Jeannette Brodbeck

Association between cannabis use and sexual risk behavior among young heterosexual adults

To study the association between cannabis use and frequent sexual risk behavior, we tested the hypothesis of a situational influence of cannabis use in sexual encounters using a combination of global association study and event-level analysis and examined possible mediator variables, including the personality trait of hedonism/risk preference, psychosocial stress, and HIV-related beliefs, using mediation models. The results of a computer-assisted telephone interview of a random sample of 2790 heterosexual men and women aged 16–24 years showed that risky sexual behavior was more frequent in cannabis-using men and women than in non-using persons. The results did not support a situational effect of cannabis intoxication on sexual risk behavior. The more frequent sexual risk behavior among cannabis users was mediated by decreased intentions to use HIV protection, by lower HIV-self-efficacy, and higher risk preference/hedonism. Only among women psychosocial stress was a partial mediator. The findings show that HIV prevention programs for cannabis-using young adults should emphasize the role of person variables instead of situation variables.

One-Year Follow-Up of Dual Diagnosis Patients Attending a 4-Month Integrated Inpatient Treatment

The purpose of this study was to assess a 4-month inpatient treatment program based on integrated models for patients with substance use and psychiatric disorders (dual diagnosis patients). On admission and at the 1-year follow-up, a consecutive sample of 118 dual diagnosis patients who entered the program were assessed by interview. Eighty-four patients (70.6%) completed the 1-year follow-up interview, reporting less frequent substance use, less severe psychiatric symptoms, a lower rehospitalization rate, and better housing conditions than on admission. Patients diagnosed with a comorbid personality disorder had a better improvement in the frequency of drinking and were less likely to be rehospitalized than patients with schizophrenia or depression. The results suggest that the integrated inpatient program may be a promising treatment approach for dual diagnosis patients. The results await replication in controlled studies that need to include an assessment of outpatient treatment following inpatient programs.

General and specific components of depression and anxiety in an adolescent population

BackgroundDepressive and anxiety symptoms often co-occur resulting in a debate about common and distinct features of depression and anxiety.MethodsAn exploratory factor analysis (EFA) and a bifactor modelling approach were used to separate a general distress continuum from more specific sub-domains of depression and anxiety in an adolescent community sample (n = 1159, age 14). The Mood and Feelings Questionnaire and the Revised Childrens Manifest Anxiety Scale were used.ResultsA three-factor confirmatory factor analysis is reported which identified a) mood and social-cognitive symptoms of depression, b) worrying symptoms, and c) somatic and information-processing symptoms as distinct yet closely related constructs. Subsequent bifactor modelling supported a general distress factor which accounted for the communality of the depression and anxiety items. Specific factors for hopelessness-suicidal thoughts and restlessness-fatigue indicated distinct psychopathological constructs which account for unique information over and above the general distress factor. The general distress factor and the hopelessness-suicidal factor were more severe in females but the restlessness-fatigue factor worse in males. Measurement precision of the general distress factor was higher and spanned a wider range of the population than any of the three first-order factors.ConclusionsThe general distress factor provides the most reliable target for epidemiological analysis but specific factors may help to refine valid phenotype dimensions for aetiological research and assist in prognostic modelling of future psychiatric episodes.

Friendships and Family Support Reduce Subsequent Depressive Symptoms in At-Risk Adolescents

Background Early life stress (ELS) consists of child family adversities (CFA: negative experiences that happened within the family environment) and/or peer bullying. ELS plays an important role in the development of adolescent depressive symptoms and clinical disorders. Identifying factors that may reduce depressive symptoms in adolescents with ELS may have important public mental health implications. Methods We used structural equation modelling and examined the impact of adolescent friendships and/or family support at age 14 on depressive symptoms at age 17 in adolescents exposed to ELS before age 11. To this end, we used structural equation modelling in a community sample of 771 adolescents (322 boys and 477 girls) from a 3 year longitudinal study. Significant paths in the model were followed-up to test whether social support mediated or moderated the association between ELS and depressive symptoms at age 17. Results We found that adolescent social support in adolescence is negatively associated with subsequent depressive symptoms in boys and girls exposed to ELS. Specifically, we found evidence for two mediational pathways: In the first pathway family support mediated the link between CFA and depressive symptoms at age 17. Specifically, CFA was negatively associated with adolescent family support at age 14, which in turn was negatively associated with depressive symptoms at age 17. In the second pathway we found that adolescent friendships mediated the path between peer bullying and depressive symptoms. Specifically, relational bullying was negatively associated with adolescent friendships at age 14, which in turn were negatively associated with depressive symptoms at age 17. In contrast, we did not find a moderating effect of friendships and family support on the association between CFA and depressive symptoms. Conclusions Friendships and/or family support in adolescence mediate the relationship between ELS and late adolescent depressive symptoms in boys and girls. Therefore, enhancing affiliate relationships and positive family environments may benefit the mental health of vulnerable youth that have experienced CFA and/or primary school bullying.

One-year outcome of an integrative inpatient treatment for dual diagnosis patients

The purpose of this study was to evaluate a 4-month dual diagnosis inpatient treatment program that was based on integrative models for patients with substance use and psychiatric disorders. At intake and at 1-year follow-up, dual diagnosis patients (N = 52) were assessed on housing and subsistence level, substance use and psychiatric symptoms. At 1-year follow-up, dual diagnosis patients reported a higher level of housing and subsistence, and less intensive psychiatric symptoms. No change occurred on frequencies of substance use. General improvement may occur even if psychotropic substances are used. Controlled studies are needed on extended inpatient treatment for dual diagnosis patients and outcomes in longer follow-ups.

General distress, hopelessness—suicidal ideation and worrying in adolescence: Concurrent and predictive validity of a symptom-level bifactor model for clinical diagnoses

Background Clinical disorders often share common symptoms and aetiological factors. Bifactor models acknowledge the role of an underlying general distress component and more specific sub-domains of psychopathology which specify the unique components of disorders over and above a general factor. Methods A bifactor model jointly calibrated data on subjective distress from The Mood and Feelings Questionnaire and the Revised Childrens Manifest Anxiety Scale. The bifactor model encompassed a general distress factor, and specific factors for (a) hopelessness—suicidal ideation, (b) generalised worrying and (c) restlessness—fatigue at age 14 which were related to lifetime clinical diagnoses established by interviews at ages 14 (concurrent validity) and current diagnoses at 17 years (predictive validity) in a British population sample of 1159 adolescents. Results Diagnostic interviews confirmed the validity of a symptom-level bifactor model. The underlying general distress factor was a powerful but non-specific predictor of affective, anxiety and behaviour disorders. The specific factors for hopelessness—suicidal ideation and generalised worrying contributed to predictive specificity. Hopelessness—suicidal ideation predicted concurrent and future affective disorder; generalised worrying predicted concurrent and future anxiety, specifically concurrent generalised anxiety disorders. Generalised worrying was negatively associated with behaviour disorders. Limitations The analyses of gender differences and the prediction of specific disorders was limited due to a low frequency of disorders other than depression. Conclusions The bifactor model was able to differentiate concurrent and predict future clinical diagnoses. This can inform the development of targeted as well as non-specific interventions for prevention and treatment of different disorders.

The association of childhood trauma and personality disorders with chronic depression: A cross-sectional study in depressed outpatients.

OBJECTIVE Chronic depression has often been associated with childhood trauma. There may, however, be an interaction between personality pathology, childhood trauma, and chronic depression. This interaction has not yet been studied. METHOD This retrospective analysis is based on 279 patients contacted for a randomized trial in an outpatient psychotherapy center over a period of 18 months from 2010 to 2012. Current diagnoses of a personality disorder and presence of chronic depression were systematically assessed using the Structured Clinical Interview for DSM-IV. Retrospective reports of childhood trauma were collected using the short form of the Childhood Trauma Questionnaire (CTQ-SF). DSM-IV-defined chronic depression was the primary outcome. The association between chronic depression, childhood trauma, and personality disorders was analyzed using correlations. Variables that had at least a small effect on correlation analysis were entered into a series of logistic regression analyses to determine the predictors of chronic depression and the moderating effect of childhood trauma. RESULTS The presence of avoidant personality disorder, but no CTQ-SF scale, was associated with the chronicity of depression (odds ratio [OR] = 2.20, P = .015). The emotional abuse subscale of the CTQ-SF did, however, correlate with avoidant personality disorder (OR = 1.15, P = .000). The level of emotional abuse had a moderating effect on the effect of avoidant personality disorder on the presence of chronic depression (OR = 1.08, P = .004). Patients who did not suffer from avoidant personality disorder had a decreased rate of chronic depression if they retrospectively reported more severe levels of emotional abuse (18.9% vs 39.7%, respectively). CONCLUSIONS The presence of avoidant personality pathology may interact with the effect of childhood trauma in the development of chronic depression. This has to be confirmed in a prospective study. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01226238.

Comparing growth trajectories of risk behaviors from late adolescence through young adulthood: an accelerated design

Risk behaviors such as substance use or deviance are often limited to the early stages of the life course. Whereas the onset of risk behavior is well studied, less is currently known about the decline and timing of cessation of risk behaviors of different domains during young adulthood. Prevalence and longitudinal developmental patterning of alcohol use, drinking to the point of drunkenness, smoking, cannabis use, deviance, and HIV-related sexual risk behavior were compared in a Swiss community sample (N = 2,843). Using a longitudinal cohort-sequential approach to link multiple assessments with 3 waves of data for each individual, the studied period spanned the ages of 16 to 29 years. Although smoking had a higher prevalence, both smoking and drinking up to the point of drunkenness followed an inverted U-shaped curve. Alcohol consumption was also best described by a quadratic model, though largely stable at a high level through the late 20s. Sexual risk behavior increased slowly from age 16 to age 22 and then remained largely stable. In contrast, cannabis use and deviance linearly declined from age 16 to age 29. Young men were at higher risk for all behaviors than were young women, but apart from deviance, patterning over time was similar for both sexes. Results about the timing of increase and decline as well as differences between risk behaviors may inform tailored prevention programs during the transition from late adolescence to adulthood.

The structure of psychopathological symptoms and the associations with DSM-diagnoses in treatment seeking individuals

BACKGROUND Research on comorbidity of psychiatric disorders identifies broad superordinate dimensions as underlying structure of psychopathology. While a syndrome-level approach informs diagnostic systems, a symptom-level approach is more likely to represent the dimensional components within existing diagnostic categories. It may capture general emotional, cognitive or physiological processes as underlying liabilities of different disorders and thus further develop dimensional-spectrum models of psychopathology. METHODS Exploratory and confirmatory factor analyses were used to examine the structure of psychopathological symptoms assessed with the Brief Symptom Inventory in two outpatient samples (n=3171), including several correlated-factors and bifactor models. The preferred models were correlated with DSM-diagnoses. RESULTS A model containing eight correlated factors for depressed mood, phobic fear, aggression, suicidal ideation, nervous tension, somatic symptoms, information processing deficits, and interpersonal insecurity, as well a bifactor model fit the data best. Distinct patterns of correlations with DSM-diagnoses identified a) distress-related disorders, i.e., mood disorders, PTSD, and personality disorders, which were associated with all correlated factors as well as the underlying general distress factor; b) anxiety disorders with more specific patterns of correlations; and c) disorders defined by behavioural or somatic dysfunctions, which were characterised by non-significant or negative correlations with most factors. CONCLUSIONS This study identified emotional, somatic, cognitive, and interpersonal components of psychopathology as transdiagnostic psychopathological liabilities. These components can contribute to a more accurate description and taxonomy of psychopathology, may serve as phenotypic constructs for further aetiological research, and can inform the development of tailored general and specific interventions to treat mental disorders.

Prevalence rates of at risk, problematic and pathological gambling in Switzerland

Background and Objectives: Few studies have assessed pathological gambling in Switzerland. We employed the National Opinion Research Center DSM Screen for Gambling Problems (NODS) to assess prevalence of gambling problems in Germanand Italian-speaking Switzerland. Methods: A random sample of 4997 individuals participated in a computer-assisted telephone interview in 2007 and 1388 of the individuals who refused to participate on the telephone interview completed a paper questionnaire. The total sample included 6385 participants (52% women); the return rate was 52.2%. Results: Among the general population over 18 years of age, 2% engaged in lifetime atrisk gambling, 0.5% in problematic and 0.3% in pathological gambling. We found pastyear prevalence rates of 0.7% of at-risk gambling, 0.1% for problematic and 0.02% for pathological gambling. Conclusions: These rates are at the lower end of international statistics and are lower than rates in previous Swiss studies. This may be due to measures to reduce false positive diagnoses in our study. Large differences between lifetime and past-year prevalence rates indicate that problematic and pathological gambling are not necessarily progressive and chronic disorders. Received 14 March 2008 Revised 31 October 2008 Accepted 19 November 2008 68 JEANNETTE BRODBECK ET AL. However, some researchers consider a cutoff score of four criteria as more adequate for a diagnosis of pathological gambling1,2. In addition to person-based cognitive, personality and biological factors, structural characteristics of the games and social factors such as cultural attitudes towards gambling, structural preventive measures and the accessibility of gambling activities have an impact on the development of gambling problems3,4. Slot-machines especially have great potential for addiction5. In Switzerland, gambling is legally regulated by a governmental monopoly. The most popular gambling activities are lotteries. Casinos were prohibited until 2002. Today, Switzerland has a very high ‘density’ of casinos (19 for a population of 7,459,000 inhabitants). Casinos are legally obliged to implement prevention measures to detect at-risk gamblers early and harm reduction measures to reduce problematic and pathological gambling, such as (self-)exclusion at casinos. In addition, proper training of casino staff and provision of data for research are required. Counselling facilities and public campaigns to increase community awareness of problematic gambling have been established during the last years. Slot-machines, other than in casinos, have been prohibited since 2005; before that they had to make a submission for authorization. To assess prevalence of problematic and pathological gambling, two instruments have been established and frequently used: The South Oaks Gambling Screen (SOGS)6 and DSM-IV-based instruments such as the National Opinion Research Center DSM Screen for Gambling Problems (NODS)7. The NODS is designed to be more restrictive than the SOGS and relates more closely to the DSM-IV-TR criteria of pathological gambling. About half of the SOGS items focus on sources of borrowed money and no items regard tolerance and withdrawal. Since, to date, there is no gold standard for the definition of pathological gambling, we rely on the current clinical definition of the DSM-IV-TR and the NODS. Until now, few gambling prevalence surveys have been conducted in European countries. Different or even not specified timeframes, selection or sampling biases and different assessment measures complicate comparison of the existing studies8. Replications of results are often missing. Thus it is difficult to formulate well-founded statements about the frequency of excessive gambling in European countries. Excessive gambling seems to be more prevalent in the US, Canada and countries of Asia than in Europe3,8. A recent British study found oneyear prevalence rates of 0.6% of problematic (including pathological) gambling in 20079. In Scandinavian countries recent one-year prevalence rates were around 0.4% for problem gambling and 0.1-0.2% for pathological gambling. An Italian study found one-year prevalence rates of 0.7% for problem gambling and 0.4% for pathological gambling8. In Switzerland only three prevalence studies of gambling problems exist. Bondolfi and colleagues10,11 found lifetime prevalence rates of 2.2% for problematic and 0.8% for pathological gambling in 1998 and of 2.2% for problematic and 1.1% for pathological gambling in 2005. Participants of the German-speaking part of Switzerland are however under-represented in these studies (32 and 36% in the study samples compared with 71% Swiss inhabitants in the German-speaking part of Switzerland). Therefore the database for this region is small and the generalizability is questionable. This is relevant because in the French-speaking part of Switzerland, the availability of gambling activities such as electronic gambling machines outside of casinos differs from the rest of Switzerland. A study by Zangerl and colleagues12 found five-year prevalence rates in the year 2004 of 1.9% for probable pathological gamblers and 1.8% for potential pathological gamblers or problem gamblers. One other study covering the Italian-speaking part of Switzerland found lifetime prevalence rates of 0.6% for both problematic and pathological gambling13.