Clinical Psychology in Europe (E-Journal)
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Trajectories of Depressive Symptoms and Associated Risk Factors From Late Adolescence to Emerging Adulthood
No full textBackground: This study addresses a research gap by identifying depressive symptom trajectories from adolescence to emerging adulthood in a German community sample using a person-centered approach. Method: The sample consisted of 3,682 adolescents and young adults (49.3% self-identified as female; age at T1: 15–19 years, M = 17.03, SD = 0.88) assessed in seven annual waves of the German Family Panel Pairfam. Latent class growth analysis was conducted with sociodemographic variables (gender, family status, parental education, economic deprivation, immigration background) and depressive symptoms, as assessed by the State-Trait Depression Scales. Results: Five depressive symptom trajectories were identified: stable low symptoms (34%), intermediate onset with decreasing symptom trajectory (8%), intermediate onset with slow increasing symptom trajectory (46%), intermediate onset with strong increase symptom trajectory (9%) and stable high symptoms (4%). Female gender and economic deprivation were predictors for all four classes associated with higher depressive symptoms with reference to the class with stable low depressive symptoms. Family status and immigration status lost their predictive impact for membership in depressive symptom trajectories when economic deprivation was included. Conclusions: Interventions should target the underlying etiological factors of female gender and economic deprivation being risk factors for trajectories of depression, taking into consideration the complexity and interaction of biopsychosocial and political variables in the development of depressive disorders
Attitudes Towards Digital Health Interventions in Germany: Findings From a Population-Based Representative Survey
No full textBackground: Digital (mental) health interventions have the potential to address barriers in mental health care. However, attitudes towards these interventions are a crucial factor to their successful implementation. Therefore, this study aims to assess those in a representative sample of the German adult population. Method: A total of N = 2,519 participants took part in the survey as part of a larger study. Following a structured face-to-face interview, participants completed a self-administered questionnaire under the supervision of the interviewer. The questionnaire was based on the E-Therapy Attitudes Measure (ETAM) and the Attitudes towards Psychological Interventions Questionnaire (APOI). Results were analyzed by means of Pearson's product moment correlation coefficients and Spearman's ρ statistics. Supplementary open-ended questions explored participants' utilization of digital health interventions for specific conditions, the conditions they perceived as suitable for those, and the perceived barriers to their adoption. Replies on open-ended questions are summarized descriptively. Results: While a majority of participants (34.0%–41.5%) indicated partial agreement with the potential usefulness and advantages of digital health interventions (Items 1-3), a substantial proportion (45.8%, 95% CI [43.8%, 47.7%]) expressed an entire refusal to use them for future psychological problems (Item 4). Older individuals and those with lower educational status expressed particular critical views. Key barriers identified by participants comprised the absence of personal contact, technical issues, and concerns related to data privacy and security. Conclusion: The results of this study indicate that while participants acknowledge the potential benefits of digital health interventions, the observed limited acceptance rates and identified barriers are to be addressed, in order to fully harness their potential
Youth, the New Adolescence: A Challenge and a Window of Opportunity for Early Mental Health Interventions
No full textNo abstract available
Dissociative Experiences and Substance Use Disorder in Adulthood After Childhood Trauma: A Systematic Review of the Literature
No full textContext: Childhood trauma is more prevalent among individuals with substance use disorders compared to the general population, representing a significant public health concern. The presence of comorbid dissociative symptoms poses a significant challenge for psychological care. Objectives: We conducted a systematic review of the literature, using the PRISMA method, to establish the relationship between dissociative experiences and substance misuse in adults who have experienced traumatic childhood events. Method: We used electronic databases (PubMed, PsycInfo, PsycArticles, Web of Science and ProQuest) up to August 2023. Studies were selected which included adults over 18 years old who had been exposed to one or more traumatic events in childhood, and which jointly assessed Substance Use Disorder (SUD) and dissociation, using quantitative methodology. The review included both cross-sectional and longitudinal studies, with the risk of bias assessed using the AXIS tool and the Qualitative Assessment Tool for Observational Cohort and Cross-Sectional Studies. The results are entered in a table and analyzed using a narrative summary. Results: Among the 18 included studies, encompassing a total of 6,451 participants, the majority (n = 10) showed a significant positive correlation between dissociative experiences and SUD. The studies collectively indicate a general trend: childhood traumatic antecedents can influence the severity of dissociative symptomatology and SUD. Discussion: These results are discussed in greater depth in relation to the two main theories explaining the link between SUD and dissociation, namely self-medication and chemical dissociation theory. This paper clarifies the relationship between dissociation and substance use in a population traumatized in childhood, although the heterogeneity of the studies necessitates a cautious interpretation of this primary finding
Towards a 21st Century Definition of Mental Health – Emerging Trends in Bringing Practice and Research Together
No full textNo abstract available
Allegiance and Treatment Quality as Moderators of the Comparative Effectiveness of Psychotherapy? A Systematic Review and Meta-Analysis of Studies Comparing Humanistic Psychotherapy to Other Psychotherapy Approaches
No full textBackground: Achieving positive outcomes in comparative RCTs examining psychotherapy interventions may be moderated by other factors than treatments alone, namely allegiance and treatment quality (bona fide, adherence). Using the study sample of a recent comprehensive review on humanistic interventions by the German Scientific Board of Psychotherapy, we assumed that higher allegiance towards non-humanistic approaches and lower treatment quality in the humanistic intervention arm would result in worse outcomes for the humanistic groups. Method: We included studies in which a humanistic psychotherapy (sub-)approach was compared to another type of psychotherapy. Data was extracted independently by the authors. A priori defined meta-regression analyses were performed with allegiance and treatment quality as main moderators and study quality (risk of bias), type of active control, humanistic psychotherapy and target population (children/adolescents; adults) as exploratory. Results: The majority of studies showed non-allegiance towards humanistic intervention arms; only about half of the humanistic interventions were bona fide treatments demonstrating high percentages of potential biases in these comparative intervention studies. However, allegiance and bona fide were significant moderators only for two (allegiance) resp. one (bona fide) of five outcome comparison. Type of active control (cognitive behavioural therapy) and disorder group (anxiety disorders) emerged as further moderators. Conclusion: We found no clear evidence for allegiance or treatment quality impacting upon treatment outcome in this re-examination. Allegiance and treatment quality were not as relevant for outcomes in this meta-analysis of RCTs as expected
ICD-11 Prolonged Grief Disorder, Physical Health, and Somatic Problems: A Systematic Review
No full textBackground: Since Prolonged Grief Disorder’s (PGD) inclusion as a mental health disorder in the ICD-11 in 2018, much of the peer-reviewed research has focused on its prevalence, assessment, and co-occurrence with other mental health disorders. There is also emerging research literature on the association between PGD and physical and somatic health outcomes. In light of this, the objective of this review was to identify and summarise the extant research on the association between PGD, and outcomes related to physical health and somatic complaints among bereaved individuals. Method: A systematic review utilized electronic databases (Web of Science, MEDLINE, Cochrane Library, PsycINFO) up to October 10, 2023. Included were cohort and cross-sectional studies since 2018 exploring links between ICD-11 PGD and physical/somatic health outcomes. Two researchers independently identified eligible studies meeting inclusion/exclusion criteria, employing quality assessment instruments to evaluate methodological rigor. Results: From the 418 articles that were initially screened, 18 met the inclusion criteria. The studies reported significant associations between PGD and physical health, somatic symptom distress, insomnia severity, blood pressure, bodily distress syndrome, chronic physical diseases, and poor- caregiver health profiles. Conclusion: Out of the 18 studies eligible for analysis, 13 (72%) established a significantly strong or moderate association between PGD and physical or somatic illness, highlighting the intricate nature of this connection. Further research is required to assess the breadth of physical and somatic health problems associated with PGD and to understand the psychological and biological mechanisms that underpin these observed relationships
Dynamic Complexity of Positive and Negative Affect in NSSI – A Daily Diary Study
No full textBackground: Non-suicidal self-injury (NSSI) is a major health problem. Functionally, it is related to affect instability and increased affective intensity. The role of negative emotions has already been extensively explored, only few studies have focused on positive emotions. The concept of dynamic complexity (DC) is particularly well suited to differentially analyze the dynamics of affect collected by ecological momentary assessment (EMA). This study examines DC of positive and negative emotions in individuals with and without NSSI history in an EMA setting. Method: Participants from a clinical NSSI group (n = 28) and a comparable clinical non-NSSI control group (n = 33) completed the Positive and Negative Affect Schedule (PANAS) once a day between six to 37 days (M = 15.60, SD = 5.80). DC was calculated for the assessed time-series of daily affect. Additionally, we fitted a linear mixed model to predict positive and negative dynamic complexity with length of stay and group. Results: Compared to controls, individuals with a history of NSSI showed significantly more positive affect and had significantly higher DC in affect in general. No significant difference for negative affect was found. Conclusion: Our results suggest that it is important to assess dynamic emotional patterns and to analyze in detail the role of positive and negative affect in individuals with NSSI in order to better understand the complex interplay between the different emotional states and to be able to use it for diagnostic purposes and clinical interventions
Effectiveness of Empower-Grief for Relatives of Palliative Care Patients: Protocol for an Exploratory Randomized Controlled Trial
No full textBackground: Grief reactions of relatives of palliative care patients are seldom addressed. Most interventions focus on Prolonged Grief Disorder (PGD) and not on its prevention. This is particularly relevant in palliative care, in which death is the result of a difficult period of a terminal illness, making caregivers particularly vulnerable to psychological distress. The purpose of the present exploratory trial is to test the efficacy of a selective intervention (Empower-Grief) for the initial problematic grief reactions and to study potential predictors of adherence and efficacy. Method: This is an exploratory Randomized Controlled Trial (RCT) studying Empower-Grief compared with Treatment as Usual (TAU). Participants will be relatives or caregivers of palliative and oncological patients with initial indicators of risk of developing PGD and will be randomly allocated to Empower-Grief and TAU. Participants will be assessed prior, at the end and six months after the intervention. The primary outcome considered will be symptoms of PGD. The assessment includes measures of anxiety and depression, coping, attachment, psychological flexibility, posttraumatic growth, social support and therapeutic alliance. Results: The trial is ongoing. Forty-four participants will be invited to participate. Conclusion: This study addresses the need for the development of empirically grounded and feasible interventions aimed at dealing with initial problematic reactions in grief, exploring potential predictors and possible venues for personalizing intervention and understanding the mechanism through which these interventions operate