Norbert Schmitz

McGill University, Montréal, Quebec, Canada

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Publications (171)505.19 Total impact

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    ABSTRACT: The problems of obesity and depression in type 2 diabetes mellitus are well documented, yet the role of weight cycling in relation to these 2 chronic conditions has not been examined. The study objective was to determine whether weight cycling predicts the development of depressive symptoms in the course of 1 year.
    Canadian Journal of Diabetes 07/2014; · 0.46 Impact Factor
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    ABSTRACT: Interventions aimed at influencing specific pathways to care may reduce the duration of untreated psychosis (DUP). The purpose of this study was to reduce delay in referral to an early intervention service following first contact for help seeking for psychosis in a defined urban catchment area.
    Social Psychiatry and Psychiatric Epidemiology 06/2014; · 2.86 Impact Factor
  • Diabetes care. 06/2014; 37(6):e146-7.
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    ABSTRACT: To examine the association between physical inactivity and anxiety symptoms in a community-based sample of men and women with type 2 diabetes mellitus.
    Canadian Journal of Diabetes 05/2014; · 0.46 Impact Factor
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    ABSTRACT: The aim of this study was to assess differences in cardiovascular risk and performance of self-care activities in people who rated their diabetes control as good or poor.A sub-sample of 77 participants who took part in the Evaluation of Diabetes Treatment telephone interview were invited into a clinic to complete a series of laboratory examinations. Self-rated diabetes control was validated using the following laboratory markers: HbA1c, total cholesterol/HDL cholesterol ratio and LDL cholesterol. Differences in blood pressure and BMI were also assessed. Finally, all participants also completed the Summary of Self-Care activities questionnaire.Those people who rated their diabetes control as fair or poor had a significantly higher BMI, HbA1c levels, total cholesterol/HDL-cholesterol ratio and systolic blood pressure. When asked about self-care activities in the past week, those people who reported their diabetes control was fair/poor had spent significantly fewer days following a general diet and exercising.People with poor self-rated diabetes control have unfavourable cardiovascular risk and decreased performance of self-care activities.
    Experimental and Clinical Endocrinology & Diabetes 03/2014; · 1.56 Impact Factor
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    ABSTRACT: To investigate the stability and longitudinal association between depression and smoking status within a community sample with type-2 diabetes, while controlling for socio-demographic and disease related variables. Adults with type-2 diabetes were recruited and agreed to be followed-up via random digit dialing for the Montreal Diabetes Health Study (DHS). At baseline, 1618 individuals were classified as never, former, light (≤10 cigarettes a day) and moderate-heavy (11+ cigarettes a day); Depression was assessed using the Patient Health Questionnaire-9 and individuals were classified as none vs. depression syndrome. Generalized Estimating Equations were used to test the association between depression syndrome and current smoking status, while controlling for other demographic and health related variables. Prevalence rates of smoking and depression showed mild-substantial agreement over time; Depression syndrome was significantly associated with moderate-heavy smoking in the fully adjusted model using cross-sectional (all 4 waves, OR = 1.46, 95% CI 1.08-1.99, p < 0.05) and longitudinal (controlling for depression at baseline; OR = 1.54, 95% CI 1.02-2.31, p < 0.05) data. Smoking and depression prevalence rates appear to be stable over time in our community sample with type-2 diabetes. Moderate-heavy smoking is strongly associated with elevated depression, both in cross-sectional and longitudinal models; persistent moderate-heavy smokers may are at increased risk of both physical and mental health complications. This burden is even greater for those with type-2 diabetes.
    Journal of Diabetes 02/2014; · 2.94 Impact Factor
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    ABSTRACT: This realist review seeks to elucidate the modifiable causal pathways through which neighborhoods affect depressive symptoms in adult populations. Studies were identified using Medline, PubMed, PsycInfo, Geobase, and Web of Science databases, and chosen using reproducible selection criteria and systematic critical appraisal. A total of 14 longitudinal studies, published between 2003 and 2011, were included. Eleven of the articles observed a significant relationship between depression and at least one of the following neighborhood-level variables: neighborhood deprivation, disorder, instability, and social ties. Proposed modifiable pathways linking neighborhood characteristics and depression include: (1) the level of neighborhood-based stress that is placed on individuals, (2) the formation and strength of protective and supportive social networks, (3) the level of resiliency to negative affectivity and stress, (4) the perceptions of the esthetic and form of residential space, and (5) the sense of control and agency in place of residence. These pathways represent potential areas for future research and intervention. Further research requires a more systematic use of longitudinal design and a diversity of physical and social environmental measures. Interventions aimed at improving affective resiliency need to be tested.
    Social Psychiatry 01/2014; · 2.05 Impact Factor
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    ABSTRACT: Prediction algorithms are useful for making clinical decisions and for population health planning. However, such prediction algorithms for first onset of major depression do not exist. The objective of this study was to develop and validate a prediction algorithm for first onset of major depression in the general population. Longitudinal study design with approximate 3-year follow-up. The study was based on data from a nationally representative sample of the US general population. A total of 28 059 individuals who participated in Waves 1 and 2 of the US National Epidemiologic Survey on Alcohol and Related Conditions and who had not had major depression at Wave 1 were included. The prediction algorithm was developed using logistic regression modelling in 21 813 participants from three census regions. The algorithm was validated in participants from the 4th census region (n=6246). Major depression occurred since Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-diagnostic and statistical manual for mental disorders IV. A prediction algorithm containing 17 unique risk factors was developed. The algorithm had good discriminative power (C statistics=0.7538, 95% CI 0.7378 to 0.7699) and excellent calibration (F-adjusted test=1.00, p=0.448) with the weighted data. In the validation sample, the algorithm had a C statistic of 0.7259 and excellent calibration (Hosmer-Lemeshow χ(2)=3.41, p=0.906). The developed prediction algorithm has good discrimination and calibration capacity. It can be used by clinicians, mental health policy-makers and service planners and the general public to predict future risk of having major depression. The application of the algorithm may lead to increased personalisation of treatment, better clinical decisions and more optimal mental health service planning.
    Journal of epidemiology and community health 01/2014; · 3.04 Impact Factor
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    ABSTRACT: Objectif Examiner le lien entre l’inactivité physique et les symptômes de l’anxiété d’un échantillon d’hommes et de femmes de la population générale ayant le diabète sucré de type 2. Méthodes Les critères d’admissibilité comprenaient les résidents du Québec, au Canada, âgés de 40 à 75 ans, ayant un diagnostic de diabète de type 2 (≤ 10 ans) et étant insulino-naïfs, qui avaient participé à une précédente enquête par téléphone sur les traitements du diabète. Parmi les 2028 répondants admissibles, 1953 (96,3 %) répondants qui avaient fourni des détails sur les symptômes d’anxiété ont été inclus dans cette analyse. Les participants ont été interviewés et ont fourni des renseignements sur les facteurs cliniques et sociodémographiques liés au diabète. Résultats Un total de 27,3 % des participants ont rapporté être inactifs physiquement. La prévalence des symptômes d’anxiété légère à grave était de 22,9 %. Les personnes qui avaient des symptômes d’anxiété légère et des symptômes d’anxiété modérée à grave étaient respectivement 1,4 fois et 1,7 fois plus susceptibles de rapporter être inactives que les personnes n’ayant pas de symptômes d’anxiété. Les analyses en sous-groupes selon le sexe révélaient que les femmes qui avaient des symptômes d’anxiété légère étaient 1,5 fois plus susceptibles de rapporter être inactives que les femmes qui n’avaient pas de symptômes d’anxiété, tandis que les hommes qui avaient des symptômes d’anxiété modérée à grave étaient 2,5 fois plus susceptibles d’être inactifs que les hommes qui n’avaient pas de symptômes d’anxiété. Conclusions Les symptômes d’anxiété dans la fourchette légère et dans la fourchette modérée à grave représentent une comorbidité clinique pertinente chez les personnes ayant le diabète de type 2, et les hommes pourraient représenter un sous-groupe particulièrement vulnérable. D’autres recherches sont recommandées pour évaluer davantage le lien entre les symptômes d’anxiété et les comportements de santé liés au diabète.
    Canadian Journal of Diabetes 01/2014; · 0.46 Impact Factor
  • Kimberley J. Smith, Norbert Schmitz
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    ABSTRACT: Objective There is a well-documented association between depression and disability in people with diabetes. However less is known about the possible association of co-occurring anxiety on these associations. The objective of this study was to assess the association of elevated anxiety and/or depression symptoms with functional disability and frequent disability days in a community sample with type 2 diabetes. Methods Participants were 1,999 people with diabetes who completed the baseline portion of the Evaluation of Diabetes Treatment study. Functional disability was assessed using the World Health Organisation Disability Assessment Schedule II. Frequent disability days were assessed using a cutoff of ≥ 14 on a question assessing past month functional disability from the Healthy Days Core Module. Depression and Anxiety were assessed with the Patient Health Questionnaire and General Anxiety Questionnaire with cutoffs of ≥ 10 applied to create groups. Additional questions examined diabetes complications, chronic conditions and sociodemographic characteristics. Results Fully-adjusted logistic regression analyses demonstrated an increased likelihood of reporting functional disability for all groups with high anxiety and/or depressive symptoms. Groups with high depressive symptoms with and without high anxiety symptoms were also more likely to report frequent disability days. Conclusions Results indicate that elevated anxiety and depression symptoms are important factors associated with increased functional disability and frequent disability days in people with diabetes.
    Psychosomatics 01/2014; · 1.73 Impact Factor
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    ABSTRACT: Objectives : Raised levels of C-reactive protein (CRP), an inflammatory biomarker, and depressive symptoms are both independently linked to risk of diabetes. The purpose of this study was to assess the joint association of CRP and depressive symptomatology with diabetes incidence in a representative sample of English people ≥ 50 years old. Method : Data were from the English Longitudinal Study of Ageing, a prospective study of community-dwelling older adults. The sample was comprised of 4955 participants without self-reported doctor-diagnosed diabetes at baseline. High CRP level was dichotomized as > 3 mg/L. Elevated depressive symptomatology was defined as ≥ 4 using the 8-item Center for Epidemiologic Studies Depression Scale. Incident diabetes was determined based on newly self-reported doctor-diagnosed diabetes. Cox proportional hazard regressions were used to examine the association between CRP and depressive symptoms with incidence of type 2 diabetes. Results : During approximately 63.2 months of follow-up, 194 participants reported diabetes diagnosis. After adjustment for socio-demographics, lifestyle behaviours, clinical factors, and BMI, the hazard ratio for diabetes was 1.63 (95% CI 0.88-3.01) for people with elevated depressive symptoms only, 1.43 (95% CI 0.99-2.07) for people with high CRP only, and 2.03 (95% CI 1.14-3.61) for people with both high CRP and elevated depressive symptoms. Conclusion : The presence of both high CRP levels and elevated depressive symptoms was associated with risk of diabetes. Further investigation into this relationship could aid in understanding the mechanisms underlying inflammation, depression, and diabetes.
    Journal of Psychosomatic Research. 01/2014;
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    ABSTRACT: OBJECTIVE To evaluate the association between recurrent subthreshold depressive episodes and functioning in a prospective community sample of people with type 2 diabetes.RESEARCH DESIGN AND METHODSA prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n=1064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (PHQ-9). Functioning (WHODAS-II) and health related quality of life (CDC unhealthy days) at four and five years follow up assessment were the outcome measures.RESULTSNearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/ impaired health related quality was nearly three times higher (RR=2.86) for participants with four subthreshold depressive episodes compared to participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/ impaired health related quality increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, p<0.001).CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.
    Diabetes care 11/2013; · 7.74 Impact Factor
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    ABSTRACT: Background There exists very little evidence to guide clinical management for preventing recurrence of major depression. The objective of this study was to develop and validate a prediction algorithm for recurrence of major depression. Methods Wave 1 and wave 2 longitudinal data from the U.S. National Epidemiological Survey on Alcohol and Related Condition (2001/2002–2003/2004) were used. Participants with a major depressive episode at baseline and who had visited health professionals for depression were included in this analysis (n = 2,711). Mental disorders were assessed based on the DSM-IV criteria. ResultsWith the development data (n = 1,518), a prediction model with 19 unique factors had a C statistics of 0.7504 and excellent calibration (P = .23). The model had a C statistics of 0.7195 in external validation data (n = 1,195) and 0.7365 in combined data. The algorithm calibrated very well in validation data. In the combined data, the 3-year observed and predicted risk of recurrence was 25.40% (95% CI: 23.76%, 27.04%) and 25.34% (95% CI: 24.73%, 25.95%), respectively. The predicted risk in the 1st and 10th decile risk group was 5.68% and 60.21%, respectively. Conclusions The developed prediction model for recurrence of major depression has acceptable discrimination and excellent calibration, and is feasible to be used by physicians. The prognostic model may assist physicians and patients in quantifying the probability of recurrence so that physicians can develop specific treatment plans for those who are at high risk of recurrence, leading to personalized treatment and better use of resources.
    Depression and Anxiety 11/2013; · 4.61 Impact Factor
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    ABSTRACT: To investigate the association between receiving workplace accommodations and the 1-year risk of mood/anxiety disorders. A general population sample of employees in Alberta, Canada, with a prior or current mental disorder (N = 715) was observed for 1 year. Mental disorders were determined on the basis of the Diagnostic and Statistical Manual, 4th revision, criteria. In participants who needed but did not receive any accommodations, 30.8% had a mood/anxiety disorder 1 year later. Receiving needed accommodations was associated with a lowered risk of 24.5%. Logistic regression showed that the percentage of having accommodation needs met was significantly associated with the risk of a mental disorder 1 year later (odds ratio = 0.27; 95% confidence interval = 0.11 to 0.65). Receiving needed accommodations was associated with better outcomes for mental disorders. Studies are needed to confirm the effectiveness of specific accommodations for enhancing the prognosis of mood/anxiety disorders.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 10/2013; · 1.88 Impact Factor
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    ABSTRACT: The reciprocal relationship between depression and functioning in people with chronic conditions is poorly understood. The aim of the present study was to analyze the dynamic relationship between depression and functioning in a community sample of people with diabetes. Participants with diabetes were assessed at baseline and three yearly follow-up assessments (n = 1,403). Depression was assessed using the Patient Health Questionnaire. Global functioning was assessed using the World Health Organization Disability Assessment Schedule II. Path analysis suggested a reciprocal relationship between depression and functioning. Baseline depression was associated with functioning at 3 years follow-up through depression and functioning at 1 and 2 years follow-up assessments. Depression and functioning might interact with each other in a dynamic way: depression at one assessment point might predict poor functioning at the next assessment point, which in turn might predict depression at the next assessment point. This should be taken into account in both treatment and research programs.
    Annals of Behavioral Medicine 09/2013; · 4.20 Impact Factor
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    ABSTRACT: The study purpose was to examine the association between changes in depressive symptoms and changes in lifestyle-related indicators among adults with type 2 diabetes. A longitudinal survey was conducted among individuals with type 2 diabetes in Quebec. The sample consisted of 1183 subjects who responded to the baseline and 1-year follow-up telephone interviews, with complete data for depressive symptoms (Patient Health Questionnaire 9). Regression models were used to determine associations between changes in depressive symptoms and changes in lifestyle-related indicators (physical activity, body mass index (BMI)) and, perception-related indicators (control of body weight and of amount of food eaten). After 1 year, 136 subjects (11.5%) developed depression (major or minor), 118 (10%) remained depressed, 829 (70%) remained not depressed and 100 (8.5%) reverted to not depressed. Subjects who developed depression, compared with those who remained not depressed, were more likely to be inactive at baseline, remain inactive at 1 year, report a worsening of their perception of controlling body weight, report maintaining a poor perception of controlling amount of food eaten and report maintaining a poor perception of controlling body weight (p<0.05). The same factors were associated with maintenance of depression at 1 year (p<0.05). Changes in BMI were not associated with changes in depressive symptoms. Physical inactivity, perception of poor control of body weight and amount of food eaten have been found to be associated prospectively with the development and persistence of depression and, therefore, should be considered priority targets for diabetes treatment. Depression is related to the continuation of poor lifestyle and perception-related indicators.
    Canadian Journal of Diabetes 08/2013; 37(4):243-8. · 0.46 Impact Factor
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    ABSTRACT: The aim of this study is to describe motivation in adolescents with cerebral palsy (CP) and factors associated with motivation level. The Dimensions of Mastery Questionnaire (DMQ) measures motivation in mastering challenging tasks and expressive elements. It was completed by 153 parents and 112 adolescents with CP. Adolescents (GMFCS in n=146 - I:50, II:43, III:13, IV:15, V:25) were assessed using the Leiter IQ and Gross Motor Function Measure. Parents completed the Vineland Adaptive Behavior Scale and the Strengths and Difficulties Questionnaire. Motivation scores were highest for mastery pleasure and social persistence with adults and lowest for gross motor and object-oriented persistence. Socio-demographic factors were not strongly correlated with DMQ. Higher gross motor ability (r=0.24-0.52) and fewer activity limitations (r=0.30-0.64, p<.001) were associated with persistence in cognitive, motor and social tasks, but not mastery pleasure. Higher IQ was associated with persistence in object-oriented tasks (r=0.42, p<.001). Prosocial behaviors correlated with high motivation (r=0.39-0.53, p<.001). Adolescents' motivation scores were higher than parents' scores. Adolescents with CP express high mastery pleasure, not related to abilities. High motivation was associated with fewer activity limitations and prosocial behaviors and aspects of family environment. Findings elucidate those at-risk for low motivation, which can influence treatment adherence and participation in challenging but meaningful activities.
    Research in developmental disabilities 08/2013; 34(10):3384-3392. · 4.41 Impact Factor
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    ABSTRACT: Diabetes-specific distress is an important psychological issue in people with diabetes. The neighborhood environment has the potential to be an important factor for diabetes distress. This study investigates the associations between neighborhood characteristics and diabetes distress in adults with type 2 diabetes. We used cross-sectional data from a community-based sample of 578 adults with type 2 diabetes from Quebec, Canada. Information on perceived neighborhood characteristics and diabetes distress was collected from phone interviews. We used factor analysis to combine questionnaire items into neighborhood factors. Information on neighborhood deprivation was derived from census data. We performed linear regressions for diabetes distress and specific domains of diabetes distress (emotional, regimen-related, physician-related and interpersonal distress), adjusting for individual-level variables. Factorial analysis uncovered 3 important neighborhood constructs: perceived order (social and physical order), culture (social and cultural environment) and access (access to services and facilities). After adjusting for individual-level confounders, neighborhood order was significantly associated with diabetes distress and all specific domains of distress; neighborhood culture was specifically associated with regimen-related distress; and neighborhood access was specifically associated with physician-related distress. The objective measure of neighborhood material deprivation was associated with regimen-related distress. Neighborhood characteristics are associated with diabetes distress in people with type 2 diabetes. Clinicians should consider the neighborhood environment reported by their patients with diabetes when assessing and addressing diabetes-specific distress.
    Journal of psychosomatic research 08/2013; 75(2):147-52. · 2.91 Impact Factor
  • K J Smith, G Gariépy, N Schmitz
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    ABSTRACT: To ascertain the impact of minor and major depression on self-reported use of and access to diabetes healthcare services, and the care components received in a community-based Quebec sample with type 2 diabetes. Adults with type 2 diabetes who took part in baseline and 1-year follow-up telephone interviews for the Diabetes Health Study were assessed (n = 1175). Information was collected regarding depression status (i.e. minor or major depression), use of and access to diabetes healthcare services, sociodemographic and diabetes characteristics, treatment, diabetes complications, disability, body mass index, residential area and depression. People with major depression were more likely to be high users or non-users of diabetes healthcare services. The high users reported more diabetes complications. People with major depression also reported more problems with accessing diabetes healthcare services, specifically having to wait too long between making their appointment and their visit, specialist care not being available in their area, general health deterioration, being unable to leave their house due to their health and problems with transportation. People with major depression were less likely to report having their feet checked by their doctor, and were more likely to report problems with getting advice from their doctor. People with diabetes need to use healthcare services in order to receive recommended care components. People with major depression and no complications are less likely to report using healthcare services; conversely, people with major depression and complications are more likely to be high users of healthcare services. People with major depression perceive more problems with the health care they receive.
    Public health 07/2013; · 1.26 Impact Factor
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    ABSTRACT: Abstract Objective: This study aimed at describing leisure activity preferences of adolescents with cerebral palsy (CP) and their relationship to participation and to identify factors associated with greater interest in particular leisure activities. Methods: A cross-sectional design was used. Participants were adolescents (n = 127; 59.5% male; ages 12-19 years old; mean = 15.3; SD = 2.01 years) with CP (GMFCS levels: I 40%, II 33%, III-IV 26%), who could complete the Preferences for Activities of Children (PAC) and other self-report questionnaires. Results: Social (2.53; 0.38) and active-physical activities were most preferred (2.10; 0.42), and self-improvement activities were least preferred (1.93; 0.49). Preference for certain activities was not strongly associated with actual involvement in these activities. Family activity-orientation, family expressiveness, and adolescent's motivation explained 15% of the variance in preferences for social activities, and 37% of the variance in preferences for self-improvement activities. Conclusion: Family factors, personal factors, and functional abilities influence leisure preferences. Rehabilitation interventions should consider adolescents' preferences and family dynamics to promote leisure participation.
    Developmental neurorehabilitation 07/2013;

Publication Stats

2k Citations
505.19 Total Impact Points


  • 2006–2014
    • McGill University
      • • Department of Psychiatry
      • • School of Physical and Occupational Therapy
      Montréal, Quebec, Canada
  • 2013
    • Forensic Psychiatric Hospital
      Coquitlam, British Columbia, Canada
  • 2010–2013
    • Douglas Mental Health University Institute
      Montréal, Quebec, Canada
  • 2007–2013
    • Université de Montréal
      • • Department of Nutrition
      • • Department of Psychology
      Montréal, Quebec, Canada
  • 2012
    • Rosalind Franklin University of Medicine and Science
      • Psychology
      North Chicago, IL, United States
    • Children's National Medical Center
      Washington, Washington, D.C., United States
  • 2011–2012
    • The University of Calgary
      • Department of Psychiatry
      Calgary, Alberta, Canada
  • 2009
    • Justus-Liebig-Universität Gießen
      Gieben, Hesse, Germany
  • 1997–2004
    • Heinrich-Heine-Universität Düsseldorf
      • Klinisches Institut für Psychosomatische Medizin und Psychotherapie
      Düsseldorf, North Rhine-Westphalia, Germany
    • University Hospital RWTH Aachen
      Aachen, North Rhine-Westphalia, Germany
    • Technische Universität Dortmund
      Dortmund, North Rhine-Westphalia, Germany
  • 1999
    • Martin Luther University of Halle-Wittenberg
      • Clinic for Psychiatry, Psychotherapy and Psychosomatics
      Halle, Saxony-Anhalt, Germany
  • 1994–1997
    • Ruhr-Universität Bochum
      • Abteilung für Medizinische Psychologie und Medizinische Soziologie
      Bochum, North Rhine-Westphalia, Germany