[Show abstract][Hide abstract] ABSTRACT: Background:
Studies have shown that dementia and cognitive impairment can increase mortality, but less is known about the association between subjectively perceived cognitive deficits (subjective cognitive decline, SCD) and mortality risk.
In this study, we analyzed mortality in non-demented individuals with SCD in a general population sample aged 75+ years.
Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+). We used the Kaplan-Meier survival method to estimate survival times of individuals with and without SCD and multivariable Cox proportional hazards regression to assess the association between SCD and mortality risk, controlled for covariates.
Out of 953 non-demented individuals at baseline, 117 (12.3%) expressed SCD. Participants with SCD showed a significantly higher case-fatality rate per 1,000 person-years (114.8, 95%CI = 90.5-145.7 versus 71.7, 95%CI = 64.6-79.5) and a significantly shorter mean survival time than those without (5.4 versus 6.9 years, p < 0.001). The association between SCD and mortality remained significant in the Cox analysis; SCD increased mortality risk by about 50%(adjusted Hazard Ratio = 1.51) during the study period. Besides SCD, older age, male gender, diabetes mellitus, stroke, and lower global cognitive functioning were also significantly associated with increased mortality.
Our findings suggest an increased mortality risk in non-demented older individuals with SCD. Even though further studies are required to analyze potential underlying mechanisms, subjective reports on cognitive deficits may be taken seriously in clinical practice not only for an increased risk of developing dementia and AD but also for a broader range of possible adverse health outcomes.
[Show abstract][Hide abstract] ABSTRACT: The desire for social distance towards individuals with obesity as part of the stigmatization process has not been investigated. The aims of this study include: (a) determining the prevalence of social distance and its domains in a population-based sample; (b) reporting levels of emotional response; and (c) investigating the association of BMI, emotional response and social distance. The data were derived from a large population based telephone survey in Germany (total n = 3,003, this sub-sample n = 1008). Emotional response to individuals with obesity was assessed for the emotions discomfort, pity, insecurity, amusement, sympathy, help and incomprehension (5-point Likert scale). Social distance was measured on a 5-point Likert scale covering different areas of social interaction. This served as the dependent variable for a linear regression model and mediation models that included BMI and emotional response. Social distance was highest for job recommendation, introduction to a friend, someone with obesity marrying into the family and renting out a room. Means of emotional responses were highest for pity (Mean = 2.58), sympathy (Mean = 2.87) and wanting to help (M = 2.76). In regression analyses, incomprehension (b = 1.095, p < 0.001) and sympathy (b = −0.833, p < 0.001) and the respondents' own BMI (b = −0.145, p < 0.001) were significantly associated to the overall amount of social distance. Mediation models revealed a significant mediation effect of BMI through sympathy (b = −0.229, % of total effect through mediation = 10.3%) and through incomprehension (b = −0.057, % of total effect through mediation = 27.5%) on social distance.
Social Science & Medicine 03/2015; 128. DOI:10.1016/j.socscimed.2015.01.002 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Alcohol use in adolescents constitutes a major public health concern. Europe is the heaviest drinking
region of the world. Several school-based alcohol prevention programs have been developed but it is not clear whether they are really effective. The present study was aimed at identifying the typology with the best evidence of effectiveness in European studies. Methods: A systematic search of meta-analyses and/or randomized controlled trials (RCTs) on interventions school-based prevention programs aimed at preventing alcohol consumption or changing the attitudes to consume alcohol. Results: A meta-analysis published in 2011 and 12 RCTs more recently published were identified. The meta-analysis evaluated 53 RCTs but only 11.3% of them were conducted in Europe. Globally, 23 RCTs (43.4%) showed some evidence of effectiveness, and 30 RCTs (56.6%) did not find significant difference between the groups. According to the conclusions of the meta-analysis, the Unplugged program should be considered as a practice option in Europe. Among the other 12 RCTs, 42% were conducted in Europe. Globally, 7 studies (58.3%) achieved positive results, and 5 studies (41.7%) did not find significant differences or produced a mixed pattern of results. Three of the 5 European trials (60%) used the Unplugged program with positive results. Conclusion: Even if further studies should be conducted to confirm these results, Unplugged appears to be the prevention project with the best evidence of effectiveness in European studies.
Clinical Practice and Epidemiology in Mental Health 03/2015; 11((Suppl 1: M6)):102-112. DOI:10.2174/1745017901511010102
[Show abstract][Hide abstract] ABSTRACT: The acquisition of social and emotional skills is associated with positive youth development, character education, healthy lifestyle behaviours, reduction in depression and anxiety, conduct disorders, violence, bullying, conflict, and anger. School-based interventions aimed to enhance these skills go beyond a problem-focused approach to embrace a more positive view of health; they could also improve the youth's wellbeing.
To describe the main features and to establish the effectiveness of universal school-based RCTs for children and the youth, aimed to promote their psychosocial wellbeing, positive development, healthy lifestyle behaviours and/or academic performance by improving their emotional and social skills.
Systematic review by searching for relevant papers in PubMed/Medline with the following key words: "mental health" OR "wellbeing" OR "health promotion" OR "emotional learning" OR "social learning" OR "emotional and social learning" OR "positive youth development" OR "life skills" OR "life skills training" AND "school". Interval was set from January 2000 to April 2014.
1,984 papers were identified through the search. Out of them 22 RCTs were included. While most interventions were characterized by a whole-school approach and SAFE practices, few studies only used standardized measures to assess outcomes, or had collected follow-up data after ≥ 6 months. The results of all these trials were examined and discussed.
Universal school-based RCTs to enhance emotional and social skills showed controversial findings, due to some methodological issues mainly. Nevertheless they show promising outcomes that are relatively far-reaching for children and youth wellbeing and therefore are important in the real world.
Clinical Practice and Epidemiology in Mental Health 03/2015; 11((Suppl 1: M2)):21-40. DOI:10.2174/1745017901511010021
[Show abstract][Hide abstract] ABSTRACT: Background:
This study aims to examine the public's attitudes and predictors of social distance towards women afflicted by eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) under specific consideration of the respondents' sex. Eating disorders are still often seen as a women's health issue, and those afflicted remain stigmatized in Western societies. The concept of social distance is a frequently used indicator in awareness campaigns. Sex-specific results could add important information to destigmatization programs.
Data originate from a German telephone survey which was conducted in 2011. Vignettes with signs and symptoms either suggestive of AN or BN were presented to the respondents randomly, who subsequently answered questions regarding beliefs about causes, contact to persons afflicted as well as desire for social distance. Stratified multiple linear regression analyses according to disorder under study were performed to examine associations between different predictors and desire for social distance.
There were significant sex differences in desire for social distance, causal attributions, and emotional reactions towards women with eating disorders. E.g., with respect to AN, women exhibited a significantly greater desire for social distance than men (p<.001), and more frequently believed that AN could be caused by sexual abuse during childhood. Regarding predictors of social distance, there was a significant positive association between age and desire for social distance equally among men and women. However, distinct sex differences came into effect concerning other predictors depending on the eating disorder under study. In BN, attribution of brain disease emerged as significant predictor of social distance among men. This is not true for women, where the attribution of weak will significantly predicted the desire for social distance.
Sex-dependent differences in attitudes and predictors of social distance towards females afflicted should be met with tailored measures in anti-stigma campaigns, addressing women and men on different levels.
[Show abstract][Hide abstract] ABSTRACT: Purpose of the study is to investigate helpseeking
preferences of the Sardinian public in case of
depression. A telephone survey was conducted among the
adult population, using quota sampling (N = 1,200).
Respondents were presented with a vignette depicting a
person with symptoms of major depressive disorder, followed
by a fully structured interview. Psychologists were
most frequently selected as source of professional help,
followed by psychiatrists and G.P.s. Residents of small
towns more frequently recommended mental health professionals
than city residents. Public help-seeking preferences
reflect the availability of services, beliefs about the
appropriate treatment of depression and attitudes towards
those providing it.
Administration and Policy in Mental Health and Mental Health Services Research 10/2014; DOI:10.1007/s10488-014-0604-y · 3.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the current classifications of mental illnesses (World Health Organization 1990, American Psychiatric Association 1994, American Psychiatric Association 2013), diagnoses are made by describing the symptoms of a clinical picture regardless of potential causes of the disease. Such a “descriptive approach” was introduced more than 40 years ago to overcome inconsistencies due to divergent causal interpretations of the same disorder in the different psychiatric schools. In fact, in the 1970s the famous UK/USA study had shown that the high frequency of schizophrenia and low frequency of affective disorders among mental hospital admissions in New York compared to those in London were largely due to the different psychiatric background influencing the practice of diagnosis (Cooper et al. 1971). What an American psychiatrist with a psychoanalytic education called schizophrenia was likely to be defined by a British psychiatrist as a manic-depressive psychosis (Gurland et al. 1972). ...
Culture Medicine and Psychiatry 10/2014; 39(1). DOI:10.1007/s11013-014-9411-x · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Alcohol dependence is among the most severely stigmatized mental disorders. We examine whether negative stereotypes and illness beliefs related to alcohol dependence have changed between 1990 and 2011.
We used data from two population surveys with identical methodology that were conducted among German citizens aged ≥18 years, living in the 'old' German states. They were conducted in 1990 and 2011, respectively. In random subsamples (1990: n = 1,022, and 2011: n = 1,167), identical questions elicited agreement with statements regarding alcohol dependence, particularly with regard to the illness definition of alcohol dependence and blame.
Overall, agreement with negative stereotypes did not change in the course of 2 decades. About 55% of the respondents agreed that alcohol dependence is an illness like any other, >40% stated that it was a weakness of character and 30% endorsed that those affected are themselves to blame for their problems.
It is apparent that promoting an illness concept of alcohol dependence has not been an easy solution to the problem of stigma. We discuss how the normative functions of alcohol dependence stigma might have prevented a reduction of negative stereotypes.
European Addiction Research 10/2014; 20(6):293-299. DOI:10.1159/000362407 · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Post-traumatic stress disorder (PTSD) should be one of the most preventable mental disorders, since many people exposed to traumatic experiences (TEs) could be targeted in first response settings in the immediate aftermath of exposure for preventive intervention. However, these interventions are costly and the proportion of TE-exposed people who develop PTSD is small. To be cost-effective, risk prediction rules are needed to target high-risk people in the immediate aftermath of a TE. Although a number of studies have been carried out to examine prospective predictors of PTSD among people recently exposed to TEs, most were either small or focused on a narrow sample, making it unclear how well PTSD can be predicted in the total population of people exposed to TEs. The current report investigates this issue in a large sample based on the World Health Organization (WHO)'s World Mental Health Surveys. Retrospective reports were obtained on the predictors of PTSD associated with 47,466 TE exposures in representative community surveys carried out in 24 countries. Machine learning methods (random forests, penalized regression, super learner) were used to develop a model predicting PTSD from information about TE type, socio-demographics, and prior histories of cumulative TE exposure and DSM-IV disorders. DSM-IV PTSD prevalence was 4.0% across the 47,466 TE exposures. 95.6% of these PTSD cases were associated with the 10.0% of exposures (i.e., 4,747) classified by machine learning algorithm as having highest predicted PTSD risk. The 47,466 exposures were divided into 20 ventiles (20 groups of equal size) ranked by predicted PTSD risk. PTSD occurred after 56.3% of the TEs in the highest-risk ventile, 20.0% of the TEs in the second highest ventile, and 0.0-1.3% of the TEs in the 18 remaining ventiles. These patterns of differential risk were quite stable across demographic-geographic sub-samples. These results demonstrate that a sensitive risk algorithm can be created using data collected in the immediate aftermath of TE exposure to target people at highest risk of PTSD. However, validation of the algorithm is needed in prospective samples, and additional work is warranted to refine the algorithm both in terms of determining a minimum required predictor set and developing a practical administration and scoring protocol that can be used in routine clinical practice.
World psychiatry: official journal of the World Psychiatric Association (WPA) 10/2014; 13(3):265-274. DOI:10.1002/wps.20150 · 14.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
It is unclear whether different biogenetic causal beliefs affect stigmatization of mentally-ill patients differently. It has been argued that in particular believing in a ‘chemical imbalance’ as a cause of mental disorder might be associated with more tolerant attitudes.
In a representative population survey in Germany (n=3642), using unlabelled case vignettes of persons with depression, schizophrenia, or alcohol dependence, we elicited agreement with three different biogenetic explanations of the illness: ‘Chemical imbalance of the brain’, ‘brain disease’ and ‘heredity’. We further investigated emotional reactions as well as the desire for social distance. For each vignette condition we calculated linear regressions with each biogenetic explanation as independent and emotional reactions as well as social distance as dependent variable controlling for socio-demographic variables.
Our cross-sectional study does not allow statements regarding causality and the explanatory power of our statistical models was low.
‘Chemical imbalance of the brain’ and ‘brain disease’ were both associated with a stronger desire for social distance in schizophrenia and depression, and with more social acceptance in alcohol dependence, whereas ‘heredity’ was not significantly associated with social distance in any of the investigated illnesses. All three biogenetic causal beliefs were associated with more fear in all three illnesses.
Our study corroborates findings that biogenetic explanations have different effects in different disorders, and seem to be harmful in depression and schizophrenia. A particular de-stigmatizing potential of the causal belief ‘chemical imbalance’ could not be found. Implications for useful anti-stigma messages are discussed.
[Show abstract][Hide abstract] ABSTRACT: Background and objectives:
Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments.
During face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment.
1860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR = 1.8; 95%CI 1.3-2.5), panic (OR = 1.4; 95%CI 1.0-2.0), generalized anxiety (OR = 1.3; 95%CI 1.1-1.7), specific phobia (OR = 1.3; 95%CI 1.1-1.6); post-traumatic stress (OR = 1.5; 95%CI 1.1-1.9); binge eating (OR = 1.8; 95%CI 1.2-2.9) and alcohol abuse (OR = 1.5; 95%CI 1.1-2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21).
A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.
Journal of Psychiatric Research 09/2014; DOI:10.1016/j.jpsychires.2014.09.007 · 3.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
In this study, we aimed to analyze the association between new—incident—subjective memory complaints (SMC) and risk of subsequent dementia in a general population sample aged 75+ years.Method
Data were derived from follow-up (FUP) waves I-V of the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). We used the Kaplan-Meier survival method to estimate dementia-free survival times of individuals with and without incident SMC and multivariable Cox proportional hazards regression to assess the association between incident SMC and risk of subsequent dementia, controlled for covariates.ResultsOf 443 non-demented individuals, 58 (13.1%) developed dementia during a subsequent 5.4-year follow-up period. Participants with incident SMC showed a significantly higher progression to dementia (18.5% vs. 10.0%; P = 0.010) and a significantly shorter mean dementia-free survival time than those without (6.2 vs. 6.8 years; P = 0.008). The association between incident SMC and risk of subsequent dementia remained significant in the multivariable Cox analysis (adjusted hazard ratio = 1.8; P = 0.028).Conclusion
Our findings suggest higher progression to dementia and shorter dementia-free survival in older individuals with incident SMC. These findings support the notion that such subjective complaints should be taken seriously in clinical practice as possible early indicators of incipient dementia.
[Show abstract][Hide abstract] ABSTRACT: Background:
Alcohol dependence is a severely stigmatized disorder. Perceived stigma may deter help-seeking and is associated with higher co-morbidity and self-stigma in persons with alcohol dependence. We assess changes in the perception of alcohol-related stigma over 21 years in the general population.
Two representative population surveys using identical methodology were conducted in Germany in 1990 and 2011 (n=1022 and n=967), eliciting the perceived discrimination and devaluation of someone with a history of alcohol problems as measured with an adoption of Link's Perceived Discrimination and Devaluation Scale (aPDDS), and perceived negative stereotypes of an "alcoholic."
Both on item level and using factor scores, attitudes changed significantly between 1990 and 2011. Perceived discrimination and devaluation of someone with a history of alcohol dependence decreased considerably by 0.44 standard deviations (SD). Perceived negative stereotypes related to unpredictability of an "alcoholic" increased slightly by 0.15 SD, while perceived stereotypes related to strangeness decreased (-0.23 SD).
Our findings suggest that particularly the image of someone who has received treatment for alcohol dependence has improved in Germany. This parallels increasing acceptance of professional treatment for alcohol dependence among the general population over the last twenty years, and contrasts with overall unchanged negative attitudes toward persons who actually suffer from alcohol problems.
Drug and Alcohol Dependence 08/2014; DOI:10.1016/j.drugalcdep.2014.07.033 · 3.42 Impact Factor