Elmar Braehler

Somatization Symptoms and Hypochondriacal Features in the General Population

Objective The principal goal of this study is to examine the base rates of somatoform symptoms and of hypochondriacal features in the general population. Methods A representative sample of 2050 persons in Germany was examined by use of screening for somatoform symptoms and the Whiteley Index. Results The most frequent somatoform symptoms were back pain, joint pain, pain in extremities, and headache, as well as abdominal symptoms (bloating or intolerance of several foods) and cardiovascular symptoms (palpitation). People reported a mean of two somatization symptoms of DSM-IV somatization disorder (SD) during the prior 2 years. Strong age and medium gender effects were found for most somatoform symptoms, as well as for composite indices. However, the sex ratio suggested in DSM-IV for SD seems to be an overestimation. Hypochondriacal features showed only small sex differences but, again, pronounced age effects. In contrast to low rates for SD, the base rates for somatization and hypochondriacal features were high and represented the health care relevance of subthreshold syndromes. Conclusion We present base rates of hypochondriacal and somatization features that may be important facets in the development of classification criteria and in the interpretation of health care expenditure.

How frequent are eating disturbances in the population? Norms of the eating disorder examination-questionnaire.

Objective The Eating Disorder Examination-Questionnaire (EDE-Q) is a self-report instrument assessing the specific psychopathology and key behaviors of eating disorders. This study sought to determine the prevalence of eating disturbances, and to provide psychometric properties and norms of the EDE-Q, in a representative German population sample. Methods A total of 2520 individuals (1166 men, 1354 women) were assessed with the EDE-Q. Results Eating disorder psychopathology was higher and most key behaviors were more prevalent in women than in men. Psychopathology declined with age ≥65 in both sexes, and showed a peak at age 55–64 in men. Overall, 5.9% of the women and 1.5% of the men revealed eating disturbances. The prevalence of eating disturbances decreased with age in women and was significantly higher in obese than in normal-weight individuals. Psychometric analyses showed favorable item characteristics. Internal consistencies of EDE-Q composite scores were ≥.80 for women and ≥.70 for men. The factor structure of the EDE-Q was partially reproduced. Sex- and age-specific population norms are reported. Discussion This study provides population norms of the EDE-Q for both sexes and across the age range, demonstrates demographic variations in symptomatology, and reveals satisfactory psychometric properties. Further research is warranted on eating disturbances in older adults.

Stigmatizing Attitudes Toward Obesity in a Representative Population-based Sample

Objective: The aim of this study was to determine stigmatizing attitudes toward obesity in the population, and its related psychological and sociodemographic determinants.

Weight bias internalization, core self‐evaluation, and health in overweight and obese persons

Weight bias has strong associations with psychopathology in overweight and obese individuals. However, self‐evaluative processes, as conceptualized in the process model of self‐stigma, and implications for other health‐related outcomes, remain to be clarified.

Assessing general side effects in clinical trials: reference data from the general population

Side effects in clinical trials are frequently assessed in an unstructured fashion, using ascertainment strategies with unclear quality criteria. To improve the assessment and interpretation of general side effects, a structured approach is presented and validated (General Assessment of Side Effects, GASE). Base rates and reference data of the general population as well as quality criteria of this new side effect ascertainment method are provided.

Traumatic experiences and post-traumatic stress disorder among elderly Germans: results of a representative population-based survey

BACKGROUND Only a few population-based studies on the epidemiology of post-traumatic stress disorders (PTSDs) are available to date. Most of the existing studies are from the U.S.A. Against the background of World War II, the extent and long-term effects of war-related traumatic experiences in the German elderly population are of special interest. Nevertheless, population-based data on this topic are lacking to date. METHODS This study examines the occurrence of traumatic experiences and the prevalence rates of PTSD according to DSM-IV and of partial PTSD in a randomly selected sample of the German general population aged 60 years and over (N = 814) using self-rating instruments. RESULTS PTSD is apparent in 3.4%; when partial post-traumatic stress syndromes are included, a total of 7.2% of the aged population are involved. The most common individual symptoms resulting from war-induced trauma are avoidance of thoughts and feelings, sleep disturbances, distressing dreams and intrusive thoughts. The most frequently mentioned traumatic experiences of the generation examined in this study were war-related trauma experienced as children or in early adulthood during World War II. As a persons age increases, so does the prevalence of war-related traumatic experiences. There are some gender differences in traumatic experiences, but not in post-traumatic symptoms. CONCLUSION The results emphasize the importance of war-related traumatic experiences from World War II in the German elderly population and their impact on the prevalence of PTSD more than 60 years later.

Age- and gender-specific prevalence and risk factors for depressive symptoms in the elderly: a population-based study

OBJECTIVES Information on the prevalence and risk factors for depressive disorders in old age is of considerable interest for the assessment of future needs of the health care system. The aim of the study is to determine age- and gender-specific prevalence of major depression (MD), minor depression (MiD), and depressive symptoms, and to analyze risk factors associated with depressive symptoms. METHODS A representative sample of the German population of 1,659 individuals aged 60 to 85 years were visited at home and answered self-rating questionnaires. Depressive symptoms and syndromes (MD, MiD) were assessed using the Patient Health Questionnaire (PHQ-9). Factors associated with depressive symptoms were determined with linear regression models for the total sample and for men and women separately. RESULTS Depressive symptoms were found in 28.7% of the participants, while 6.6% were affected by MD or MiD. The highest prevalence of MD and depressive symptoms was found in the oldest age groups. MiD showed an unsteady course across age groups in both sexes. In the total sample as well as in the male subsample, depressive symptoms were significantly associated with increasing age, lower household income, an increasing number of medical conditions, and lower social support. In women only, the number of medical conditions and lacking social support were significantly associated with depressive symptoms. CONCLUSIONS Depressive symptoms are common in old age and occur on a spectrum ranging from very mild forms to MD. The potential modifiability of a number of risk factors for depressive symptoms opens possibilities of secondary prevention such as treatment of chronic diseases as well as support in requirements of daily living.

Are psychological features useful in classifying patients with somatic symptoms

Objective: To evaluate psychological characteristics that could be used for the classification of somatic syndromes requesting medical care. Positive psychological classification criteria are needed to justify the classification of somatic syndromes as Diagnostic and Statistical Manual of Mental Disorders- or International Classification of Diseases-10 section F/mental disorders diagnosis. Methods: From a population-based sample of 2510 people, subsamples reporting high scores for somatic symptoms (SOM+; n = 154) versus average scores for somatic symptoms (SOM−; n = 167) were defined. Telephone interviews (e.g., structured interviews for diagnoses, healthcare use, symptom history, possible psychological characteristics), self-rating scales (e.g., Pain Disability Index, depression scale Patient Health Questionnaire-9), and general practitioners reports were collected for these subsamples. In addition to somatic symptoms, we used healthcare use and disability as major external validation criteria. Results: There was strong evidence for ten of the 28 binary coded psychological variables to identify those people with somatic symptoms who needed medical help and/or were seriously disabled. These variables included “avoidance of physical activities,” “bias for somatic illness attributions,” “self-concept of being physically weak,” and “desperation because of somatic symptoms.” The relevance of these psychological characteristics was partially further confirmed by stepwise regression analyses, which showed incremental validity compared with variables like somatic symptoms and depression. Conclusions: This study identified several psychological characteristics of people with somatic complaints who need medical care. These features can be assessed, using binary variables that are more feasible for classification processes. These psychological criteria should be included in classification rules for people with somatic syndromes (e.g., somatoform disorders). PHQ = Patient Health Questionnaire; PDI = Pain Disability Index.

What determines public support of obesity prevention

Objective: To determine public support of obesity prevention. Design: Representative population-based survey. Setting: Random digit dialling telephone survey of non-institutionalised individuals aged ⩾14 years in Germany. Participants: Representative sample of 1000 individuals. Main outcome measures: Interview-based assessment of prevention support, problem identification, causal attributions and responsibility beliefs regarding obesity. Results: Support for obesity prevention with a focus on behavioural change in children (89.7%) and provision of information in adults (82.2%) was substantial, but regulations were less supported (42.2%). Predictors of prevention support were attributing causes of obesity to the food environment and lack of physical activity, greater problem identification, societal responsibility beliefs and sociodemographic characteristics including female gender and higher age. An information deficit concerning the definition, prevalence, and environmental and genetic risk factors was identified. Conclusion: Results show a high public readiness for obesity prevention with a focus on individual behavioural change, but not for regulations. Addressing specific information deficits regarding the definition, prevalence and causes of obesity could further enhance the public’s understanding of obesity and help to establish obesity prevention measures.

Posttraumatic stress disorder and its comorbidity with depression and somatisation in the elderly – A German community-based study

Objectives: Even 60 years after World War II, the German elderly population is significantly more often affected by posttraumatic symptomatology compared to the younger cohorts. This study is addressing prevalence rates of posttraumatic symptomatology and its comorbidity with depression and somatisation. Methods: This study examines posttraumatic stress disorder (PTSD) according to DSM-IV, partial PTSD, depression and somatisation in a randomly selected sample of the German general population aged 60–85 years (N = 1.659) using self-rating instruments (Patient Health Questionnaire, PHQ; Post Traumatic Diagnostic Scale, PTDS). Results: One-month prevalence rate was 4.0% for DSM-IV PTSD; another 12.2% fulfilled the criteria of partial PTSD. A significant increase across the age groups was found for partial PTSD. 11.5% of the persons affected by posttraumatic symptomatology fulfil the criteria of a somatoform syndrome, 8.6% fulfil the criteria of major depression and 10.4% fulfil the criteria of other depressive syndromes according to the PHQ. A current posttraumatic symptomatology is associated with increased prevalence rates of somatoform and depressive disorders. Moreover, traumatic experiences without a current PTSD are associated with increased rates of somatoform disorders. Conclusion: Posttraumatic symptomatology is a common phenomenon in the German elderly population. Especially, subsyndromal disorders are very common and increasing across the age groups. Posttraumatic symptomatology is associated with an increased risk of depressive and somatoform disorders. As posttraumatic symptoms are often neglected in geriatric health care, future effort should address the recognition and treatment of posttraumatic symptoms in elderly patients.