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Anorexia Nervosa: Striving for Control
Full text linkAnorexia nervosa (AN) is an eating disorder characterized by severely low bodyweight, fear of weight-gain, and a subjective believe to be “fat”. An elevated need for control and fear of losing control are considered core aspects in the development and maintenance of AN and restricting food intake is thought to function as a means to gain feelings of control (Fairburn, Shafran, & Cooper, 1999; Schmidt & Treasure, 2006). Feelings of inefficiency (i.e. lack of control regarding personal goals) have been found to predict longer duration of treatment and worse treatment outcome, underlining the relevance of the need for control in AN (Olatunji, Levinson, & Calebs, 2018; Pinto, Heinberg, Coughlin, Fava, & Guarda, 2008; Surgenor, Maguire, Russell, & Touyz, 2007). The constant striving for control could lead to rumination and negative affect – two further important symptoms associated with AN. The Goal Progress Theory of rumination (GPT; Carver & Scheier, 1990; Martin & Tesser, 1996) proposes that perceived discrepancies between desired goals (in the case of AN e.g. goals regarding lowest possible calorie intake, weight, etc.) and the current state (in the case of AN e.g. the subjective conviction of having eaten or weighing too much) trigger ruminative thoughts, which subsequently lead to negative affect. Following this theory, it could be suggested that gaining feelings of goal-progress and control could lessen the burdening repetitive thoughts and negative affect and that individuals with AN try to achieve this by restricting food intake. This dietary restriction requires self-control. However, previous research has shown that patients with AN typically not only show such elevated self-control, but also display rigid habitual behaviours and routines, struggle with set-shifting, and often display comorbid obsessive-compulsive symptoms (Treasure & Schmidt, 2013; Halmi et al., 2003). This raises the question of whether food restriction in AN is indeed an act of self-control or rather a habit. Recent scientific development has challenged the traditional dichotomy between controlled and automatic processes (Shiffrin & Schneider, 1977), instead suggesting that they are intertwined in such a way that often self-control works via the establishment of goal-serving habits and routines (Gillebaart & de Ridder, 2015; Galla & Duckworth, 2015).
These theoretical considerations can generally draw support from previous research, but have not been investigated explicitly in the context of AN. It was the main goal of this thesis to analyse associations between feelings of inefficiency, rumination and negative affect, controlled and habitual behaviour, and eating behaviour to establish an empirical foundation for the proposed relationships between these aspects of AN.
Study 1 (Fürtjes, Seidel, et al., 2020) employed ecological momentary assessment (EMA; data collection several times a day over a period of several days in the natural environment of the participants) to investigate associations between feelings of inefficiency, rumination, and affect in a sample of individuals with a history of AN who had recovered from the disorder in terms of eating behaviour and bodyweight and age-matched healthy control participants (HC). AN participants displayed elevated rumination about bodyweight/figure (but not food) and negative affect compared to HC, suggesting that these cognitive-affective symptoms are persistent even after recovery. Analyses investigating associations with inefficiency showed that inefficiency was associated with heightened rumination and negative affect, which is in line with the GPT. Furthermore, AN participants showed higher levels of inefficiency than HC and stronger associations between rumination and negative affect. These findings indicate that feelings of lack of goal-progress and control are a central aspect of AN, likely contributing to maintenance of the disorder by triggering dysfunctional cognitive-affective processes. The fact that these associations were still present in a sample of recovered individuals underlines the persistence of these processes, suggesting that they might not only maintain the disorder but could also present a vulnerability factor or contribute to risk of relapse.
Study 2 (Fürtjes et al., 2018) made use of EMA and leptin, an endocrinological marker of undernutrition, to further investigate associations between rumination and affect in a sample of patients with acute AN, once at the beginning of treatment and again after weight-restoration. In line with Study 1, results confirmed that rumination about bodyweight/figure and negative affect are closely linked in AN and that this association persists even after weight-gain. Thoughts about food on the other hand were associated with leptin levels, declined with weight-gain, and showed weaker associations with affect. This suggests that thoughts about food may reflect a physiological symptom of the disorder, connected to undernourishment, whereas thoughts about bodyweight/figure might present a cognitive-affective symptom which could be involved in maintenance of the disorder (as suggested by Study 1).
To test supporting evidence for the interaction of self-control and habits in the regulation of eating behaviour, Study 3 (Fürtjes, King, et al., 2020) employed task-based measures of controlled and automatic processing as well as self-report measures of self-control, habitual behaviour, and eating behaviour in a large female sample representative of the general population through an online study design. Results obtained via structural equation modelling (SEM) revealed that eating behaviour appears to be largely guided by habits and automatic behavioural tendencies, whereas controlled aspects have an indirect influence via this association. These findings could be interpreted as support for the proposal that self-control might work via the establishment of goal-serving habits and routines, which outlines the possibility that the restrictive eating behaviour in AN might be achieved and maintained via a combination of self-control and rigid routines and habits.
Taken together, the research presented in this thesis was able to demonstrate how striving for control as a core aspect of AN might play a role in triggering dysfunctional cognitive-affective processes, likely contributing to development and maintenance of the disorder, and that self-control and habitual behaviour interact inguiding human eating behaviour, carrying implications for the mechanisms behind restrictive eating in AN. Clinical implications that can be derived from this research include addressing need for control and feelings of inefficiency in therapy to enable improvement of dysfunctional cognitive-affective processes as well as eating behaviour
Monitoring alcohol consumption in Europe based on self-reported measures
Full text linkIntroduction: Alcohol is a major contributor to the burden of disease globally. In Europe, there is a long-standing tradition of drinking alcohol, with per capita consumption being the highest in the world, even if it has been declining in recent decades. Changes in per capita consumption are likely to be related to factors operating at societal level, of which globalisation has been one of the most important factors. Since early 2020, the global pandemic of the Coronavirus Disease 2019 (COVID-19) has caused serious disruptions to day-to-day and community life. As a consequence of the pandemic and the measures taken to contain the spread of the virus, patterns and levels of alcohol consumption are expected to change due to reduced alcohol availability, and according to income levels and distress experiences. Surveys are used to assess such short-term trends, but also to identify drinking patterns that cannot be derived from other sources such as alcohol purchases. However, general population surveys usually fail to capture the entire amount of alcohol consumed within a population. This inherently limiting factor of surveys is called underreporting and not well understood to date.
Aims and Objectives: The overall aim of this dissertation was to provide a comprehensive and up-to-date assessment of alcohol consumption in Europe using survey data, as well as to compare survey-based annual consumption estimates with per capita consumption data, i.e., sales and other data derived. For this purpose, the following three objectives were of interest: First, to determine and to compare European drinking practices across 19 countries using survey data from 2015 (study I). Second, to examine changes in alcohol consumption during the first months of the COVID-19 pandemic in 21 European countries and whether these changes were associated with income and pandemic-related distress experiences (study II). Third, to estimate the degree of under-reporting of alcohol consumption in surveys and to study possible factors related to under-reporting based on 39 surveys from 23 European countries (study III).
Design: All studies are based on individual-level data from cross-sectional pan-European surveys covering the general adult population.
In study I, European drinking practices were determined by the means of latent class analysis using key indicators of alcohol consumption (past-year drinking frequency and quantity, risky single-occasion drinking, and preferred alcoholic beverage) derived from nationally representative data from 2015. In a second step, the identified drinking practices were compared across countries.
In study II, self-reported changes in drinking frequency, drinking quantity, and the frequency of heavy episodic drinking over the past month were assessed in a large convenience sample collected between April and July 2020. Additionally, past-year alcohol consumption was recorded using the consumption items of the Alcohol Use Disorder Identification Test in order to obtain an estimate of alcohol consumption during the pre-pandemic period. Income and distress experiences were recorded as factors hypothesised to be associated with self-reported changes in consumption.
In Study III, nationally representative surveys conducted between 2008 to 2015 were combined and compared with alcohol per capita consumption estimates for the same years and countries, in order to estimate survey-based under-reporting of alcohol consumption at the national level. Per capita consumption estimates were retrieved from sales statistics and corrected for unrecorded and tourist consumption.
Data sources: Survey data were obtained from large-scale alcohol surveys covering the majority of European Union countries plus some non-European Union countries.
Statistical analyses: To identify European drinking practices (study I), survey-weighted latent class models of key indicators of alcohol consumption, adjusted for respondent’s location, were conducted. The resulting class prevalence estimates were then contrasted across locations, and fractional response regression models were calculated for membership probabilities of each class (dependent variable) in explorative analysis, with sociodemographic data and individual alcohol harm experiences serving as independent variables.
To identify changes in overall alcohol consumption over the past month during the COVID-19 pandemic (study II), a consumption-change score was calculated by combining the single change indicators (i.e., drinking frequency, drinking quantity, and frequency of heavy episodic drinking; range: -1 to +1). Multilevel linear regressions with the random intercept country of residence were used to test for statistical significance of the consumption-change score (dependent variable), adjusting for sample weights and past-year alcohol consumption, as well as for associations with income group and pandemic-related distress experiences.
To quantify the extent to which national surveys assess alcohol per capita consumption (study III), coverage rates were calculated. Coverage is defined by dividing the survey-based annual alcohol consumption estimates by per capita consumption estimates. Using fractional response regressions, differences in coverage rates (dependent variable) across transnational regions, as well as the relative importance of heavy episodic drinking prevalence and indicators of survey methodology were tested.
Results: Three latent classes of drinking practices were identified: a ‘light to moderate drinking without risky single-occasion drinking’ class (prevalence: 68.0%, 95% Confidence interval [CI]: 66.7, 69.3), a ‘infrequent heavy drinking’ class (prevalence: 12.6%, 95% CI: 11.5, 13.7), and a ‘regular drinking with at least monthly risk single-occasion drinking’ class (prevalence: 19.4%, 95% CI: 18.1, 20.9). In contrast to the former drinking practice of light to moderate drinking, the latter two were characterised by a high average amount of alcohol consumed per drink day, exceeding 100 grams pure alcohol and 60 grams pure alcohol per drink day, respectively. Regional variations in the distribution of drinking practices were observed, with the ‘light to moderate drinking without risky single-occasion drinking’ class prevailing particularly in southern European countries.
In study II, an average decrease in overall alcohol consumption during the first months of the COVID-19 pandemic indicated by a negative consumption-change score was observed (-0.14, 95% CI: -0.18, -0.10). This average decline according to the consumption-change indicator was observed in all countries studied, except Ireland (no change) and the United Kingdom (increase). The most marked decrease was reported in the frequency of heavy episodic drinking (-0.17, 95% CI: -0.20, -0.14). Respondents with low- or average income, as well as those experiencing distress were more likely to increase their alcohol consumption than to decrease it.
In study III, the average total alcohol consumption coverage was 36.5% (95% CI: 33.2, 39.8), with large variations in coverage rates between countries. While the prevalence of heavy episodic drinking explained up to 10% of the variance in coverage, there were no systematic variations across European regions or the survey methodologies studied, such as non-response rates.
Conclusions: In many European countries, a combination of a light to moderate and risky drinking practices prevailed. With a combined prevalence of 32.0%, almost every third respondent engaged in some form of risky drinking. During the first months of the COVID-19 pandemic, overall alcohol consumption, and particularly heavy episodic drinking, appeared to have declined on average in the countries studied. On the other hand, people with low- or average incomes and those suffering from pandemic-related distress were at increased risk of escalating their alcohol consumption during this period. The results contribute both to an up-to-date assessment of alcohol consumption in Europe, including the identification of populations at increased risk of alcohol-related harm, and to the body of evidence on reducing alcohol availability as an effective measure to lower population-level consumption. Beyond consequences for alcohol policy, benefits and limitations of surveys in the field of alcohol epidemiology are discussed. In light of the substantial and apparently unsystematic under-reporting of alcohol consumption in surveys, a rethinking of this methodology is required. Presenting survey-based data and its limitations in an upfront manner, as well as applying sophisticated statistical methods are two options to address current challenges.:Statement for a publication-based dissertation I
Table of contents III
List of tables V
List of figures VII
Abbreviations IX
Synopsis XI
1 Introduction 1
1.1 Determinants of alcohol consumption and alcohol-related harm 3
1.1.1 Individual vulnerability factors 4
1.1.2 Societal vulnerability factors 5
1.2 The impact of the COVID-19 pandemic on alcohol consumption 8
1.3 Strengths and limitations of survey research 11
2 Aims and objectives 13
3 Study design and methodology 14
3.1 The Standardised European Alcohol Survey 15
3.1.1 The RARHA SEAS questionnaire 15
3.1.2 Sampling procedure and data pre-processing 16
3.1.3 Calculation of annual alcohol consumption 17
3.1.4 Research ethics 17
3.2 Harmonising Alcohol-related Measures in European Surveys 17
3.2.1 Questionnaires 18
3.2.2 Sampling procedures and harmonising of the questionnaires 18
3.2.3 Research ethics 19
3.3 The Alcohol Use and COVID-19 Survey 19
3.3.1 Survey development and design 19
3.3.2 Survey dissemination 21
3.3.3 Calculation of survey and population weights 22
3.3.4 Research ethics 24
4 Study I – A new perspective on the European drinking culture: a model-based approach to determine variations in drinking practices across 19 European countries 25
4.1 Abstract 25
4.2 Introduction 26
4.3 Methods 27
4.4 Results 30
4.5 Discussion 35
5 Study II – Alcohol consumption during the COVID-19 pandemic in Europe: a large-scale cross-sectional study in 21 countries 38
5.1 Abstract 38
5.2 Introduction 39
5.3 Methods 40
5.4 Results 42
5.5 Discussion 49
6 Study III – Why is per capita consumption underestimated in alcohol surveys? Results from 39 surveys in 23 European countries 53
6.1 Abstract 53
6.2 Introduction 54
6.3 Methods 56
6.4 Results 62
6.5 Discussion 64
7 General discussion 69
7.1 Summary of findings 69
7.2 Strengths and limitations 70
7.3 Implications for future research 72
7.3.1 New impulses for drinking culture research 72
7.3.2 The realisation of multi-country online surveys 73
7.3.3 Consequences of low alcohol consumption coverage in alcohol surveys 74
7.4 Implications for alcohol policy 75
7.4.1 Altered availability of alcohol as a secondary outcome of the COVID-19 pandemic 76
7.4.2 Towards a comprehensive alcohol control policy for Europe 78
7.4.3 Alcohol screening and access to health care in high-risk drinking populations
7.5 Outlook 81
7.6 Conclusion 83
8 References 85
9 Appendix 106
9.1 Appendix A (study I) 106
9.2 Appendix B (study II) 126
9.3 Appendix C (study III) 152
10 Erklärung gemäß §5 der Promotionsordnung 16
Cortical and Subcortical Brain Alterations in Specific Phobia and Its Animal and Blood-Injection-Injury Subtypes: A Mega-Analysis From the ENIGMA Anxiety Working Group
No full textObjective: Specific phobia is a common anxiety disorder, but the literature on associated brain structure alterations exhibits substantial gaps. The ENIGMA Anxiety Working Group examined brain structure differences between individuals with specific phobias and healthy control subjects as well as between the animal and blood-injection-injury (BII) subtypes of specific phobia. Additionally, the authors investigated associations of brain structure with symptom severity and age (youths vs. adults).
Methods: Data sets from 31 original studies were combined to create a final sample with 1,452 participants with phobia and 2,991 healthy participants (62.7% female; ages 5-90). Imaging processing and quality control were performed using established ENIGMA protocols. Subcortical volumes as well as cortical surface area and thickness were examined in a preregistered analysis.
Results: Compared with the healthy control group, the phobia group showed mostly smaller subcortical volumes, mixed surface differences, and larger cortical thickness across a substantial number of regions. The phobia subgroups also showed differences, including, as hypothesized, larger medial orbitofrontal cortex thickness in BII phobia (N=182) compared with animal phobia (N=739). All findings were driven by adult participants; no significant results were observed in children and adolescents.
Conclusions: Brain alterations associated with specific phobia exceeded those of other anxiety disorders in comparable analyses in extent and effect size and were not limited to reductions in brain structure. Moreover, phenomenological differences between phobia subgroups were reflected in diverging neural underpinnings, including brain areas related to fear processing and higher cognitive processes. The findings implicate brain structure alterations in specific phobia, although subcortical alterations in particular may also relate to broader internalizing psychopathology
The role of fearful spells as risk factors for panic pathology and other mental disorders: A prospective-longitudinal study among adolescents and young adults from the community
Full text linkBackground. Previous research suggests that individuals experiencing DSM-IV panic attacks (PA) are at increased risk for various forms of psychopathology, including anxiety, depressive and substance use disorders. However, little is known regarding whether the sole occurrence of fearful spells (FS-only; distressing spells of anxiety with less than four panic symptoms and/or lacking crescendo in symptom onset) similarly elevates the risk for subsequent psychopathology and could therefore be promising to identify high-risk groups for targeted preventive interventions. Thus, the current dissertation thesis aims to examine (a) whether FS-only predict incident mental disorders in addition to full-blown PA and whether their associations with subsequent psychopathology differ from those obtained for PA, (b) whether FS-only, PA, and panic disorder (PD) share similar etiologies, (c) which characteristics of initial FS/PA and other risk factors predict a progression to more severe panic pathology and other mental disorders, and (d) whether help-seeking/potential treatment in individuals with panic alters the risk for subsequent psychopathology.
Methods. A representative community sample of adolescents and young adults (N=3021, aged 14-24 at baseline) was prospectively followed up in up to three assessment waves over a time period of up to 10 years. FS-only, PA, PD, and other mental disorders were assessed at each assessment wave using the DSM-IV-M-CIDI. Additional modules/questionnaires were used to assess characteristics of initial FS/PA (T1/T2), potential risk factors, and help-seeking/potential treatment. Logistic regressions were applied to test associations (Odds Ratios, OR) of FS-only and PA at baseline with incident mental disorders at follow-up as well as respective interactive effects with help-seeking at baseline. Associations (Hazard Ratios, HR) of putative risk factors with the onset of panic pathology (FS-only, PA, and PD) or the onset of subsequent anxiety/depressive vs. substance use disorders in those with panic pathology (aggregated data across assessment waves) were estimated with Cox regressions. Multinomial logistic regressions were used to test associations of initial FS/PA characteristics (aggregated from T1 and T2) with PA and PD (lifetime incidences aggregated across assessment waves).
Results.
FS-only at baseline predicted incident anxiety and depressive disorders at follow-up (OR 1.59-4.36), while PA at baseline predicted incident anxiety, depressive, and substance use disorders at follow-up (OR 2.08-8.75; reference group: No FS/PA). Merely any anxiety disorder (OR=3.26) and alcohol abuse/dependence (OR=2.26) were significantly more strongly associated with PA than with FS-only. Female sex, parental anxiety disorders, parental depressive disorders, behavioral inhibition, harm avoidance, lower coping efficacy, and parental rejection predicted FS-only, PA, and PD (HR 1.2-3.0), whereas the associations with other risk factors partially differed for FS-only, PA, and PD and tended to be more pronounced for PA and PD than for FS-only.
Alcohol consumption, use of drugs/medication, and physical illness as perceived reasons for the initial FS/PA were associated with the occurrence of full-blown PA (without PD, OR 2.46-5.44), while feelings of anxiety/depression and having always been anxious/nervous as perceived reasons for the initial FS/PA, appraising the initial FS/PA as terrible and long-term irritating/burdensome, subsequent feelings of depression, avoidance of situations/places, and consumption of medication, alcohol, or drugs were associated with the development of PD (OR 2.64-4.15). A longer duration until “feeling okay again” was associated with both PA and PD (OR 1.29-1.63 per category). Moreover, partially different risk constellations in subjects with panic pathology (FS/PA/PD) predicted the onset of subsequent anxiety/depressive vs. substance use disorders. Panic pathology (FS/PA) and help-seeking/potential treatment at baseline interacted on predicting incident PD (OR=0.09) and depression (OR=0.22) at follow-up in a way that panic pathology only predicted these disorders in individuals not seeking help at baseline.
Conclusions. Findings suggest that individuals with FS-only are at similar risk of developing subsequent psychopathology compared to individuals with full-blown PA. Specific initial FS/PA characteristics and additional risk factors may be used to identify sub-groups of individuals with panic pathology, which are at particular risk of progressing to more severe panic pathology or other mental disorders and might therefore profit from supplemental outcome-related preventive interventions in addition to panic-specific treatment. Future research may replicate the current findings and test the efficacy of targeted preventive interventions in panickers at elevated risk for PD and other forms of psychopathology.:CONTENT
0 Synopsis 10
1 Introduction 13
1.1 Current challenges in clinical psychology 13
1.2 Psychological models of mental disorders 13
1.3 Diagnostic approaches to psychopathology 15
1.4 Methodological issues 16
1.5 Preventive and early treatment interventions 17
2 Panic pathology 18
2.1 Definitions 18
2.2 Epidemiology 19
2.3 Etiology 20
2.4 Physiological, neurobiological, and genetic findings 21
2.5 Unresolved issues 22
3 Aims 24
4 Methods 26
5 Study I: Associations of fearful spells and panic attacks with incident anxiety, depressive, and substance use disorders: A 10-year prospective-longitudinal community study of adolescents and young adults 27
5.1 Abstract 27
5.2 Introduction 27
5.3 Materials and methods 28
5.4 Results 30
5.5 Discussion 35
6 Study II: Characteristics of initial fearful spells and their associations with DSM-IV panic attacks and panic disorder in adolescents and young adults from the community 37
6.1 Abstract 37
6.2 Introduction 37
6.3 Materials and methods 38
6.4 Results 41
6.5 Discussion 43
7 Study III: Risk factors for fearful spells and panic: A 10-year prospective-longitudinal study among adolescents and young adults 47
7.1 Abstract 47
7.2 Introduction 47
7.3 Materials and methods 49
7.4 Results 52
7.5 Discussion 60
8 Study IV: Does help-seeking alter the risk for incident psychopathology in adolescents and young adults with and without fearful spells or panic attacks? Findings from a 10-year prospective-longitudinal community study 63
8.1 Abstract 63
8.2 Introduction 63
8.3 Materials and methods 64
8.4 Results 66
8.5 Discussion 70
9 General discussion 73
9.1 Summary and discussion of main findings 73
9.2 Preventive interventions among individuals with panic pathology 75
9.3 Research implications 77
10 Conclusions 78
11 References 79
12 Appendix 94
12.1 Acknowledgements 94
12.2 Erklärung zu den Eigenanteilen an einzelnen Publikationen 95
12.3 Eigenständigkeitserklärung 96Theoretischer Hintergrund. Auf Grundlage früherer Forschungsbefunde ist anzunehmen, dass Personen mit DSM-IV-Panikattacken (PA) ein erhöhtes Risiko für zahlreiche psychische Störungen, einschließlich Angst-, depressiver und Substanzstörungen, aufweisen. Unklar ist jedoch, ob das alleinige Auftreten von Fearful Spells (FS-only, Angstanfälle mit weniger als vier Paniksymptomen und/oder fehlendem Crescendo in der Symptomentwicklung) das Risiko für Psychopathologie in ähnlicher Weise erhöht und hilfreich sein könnte, um Hochrisikogruppen für Präventivinterventionen zu identifizieren. Innerhalb der vorliegenden Dissertation wird daher untersucht, (a) ob FS-only zusätzlich zu PA inzidente psychische Störungen vorhersagen und ob sich Unterschiede in den Assoziationen von FS-only vs. PA mit nachfolgender Psychopathologie ergeben, (b) ob FS-only, PA und Panikstörung (PS) ähnliche Ätiologien teilen, (c) welche Merkmale initialer FS/PA und welche anderen Risikofaktoren die Entwicklung schwerer Panikpathologie und weiterer psychischer Störungen vorhersagen und (d) ob Hilfesuchverhalten/potenzielle Behandlung bei Personen mit Panik das Risiko für nachfolgende Psychopathologie verändert.
Methodik. Eine repräsentative Bevölkerungsstichprobe Jugendlicher und junger Erwachsener (N=3021, 14-24 Jahre zur Baseline-Erhebung) wurde in bis zu drei Erhebungswellen über einen Zeitraum von bis zu 10 Jahren untersucht. FS-only, PA, PS und andere psychische Störungen wurden zu jeder Erhebungswelle mithilfe des DSM-IV-M-CIDI erfasst. Merkmale initialer FS/PA (T1/T2), mögliche Risikofaktoren sowie Hilfesuchverhalten/potenzielle Behandlung wurden mit weiteren Modulen und Fragebögen erhoben. Mithilfe logistischer Regressionen wurden Assoziationen (Odds Ratios, OR) von FS-only und PA zu Baseline mit inzidenten psychischen Störungen zum Follow-Up sowie diesbezügliche Interaktionen mit Hilfesuchverhalten zu Baseline getestet.
Zusammenhänge zwischen möglichen Risikofaktoren und dem Auftreten von Panikpathologie (FS-only, PA und PS) bzw. nachfolgender Angst-/depressiver und Substanzstörungen bei Personen mit Panikpathologie (Verwendung von über die Erhebungswellen hinweg aggregierter Daten) wurden mithilfe von Cox-Regressionen geschätzt. Multinomiale logistische Regressionen wurden genutzt, um Assoziationen von Merkmalen initialer FS/PA (aggregiert über T1 und T2) mit PA und PS (über die Erhebungswellen hinweg aggregierte Lebenszeitinzidenzen) zu erfassen.
Ergebnisse. FS-only zu Baseline sagten inzidente Angst- und depressive Störungen zum Follow-Up vorher (OR 1.59-4.36), wohingegen PA zu Baseline inzidente Angst-, depressive und Substanzstörungen zum Follow-Up vorhersagten (OR 2.08-8.75; Referenzkategorie: Keine FS/PA). Lediglich irgendeine Angststörung (OR=3.26) und Alkoholmissbrauch/-abhängigkeit (OR=2.26) waren signifikant stärker mit PA als mit FS-only assoziiert. Weibliches Geschlecht, elterliche Angst- und depressive Störungen, Verhaltenshemmung, Schadensvermeidung, geringere Coping-Erwartung und elterliche Zurückweisung sagten FS-only, PA und PS vorher (HR 1.2-3.0), während sich teils unterschiedliche Assoziationen anderer Risikofaktoren mit FS-only, PA und PS ergaben, die tendenziell stärker für PA und PS als für FS-only waren.
Alkoholkonsum, Drogen-/Medikamentengebrauch und körperliche Erkrankungen als wahrgenommene Gründe für die initiale FS/PA waren mit dem Auftreten vollständiger PA assoziiert (ohne PS; OR 2.46-5.44), während Gefühle von Angst/Depression und die Einschätzung schon immer ängstlich/nervös gewesen zu sein als wahrgenommene Gründe für die initiale FS/PA, die Bewertung der initialen FS/PA als schrecklich und langfristig verunsichernd/belastend, nachfolgende Gefühle von Niedergeschlagenheit, Vermeidung von Situationen/Orten und Konsum von Medikamenten, Alkohol oder Drogen mit der Entwicklung von PS assoziiert waren (OR 2.64-4.15).
Eine längere Dauer bis sich die betroffene Person wieder vollständig in Ordnung fühlte war sowohl mit PA als auch mit PS assoziiert (OR 1.29-1.63 pro Kategorie). Weiterhin sagten teils unterschiedliche Risikokonstellationen bei Personen mit Panikpathologie (FS/PA/PS) die nachfolgende Entstehung von Angst-/depressiven und Substanzstörungen vorher. Panikpathologie (FS/PA) und Hilfesuchverhalten/potenzielle Behandlung zu Baseline interagierten bei der Vorhersage von inzidenter PS (OR=0.09) und Depression (OR=0.22) zum Follow-Up; d.h. das Vorhandensein von Panikpathologie sagte diese Störungen nur bei Personen ohne, nicht aber bei Personen mit Hilfesuchverhalten zu Baseline vorher.
Schlussfolgerungen. Die vorliegenden Ergebnisse implizieren, dass Personen mit FS-only im Vergleich zu Personen mit vollständigen PA ein ähnliches Risiko für die Entwicklung nachfolgender Psychopathologie aufweisen. Spezifische Merkmale initialer FS/PA und zusätzliche Risikofaktoren könnten zur Identifikation von Sub-Gruppen von Personen mit Panik genutzt werden, die sich durch ein besonderes Risiko für schwergradige Panikpathologie und andere psychische Störungen auszeichnen und demzufolge von Outcome-bezogenen Präventionen (ergänzend zu Panik-spezifischer Intervention) profitieren könnten. Zukünftige Studien sollten die vorliegenden Befunde replizieren und die Effektivität gezielter Präventivinterventionen bei Personen mit erhöhtem Risiko für PS und andere psychische Störungen testen.:CONTENT
0 Synopsis 10
1 Introduction 13
1.1 Current challenges in clinical psychology 13
1.2 Psychological models of mental disorders 13
1.3 Diagnostic approaches to psychopathology 15
1.4 Methodological issues 16
1.5 Preventive and early treatment interventions 17
2 Panic pathology 18
2.1 Definitions 18
2.2 Epidemiology 19
2.3 Etiology 20
2.4 Physiological, neurobiological, and genetic findings 21
2.5 Unresolved issues 22
3 Aims 24
4 Methods 26
5 Study I: Associations of fearful spells and panic attacks with incident anxiety, depressive, and substance use disorders: A 10-year prospective-longitudinal community study of adolescents and young adults 27
5.1 Abstract 27
5.2 Introduction 27
5.3 Materials and methods 28
5.4 Results 30
5.5 Discussion 35
6 Study II: Characteristics of initial fearful spells and their associations with DSM-IV panic attacks and panic disorder in adolescents and young adults from the community 37
6.1 Abstract 37
6.2 Introduction 37
6.3 Materials and methods 38
6.4 Results 41
6.5 Discussion 43
7 Study III: Risk factors for fearful spells and panic: A 10-year prospective-longitudinal study among adolescents and young adults 47
7.1 Abstract 47
7.2 Introduction 47
7.3 Materials and methods 49
7.4 Results 52
7.5 Discussion 60
8 Study IV: Does help-seeking alter the risk for incident psychopathology in adolescents and young adults with and without fearful spells or panic attacks? Findings from a 10-year prospective-longitudinal community study 63
8.1 Abstract 63
8.2 Introduction 63
8.3 Materials and methods 64
8.4 Results 66
8.5 Discussion 70
9 General discussion 73
9.1 Summary and discussion of main findings 73
9.2 Preventive interventions among individuals with panic pathology 75
9.3 Research implications 77
10 Conclusions 78
11 References 79
12 Appendix 94
12.1 Acknowledgements 94
12.2 Erklärung zu den Eigenanteilen an einzelnen Publikationen 95
12.3 Eigenständigkeitserklärung 9
Wie gelingt die optimierte Inanspruchnahme indikativer Präventionsprogramme für psychische Auffälligkeiten im Vor- und Grundschulalter im deutschen Gesundheitssystem? – Ergebnisse einer prospektiven Implementationsstudie
Full text linkWie gelingt die Prävention psychischer Beschwerden? Erprobung einer innovativen Versorgungskette: Von der Vorsorgeuntersuchung zur indikativen Präventionsmaßnahme bei emotionalen und Verhaltensauffälligkeiten im Vor- und Grundschulalter. Wie ist die Teilnahmebereitschaft der Familien und Kinderärzt*innen an der innovativen Versorgungskette und welche Barrieren und Förderfaktoren der Inanspruchnahme von Präventionsprogrammen konnten identifiziert werden.:0 Synopse 9
1 Einleitung 19
1.1 Epidemiologie psychischer Störungen 19
1.2 Individuelle und gesellschaftliche Krankheitslast psychischer Störungen 22
1.3 Prävention psychischer Störungen 24
1.3.1 Präventionsansatz bei psychischen Störungen 24
1.3.2 Wirksamkeit von Präventionsprogrammen 27
1.3.3 Inanspruchnahme von Präventionsprogrammen 29
1.3.4 Barrieren und Förderfaktoren der Inanspruchnahme von professioneller Hilfe 30
2 Ziele und Fragestellungen der Thesis 35
3 Studiendesign und Methodik - Beitrag 1: Wie gelingt die Prävention psychischer Beschwerden? Von der Vorsorgeuntersuchung zur indikativen Präventionsmaßnahme bei emotionalen und Verhaltensauffälligkeiten im Vor- und Grundschulalter: eine prospektive Implementationsstudie 38
3.1 Zusammenfassung 38
3.2 Trailer 39
3.3 Hintergrund und Fragestellung 39
3.4 Studiendesign und Untersuchungsmethoden 40
3.4.1 Vorgehen 40
3.4.2 Stichprobe 41
3.4.3 Präventionsmaßnahmen 44
3.4.4 Evaluation des Versorgungspfades 45
3.5 Diskussion 48
3.5.1 Schlussfolgerungen 49
3.5.2 Fazit für die Praxis 49
4 Beitrag 2: Indikative Präventionsprogramme zur Förderung der seelischen Gesundheit im Vor- und Grundschulalter: Teilnahmebereitschaft von Kinderärzt*innen und Familien an einer innovativen Versorgungskette 50
4.1 Zusammenfassung 50
4.2 Einleitung 51
4.3 Methoden 53
4.3.1 Studiendesign und Untersuchungsablauf 53
4.3.2 Erhebungsinstrumente 56
4.3.3 Statistische Analysen 58
4.4 Ergebnisse 58
4.4.1 Teilnahmebereitschaft der FfPaed an der Umsetzung des Screenings 58
4.4.2 Zugangswege in die Versorgung und Prävention 60
4.4.3 Teilnahmebereitschaft der Familien am Screening und an indikativen Präventionsmaßnahmen 63
4.4.4 Ablehnungsgründe 67
4.5 Diskussion 68
4.5.1 Limitationen 71
4.5.2 Fazit 71
5 Beitrag 3: Barrieren und Förderfaktoren der Inanspruchnahme von Präventionsprogrammen zur Förderung der seelischen Gesundheit bei Kindern im Vor- und Grundschulalter 73
5.1 Zusammenfassung 73
5.2 Einleitung 75
5.3 Methoden 79
5.3.1 Stichprobe und Untersuchungsablauf 79
5.3.2 Erhebungsinstrumente 80
5.3.3 Statistische Analysen 81
5.4 Ergebnisse 83
5.4.1 Stichprobenbeschreibung 83
5.4.2 Barrieren und Förderfaktoren der Inanspruchnahme 86
5.5 Diskussion 105
5.5.1 Limitationen der Studie 108
5.5.2 Schlussfolgerung 109
6 Allgemeine Diskussion 111
6.1 Übergreifende Ergebnisdiskussion zu den Teilfragestellungen und Ableitung von Implikationen 112
6.2 Stärken und Schwächen der Arbeit 128
6.3 Beantwortung der Hauptfragestellung „Wie gelingt die optimierte Inanspruchnahme indikativer Präventionsprogramme für psychische Auffälligkeiten im Vor- und Grundschulalter im deutschen Gesundheitssystem?“ und Implikationen für die Umsetzung von Präventionsmaßnahmen 131
7 Schlussfolgerung 134
8 Referenzverzeichnis 136
9 Anhang 162
9.1 Tabellenverzeichnis 162
9.2 Abbildungsverzeichnis 164
9.3 Abkürzungsverzeichnis 165
9.4 Danksagung 166
9.5 Eigenständigkeitserklärung 16
Brain Aging in Specific Phobia: An ENIGMA-Anxiety Mega-Analysis
No full textIntroduction Specific phobia (SPH) is a prevalent anxiety disorder and may involve advanced biological aging. However, brain age research in psychiatry has primarily examined mood and psychotic disorders. This mega-analysis investigated brain aging in SPH participants within the ENIGMA-Anxiety Working Group. Methods 3D brain s tructural MRI scans from 17 international samples (600 SPH individuals, of whom 504 formally diagnosed and 96 questionnaire-based cases; 1,134 controls; age range: 22-75 years) were processed with FreeSurfer. Brain age was estimated from 77 subcortical and cortical regions with a publicly available ENIGMA brain age model. The brain-predicted age difference (brain-PAD) was calculated as brain age minus chronological age. Linear mixed-effect models examined group differences in brain-PAD and moderation by age. Results No significant group difference in brain-PAD manifested ( β diagnosis (SE)=0.37 years (0.43), p =0.39). A negative diagnosis-by-age interaction was identified, which was most pronounced in formally diagnosed SPH ( β diagnosis-by-age =-0.08 (0.03), pFDR =0.02). This interaction remained significant when excluding participants with anxiety comorbidities, depressive comorbidities, and medication use. Post-hoc analyses revealed a group difference for formal SPH diagnosis in younger participants (22-35 years; β diagnosis =1.20 (0.60), p <0.05, mixed-effects d (95% confidence interval)=0.14 (0.00-0.28)), but not older participants (36-75 years; β diagnosis =0.07 (0.65), p =0.91). Conclusions Brain aging did not relate to SPH in the full sample. However, a diagnosis-by-age interaction was observed across analyses, and was strongest in formally diagnosed SPH. Post-hoc analyses showed a subtle advanced brain aging in young adults with formally diagnosed SPH. Taken together, these findings indicate the importance of clinical severity, impairment and persistence, and may suggest a slightly earlier end to maturational processes or subtle decline of brain structure in SPH
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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