Heide Glaesmer

A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population

BACKGROUND The 4-item Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report questionnaire that consists of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). Given that PHQ-4, PHQ-2, and GAD-2 have not been validated in the general population, this study aimed to investigate their reliability and validity in a large general population sample and to generate normative data. METHODS A nationally representative face-to-face household survey was conducted in Germany in 2006. The survey questionnaire consisted of the PHQ-4, other self-report instruments, and demographic characteristics. RESULTS Of the 5030 participants (response rate=72.9%), 53.6% were female and mean (SD) age was 48.4 (18.0) years. The sociodemographic characteristics of the study sample closely match those of the total populations in Germany as well as those in the United States. Confirmatory factor analyses showed very good fit indices for a two-factor solution (RMSEA .027; 90% CI .023-.032). All models tested were structurally invariant between different age and gender groups. Construct validity of the PHQ-4, PHQ-2, and GAD-2 was supported by intercorrelations with other self-report scales and with demographic risk factors for depression and anxiety. PHQ-2 and GAD-2 scores of 3 corresponded to percentile ranks of 93.4% and 95.2%, respectively, whereas PHQ-2 and GAD-2 scores of 5 corresponded to percentile ranks of 99.0% and 99.2%, respectively. LIMITATION A criterion standard diagnostic interview for depression and anxiety was not included. CONCLUSIONS Results from this study support the reliability and validity of the PHQ-4, PHQ-2, and GAD-2 as ultra-brief measures of depression and anxiety in the general population. The normative data provided in this study can be used to compare a subjects scale score with those determined from a general population reference group.

Prevalence of complicated grief in a representative population-based sample

BACKGROUND Complicated grief (CG) has been proposed as a distinct diagnostic category in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). However, few epidemiological studies to date have measured CG in the general population. METHODS Prevalence of CG, sociodemographic characteristics, and grief-related factors were examined in a representative population-based survey (N = 2520) through face-to-face contact. The sample included all bereaved subpopulations and all age groups from 14 to 95 years. RESULTS The conditional prevalence of developing CG after major bereavement was 6.7%; the prevalence of CG in the general sample was 3.7%. Predictors of higher risk for developing CG were female gender, lower income (< €1250/month), older age (> 61 years), having lost a child or a spouse, or cancer as the cause of death. LIMITATIONS The sample of bereaved people was small, and some categories contained very few cases. Psychiatric comorbidities were not assessed in this study. CONCLUSIONS The results indicate that CG is prevalent in the population, and risk factors were identified.

Separating Optimism and Pessimism: A Robust Psychometric Analysis of the Revised Life Orientation Test (LOT-R)

The internal structure of the revised Life Orientation Test (LOT-R, German version; M. F. Scheier, C. S. Carver, & M. W. Bridges, 1994) was analyzed in a sample of 46,133 participants who ranged in age from 18 years to 103 years. Confirmatory factor analysis showed that dispositional optimism, as measured by the LOT-R, is bidimensional, consisting of an Optimism and a Pessimism factor. Consistent with previous results, there were small to moderate negative correlations between Optimism and Pessimism, but the strength of the association continuously decreased with age. The relative independence of the 2 dimensions occurred in both genders and across different age groups of patients with different medical disorders.

Updates on the prevalence of body dysmorphic disorder: A population-based survey

Body dysmorphic disorder (BDD) is characterised by a preoccupation with perceived defects in ones appearance, which leads to significant distress and/or impairment. Although several studies have investigated the prevalence of BDD, many studies have methodological limitations (e.g., small sample sizes and student populations), and studies on the prevalence of BDD in the general population are limited. In the current study, 2510 individuals participated in a representative German nationwide survey. Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for BDD and associated characteristics such as suicidality and the prevalence of plastic surgeries were examined using self-report questionnaires. The prevalence of current BDD was 1.8% (N=45). Further, individuals with BDD, relative to individuals without BDD, reported significantly more often a history of cosmetic surgery (15.6% vs. 3.0%), higher rates of suicidal ideation (31.0% vs. 3.5%) and suicide attempts due to appearance concerns (22.2% vs. 2.1%). The current findings are consistent with previous findings, indicating that self-reported BDD is a common disorder associated with significant morbidity.

Psychometric properties and population-based norms of the Life Orientation Test Revised (LOT-R).

OBJECTIVES The relevance of the construct optimism in health psychology has been convincingly demonstrated in numerous studies. Population-based studies about dispositional optimism and the psychometric properties of the Life Orientation Test LOT-R as well as population-based norms are lacking. DESIGN A representative population survey in Germany was conducted to investigate psychometric properties of the LOT-R and to deliver population-based norms. METHODS A representative sample of 2,372 adults aged 18-93 years were screened using self-rating instruments. Results. The confirmatory factor analysis (CFA) confirmed two factors. Optimism and pessimism are negatively correlated (r=-.20). Indications for convergent validity were demonstrated with depression, satisfaction with life, subjective state of health and health care utilization. Optimism is more strongly related to all indicators than pessimism. Since there are only marginal age and gender differences, norm data are given for the entire population. CONCLUSIONS Our study confirms the bi-dimensionality of the LOT-R and thus underpins that optimism and pessimism are two independent constructs rather than a single bipolar trait. Psychometric properties were found to be satisfactory. Together with the norm values reported in the paper, this instrument can, thus, be employed to measure dispositional optimism or pessimism in individual diagnostics as well as in epidemiological research.

The prevalence of compulsive hoarding and its association with compulsive buying in a German population-based sample.

The aims of the study were to estimate the prevalence rate of compulsive hoarding, and to determine the association between compulsive hoarding and compulsive buying in a nationally representative sample of the German population (N = 2307). Compulsive hoarding was assessed with the German version of the Saving Inventory-Revised (SI-R; Frost, R.O., Steketee, G., & Grisham, J. (2004). Measurement of compulsive hoarding: saving inventory-revised. Behaviour Research and Therapy, 42, 1163-1182.). The point prevalence of compulsive hoarding was estimated to be 4.6%. Individuals with compulsive hoarding did not differ significantly from those without compulsive hoarding regarding age, gender, and other sociodemographic characteristics. Significant correlations were found between the compulsive hoarding and the compulsive buying measures. Participants with compulsive hoarding reported a higher propensity to compulsive buying than respondents without hoarding. About two thirds of participants classified as having compulsive hoarding were also defined as suffering from compulsive buying. In summary, these results suggest that compulsive hoarding may be relatively prevalent in Germany and they confirm the close association between compulsive hoarding and compulsive buying through the investigation of a large scale representative sample.

Cardiovascular risk factors in primary care: methods and baseline prevalence rates - the DETECT program

ABSTRACT Objectives: DETECT is an epidemiological study in primary care to examine (a) the prevalence rates and comorbidity of diabetes mellitus, hypertension, hyperlipidaemia and coronary heart disease (CHD), and associated conditions; (b) the frequency of behavioural and clinical risk factors for onset and progression; (c) the 12-month course and outcome; and (d) the met and unmet needs for these patients. Methods: Three-stage, cross-sectional clinical-epidemiological study with a prospective-longitudinal component in a nationally representative sample of N = 3795 primary care settings [response rate (RR): 60.2%] and N = 55 518 patients (RR: 95.5%). Patients completed a standardized assessment, including questionnaires for patients and the physician and diagnostic screening measures (i.e. blood pressure, heart rate, body mass index and waist circumference assessments). A subsample of patients (N = 7519) also completed a standardized laboratory screening program and was followed-up after 12 months. Data were weighted to adjust for non-response, regional distribution and attrition. Results: (1) Doctors and patients sample can be regarded as representative for primary care settings in Germany. (2) The clinician-rated point prevalence of hypertension is highest (35.5%), followed by hyperlipidaemia (29.1%), diabetes (14.1%) and CHD (12.1%); prevalence rates of each disorder as well as their co-incidence rates increase markedly with age. (3) The vast majority (78%) of all patients revealed multiple (3+) behavioural and clinical risk factors. Conclusion: The findings of DETECT underline the considerable burden for primary care doctors in managing a highly morbid patient population, with predominantly complex risk factor constellations, in routine care. Our data provide, in unprecedented detail, a basis for calculating age-, gender- and risk-group-adjusted risk-factor profiles in routine care.

Posttraumatische Belastungsstörungen in Deutschland

In a representative epidemiological study (n=2426) with a broad age range of respondents (14-93 years), prevalence rates of traumatic life events, post-traumatic stress disorder (PTSD), and partial PTSD were estimated. A standardized interview using the trauma checklist of the Composite International Diagnostic Interview and a DSM-IV PTSD symptom checklist (Modified PTSD Symptom Scale) were applied. One-month prevalence rates were 2.3% for DSM-IV PTSD and 2.7% for partial PTSD. There were no gender differences but age-group differences did appear: among persons older than 60, the prevalence of PTSD was 3.4%, whereas the prevalence was estimated at 1.3% among persons aged 14-29 years and 1.9% among those aged 30-59 years. Partial PTSD exhibited the same age distribution, with 3.8% in the elderly, 2.4% in the middle-aged, and 1.3% in young adults. The results correspond with those of other international studies taking war-related consequences for older age groups into account. Our representative study provides the first evidence of higher PTSD prevalence rates among older age groups in the German population, which is assumed to be related to consequences of World War II.

The Association of Traumatic Experiences and Posttraumatic Stress Disorder With Physical Morbidity in Old Age: A German Population-based Study

Objective: To examine the relationship of traumatic experiences and posttraumatic stress disorder (PTSD) among a representative population sample of 1456 German elderly (60-85 years). Several studies have suggested that PTSD and traumatic experiences are related to adverse health outcomes. However, many past studies were based on special samples such as combat veterans or survivors of natural disasters. Methods: Using self-report data and regression analyses, we investigated the association of traumatic experiences and PTSD with several medical conditions. Results: Traumatized subjects had a significantly increased risk for all the medical conditions under study compared with those participants without a traumatic exposure, ranging from odds ratio of 1.37 (95% confidence interval [CI] = 1.07-1.75) for hypertension up to 5.12 (95% CI = 2.25-11.6) for cancer. There are significant associations of current PTSD with cardiovascular diseases (angina pectoris/coronary artery disease, congestive heart failure, and peripheral vascular disease) and cardiovascular risk factors (hypertension and elevated cholesterol level; odds ratio of 1.94 [95% CI = 1.14-3.31]) for peripheral vascular disease up to 3.76 [95% CI = 2.11-6.70] for elevated cholesterol level), as well as with asthma, cancer, back pain, hard of hearing, osteoporosis, stomach problems, and thyroid disorders. Conclusions: These findings suggest an association between traumatic stress and PTSD with impaired physical health in a general population sample in the German elderly. It underscores the importance of traumatic experiences and PTSD not only for mental health but also for physical health as a long-term consequence.Abbreviations:PTSD = posttraumatic stress disorder; PTDS = Posttraumatic Diagnostic Scale; CI = confidence interval; OR = odds ratio

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.