Herbert Fliege

Risk factors and correlates of deliberate self-harm behavior: A systematic review

OBJECTIVE Deliberate self-harm behavior--without suicidal intent--is a serious health problem and may be studied as a clinical phenomenon in its own right. Empirical studies of sociodemographic and psychological correlates and risk factors are systematically reviewed. METHODS We searched Medline, PsycINFO, PSYNDEX (German psychological literature), and reference lists. We targeted self-induced bodily harm without conscious suicidal intent. Studies on suicidal behavior or self-poisoning were only included if they also assessed nonsuicidal self-harm. RESULTS Fifty-nine original studies met the criteria. Deliberate self-harm may occur at all ages, yet adolescents and young adults are at a higher risk. Evidence on gender is complex. Only 5 studies realize a prospective design (6 months to 10 years) and test predictors. The majority use cross-sectional and retrospective methods. No longitudinal study (separately) examines new incidence. Evidence of correlates encompasses distal/proximal, person/environment, and state/trait factors. Many studies report associations between current self-harm behavior and a history of childhood sexual abuse. Adolescent and adult self-harmers experience more frequent and more negative emotions, such as anxiety, depression, and aggressiveness, than persons who do not self-harm. Two studies yield specific interactions between childhood trauma and current traits and states such as low emotional expressivity, low self-esteem, and dissociation with respect to a vulnerability to self-harm. CONCLUSION Evidence of distal, biographical stressors is fairly strong. Proximal stressors have rarely been investigated; protective factors, hardly at all. Despite many findings of correlates, the data do not yet justify terming them risk factors. Longitudinal studies are needed.

The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples.

Objective: The aim was to translate, revise, and standardize the Perceived Stress Questionnaire (PSQ) by Levenstein et al. (1993) in German. The instrument assesses subjectively experienced stress independent of a specific and objective occasion. Methods: Exploratory factor analyses and a revision of the scale content were carried out on a sample of 650 subjects (Psychosomatic Medicine patients, women after delivery, women after miscarriage, and students). Confirmatory analyses and examination of structural stability across subgroups were carried out on a second sample of 1,808 subjects (psychosomatic, tinnitus, inflammatory bowel disease patients, pregnant women, healthy adults) using linear structural equation modeling and multisample analyses. External validation included immunological measures in women who had suffered a miscarriage. Results: Four factors (worries, tension, joy, demands) emerged, with 5 items each, as compared with the 30 items of the original PSQ. The factor structure was confirmed on the second sample. Multisample analyses yielded a fair structural stability across groups. Reliability values were satisfactory. Findings suggest that three scales represent internal stress reactions, whereas the scale “demands” relates to perceived external stressors. Significant and meaningful differences between groups indicate differential validity. A higher degree of certain immunological imbalances after miscarriage (presumably linked to pregnancy loss) was found in those women who had a higher stress score. Sensitivity to change was demonstrated in two different treatment samples. Conclusion: We propose the revised PSQ as a valid and economic tool for stress research. The overall score permits comparison with results from earlier studies using the original instrument. PSQ = Perceived Stress Questionnaire; ICD = International Classification of Diseases; QoL = quality of life; IBD = inflammatory bowel disease; SEM = structural equation modeling; MSA = multisample analysis; TLI = Tucker-Lewis index; CFI = comparative fit index.

Validierung des “Perceived Stress Questionnaire“ (PSQ) an einer deutschen Stichprobe

Zusammenfassung. Der “Perceived Stress Questionnaire“ (PSQ) von Levenstein et al. (1993), ein Instrument zur Erfassung der aktuellen subjektiv erlebten Belastung, wurde in einer deutschen Fassung an N = 650 Probanden teststatistisch uberpruft (n = 249 stationar psychosomatische Patienten, n = 81 Frauen nach Fehlgeburt, n = 74 Frauen nach komplikationsloser Entbindung, n = 246 Medizinstudierende). Faktorenanalytisch finden sich - abweichend vom Original - 4 Faktoren (Sorgen, Anspannung, Freude, Anforderungen), die sich in 4 Skalen mit je funf Items uberfuhren lassen mit internen Konsistenzwerten zwischen Cronbachs Alpha = .80 und = .86. Der ursprungliche Umfang wurde von 30 auf 20 Items reduziert. Interkorrelationsmuster und Gruppendifferenzen legen nahe, das die ersten drei Skalen die interne Stresreaktion des Individuums abbilden, wahrend die Skala “Anforderungen“ die Wahrnehmung auserer Stressoren fokussiert. Fur die Konstruktvaliditat sprechen Zusammenhangsmuster mit Merkmalen der subjektiven Lebensqua...

Determinants of the quality of life of patients with congenital heart disease.

Objective: The improvement of the quality of life of chronically ill patients has become an important goal in treatment. However, it is seldom taken into account that many other factors, in addition to somatic factors, have an influence on the quality of life of patients. Using patients with congenital heart defects as an example, we examined the relative significance of biological factors, compared to psychological and social factors, for the various quality of life dimensions. Research design and methods: One hundred and eleven patients (aged 33 ± 12 years) with different degrees of cardiac dysfunction were examined (NYHA 0: 2 I: 56, II: 38, III: 13, IV: 2). All patients for whom there was no contra-indication underwent a treadmill ergometry in order to determine their level of cardiopulmonary functioning (peak oxygen consumption:

An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception

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Correlation between immune and neuronal parameters and stress perception in allergic asthmatics

). All patients were asked to fill out questionnaires concerning their quality of life (WHOQOL-Bref), their cardiac complaints (Giessener Complaint Questionnaire GBB), their personality traits (Giessen Test GTS), and the social support they experience (Social Support Questionnaire SOZU-k22). The data were analyzed using a linear structural equation model (SEM). Results: In all aspects but the social domain, the HRQL of CgHD patients was significantly diminished compared to the normal population. The SEM proposed was valid, showing good indices of fit (χ2=1.18; p=0.55; AGFI=0.92). The level of cardiopulmonary functioning was most significant for the reporting of specific cardiac complaints (β=−28) and for the physical component of the general HRQL (β=32), although the former was also influenced by a depressed disposition (β=−0.20) and the extent of social support experienced (β=0.18). The objective findings, however, had virtually no individual significance for the psychological (β=0.09) and social domains (β=−0.02). These HRQL domains are primarily influenced by depressive personality traits (β=−26/−0.16) and the social support experienced (β=0.51/0.51). Conclusions: The patient’s organic dysfunction primarily determines illness-specific complaints but has little relevance for the psychological and social aspects of the HRQL. These aspects are predominantly determined by the patient’s depressive disposition and by the experienced social support. A successful therapy should therefore take biological as well as psycho-social determinants of the quality of life into account.

Psychosocial stress of living donors after living donor liver transplantation.

In the past, a German Computerized Adaptive Test, based on Item Response Theory (IRT), was developed for purposes of assessing the construct depression [Computer‐adaptive test for depression (D‐CAT)]. This study aims at testing the feasibility and validity of the real computer‐adaptive application.

T-cell immune parameters and depression in patients with Crohn's Disease

OBJECTIVES This study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction. STUDY DESIGN AND SETTING Item response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n=116 inpatients, (N3) together with established stress questionnaires as validity criteria. RESULTS The final banks included n=38 stress exposure items and n=31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE<0.32; rho>0.90) using 7.0+/-2.3 (M+/-SD) stress reaction items and 11.6+/-1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6+/-2.1 for the dimension stress reaction and 10.0+/-4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations. CONCLUSIONS The Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making.