Elmar Brähler

Sexual desire and sexual activity of men and women across their lifespans: results from a representative German community survey

To present data on sexual desire and sexual activity from a representative survey of men and women covering the total age range of the adult German population, as previous studies have usually been based on samples selected for gender (either men or women) and age (ageing populations).

Fragebogen zur Messung beruflicher Gratifikationskrisen

Zusammenfassung: Das zur Erklarung gesundheitlicher Risiken infolge chronischer psychomentaler und sozioemotionaler Arbeitsbelastungen entwickelte Modell beruflicher Gratifikationskrisen ist in verschiedenen, z.T. internationalen epidemiologischen und experimentellen Untersuchungen anhand eines standardisierten Messverfahrens erfolgreich uberpruft worden. Erstmals werden hier Ergebnisse der psychometrischen Testung des Messverfahrens an einer fur die erwerbstatige Bevolkerung Deutschlands reprasentativen Stichprobe vorgestellt (N = 666 Manner und Frauen; durchschnittliches Alter: 40.1±11.2). Die das Modell messenden Skalen werden bezuglich interner Konsistenz, Item-Skalen- und Interskalen-Korrelationen sowie kriterienbezogener Validitat charakterisiert. Ferner wird die faktorielle Validitat des Messmodells durch konfirmatorische Testung von vier alternativen Strukturmodellen uberpruft, wobei der Modell-Fit der theoriekonform spezifizierten derjenigen der weniger spezifizierten uberlegen ist. Zusammenfasse...

Adjustment disorder as proposed for ICD-11: Dimensionality and symptom differentiation.

Although Adjustment Disorder as a diagnostic category is widely used in clinical practice it is critically discussed that it has not been conceptualized as a category with unique symptoms. Hence, the conceptualization of Adjustment Disorder is subject to substantive change in ICD-11 including core symptoms and additional features in a uni-faceted concept. Adjustment Disorder was assessed with a self-rating instrument in a representative sample of the German general population (N=2512). Confirmatory factor analyses (CFA) were applied to test the dimensionality of symptoms according to the new diagnostic concept. Latent class analysis (LCA) was applied to test whether there are distinguishable subgroups with respect to symptomatology. 2.0% of the sample were diagnosed with Adjustment Disorder according to the new diagnostic algorithm. The proposed six factor model shows best fit with good reliability of the factors in the CFA compared to competing models. However the factors are highly correlated and not distinguishable. The LCA identified three latent classes, reflecting low, mild and moderate to severe symptoms. The findings support the uni-faceted concept of Adjustment Disorder as it is conceptualized in the new diagnostic concept in ICD-11 in a general population sample. This clearer diagnostic concept will inform research as well as clinical practice.

Procrastination, Distress and Life Satisfaction across the Age Range – A German Representative Community Study

Addressing the lack of population-based data the purpose of this representative study was to assess procrastination and its associations with distress and life satisfaction across the life span. A representative German community sample (1,350 women; 1,177 men) between the ages of 14 and 95 years was examined by the short form of the General Procrastination Scale (GPS-K; 1) and standardized scales of perceived stress, depression, anxiety, fatigue and life satisfaction. As hypothesized, procrastination was highest in the youngest cohort (14–29 years). Only in the youngest and most procrastinating cohort (aged 14 to 29 years), men procrastinated more than women. As we had further hypothesized, procrastination was consistently associated with higher stress, more depression, anxiety, fatigue and reduced satisfaction across life domains, especially regarding work and income. Associations were also found with lack of a partnership and unemployment. Findings are discussed with regard to potential developmental and cohort effects. While procrastination appears to be a pervasive indicator for maladjustment, longitudinal analyses in high-risk samples (e.g. late adolescence, unemployment) are needed to identify means and mechanisms of procrastinating.

Sleep quality in the general population: psychometric properties of the Pittsburgh Sleep Quality Index, derived from a German community sample of 9284 people

BACKGROUND The Pittsburgh Sleep Quality Index (PSQI) is frequently used to assess sleep problems in patients. The aim of this study was to provide reference values for this questionnaire, to test psychometric properties, and to analyze associations with psychological, sociodemographic, and behavioral factors. METHODS A German community sample comprising 9284 adult residents (aged 18-80 years) was surveyed using the PSQI and several other questionnaires. RESULTS According to the generally accepted cut-off (PSQI > 5), 36% of the general population slept badly. Females reported significantly more sleep problems than males (mean scores: M = 5.5 vs. M = 4.4, respectively; effect size d = 0.35), but there was no linear association between age and sleep quality. Sleep problems were correlated with fatigue, quality of life (physical as well as mental), physical complaints, anxiety, and lack of optimism. Sleep quality was also strongly associated with socioeconomic status, professional situation (poorest sleep quality in unemployed people), and obesity. In addition to the results of the PSQI total score, mean scores of specific components of sleep quality were presented (sleep latency, sleep duration, and use of sleep medication). CONCLUSION The PSQI proved to be a suitable instrument for measuring sleep quality. Gender differences, psychological factors, and obesity should be taken into account when groups of patients are compared with respect to sleep problems.

Noise annoyance is associated with depression and anxiety in the general population- the contribution of aircraft noise

Background While noise annoyance has become recognized as an important environmental stressor, its association to mental health has hardly been studied. We therefore determined the association of noise annoyance to anxiety and depression and explored the contribution of diverse environmental sources to overall noise annoyance. Patients and Methods We investigated cross-sectional data of n = 15.010 participants of the Gutenberg Health Study (GHS), a population-based, prospective, single-center cohort study in Mid-Germany (age 35 to 74 years). Noise annoyance was assessed separately for road traffic, aircraft, railways, industrial, neighborhood indoor and outdoor noise (“during the day”; “in your sleep”) on 5-point scales (“not at all” to “extremely”); depression and anxiety were assessed by the PHQ-9, resp. GAD-2. Results Depression and anxiety increased with the degree of overall noise annoyance. Compared to no annoyance, prevalence ratios for depression, respectively anxiety increased from moderate (PR depression 1.20; 95%CI 1.00 to 1.45; PR anxiety 1.42; 95% CI 1.15 to 1.74) to extreme annoyance (PR depression 1.97; 95%CI 1.62 to 2.39; PR anxiety 2.14; 95% CI 1.71 to 2.67). Compared to other sources, aircraft noise annoyance was prominent affecting almost 60% of the population. Interpretation Strong noise annoyance was associated with a two-fold higher prevalence of depression and anxiety in the general population. While we could not relate annoyance due to aircraft noise directly to depression and anxiety, we established that it was the major source of annoyance in the sample, exceeding the other sources in those strongly annoyed. Prospective follow-up data will address the issue of causal relationships between annoyance and mental health.

A brief form of the Perceived Social Support Questionnaire (F-SozU) was developed, validated, and standardized

OBJECTIVES Development of a brief instrument (F-SozU K-6) for the measurement of perceived social support in epidemiologic contexts by shortening a well-established German questionnaire (F-SozU K-14). STUDY DESIGN AND SETTING The development of the F-SozU K-6 consisted of two phases; phase 1: the F-SozU K-14 was presented to a general population sample representative for the Federal Republic of Germany (N = 2,007; age: 14-92 years). Six items for the short form were selected based on the maximization of coefficient alpha. Phase 2: the new short form (F-SozU K-6) was evaluated and standardized in an independent second population survey (N = 2,508, age: 14-92 years). RESULTS The F-SozU K-6 showed very good reliability and excellent model fit indices for the one-dimensional factorial structure of the scale. Furthermore, strict measurement invariance was detected allowing unbiased comparison of means and correlation coefficients and path coefficients between both sexes across the full lifespan from adolescence (14-92 years). Well-established associations of perceived social support with depression and somatic symptoms could be replicated using the short form. CONCLUSION The F-SozU K-6 presents a reliable, valid, and economical instrument to assess perceived social support and can thus be effectively applied within the frameworks of clinical epidemiologic studies or related areas.

Assessment of depression severity with the PHQ-9 in cancer patients and in the general population

BackgroundThe Patient Health Questionnaire PHQ-9 is a widely used instrument to screen for depression in clinical research. The first aim of this study was to psychometrically test the PHQ-9 in a large sample of cancer patients. The second aim was to calculate unbiased estimates of the depression burden for several cancer groups taking into account age and gender distributions.MethodsA sample of 2,059 cancer patients with varying diagnoses were examined in this study six months after discharge from a rehabilitation clinic. A representative sample of 2,693 people from the general population served as controls. Expected PHQ-9 mean scores of the general population sample, regressed on age and gender, were calculated to enable a fair comparison of different groups of cancer patients.ResultsWhile the reliability (Cronbach’s alpha) for the PHQ-9 scale was good (alpha ≥ 0.84), the CFA fit indices of the one-dimensional solution were unsatisfactory in the patients’ sample. The factorial analysis confirmed two factors. PHQ-9 mean scores for 15 types of cancer are given, ranging from 4.0 (prostate) to 8.2 (thyroid gland). Differences between expected mean scores (derived from the general population) and raw mean scores of the cancer subsamples are reported that provide a better estimate of the depression burden.ConclusionsThe results confirmed that the PHQ-9 performs well in testing depression in cancer patients. Regression coefficients can be used for performing unbiased comparisons among cancer groups, not only for this study. The burden of patients with testis cancer and Hodgkin lymphoma is underestimated when age and gender are not taken into account.

Association Between Restless Legs Syndrome and Adult ADHD in a German Community-Based Sample.

Objective: Previous research in clinical samples indicated a significant association between ADHD and restless legs syndrome (RLS). The present study examined the association between adult ADHD and RLS in the German population. Method: Self-rating instruments to assess RLS, childhood ADHD, and adult ADHD were administered to a community-based sample (N = 1,632). In addition, current depression and anxiety, sleep disturbances, weight, and height were assessed by self-report. Results: Adult ADHD was associated with statistically significant increases in the odds of meeting diagnostic criteria for RLS even when adjusting for potential confounding variables such as weight (odds ratio [OR] = 3.18, 95% confidence interval [CI] = [1.29, 7.63], p< .001). However, the association did not hold true after adjusting for the presence of sleep disturbances (OR = 2.02, 95% CI = [0.82, 4.96], p = .13). Conclusion: The findings suggest a strong link between RLS and adult ADHD symptoms. Clinicians should be aware of RLS among adult ADHD patients, especially as there might be a negative interactive effect.

Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample

BACKGROUND The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psychological variables, and behavioral factors. METHODS A German community sample (n=9721) with an age range of 18-80 years was surveyed using the GAD-7 and several other questionnaires. RESULTS Confirmatory factor analyses confirmed the unidimensionality and measurement invariance of the GAD-7 across age and gender. Females were more anxious than males (mean scores: M=4.07 vs. M=3.01; effect size: d=0.33). There was no linear age trend. A total of 5.9% fulfilled the cut-off criterion of 10 and above. Anxiety was correlated with low quality of life, fatigue, low habitual optimism, physical complaints, sleep problems, low life satisfaction, low social support, low education, unemployment, and low income. Cigarette smoking and alcohol consumption were also associated with heightened anxiety, especially in women. When comparing the GAD-7 (7 items) with the ultra-short GAD-2 (2 items), the GAD-7 instrument was superior to the GAD-2 regarding several psychometric criteria. LIMITATIONS The response rate (33%) was low. Because of the cross-sectional character of the study, causal conclusions cannot be drawn. A further limitation is the lack of a gold standard for diagnosing anxiety. CONCLUSIONS The GAD-7 can be recommended for use in clinical research and routine.