). A possible explanation for this observation is reduced reward sensitivity, which implies a short-term treatment effect. Both groups showed improvement in inhibiting eye movements towards food and neutral stimuli over time (i.e. first saccade errors overall p < .001, second saccade errors overall p < .003). This could indicate increased inhibitory control due to training effects from the study paradigm. The results suggest that food-related impulsivity represents an underlying mechanism of BED and that it is modifiable by cognitive behavioral interventions.
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http://dx.doi.org/10.1038/s41598-021-87231-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050257PMC
April 2021

Barriers to Behavior Change in Parents With Overweight or Obese Children: A Qualitative Interview Study.

Front Psychol 2021 26;12:631678. Epub 2021 Mar 26.

Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany.

Overweight and obesity among children and adolescents are global problems of our time. Due to their authority and role modeling, parents play an essential part in the efficacy of prevention and intervention programs. This study assessed the barriers that parents of overweight/obese children face in preventive and interventional health care utilization. Sixteen parents were qualitatively interviewed. A content analysis was performed, and barriers to change were allocated to their stage of change according to the transtheoretical model. Among the main barriers is the underestimation of health risks caused by overweight/obesity in association with diminished problem awareness. Parents seem not necessarily in need of theoretical knowledge for prevention and interventions. They do however need support in evaluating the weight status of their child and the knowledge of whom to turn to for help as well as specific and hands-on possibilities for change. The results extend past studies by adding specific barriers to change that parents commonly experience. Possibilities to address these barriers, e.g., through trainings at the pediatric practice or adoption of conversation techniques, are discussed. Future studies might identify subgroups experiencing specific barriers and thus be able to address these in an individualized way.
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http://dx.doi.org/10.3389/fpsyg.2021.631678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034266PMC
March 2021

The impact of maternal eating disorders on breastfeeding practices: a systematic review.

Arch Womens Ment Health 2021 10 8;24(5):693-708. Epub 2021 Apr 8.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076, Tübingen, Germany.

Breastfeeding is an effective way to protect and promote the health of the infant and mother. Cultural, social, economic, medical, or psychological factors might interfere with successful breastfeeding. Therefore, maternal eating disorders (EDs) may have detrimental effects on the decision of breastfeeding initiation and on its continuation. There is limited knowledge about the breastfeeding practices of mothers with EDs. We performed a systematic review to generate more evidence in this area. A search was conducted in PubMed and PsycINFO, and several journals were hand searched for relevant publications. Of N = 3904 hits, 13 full texts were included in the qualitative analysis. The findings on total duration of BF between mothers with and without EDs were mixed, but women with EDs showed more negative experiences and emotional problems during BF. There was not enough evidence to conclude on breastfeeding initiation, or on the duration of exclusive breastfeeding. Maternal EDs might have a negative impact on BF practices with possible negative effects on the maternal-child feeding environment. Further studies with comparable data and information on the women's partners' attitudes about breastfeeding are needed.
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http://dx.doi.org/10.1007/s00737-021-01103-wDOI Listing
October 2021

Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review.

J Eat Disord 2021 Mar 18;9(1):38. Epub 2021 Mar 18.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany.

Background: An extensive amount of research has underlined the potential role of impulsivity in the development and maintenance of binge eating behaviour. Food-related impulsivity has particularly received attention given its close relationship with overeating and binge eating episodes. Besides the available evidence, our understanding regarding the effectiveness of treatment modalities for binge eating targeting impulsivity and related constructs (e.g., food craving, inhibitory control, and reward sensitivity) is limited. Thus, this systematic review aimed to investigate whether binge eating behaviour is changeable by interventions that are impulsivity-focused and food-related and whether one of these interventions is superior to the others.

Method: A search on PubMed and PsycINFO was performed for relevant articles published up to September 2020. Studies delivering food-related impulsivity treatment to individuals suffering from binge eating episodes and including a control condition without this treatment were investigated. Following the search, 15 studies meeting the eligibility criteria were analysed.

Results: Analyses revealed that available impulsivity-focused approaches can be categorised as psychotherapy, pharmacotherapy, computer-assisted cognitive training, and direct neuromodulation interventions. Regarding their effectiveness, it appeared that all of these approaches might be promising to change food-related impulsivity in individuals with binge eating episodes, particularly to decrease binge eating symptoms. However, a superior intervention approach in this early state of evidence could not be determined, although food-related cue exposure, transcranial direct current stimulation, and the combination of several interventions seem fruitful.

Conclusion: Efforts to treat binge eating behaviour with interventions focusing on food-related impulsivity appear to be promising, particularly concerning binge eating frequency, and also for food craving and inhibitory control. Given limited research and varying methods, it was not possible to conclude whether one impulsivity-focused intervention can be considered superior to others.
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http://dx.doi.org/10.1186/s40337-021-00384-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977597PMC
March 2021

Optimising care pathways for adult anorexia nervosa. What is the evidence to guide the provision of high-quality, cost-effective services?

Eur Eat Disord Rev 2021 May 24;29(3):306-315. Epub 2021 Feb 24.

Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBERobn, Barcelona, Spain.

The aim of this paper is to consider how changes in service planning and delivery might improve the care pathways for adult anorexia nervosa. Although anorexia nervosa has a long history in Europe, its framing as a mental disorder is quite recent. The changing forms and increasing epidemiology of eating disorders has led to the expansion of specialised services. Although some services provide care over the entire clinical course, more often services are divided into those that care for children and adolescents or adults. The transition needs to be carefully managed as currently these services may have a different ethos and expectations. Services for adults have a broad range of diversity (diagnostic subtype, medical severity, comorbidity, stage of illness and psychosocial functioning) all of which impacts on prognosis. A tailored, approach to treatment planning could optimise the pathway. Facilitating early help seeking and rapid diagnosis in primary care and reducing specialised services waiting lists for assessment and treatment could be a form of secondary prevention. The use of precision models and /or continuous outcome monitoring might reduce the third of patients who require more intensive care by applying augmentation strategies. Finally, gains from intensive care might be sustained by relapse prevention interventions and community support to bridge the transition home. Together these measures might reduce the proportion of patients (currently a third) with ill health for over 20 years. For this group rehabilitation strategies may improve functioning until new treatment emerge.
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http://dx.doi.org/10.1002/erv.2821DOI Listing
May 2021

[Patient Empowerment in Times of an Increasingly Digitalized Medicine].

Psychother Psychosom Med Psychol 2021 Jan 17;71(1):7-8. Epub 2021 Feb 17.

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http://dx.doi.org/10.1055/a-1255-7697DOI Listing
January 2021

Motivation-Enhancing Psychotherapy for Inpatients With Anorexia Nervosa (MANNA): A Randomized Controlled Pilot Study.

Front Psychiatry 2021 1;12:632660. Epub 2021 Feb 1.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.

Patients with anorexia nervosa (AN) are frequently characterized by an unstable readiness to change and high ambivalence toward treatment. Enhancing readiness to behavioral change therefore plays an essential role for adherence to treatment especially for severely ill patients treated in inpatient settings. Therefore, a novel 10 week program for the individual psychotherapy sessions was designed using elements from motivational interviewing to be applied within the multidisciplinary inpatient treatment for patients with AN. In a randomized controlled pilot trial, = 22 patients with AN received either the new intervention or treatment as usual in one of two recruiting university hospitals. Readiness to change, eating disorder pathology, therapeutic alliance as well as acceptance and feasibility of the new intervention were measured from patients and therapists in week 1, 5, and 10 of inpatient treatment. Results confirm acceptance and feasibility of the MANNA intervention as evaluated by patients as well as therapists. Patients receiving the new intervention completed their inpatient treatment significantly more often on regular terms than patients receiving treatment as usual. No differences between the groups could be found concerning therapeutic alliance during and at the end of treatment and readiness to change. Absolute numbers of BMI increase indicate a larger increase in the intervention group albeit not significant in this pilot study sample. Limitations of the study such as the small sample size as well as possible adaptions and advancements of the intervention that need to be examined in a larger clinical trial of efficacy are discussed. This phase II study is registered with the German Clinical Trials Register (DRKS) under the trial number DRKS00015639.
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http://dx.doi.org/10.3389/fpsyt.2021.632660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882628PMC
February 2021

Body Image Disturbances and Weight Bias After Obesity Surgery: Semantic and Visual Evaluation in a Controlled Study, Findings from the BodyTalk Project.

Obes Surg 2021 Apr 6;31(4):1625-1634. Epub 2021 Jan 6.

Department of Medicine, University of Padova, Padova, Italy.

Purpose: Body image has a significant impact on the outcome of obesity surgery. This study aims to perform a semantic evaluation of body shapes in obesity surgery patients and a group of controls.

Materials And Methods: Thirty-four obesity surgery (OS) subjects, stable after weight loss (average 48.03 ± 18.60 kg), and 35 overweight/obese controls (MC), were enrolled in this study. Body dissatisfaction, self-esteem, and body perception were evaluated with self-reported tests, and semantic evaluation of body shapes was performed with three specific tasks constructed with realistic human body stimuli.

Results: The OS showed a more positive body image compared to HC (p < 0.001), higher levels of depression (p < 0.019), and lower self-esteem (p < 0.000). OS patients and HC showed no difference in weight bias, but OS used a higher BMI than HC in the visualization of positive adjectives (p = 0.011). Both groups showed a mental underestimation of their body shapes.

Conclusion: OS patients are more psychologically burdened and have more difficulties in judging their bodies than overweight/obese peers. Their mental body representations seem not to be linked to their own BMI. Our findings provide helpful insight for the design of specific interventions in body image in obese and overweight people, as well as in OS.
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http://dx.doi.org/10.1007/s11695-020-05166-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012323PMC
April 2021

Weight bias and linguistic body representation in anorexia nervosa: Findings from the BodyTalk project.

Eur Eat Disord Rev 2021 Mar 30;29(2):204-215. Epub 2020 Nov 30.

Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.

Objective: This study provides a comprehensive assessment of own body representation and linguistic representation of bodies in general in women with typical and atypical anorexia nervosa (AN).

Methods: In a series of desktop experiments, participants rated a set of adjectives according to their match with a series of computer generated bodies varying in body mass index, and generated prototypic body shapes for the same set of adjectives. We analysed how body mass index of the bodies was associated with positive or negative valence of the adjectives in the different groups. Further, body image and own body perception were assessed.

Results: In a German-Italian sample comprising 39 women with AN, 20 women with atypical AN and 40 age matched control participants, we observed effects indicative of weight stigmatization, but no significant differences between the groups. Generally, positive adjectives were associated with lean bodies, whereas negative adjectives were associated with obese bodies.

Discussion: Our observations suggest that patients with both typical and atypical AN affectively and visually represent body descriptions not differently from healthy women. We conclude that overvaluation of low body weight and fear of weight gain cannot be explained by generally distorted perception or cognition, but require individual consideration.
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http://dx.doi.org/10.1002/erv.2812DOI Listing
March 2021

Medical education in times of COVID-19: German students' expectations - A cross-sectional study.

PLoS One 2020 18;15(11):e0241660. Epub 2020 Nov 18.

Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.

Background: Since the COVID-19 pandemic has affected the education of medical students, medical faculties have faced the challenge of adapting instruction to digital platforms. Although medical students are willing to support pandemic response efforts, how the crisis will affect their medical training remains uncertain. Thus, in this study, we investigated the teaching- and learning-related stressors and expectations of medical students in Germany during the COVID-19 pandemic.

Methods: A cross-sectional survey was distributed online to undergraduate medical students at medical faculties in Germany. Students answered questions about COVID-19 and teaching (on a 7-point Likert scale from 0 ("not at all") to 6 ("completely")) and completed mental well-being measurements, including the State-Trait Anxiety Inventory (STAI), the Generalised Anxiety Disorder scale (GAD-7) and the Perceived Health Questionnaire (PHQ-9). Descriptive data analysis, a t-test and Pearson correlations were performed to process the data.

Results: Medical students felt well-informed about COVID-19 in general (M = 5.64, SD = 1.28) and in the medical context (M = 5.14, SD = 1.34) but significantly less informed about the pandemic in the academic context, M = 2.47, SD = 1.49, t(371) = 31.98, p < .001. Their distress levels were high (STAI: M = 45.12, SD = 4.73) and significantly correlated with the academic context (rp = .164, p < .01) but not their private lives. Concerning how they were taught, they most often expected online lectures (91.7%) and live broadcasts (67.2%) and less often expected innovative digital teaching strategies, including serious games (17.3%) and virtual-reality exercises (16.7%).

Discussion: Medical students seem to be aware of the COVID-19 pandemic and its consequences for academic and healthcare contexts. They also seem to think that their teachers will enhance their digital competencies during the pandemic. Therefore, faculties of medicine need to rapidly and adequately digitalise their approaches to teaching.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241660PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673791PMC
December 2020

Effectiveness and cost-effectiveness of an electronic mindfulness-based intervention (eMBI) on maternal mental health during pregnancy: the mindmom study protocol for a randomized controlled clinical trial.

Trials 2020 Nov 17;21(1):933. Epub 2020 Nov 17.

Universitätsklinikum Heidelberg Frauenklinik, Heidelberg, Germany.

Background: Mental disorders are common during the peripartum period and may have far-reaching consequences for both mother and child. Unfortunately, most antenatal care systems do not provide any structured screening for maternal mental health. As a consequence, mental illnesses are often overlooked and not treated adequately. If correctly diagnosed, cognitive behavioral therapy is currently the treatment of choice for mental illnesses. In addition, mindfulness-based interventions (MBIs) seem to represent a promising treatment option for anxiety and depression during the peripartum period. Considering the internet's increasing omnipresence, MBIs can also be offered electronically via a (tablet) computer or smartphone (electronically based MBI = eMBI).

Objective: The current study aims to examine the clinical effectiveness and cost-effectiveness of an eMBI (the mindmom application) developed by an interdisciplinary team of gynecologists, psychologists, and midwives, teaching pregnant women how to deal with stress, pregnancy-related anxiety, and depressive symptoms. The study sample consists of pregnant women in their third trimester who screened positive for emotional distress. The mindmom study is a bicentric prospective randomized controlled trial (RCT), which is currently conducted at the University women's hospitals of Heidelberg and Tübingen, Germany.

Methods: Within the scope of the routine prenatal care, pregnant women attending routine pregnancy care in Baden-Wuerttemberg, Germany, are invited to participate in a screening for mental distress based on the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS screening result > 9 will be referred to one of the mindmom coordinating study centers and are offered counseling either face-to-face or via videotelephony. After an initial psychological counseling, women are invited to participate in an eMBI in their last pregnancy trimester. The study will enroll N = 280 study participants (N = 140 per group), who are randomized 1:1 into the intervention (IG) or control group (treatment as usual = TAU). All participants are requested to complete a total of 7 digital assessments (5 visits pre- and 2 follow-up visits postpartum), involving self-report questionnaires, sociodemographic and medical data, physiological measures, and morning cortisol profiles. The primary outcome will be depressive and anxiety symptoms, measured by the Edinburgh Postnatal Depression Scale, the State Trait Anxiety Questionnaire, and the Pregnancy-Related Anxiety Questionnaire. Secondary outcomes include mindfulness, satisfaction with birth, quality of life, fetal attachment, bonding, mode of delivery, and cost-effectiveness.

Discussion: This is the first German RCT to examine the (cost-)effectiveness of an eMBI on maternal mental health during pregnancy. If successful, the mindmom app represents a low-threshold and cost-effective help for psychologically distressed women during pregnancy, thereby reducing the negative impact on perinatal health outcome.

Trial Registration: Deutsches Register Klinischer Studien, German Clinical Trials Register DRKS00017210 . Registered on 13 January 2020. Retrospectively registered.
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http://dx.doi.org/10.1186/s13063-020-04873-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672841PMC
November 2020

Unmet Supportive Care Needs Among Women With Breast and Gynecological Cancer: Relevance of Attachment Anxiety and Psychological Distress.

Front Psychol 2020 21;11:558190. Epub 2020 Oct 21.

Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital, Essen, University of Duisburg-Essen, Essen, Germany.

Objective: Attachment anxiety and avoidance are known risk factors for the development of unmet needs and poor well-being among patients with chronic diseases. Few studies have addressed this in individuals with cancer. We aimed to explore the relationship between supportive care needs, attachment styles and distress in women with breast and gynecological cancer.

Methods: Using a cross-sectional paper-pencil ( = 157) and online survey ( = 614), a total of 771 patients with breast or gynecological cancer completed a set of validated questionnaires. From September 2013 to January 2014, consecutive inpatients and outpatients of the university hospital Tuebingen were included in the study. Further, participants were recruited through social media, patient internet platforms, self-help group leaders and patient networks. We used the Supportive Care Needs Survey (SCNS-SF-34) with the need dimensions: health system, patient care, psychological, physical, and sexual needs, as well as the Experiences in Close Relationships-Revised Questionnaire, and the Distress Thermometer. A multiple linear regression model was used to analyze the influence of attachment styles (anxiety and avoidance) on the SCNS-SF-34 dimensions. A moderation analysis was used to explore the influence of the interaction between attachment anxiety and distress for all SCNS-SF-34 dimensions.

Results: Attachment anxiety was a significant determinant and led to higher unmet supportive care needs in all dimensions, whereas attachment avoidance was not significant. Distress did moderate the relationship between attachment anxiety and psychological and health system needs and led to a higher unmet needs development. For the other SCNS-SF-34 dimensions, distress was not confirmed as a moderator.

Conclusion: Our findings highlight attachment anxiety as a risk factor for the development of unmet supportive care needs and potentially impaired psychological adjustment to cancer. Further studies are needed to elucidate the interactions between attachment styles, distress and supportive care needs among cancer patients.
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http://dx.doi.org/10.3389/fpsyg.2020.558190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609386PMC
October 2020

Medical identity; perspectives of students from two countries.

BMC Med Educ 2020 Nov 10;20(1):420. Epub 2020 Nov 10.

Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany.

Background: The development of professional identity is a fundamental element of medical education. There is evidence that in Germany, students' perceptions of the ideal and real doctor differ, and that of themselves as physicians falls between these constructs. We sought to compare students' perceptions of themselves, the ideal doctor, and the 'real' doctor and investigate differences from first to final year in the relationships between these constructs, as well as differences between Australian and German cohorts.

Method: Students in the first and final years of their medical program at one Australian and one German university were invited to complete the Osgood and Hofstatter polarity profile, involving the description of their mental image of the ideal and real doctor, and the doctor they hope to become, with adjectives provided.

Results: One hundred sixty-seven students completed the survey in Australia (121 year 1, 46 year 5) and 188 in Germany (164 year 1, 24 year 6). The perception of the ideal doctor was consistent across all respondents, but that of the real doctor and self-image differed between country and year. Differences existed between country cohorts in perceptions of 'confidence', 'strength', 'capability' and 'security'.

Conclusions: The pattern previously reported among German students was maintained, but a different pattern emerged among Australian students. Differences between countries could reflect cultural differences or variations in the overt and hidden curricula of medical schools. Some of the constructs within the profiles are amenable to educational interventions to improve students' confidence and sense of capability.
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http://dx.doi.org/10.1186/s12909-020-02351-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654572PMC
November 2020

Effects of Bariatric Surgery on Depression: Role of Body Image.

Obes Surg 2021 04 22;31(4):1864-1868. Epub 2020 Oct 22.

Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.

Background: It has been suggested that psychosocial functioning improves after bariatric surgery, but the mechanism of this effect remains unclear. We propose that body image mediates the association between %EWL and improvement in depressive symptoms.

Materials And Methods: To investigate this hypothesis, we conducted a mediation analysis in longitudinal data from 52 patients after LSG.

Results: %EWL had no direct effect on depressive symptoms as assessed through the patient health questionnaire (PHQ-9), but a small indirect effect that was mediated through negative evaluation of the body (BIQ-20).

Conclusions: We interpret this observation in the context of complex individual etiologies of obesity and argue for a stronger focus on psychological interventions in aftercare regimes. This may be specifically relevant for patients with eating disorders or a desire for body contouring surgery.
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http://dx.doi.org/10.1007/s11695-020-05057-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012322PMC
April 2021

Care providers' views on burden of psychosomatic symptoms of IS-traumatized female refugees participating in a Humanitarian Admission Program in Germany: A qualitative analysis.

PLoS One 2020 5;15(10):e0239969. Epub 2020 Oct 5.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.

Background: Traumatized refugees often suffer from diverse psychosomatic symptoms. Female Yazidi refugees from Northern Iraq who survived attacks of the so-called "Islamic State" were brought to Germany to receive special medical and psychotherapeutic treatment in a unique worldwide humanitarian admission program (HAP). Here, we report on their psychosomatic symptoms and helpful strategies from the perspective of care providers.

Methods: Care providers (N = 84) in this HAP were interviewed in an individual setting as well as in focus groups to gather information about the HAP beneficiaries' psychosomatic symptoms. Data analysis followed Qualitative Content Analysis by Mayring.

Results: The care providers reported five main psychological burdens of the Yazidis: 1) insecurity regarding loss, 2) worries about family members, 3) ambivalence about staying in Germany or returning to Iraq, 4) life between two worlds and 5) re-actualization of the traumatic experiences. The predominant psychological symptoms the care providers noticed were fear, depressive symptoms, feelings of guilt, and sleep and eating disorders. Regarding somatic symptoms, the care providers mainly received complaints about pain in the head, back, chest and stomach. Helpful strategies for providing adequate health care were care providers' cooperating with physicians, precise documentation of beneficiaries' symptoms, and additional support in directing the beneficiaries through the health care system. Regarding psychotherapy, interpreters help to overcome language barriers, onsite psychotherapy, flexible therapy appointments, psychoeducational methods, time for stabilization, and support in coping with daily life aspects. In the care providers' experience, psychotherapists have to build a relationship of trust. After grief therapy, a trauma-specific therapy in a culturally adapted way is possible.

Conclusion: The HAP is a unique model health care program to offer highly traumatized refugees medical and psychological help. Care providers reported on several (psycho-)somatic symptoms of the traumatized women. The strategies the HAP care providers perceived as helpful can be recommended for similar projects in the future.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239969PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535032PMC
November 2020

The effectiveness of health-oriented leadership interventions for the improvement of mental health of employees in the health care sector: a systematic review.

Int Arch Occup Environ Health 2021 Feb 4;94(2):203-220. Epub 2020 Oct 4.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.

Purpose: An increasing prevalence of work-related stress and employees' mental health impairments in the health care sector calls for preventive actions. A significant factor in the workplace that is thought to influence employees' mental health is leadership behavior. Hence, effective leadership interventions to foster employees' (leaders' and staff members') mental health might be an important measure to address this pressing issue.

Methods: We conducted a systematic review according to the PRISMA statement (Liberati et al. 2009) and systematically searched the following databases: PubMed (PMC), Web of Science, PsycINFO (EBSCOhost), EconLit (EBSCOhost), and Business Source Premier (EBSCOhost). In addition, we performed a hand search of the reference lists of relevant articles. We included studies investigating leadership interventions in the health care sector that aimed to maintain/foster employees' mental health.

Results: The systematic search produced 11,221 initial search hits in relevant databases. After the screening process and additional literature search, seven studies were deemed eligible according to the inclusion criteria. All studies showed at least a moderate global validity and four of the included studies showed statistically significant improvements of mental health as a result of the leadership interventions.

Conclusions: Based on the findings, leadership interventions with reflective and interactive parts in group settings at several seminar days seem to be the most promising strategy to address mental health in health care employees. As the available evidence is limited, efforts to design and scientifically evaluate such interventions should be extended.
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http://dx.doi.org/10.1007/s00420-020-01583-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532985PMC
February 2021
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