Grit Klinitzke

Risk of completed suicide after bariatric surgery: a systematic review

Bariatric surgery is one of the most effective treatments for morbid obesity, and a large body of research indicates significant long‐term weight loss. While overall mortality decreases in patients who received bariatric surgery, a number of studies have shown that suicide rates are higher in bariatric patients than in control groups. The objective of this study was to present a systematic review of suicide mortality after bariatric surgery and calculate an estimate for the suicide rate. Literature researches of the databases PubMed, Web of Knowledge, PsychInfo, ScienceDirect and Google Scholar were conducted. Thirty studies concerning bariatric surgery and completed suicides met the inclusion criteria. We included 28 studies in the estimation of a suicide rate for the bariatric population. Only one study (Tindle et al.) put a main focus on suicide after bariatric surgery; this was therefore chosen as an adequate reference figure for comparison. The other 27 chosen studies were compared with World Health Organization data and the suicide rate reported by Tindle et al. Twenty‐three thousand eight hundred eighty‐five people were included in the analysis. In the literature, we found a total of 95 suicides when examining 190,000 person‐years of post‐bariatric surgery data. Little information was provided describing the reasons for suicide and the time‐point of these events after surgery. We estimated a suicide rate of 4.1/10,000 person‐years (95% confidence interval [3.2, 5.1]/10,000 person‐years). A comparison with Tindle et al. demonstrates that their rate is significantly higher than our estimate (P = 0.03). Bariatric surgery patients show higher suicide rates than the general population. Therefore, there is a great need to identify persons at risk and post‐operative psychological monitoring is recommended.

Obesity and suicide risk in adults—A systematic review

BACKGROUND There is evidence from prospective studies that obesity is positively associated with depression. In contradiction to this, however, a number of studies have revealed that the number of completed suicides decreases with increasing BMI. The objective of this systematic review is to elucidate this ambiguous research field, providing an overview of literature examining the relationship between obesity and risk of suicide in adults (>18 years). METHODS Literature searches of the databases PubMed/Medline, PsychInfo, and Web of Sciences were conducted. Fifteen studies concerning completed suicide, suicide attempts and suicidal ideation met the inclusion criteria (seven prospective and eight cross-sectional studies). RESULTS Eight studies evaluating completed suicide reported an inverse relationship between BMI and suicide, meaning that obese people are less likely to commit suicide than people of low or normal weight, whereas one study showed no association and one showed a positive association. Studies about suicide attempts and ideation, on the other hand, found results that differed depending on gender. While obese woman reported more suicide attempts and suicidal ideation, obese men reported less attempts and thoughts. DISCUSSION The role of confounding variables such as age or psychiatric illness on suicide risk are discussed and remaining research questions are outlined, especially regarding the role of different underlying biological pathways and consideration of different classes of obesity.

EXTREME OBESITY IS ASSOCIATED WITH SUICIDAL BEHAVIOR AND SUICIDE ATTEMPTS IN ADULTS: RESULTS OF A POPULATION-BASED REPRESENTATIVE SAMPLE

A number of studies have revealed that the number of completed suicides decreases with increasing body mass index (BMI). However, only few studies have evaluated the association between suicidal behavior, suicide attempts, and the various BMI categories. The aim of this study was to determine whether obesity is positively associated with increased suicide attempts and suicidal behavior with consideration of gender differences.

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder☆

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n=69) or a wait-list condition (n=70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination-Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d=1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82≤d≤1.11). In the treatment group significant improvement was still observed for all measures 1year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.

Gesundheitsbezogene Lebensqualität und Posttraumatische Belastungsstörungen bei in der DDR politisch Inhaftierten

PURPOSE Political persecution was and is a reality in our world. The study investigated effects of political imprisonment in the former German Democratic Republic on the current health-related quality of life and on the existence of a post-traumatic stress disorder (PTSD). METHODS A sample of 157 former political prisoners was surveyed with a questionnaire containing the EORTC QLQ-C30 and the IES-R. RESULTS Former political prisoners of the GDR reported a lower quality of life than the general population. There is no consistent impact of imprisonment-related variables (e. g. duration of imprisonment) on health-related quality of life. At least, based on questionnaire data it can be estimated that 50% of the people in the sample suffer from a PTSD. CONCLUSION The results provide further evidence that former political prisoners suffer from the traumatic experience of political persecution also in a long term.

Internet-Based Treatments - Experiences from Sweden

Worldwide, Gerhard Andersson is one of the most influential researchers working on internet-based psychological treatments. Moreover, he is also one of the leading researchers in the field of psychologically oriented tinnitus research. He is full professor of clinical psychology at Linkoping University and affiliated professor at the Karolinska Institute in Stockholm at the Department of Clinical Neuroscience, Section Psychiatry. Professor Andersson has been highly productive, having produced more the 300 scientific papers. During his whole career he has worked part-time with patients. Apart from his own research and clinical work, Professor Andersson has editorial responsibilities for several journals including Cognitive Behaviour Therapy, Plos One, BMC Psychiatry, and Scandinavian Journal of Psychology. The interview was conducted by Professor Thomas Berger.

Die therapeutische Beziehung in einem internetbasierten Programm zur Behandlung der Binge-Eating-Störung

OBJECTIVE Findings about the association between working alliance and therapy outcome in Internet-based treatments are contradictory. Evidence for the working alliance in Internet-based treatment for Binge Eating Disorder is still missing and can help to elucidate this question. METHODS AND RESULTS In an Internet-based cognitive-behavioral intervention, working alliance (WAI-S, mid n = 59; post n = 49) and eating disorder symptoms (EDE-Q, n = 49) as therapy outcome were assessed. A positive working alliance was reported by study participants. Working alliance had significant correlations with and EDE-Q-scales but not with binge eating episodes. CONCLUSIONS Our study refers to the important role working alliance has for therapy outcome.

[Increased anxiety and depression as long-term consequences of political imprisonment].

OBJECTIVE By recent estimates, 200,000 persons were imprisoned for political reasons in the German Democratic Republic (GDR) between 1949 and 1989. Former political prisoners suffer from the experience of political persecution also in a long-term. The aim of this study was to assess long-term effects on anxiety and depression. METHODS Anxiety and depression were assessed by using the Hospital Anxiety and Depression Scale, German version (HADS). RESULTS The anxiety of the former political detainees is significantly increased in comparison to an age- and gender matched subsample of the general population (10 vs. 4,8; p < 0,001, effect size d = 1,33). The same applies to the depression (9.7 vs. 5,6; p < 0,001; effect size d = 0,92). CONCLUSIONS Even many years after the political detention people report highly increased anxiety and depression.

Internetbasierte Therapie nach Verlust eines Kindes in der Schwangerschaft - Einfluss sozialer Unterstützung auf die Verarbeitung des Verlusts

Hintergrund: Der Verlust eines Kindes in der Schwangerschaft stellt für die betroffenen Eltern eine hohe psychische Belastung dar, die zu manifesten psychischen Erkrankungen führen kann. Verschiedene Studien haben gezeigt, dass die wahrgenommene soziale Unterstützung durch das Umfeld der Betroffenen nach einem pränatalen Kindsverlust mit geringerer prolongierter Trauersymptomatik einhergeht. Methode: Untersucht wurden 99 Eltern, die ihr Kind während der Schwangerschaft verloren hatten. Sie nahmen an einem 5-wöchigen internetbasierten Behandlungsprogramm zur Schreibtherapie teil, welches die 3 Phasen «Selbstkonfrontation», «kognitive Umstrukturierung» und «Social Sharing» beinhaltete. Neben allgemeiner psychischer Belastung (BSI), prolongierter Trauer (ICG) und traumatischem Stress (IES-R) wurde auch die soziale Unterstützung (BSSS) mit den Dimensionen «wahrgenommene Unterstützung» und «erhaltene Unterstützung» bzw. «Bedürfnis nach Unterstützung» und «Suche nach Unterstützung» sowohl zum Zeitpunkt vor der Behandlung als auch nach deren Abschluss erhoben. Ergebnisse: Während das Bedürfnis nach sozialer Unterstützung im Verlauf der Behandlung signifikant abnahm, erhöhten sich die Werte der anderen 3 Dimensionen sozialer Unterstützung signifikant. Die wahrgenommene und erhaltene soziale Unterstützung waren signifikant invers mit der allgemeinen psychischen Belastung und der prolongierten Trauer nach einem pränatalen Verlust assoziiert. Erhaltene Unterstützung und die Suche nach Unterstützung gingen mit der Verbesserung verschiedener Symptome nach der internetbasierten Behandlung einher. Schlussfolgerung: Die Ergebnisse weisen darauf hin, dass sowohl die erhaltene Unterstützung als auch die aktive Suche nach Unterstützung für die Wirksamkeit des internetbasierten Behandlungsprogramms für Betroffene nach einem Kindsverlust relevant sind. Zudem kann das hier vorgestellte internetbasierte Behandlungsangebot nach dem pränatalen Verlust eines Kindes eine gute Unterstützungsmöglichkeit darstellen und aktivierend bei der Suche nach Unterstützung wirken.

Körperbeschwerden nach politischer Inhaftierung und deren Zusammenhang mit Ängstlichkeit und Depressivität

Hintergrund: Über 200.000 Menschen waren in der DDR aus politischen Gründen inhaftiert. Mehrere Studien existieren zu den psychischen (Langzeit-)Folgen dieser biografischen Erfahrung. Weniger untersucht wurden bisher die körperlichen Folgen. Ziel dieser Studie ist (1) die Ausprägungen körperlicher Beschwerden von ehemals politisch Inhaftierten in der DDR mit Daten aus der Allgemeinbevölkerung zu vergleichen, (2) die körperlichen Beschwerden mit soziodemografischen und Inhaftierungsmerkmalen in Beziehung zu setzen und (3) den Zusammenhang zwischen körperlichen Beschwerden und Ängstlichkeit sowie Depressivität innerhalb der Gruppe der ehemals Inhaftierten zu untersuchen. Methoden: In dieser Querschnittstudie beantworteten 149 Personen, die aus politischen Gründen in der DDR inhaftiert waren, einen Fragebogen über körperliche Beschwerden (Gießener Beschwerdebogen, Kurzform), Ängstlichkeit und Depressivität (Hospital Anxiety and Depression Scale). Für den Vergleich mit der Allgemeinbevölkerung wurde eine hinsichtlich Alter und Geschlecht vergleichbare Stichprobe aus einer deutschen Repräsentativbefragung verwendet (n = 473). Ergebnisse: Ehemalige politisch Inhaftierte berichten im Vergleich zur Allgemeinbevölkerung auch viele Jahre nach der politischen Inhaftierung deutlich mehr körperliche Beschwerden (p < 0,001). Soziodemografische Merkmale und Merkmale der Inhaftierung stehen nur punktuell mit den angegebenen Körperbeschwerden im Zusammenhang. Zur Vorhersage von Ängstlichkeit in der Gruppe der politisch Inhaftierten leisten insbesondere Herzbeschwerden einen substantiellen Beitrag, zur Vorhersage von Depressivität Erschöpfung. Die Haftdauer ist für Ängstlichkeit und Depressivität kein signifikanter Prädiktor. Schlussfolgerungen: Personen, die aus politischen Gründen in der DDR inhaftiert waren, stellen eine Risikogruppe in der medizinischen Versorgung dar. Sie berichten über deutlich mehr Körperbeschwerden als die Allgemeinbevölkerung und weisen stark erhöhte Werte für Depression und Ängstlichkeit auf.