Gabriele Schmutzer

Maltreatment in childhood and adolescence: results from a survey of a representative sample of the German population.

BACKGROUND There are no up-to-date, representative studies on the frequency of maltreatment (abuse or neglect) among children and adolescents in Germany. METHODS In a cross-sectional study, standardized questionnaires were administered to persons aged 14 and older in a representative sample of the German population. Statistics on maltreatment in childhood and adolescence were collected with the German version of the Childhood Trauma Questionnaire. Regression analysis was used to detect potential associations of maltreatment with demographic variables including sex, age, place of birth, and social class. RESULTS 2504 of the 4455 persons contacted (56%) completed the study. Severe emotional abuse in childhood and/or adolescence was reported by 1.6% of persons in the overall sample, severe physical abuse by 2.8%, and severe sexual abuse by 1.9%. Severe emotional neglect was reported by 6.6% and severe physical neglect by 10.8%. Female sex was a predictor for severe sexual abuse, while belonging to a low or middle social stratum was a predictor for severe physical abuse and neglect. Being older at the time of the survey was a predictor for severe physical neglect. All types of maltreatment were significantly correlated with each other (p<0.001). CONCLUSION The frequencies of various types of abuse and neglect of children and adolescents that were retrospectively determined in this up-to-date study by questionnaire of a representative sample of the German population, and the correlations between them, correspond to those found in a German population-based study in 1995 and in recent American studies.

Posttraumatic stress disorder in fibromyalgia syndrome: prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome.

&NA; The prevalence of posttraumatic stress disorder in 395 fibromyalgia syndrome patients of different clinical settings was 45.3%, and was 3.0% in age‐ and sex‐matched population controls. &NA; A link between fibromyalgia syndrome (FMS) and posttraumatic stress disorder (PTSD) has been suggested because both conditions share some similar symptoms. The temporal relationships between traumatic experiences and the onset of PTSD and FMS symptoms have not been studied until now. All consecutive FMS patients in 8 study centres of different specialties were assessed from February 1 to July 31, 2012. Data on duration of chronic widespread pain (CWP) were based on patients’ self‐reports. Potential traumatic experiences and year of most burdensome traumatic experience were assessed by the trauma list of the Munich Composite International Diagnostic Interview. PTSD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders IV symptom criteria by the Posttraumatic Diagnostic Scale. Age‐ and sex‐matched persons of a general population sample were selected for controls. Three hundred ninety‐five of 529 patients screened for eligibility were analysed (93.9% women, mean age 52.3 years, mean duration since chronic widespread pain 12.8 years); 45.3% of FMS patients and 3.0% of population controls met the criteria for PTSD. Most burdensome traumatic experience and PTSD symptoms antedated the onset of CWP in 66.5% of patients. In 29.5% of patients, most burdensome traumatic experience and PTSD symptoms followed the onset of CWP. In 4.0% of patients’ most burdensome traumatic experience, PTSD and FMS symptoms occurred in the same year. FMS and PTSD are linked in several ways: PTSD is a potential risk factor of FMS and vice versa. FMS and PTSD are comorbid conditions because they are associated with common antecedent traumatic experiences.

A Cluster Within the Continuum of Biopsychosocial Distress Can Be Labeled “Fibromyalgia Syndrome” — Evidence from a Representative German Population Survey

Objective. We tested the hypothesis that “fibromyalgia syndrome” is a biopsychosocial continuum disorder. Methods. A cross-sectional survey of a representative sample of the German general population with persons ≥ 14 years of age was conducted based on face-to-face contacts. Physical distress was measured by the regional pain scale (RPS) and the Patient Health Questionnaire 15 (PHQ-15), psychological distress by the PHQ-9, and social distress by the Oslo Social Support Scale. Health-related quality of life (HRQOL) was measured by the 12-item form of the Medical Outcome Study Short Form Health Survey. A k-means clustering procedure with 2–8 clusters preset was used to classify the scores of the RPS, PHQ-9, and PHQ-15. The number of clusters retained was based on the stability and interpretability of the clusters. The cluster analysis was first performed with a randomly selected half of the sample and then cross-validated on the second half of the total sample. Results. A 4-cluster solution produced the most stable and meaningful results. Cluster 1 was very low on all symptom scores. Cluster 2 was low on pain sites, somatic symptoms, and depression. Cluster 3 was high on pain scores, moderate on somatic symptoms, and low on depression. Cluster 4 was high on all symptom scores. The centroids of cluster 4 met the survey criteria of fibromyalgia syndrome. Cluster 4 reported a lower HRQOL and less social support compared to the other 3 groups. Conclusion. A cluster within the continuum of biopsychosocial distress can be labeled fibromyalgia syndrome.

Prevalence and predictors of pain in several body regions. Results of a representative German population survey

BACKGROUND There are no data available from representative samples of the general German population on predictors of widespread pain (WP) and fibromyalgia syndrome (FMS). METHODS A cross-sectional survey of a representative sample of the German general population with persons over 14 years old was conducted based on face-to-face contact using standardised questionnaires. The number of pain sites and the presence of WP and FMS were assessed by the regional pain scale (RPS), somatic symptom intensity was measured by the Patient Health Questionnaire (PHQ-15), depressed mood by PHQ 9 and health-related quality of life (HRQOL) by the Short Form Health Survey (SF-12). RESULTS Out of 4064 persons contacted, 2524 (62.1%) completed the study. The prevalence of CWP was 8.6% and of FMS 3.8%. The sex ratio for WP and FMS was 1:1. The variance of the number of pain sites was explained by older age, low social class index, high somatic symptom intensity, low depressed mood in 52.4% (p<0.001). Older age (OR 2.0, 95% CI 1.71; 2.36; <0.001), low social class index (OR 0.64; 95% CI 0.46; 0.91; p=0.01) and potential somatoform syndrome (OR 3.0; 95% CI 1.27; 7.15; p<0.001) predicted WP with a probability 94.4%. Older age (OR 1.39, 95% CI 1.19; 1.62, p <0.001), low social class index (OR 0.61, 95% CI .40, 0.93; p=0.02) and potential somatoform syndrome (OR 19.42; 95% CI 10.31; 36.61; p<0.001) predicted FMS with a probability 97.7%. CONCLUSION WP and FMS are components of a complex of high somatic symptom intensity, low social class index and older age.

Widespread pain in older Germans is associated with posttraumatic stress disorder and lifetime employment status – Results of a cross-sectional survey with a representative population sample

Summary The association between civilian and war‐related traumatic events and widespread pain in older Germans was completely attenuated by posttraumatic stress disorder and lifetime employment status. ABSTRACT Whether self‐reported lifetime civilian and war‐related potential traumatic events are associated with widespread pain (WP) and if so, whether the association is attributable to posttraumatic stress disorder (PTSD) and depression has not been studied in a representative sample of the general population. In a randomly selected sample of the German general population, persons aged 60–85 years answered validated self‐rating instruments: Regional Pain Scale, trauma list of the Composite International Diagnostic Interview, Posttraumatic Diagnostic Scale, and Patient Health Questionnaire 2. Participants with WP were compared with participants with no or local or regional pain (controls). Stepwise hierarchical logistic regression analyses were performed with WP as the dependent variable and demographic data, potential traumatic events, PTSD, and depressive disorder as independent variables. Of 773 respondents, 147 (19.0%) reported WP. Participants with WP reported rape (4.1% vs 1.0%, P = 0.01), life‐threatening illness (11.6% vs 6.1%, P = 0.02), witnessing trauma (19.2% vs 8.4%, P = 0.001), and cumulative potential traumatic events (24.5% vs. 16.5%, P = 0.004) more frequently than the 626 controls. The prevalence of full PTSD (10.9% vs 2.2%; P < 0.0001) and of potential depressive disorder (13.7% vs 6.6%, P = 0.02) was higher in participants with WP than in controls. The significant association between some potential traumatic events and WP was completely abrogated after adjusting for demographic variables and PTSD. In the final model, PTSD (odds ratio 3.43, 95% confidence interval 1.88–6.26) and lifetime employment status as a worker (odds ratio 1.55, 95% confidence interval 1.04–2.31) predicted WP. Prospective studies are necessary to understand the temporal association of PTSD and WP.

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.

Domains of disgust sensitivity: revisited factor structure of the questionnaire for the assessment of disgust sensitivity (QADS) in a cross-sectional, representative German survey.

BackgroundDisgust sensitivity is defined as a predisposition to experiencing disgust, which can be measured on the basis of the Disgust Scale and its German version, the Questionnaire for the Assessment of Disgust Sensitivity (QADS). In various studies, different factor structures were reported for either instrument. The differences may most likely be due to the selected factor analysis estimation methods and the small non-representative samples. Consequently, the aims of this study were to explore and confirm a theory-driven and statistically coherent QADS factor structure in a large representative sample and to present its standard values.MethodsThe QADS was answered by N = 2473 healthy subjects. The respective households and participants were selected using the random-route sampling method. Afterwards, the collected sample was compared to the information from the Federal Statistical Office to ensure that it was representative for the German residential population. With these data, an exploratory Promax-rotated Principal Axis Factor Analysis as well as comparative confirmatory factor analyses with robust Maximum Likelihood estimations were computed. Any possible socio-demographic influences were quantified as effect sizes.ResultsThe data-driven and theoretically sound solution with the three highly interrelated factors Animal Reminder Disgust, Core Disgust, and Contamination Disgust led to a moderate model fit. All QADS scales had very good reliabilities (Cronbachs alpha) from .90 to .95. There were no age-differences found among the participants, however, the female participants showed remarkably higher disgust ratings.ConclusionsBased on the representative sample, the QADS factor structure was revised. Gender-specific standard percentages permit a population-based assessment of individual disgust sensitivity. The differences of the original QADS, the new solution, and the Disgust Scale - Revised will be discussed.

Prevalence of Chronic Disabling Noncancer Pain and Associated Demographic and Medical Variables: A Cross-Sectional Survey in the General German Population.

Objectives:In population surveys, up to 30% of participants reported chronic pain. Reports of chronic pain do not necessarily imply disability associated with pain. We assessed the prevalence of chronic disabling noncancer pain and associated demographic and medical variables in a sample of the general German population. Methods:A cross-sectional survey was conducted with 4360 people aged 14 years and above, who were representative of the German population. Measures were obtained for demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (based on a chronic pain grade questionnaire), and disease load (based on the self-reported comorbidity questionnaire). Results:Responses were received from 2508 people. The prevalence of chronic pain was 28.3% (95% [confidence interval] CI, 26.5%-30.1%). In all, 7.3% (95% CI, 5.9%-8.7%) of participants met the criteria of chronic disabling noncancer pain. Chronic disabling noncancer pain was associated with age above 65 years (odds ratios [OR]=4.81 [95% CI, 1.57-14.79]), low family income (OR=2.54 [95% CI, 1.36-4.74]), obesity (OR=3.58 [95% CI, 2.21-5.79]), heart disease (OR=2.23 [95% CI, 3.69-11.40]), stomach disease (OR=4.24 [95% CI, 2.12-8.49]), and rheumatic disease (OR=3.67 [95% CI, 2.16-6.23]) when compared with no chronic pain. Chronic disabling noncancer pain was associated with low family income (OR=2.29 [95% CI, 1.23-4.27]), obesity (OR=2.14 [95% CI, 1.30-3.52]), and depression (OR=3.26 [95% CI, 1.90-5.66]) when compared with chronic nondisabling noncancer pain. Conclusions:Prevalence rates of chronic disabling pain in the general population rather than prevalence rates of chronic pain might provide evidence in support of pain specialist care. The association of chronic disabling noncancer pain with mental disorders highlights the need for psychosocial services in chronic pain management.

The Impact of Body Weight and Depression on Low Back Pain in a Representative Population Sample

OBJECTIVE Low back pain (LBP), obesity, and depression are highly prevalent health conditions. We assessed the relative impact of body weight and depression on different types of LBP in a representative population sample. DESIGN This is a cross-sectional study. SETTING AND PATIENTS Two thousand five hundred ten subjects aged 14-90 years were randomly selected from the German general population in 2012. MEASURES Pain sites and duration of pain were assessed by the Widespread Pain Index( WPI), depression by the Beck Depression Inventory Primary Care Questionnaire, disability by the European Organization for Research and Treatment of Cancer questionnaire, and current body mass index (BMI, kg/m(2) ) by self-reported body weight and height. Widespread pain was defined by ≥7/19 pain sites in the WPI. Hierarchical logistic regression analyses were performed with different types of LBP as the dependent variable, and age, gender, lifetime employment status as a worker, number of pain sites, BMI, and depression as independent variables. RESULTS One thousand six hundred eighty-seven (67.1%) of participants reported no pain. Five hundred six (20.2%) reported chronic LBP and 84 (3.3%) reported disabling chronic LBP. Age (odds ratio [OR] 1.05 [95% confidence interval {CI} 1.04-1.06]), BMI (OR 1.08 [95% CI 1.05.-1.11]), and depression (OR 1.38 [95% CI 1.30-1.49]) independently predicted chronic LPB compared with persons without pain. Age (OR 1.07 [95% CI 1.05-1.09]), BMI (OR 1.07 [95% CI 1.03-1.13]), and depression (OR 1.71 [95% CI 1.55-1.88]) independently predicted disabling chronic LPB compared with persons without pain. Age (OR 1.03 [95% CI 1.01-1.05]), widespread pain (OR 5.23 [95% CI 3.04-9.00), and depression (OR 1.34 [95% CI 1.16-1.55]) independently predicted disabling chronic LPB compared with persons with nondisabling chronic LBP. CONCLUSION BMI and depression are modifiable risk indicators for chronic disabling LBP.

Prävalenz und Prädiktoren urogenitaler Schmerzen des Manns

BACKGROUND In Germany no data are available on the prevalence and predictors of urogenital pain in men from representative population samples. MATERIALS AND METHODS Persons older than 14 years of age from a representative sample of the German population were examined by standardized questionnaires within a cross-sectional survey. Urogenital pain was assessed by the German version of the National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), depression by the patient health questionnaire PHQ-9 and health-related quality of life by the short form health survey SF-36. RESULTS A total of 2,043 persons (66.5%s) took part in the study and 960 men with a mean age of 47.2 years were analyzed. The 1-week prevalence of urogenital pain was 9.6% whereby 2.4% met the criteria of mild and 1.9% the criteria of severe prostatitis-like symptoms. The total pain score of the NIH-CPSI was predicted by old age, high income and high depression scores. Men with mild and severe prostatitis-like symptoms reported higher depression and lower health-related quality of life than men without prostatitis-like symptoms CONCLUSIONS Prostatitis-like symptoms are associated with depression and reduced health-related quality of life in the general population.