Antje Bittner

Effects of an early intervention on perceived stress and diurnal cortisol in pregnant women with elevated stress, anxiety, and depressive symptomatology

The goal of the present investigation was to examine effects of a cognitive-behavioral group intervention for pregnant women with subclinically elevated stress, anxiety and/or depression on perceived stress and salivary cortisol levels. Expectant mothers were recruited in gynaecologist practices. They participated in a screening, a standardized diagnostic interview (Munich-Composite Diagnostic Interview, M-CIDI), and were randomly assigned to an intervention (N = 21) and treatment as usual control group (N = 40). The intervention consisted of a manualized cognitive-behavioral group program for expectant mothers with subclinically elevated stress, depression, and/or anxiety symptoms. Stress questionnaire (prenatal distress (PDQ), perceived stress (PSS)) as well as diurnal salivary cortisol assessment took place at T1 (antenatal, preintervention), at T2 (antenatal, post-intervention) and T3 (3-month postpartum). Subjects that participated in the intervention exhibited a significant post-treatment change in morning cortisol (cortisol awakening response, CAR) in contrast to control subjects, F(8,51) = 2.300, p = 0.047. Intervention participants showed a smaller CAR subsequent to the intervention, displaying a lessened stress reaction. This effect was not observed in the control group. In contrast, we failed in discovering a significant difference between the research groups regarding the cortisol area under curve parameter (AUC) and the applied subjective stress questionnaires. Evaluation results were thus heterogeneous. Nevertheless, intervention effects on the CAR are promising. Our results suggest that a cognitive-behavioral intervention might lead to an improvement in the biological stress response of pregnant women with subclinically elevated stress, anxiety, or depressive symptoms.

Psychometric properties of the Retrospective Self Report of Inhibition (RSRI) in a representative German sample.

The present study examined the internal consistency, factorial structure, and construct validity of the German version of the Retrospective Self Report of Inhibition (RSRI), a questionnaire measure of behavioral inhibition. The research was based on data from a German prospective‐longitudinal community study of 3021 adolescents and young adults (aged 14–24 years at baseline). Diagnostic assessment was based on the DSM‐IV/M‐CIDI and general psychopathological distress was assessed with SCL‐90‐R. Results of confirmatory factor analysis indicated adequate fit of the two‐factor model, suggested by the authors of the original version. Indices of internal consistency of the RSRI and its subscales ‘social/school’ and ‘fear/illness’ were shown to be sufficient for the total sample and even higher in subgroups of subjects with certain DSM‐IV diagnoses. Associations with variables such as mental distress, parental psychopathology, and DSM‐IV disorders were in line with theoretical assumptions and confirm different aspects of the validity (convergent, concurrent, predictive) of the instrument. The psychometric properties of the German RSRI were found to be comparable to those of the English version. The applicability of this questionnaire in German‐speaking countries is therefore recommended for adolescents and young adults. Copyright

Early intervention in pregnant women with elevated anxiety and depressive symptoms: efficacy of a cognitive-behavioral group program.

To examine whether a cognitive-behavioral group program among pregnant women with elevated levels of anxiety or depression may reduce anxious and depressive symptoms and has a positive impact on risk factors for anxiety disorders and depression. A total of 753 participants were recruited. After completion of the clinical standardized interview, 160 participants were randomized to an intervention group or a control condition. Psychometric assessments took place at T1 (preintervention), T2 (antenatal follow-up), and T3 (3 months postpartum). Analyses included women who took part in all 3 assessments (intervention group, N = 21; control group, N = 53). The subjective program evaluation by the participants was highly positive, but with the exception of a short-term effect on the quality of an intimate partnership (F1/67 = 4.056; P < .05], intervention effects on anxiety or depressive symptoms were not found. However, there was an intervention effect 3 months postpartum for participants with high depressive symptoms at T1 (Edinburgh Postnatal Depression Scale score of ≥10) (F1/69 = 5.410; P < .05). The results argue against a general efficacy of a cognitive-behavioral group program for pregnant women with rather low levels of anxiety and depression. For women with higher depressive symptoms during pregnancy, a cognitive-behavioral group program may have a positive impact on the course of depressive symptoms during the postpartum period.

A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks

Purpose. This study examined whether a short-term psychosomatic intervention during pregnancy had effects on characteristics of labour and delivery as well as on the long-term course of anxiety, depression and physical complaints in pregnant in-patient women. Methods. All gynaecological and obstetric inpatients of a university hospital, who had either exhibited complications during their pregnancy or were considered high-risk pregnancies, were examined. Symptoms of anxiety and depression (HADS) and physical symptoms (GBB) were assessed by standardised questionnaires. Women with elevated scores on either the HADS or the GBB were randomly assigned to either a treatment group, which had received a psychosomatic intervention or an untreated control group. Of the n = 238 women who were assessed during their stay in our hospital, n = 135 were included in the follow-up 1-year later. Results. More than one-third of the participants (38.7%) had elevated scores of anxiety, depression and/or physical symptoms. The psychosomatic intervention had a significant effect on anxiety scores (p = 0.006), but not on depression scores, physical complaints and characteristics of labour and delivery. Conclusions. Findings suggest that a short-term psychosomatic intervention can have a positive long-term effect on anxiety symptoms. Future studies are needed to show whether the reduction of anxiety symptoms in turn can lead to a reduction of postnatal complications and lower rates of disturbed mother–child interactions.

Which gynecological and obstetric patients want to attend psychosomatic services

Objective. The aim of this study is to explore the wish of gynecological and obstetric inpatients to attend psychosomatic services. Predictors influencing this wish are evaluated. Method. Three groups of patients participated in the study. The groups consisted of patients diagnosed with malignant gynecological diseases (n = 175), benign gynecological diseases (n = 302), and obstetric diseases (n = 238). The following domains were assessed in a cross-sectional design: symptoms of anxiety and depression (HADS), physical complaints (GBB-24), health-related quality of life (SF-12), and the wish to attend psychosomatic services. Results. 34% of the participants indicated that they wanted to attend psychosomatic services during their stay in the hospital. The group of patients diagnosed with malignant gynecological diseases had the highest proportion of women who stated that wish (43%). Multiple logistic regression models showed that former psychotherapeutic experiences as well as low psychological quality of life predicted the wish to attend psychosomatic services in patients diagnosed with malignant gynecological or obstetric diseases. Conclusion. It was shown that a considerable proportion of patients wanted to attend psychosomatic care during their hospitalization. Contrary to physical and sociodemographic variables, psychological factors were significant predictors of the inpatients wish to attend psychosomatic services. This suggests that the subjective estimation of impairments is a major predictor of the wish to attend psychosomatic care.

Menopausal syndrome limited to hot flushes and sweating a representative survey study

Abstract Objective: The menopausal syndrome is described as a series of various physical and nonphysical symptoms attributed to perimenopausal changes in hormone levels. However, evidence is biased by focusing research on the target group of middle aged women only. To overcome this bias, we examined the occurrence of menopausal symptoms during the entire life span in both women and men. Methods: Therefore, we studied the occurrence of menopausal symptoms with the widely used Menopause Rating Scale (MRS) across the entire life span in both women and men. To this end, we performed a nationwide cross-sectional survey study in Germany in which we examined a representative sample of 2527 persons aged from 14 to 95 years. Additionally, sociodemographic factors and self-efficacy were surveyed. Results: Although the overall MRS score was generally higher for women compared to men, there was no specific peak for the time of menopause. Instead the score increased linearly with age for both sexes. Furthermore, it was stronger associated with sociodemographic variables and self-efficacy than with the sex of the participants. Among all assessed symptoms, only hot flushes and sweating, but none of the others, emerged as specific for the menopausal episode. Conclusions: Our data indicate that among symptoms commonly classified as menopausal only hot flushes and sweating appear to be specific for the perimenopausal episode. Other symptoms may be caused by a multifactorial etiopathogenesis including physical, sociodemographic, cultural and psychological factors that, in turn, might benefit from multimodal treatment regimes.

Klimakterische Beschwerden über die Lebensspanne? Ergebnisse einer repräsentativen Umfrage in der deutschen Allgemeinbevölkerung

Aim of the present investigation was the assessment of magnitude and distribution of subjective menopausal complaints in the German population. Study participants included 1 350 women aged 14-92 years, completing the menopause rating scale (MRS II). A total of 22% of the women exhibited considerable/severe menopausal complaints. Symptoms as sleep problems, joint and muscular discomfort, heart discomfort and physical and mental exhaustion increased drastically with advancing age. Hot flushes/sweating were the only symptoms specifically assigned to the menopausal period. Significant predictors for the intensity of menopausal complaints were: region of living, age, level of psychic burden, somatic complaints, depression, stress and fatigue. It is concluded that menopausal symptoms referred to in the literature must be questioned to be phase specific. Further research on aetiological factors is needed.

Visualizing Multivariate Dependencies with Association Chain Graphs

In a recent paper, a new type of graph to visualize the results from graphical models was proposed. Association chain graphs (ACGs) provide a richer visualization than conventional graphs (directed acyclic and recursive regression graphs) if the data can be described with only a small number of parameters. ACGs display not only which associations reach statistical significance, but also the magnitude of associations (confidence intervals for statistical main effects) as the contrast color to the background color of the graph. In this paper, the ACG visualization is extended especially for the case where all variables are binary by illustrating their relative frequencies. This shows the degrees of associations not only on the individual (as expressed by odds ratios or other indexes of association) but also on the community level. We applied the approach to an extensive example of birth and childhood factors for the onset of affective mental disorders using data from the EDSP (Early Developmental Stages of ...

Prävention von Angststörungen im Kindes- und Jugendalter

Viele Kinder und Jugendliche sind in ihrem Alltag mit Angsten konfrontiert. Nicht immer ist dabei auf Anhieb klar zu unterschieden, ob es sich hierbei urn normale, alterstypische Angste handelt oder ob sie bereits das Ausmas einer Angststorung erreicht haben. Die Grenzen sind fliesend.

16 Frühintervention bei Schwangeren zur Prävention peripartaler Störungen

Antenatale psychische Belastungen wie Stress, Angste und/oder Depression konnen sich auf den Schwangerschafts- und Geburtsverlauf und die kindliche Entwicklung auswirken. Ein inhaltlich ausgewogenes und fur Betroffene niedrigschwellig zugangliches Angebot an Masnahmen zur fruhzeitigen Behandlung bzw. Pravention solcher Beschwerden ist fur die klinische Praxis zu fordern. Dazu steht mittlerweile eine Reihe von Interventionen zur Verfugung, die ihre Wirksamkeit fur Mutter und Kind nachweisen konnten. Einzelinterventionen fur ein Hochrisikoklientel scheinen wahrend der Schwangerschaft praktikabeler zu sein als geschlossene Gruppeninterventionen. Beispielhaft werden Konzeption und vorlaufige Ergebnisse der Evaluation des deutschen Gruppenprogramms «LOS – Lebensfroh und optimistisch durch die Schwangerschaft» vorgestellt.