Lena Spangenberg

The Somatic Symptom Scale–8 (SSS-8): A Brief Measure of Somatic Symptom Burden

IMPORTANCE Somatic symptoms are the core features of many medical diseases, and they are used to evaluate the severity and course of illness. The 8-item Somatic Symptom Scale (SSS-8) was recently developed as a brief, patient-reported outcome measure of somatic symptom burden, but its reliability, validity, and usefulness have not yet been tested. OBJECTIVE To investigate the reliability, validity, and severity categories as well as the reference scores of the SSS-8. DESIGN, SETTING, AND PARTICIPANTS A national, representative general-population survey was performed between June 15, 2012, and July 15, 2012, in Germany, including 2510 individuals older than 13 years. MAIN OUTCOMES AND MEASURES The SSS-8 mean (SD), item-total correlations, Cronbach α, factor structure, associations with measures of construct validity (Patient Health Questionnaire-2 depression scale, Generalized Anxiety Disorder-2 scale, visual analog scale for general health status, 12-month health care use), severity categories, and percentile rank reference scores. RESULTS The SSS-8 had excellent item characteristics and good reliability (Cronbach α = 0.81). The factor structure reflects gastrointestinal, pain, fatigue, and cardiopulmonary aspects of the general somatic symptom burden. Somatic symptom burden as measured by the SSS-8 was significantly associated with depression (r = 0.57 [95% CI, 0.54 to 0.60]), anxiety (r = 0.55 [95% CI, 0.52 to 0.58]), general health status (r = -0.24 [95% CI, -0.28 to -0.20]), and health care use (incidence rate ratio, 1.12 [95% CI, 1.10 to 1.14]). The SSS-8 severity categories were calculated in accordance with percentile ranks: no to minimal (0-3 points), low (4-7 points), medium (8-11 points), high (12-15 points), and very high (16-32 points) somatic symptom burden. For every SSS-8 severity category increase, there was a 53% (95% CI, 44% to 63%) increase in health care visits. CONCLUSIONS AND RELEVANCE The SSS-8 is a reliable and valid self-report measure of somatic symptom burden. Cutoff scores identify individuals with low, medium, high, and very high somatic symptom burden.

Dimensional assessment of depressive severity in the elderly general population: Psychometric evaluation of the PHQ-9 using Rasch Analysis

BACKGROUND The depression module of the Patient Health questionnaire (PHQ-9) is a wide-spread self-report instrument for the assessment of depression with compelling psychometric characteristics when relying on classical test theory assumptions. This study aimed at evaluating whether the PHQ-9 may be interpreted as a dimensional scale measuring depression severity in the elderly general population using Rasch analysis with special emphasis on its unidimensional structure and differential item functioning (DIF) due to gender, age, and the presence of somatic multimorbidity. METHODS A representative sample of the elderly German general population (N=1631; age 60-85 years, 53.5% female) filled in the PHQ-9, a questionnaire about chronic medical conditions and a demographic data sheet. Unidimensionality and psychometric properties of the PHQ-9 were ascertained applying confirmatory factor analysis (CFA) and Rasch analysis. RESULTS Results revealed substantial violations of the unidimensionality of the scale: item 8 (retardation or agitation) had to be eliminated and multiple residual correlations were added. Gender-related DIF emerged for two items, and three items showed insufficient Rasch model fit. LIMITATIONS The large sample leads to high statistical power that might technically increase the probability of detecting model misfit or DIF. The sampling procedure leads to a possible underestimation of morbidity due to the exclusion of those elderly patients living in nursing homes. CONCLUSIONS Results suggest that - when applied in the elderly general population - the PHQ-9 should be interpreted in terms of a diagnostic algorithm for classificatory decisions about a DSM-IV based probable diagnosis of depression rather than as a dimensional scale.

The association of depression and multimorbidity in the elderly: implications for the assessment of depression

Background:  Depression and multimorbidity are common in the elderly. Assessing depression might be difficult because of the overlap of depressive and somatic symptoms, possibly leading to confounded results.

The German version of the Interpersonal Needs Questionnaire (INQ) - Dimensionality, psychometric properties and population-based norms

PURPOSE The Interpersonal Needs Questionnaire (INQ) assesses the two interpersonal constructs perceived burdensomeness (PB) and thwarted belongingness (TB) that lead to suicidal ideation, according to the interpersonal theory of suicide (IPTS). The present study investigates dimensionality and psychometric properties of the German version of the INQ in a population-based representative sample and delivers norm values. METHODS The German INQ as well as measures of depression and past suicidality were administered to a population-based representative sample of the German general population (n=2513) to analyze its dimensionality and construct validity by confirmatory factor analysis and correlational analysis. RESULTS Results of the confirmatory factor analysis were in line with the assumption of two-dimensionality of the INQ. The two subscales showed very good internal consistencies (α ≥ 0.89) as well as correlations with depression and suicidality that indicate convergent validity. There were no gender effects but slight age effects in the scores of both subscales. Population-based norms are provided. LIMITATIONS Convergent validity was solely examined with measures of depression and suicidal thoughts instead of further suitable constructs like loneliness and social support. Divergent validity was not investigated in the study. CONCLUSION The German version of the INQ shows good psychometric properties making it a promising tool for assessing PB and TB. The provided norms enable researchers to compare INQ scores of their samples with reference values of a population-based representative sample.

Attitudes Towards (Psychotherapy) Groups: Results of a Survey in a Representative Sample

Abstract Based upon observations indicating decreasing attractiveness of groups within and outside the clinical field, the present study aimed to determine attitudes toward, and expectations of, groups in a representative sample of 2512 German citizens. The survey also included questions specifically related to group psychotherapy and its acceptance. In addition, psychological characteristics of respondents (measures of narcissism, psychological impairment, and emotion regulation) and socio-demographic variables were assessed to examine their potential association with group-related attitudes. In total, the survey revealed a relatively positive picture of attitudes and expectations toward groups in general and psychotherapy groups in particular. Those with more open attitudes towards groups were comparatively less distressed, anxious, and depressed; they favored emotional reappraisal instead of suppression as the dominant strategy to regulate their emotions. Contrary to prediction, narcissism did not influence attitudes towards groups. The results are related to current discussions of the attractiveness of groups and to implications for the practice of group psychotherapy.

Nachdenken über das Wohnen im Alter

BACKGROUND Providing care and support for the elderly is a future challenge. MATERIALS AND METHODS Using regression analysis, a representative population-based sample (n = 1,445) was examined with respect to whether they had considered future housing and which variables influenced their thoughts and preferences. RESULTS The majority of the sample reported thinking about housing in old age and preferred to stay at home in old age. Thoughts about future housing and housing preferences were predicted by different factors in the age groups analyzed. Thinking about future housing was positively associated with increasing age and depression. Other relevant predictors were gender, living with a partner, images of old age (especially negative ones), and anticipated subjective health. These variables also predicted housing preferences. CONCLUSIONS Thoughts about future living arrangements are widespread, and their importance increases with age. The wishes reported do contrast to a certain extent with reality. Planning future care as well as developing consultation guidelines should address these issues while considering the reported influences.ZusammenfassungHintergrundDie Versorgung älterer Menschen mit Unterstützungs- und Pflegebedarf muss gewährleistet werden.Material und MethodenIn einer repräsentativen Stichprobe ab 45-Jähriger (n= 1445) wurde regressionsanalytisch untersucht, ob und wie die Personen sich mit ihrer Wohnsituation im Alter gedanklich auseinandersetzen und welche Einflüsse es auf die Beschäftigung mit der Thematik einerseits und die Wohnpräferenz andererseits gibt.ErgebnisseDie Mehrzahl der Befragten hat über Wohnen im Alter nachgedacht und wünscht, weiter im eigenen Haushalt zu leben. Prädiktoren für die Beschäftigungsintensität und die Wohnpräferenzen unterscheiden sich nach Alter. Positiv mit der Intensität sind steigendes Alter und Depressvität assoziiert. Andere bedeutende Prädiktoren, auch hinsichtlich der Wohnpräferenz, sind Geschlecht, Zusammenleben mit einem Partner, Altersbilder (insbesondere negative) und die subjektiv erwartete Erkrankungswahrscheinlichkeit.SchlussfolgerungenWohnthemen haben einen hohen und mit dem Alter steigenden Stellenwert. Wohnwünsche stehen zum Teil im Widerspruch zur aktuellen Versorgungsrealität und sollten, wie ihre Einflussfaktoren, bei Versorgungsplanungen und Beratungskonzepten Eingang finden.AbstractBackgroundProviding care and support for the elderly is a future challenge.Materials and methodsUsing regression analysis, a representative population-based sample (n = 1,445) was examined with respect to whether they had considered future housing and which variables influenced their thoughts and preferences.ResultsThe majority of the sample reported thinking about housing in old age and preferred to stay at home in old age. Thoughts about future housing and housing preferences were predicted by different factors in the age groups analyzed. Thinking about future housing was positively associated with increasing age and depression. Other relevant predictors were gender, living with a partner, images of old age (especially negative ones), and anticipated subjective health. These variables also predicted housing preferences.ConclusionsThoughts about future living arrangements are widespread, and their importance increases with age. The wishes reported do contrast to a certain extent with reality. Planning future care as well as developing consultation guidelines should address these issues while considering the reported influences.

[Future psychotherapists? Vocational plans and motivation for choosing psychotherapy as a career in german psychology students].

BACKGROUND in Germany psychology students can be seen as the major personal resource in psychotherapy. Nevertheless there are few studies on their vocational plans and their interest in psychotherapeutic training. METHOD 480 psychology students completed a self-developed questionnaire on their career expectations. RESULTS 90% of respondents report interest in clinical work and psychotherapeutic training. Most frequently they mention improving therapeutic competencies and career options as pros and current training requirements as cons. Their theoretical orientation (38% behaviour therapy, 19% psychodynamic therapy) is associated with their psychotherapeutic knowledge, study conditions and respondents characteristics. CONCLUSIONS psychology students consider working and training conditions for psychologists and psychotherapists, when thinking about their future career.

Dimensionality, psychometric properties and population-based norms of the German version of the Revised Acquired Capability for Suicide Scale (ACSS-FAD).

The aim of the present study was the validation of the Acquired Capability for Suicide Scale-Fearlessness about Death (ACSS-FAD) in a large population sample to further establish its reliability and validity, and to provide norm values. We assessed the ACSS-FAD, measures of depression, history of suicidal behavior, and anxiety in a representative sample of the German population (N=2513) and analyzed its dimensionality, invariance across sex and construct validity by means of confirmatory factor analysis, correlational analysis and analysis of variance. The one-factorial structure achieved satisfactory model fit after introducing several correlating error terms. Across sex, partial scalar invariance could be established. Depression and anxiety showed negative associations with the ACSS-FAD while no relation with past suicidal behavior was found. Because mean scores in the ACSS-FAD were affected by sex and age group, sex and age-specific norm values were calculated. Our findings support the one-factorial structure of the ACSS-FAD when the measurement model is slightly modified, pointing out the need of revising the wording of some items. The validity of the measure should be further examined in clinical samples.

Psychometrische Überprüfung einer Kurzform des Narcissistic Personality Inventory (NPI-15): Dimensionalität und psychometrische Eigenschaften des NPI-15 in einer repräsentativen Bevölkerungsstichprobe

The Narcissistic Personality Inventory (NPI) is a commonly used measure of narcissism. This study administered a 15 item short version of the NPI (NPI-15). Central aims of the present study were to examine its dimensionality, and to provide data on its psychometric properties. NPI-15 and Hospital Anxiety and Depression Scale (HADS-D) were assessed in a representative sample of the German population (N=2,512). According to Scree-plot and model fit, a solution with 2 or 3 factors seemed feasible. Because of factor loadings and item-level associations to depression/anxiety we decided to favour a 2-factor-solution. 2 subscales reflecting different facets of narcissism were compiled (leadership ability/personality [LA/LP], grandiosity [G]). The psychometric properties of these scales were good (LA/LP) respectively unsatisfactory (G). The validity of the NPI-15 needs to be further studied.

Investigating the Dynamics of Suicidal Ideation

Background: Although the fluctuating nature of suicidal ideation (SI) has been described previously, longitudinal studies investigating the dynamics of SI are scarce. Aim: To demonstrate the fluctuation of SI across 6 days and up to 60 measurement points using smartphone-based ecological momentary assessments (EMA). Method: Twenty inpatients with unipolar depression and current and/or lifetime suicidal ideation rated their momentary SI 10 times per day over a 6-day period. Mean squared successive difference (MSSD) was calculated as a measure of variability. Correlations of MSSD with severity of depression, number of previous depressive episodes, and history of suicidal behavior were examined. Results: Individual trajectories of SI are shown to illustrate fluctuation. MSSD values ranged from 0.2 to 21.7. No significant correlations of MSSD with several clinical parameters were found, but there are hints of associations between fluctuation of SI and severity of depression and suicidality. Limitations: Main limitation of this study is the small sample size leading to low power and probably missing potential effects. Further research with larger samples is necessary to shed light on the dynamics of SI. Conclusion: The results illustrate the dynamic nature and the diversity of trajectories of SI across 6 days in psychiatric inpatients with unipolar depression. Prediction of the fluctuation of SI might be of high clinical relevance. Further research using EMA and sophisticated analyses with larger samples is necessary to shed light on the dynamics of SI.