Lutz Goldbeck

History of Maltreatment and Mental Health Problems in Foster Children: A Review of the Literature

OBJECTIVE Foster children often experience compromising situations such as neglect, physical abuse, or sexual abuse before out-of-home placement. This article aims to give a literature review related to the development and mental health of foster children with special consideration of trauma history. METHODS A computer-based literature search was conducted in the databases Medline, PsycINFO, PSYNDEXplus, and SCOPUS. We determined a time frame from 1998 to 2009. RESULTS The literature search resulted in 32 articles reporting empirical data about development and mental health in foster children. Very high rates of exposure to maltreatment, developmental delays and mental disorders were found. A broad spectrum of externalizing as well as internalizing symptoms and a high prevalence of comorbid mental disorders were found. CONCLUSIONS Foster children exhibit a broad pattern of developmental problems and psychopathology. The etiology of these disorders is discussed in the context of multiple risk factors, especially that of persistent maltreatment.

Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of The International Depression Epidemiological Study across nine countries

Background Individuals with chronic diseases and parent caregivers are at increased risk for symptoms of depression and anxiety. Prevalence of psychological symptoms was evaluated in adolescents and adults with cystic fibrosis (CF) and parent caregivers across nine countries. Methods Patients with CF, ages 12 years and older, and caregivers of children with CF, birth to18 years of age, completed measures of depression and anxiety across 154 CF centres in Europe and the USA. Psychological symptoms were compared across countries using χ2. Logistic regression examined extent of comorbid symptoms, predictors of depression and anxiety, and concordance between parent and adolescent symptomatology. Results Psychological symptoms were reported by 6088 patients with CF and 4102 parents. Elevated symptoms of depression were found in 10% of adolescents, 19% of adults, 37% of mothers and 31% of fathers. Elevations in anxiety were found in 22% of adolescents, 32% of adults, 48% of mothers and 36% of fathers. Overall, elevations were 2–3 times those of community samples. Participants reporting elevated anxiety were more likely to report depression (ORs: adolescents=14.97, adults=13.64, mothers=15.52, fathers=9.20). Significant differences in reports of depression and anxiety were found by patient age and parent respondent. Concordance between 1122 parent–teen dyads indicated that adolescents whose parents reported depression were more likely to be elevated on depression (OR=2.32). Similarly, adolescents whose parents reported anxiety were more likely to score in the elevated range on the anxiety measure (OR=2.22). Conclusions Symptoms of depression and anxiety were elevated in both patients with CF and parents across several European countries and the USA. Annual screening of psychological symptoms is recommended for both patients and parents.

Prevalence of mental disorders among adolescents in German youth welfare institutions

ObjectiveMultiple psycho-social risk factors are common in children and adolescents in youth welfare, especially in residential care. In this survey study we assessed the prevalence of behavioral, emotional symptoms and mental disorders in a German residential care population.Methods20 residential care institutions including 689 children and adolescents (age 4 – 18 years; mean 14.4; SD = 2.9) participated. A two-step design was performed. First, the children and adolescents and their residential caregivers answered a standard symptom checklist (CBCL/YSR). For those participants scoring more than one standard deviation above the mean of their German population reference group, a standardized clinical examination was performed to specify an ICD-10 diagnosis.ResultsThe study population reached high average scores in almost all scales and subscales of the CBCL and YSR (mean CBCL total score T = 64.3, SD = 9.7, Median = 66.0). The prevalence of mental disorders according to the diagnostic criteria of ICD-10 was 59.9%, with a predominance of externalizing and disruptive disorders. High rates of co-morbidity were observed.ConclusionChildren and adolescents in youth welfare and residential care are a neglected high risk population. Providing adequate psychiatric diagnosis and multimodal treatment for this group is necessary.

International Committee on Mental Health in Cystic Fibrosis: Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus statements for screening and treating depression and anxiety

Studies measuring psychological distress in individuals with cystic fibrosis (CF) have found high rates of both depression and anxiety. Psychological symptoms in both individuals with CF and parent caregivers have been associated with decreased lung function, lower body mass index, worse adherence, worse health-related quality of life, more frequent hospitalisations and increased healthcare costs. To identify and treat depression and anxiety in CF, the CF Foundation and the European CF Society invited a panel of experts, including physicians, psychologists, psychiatrists, nurses, social workers, a pharmacist, parents and an individual with CF, to develop consensus recommendations for clinical care. Over 18 months, this 22-member committee was divided into four workgroups: Screening; Psychological Interventions; Pharmacological Treatments and Implementation and Future Research, and used the Population, Intervention, Comparison, Outcome methodology to develop questions for literature search and review. Searches were conducted in PubMed, PsychINFO, ScienceDirect, Google Scholar, Psychiatry online and ABDATA by a methodologist at Dartmouth. The committee reviewed 344 articles, drafted statements and set an 80% acceptance for each recommendation statement as a consensus threshold prior to an anonymous voting process. Fifteen guideline recommendation statements for screening and treatment of depression and anxiety in individuals with CF and parent caregivers were finalised by vote. As these recommendations are implemented in CF centres internationally, the process of dissemination, implementation and resource provision should be closely monitored to assess barriers and concerns, validity and use.

Psychosocial interventions for adolescent cancer patients: a systematic review of the literature

Objective: Both cancer diagnosis and the consequent treatment are particularly challenging for adolescent patients. Adjuvant psychological interventions to reduce cancer‐related distress are therefore a fundamental part of a multidisciplinary treatment. Assuming that psycho‐oncology has to consider developmentally specific aspects, this review summarizes empirical studies of the efficacy and effectiveness of psychosocial interventions for adolescent cancer patients.

Posttraumatic stress, depression and anxiety among adult long-term survivors of cancer in adolescence

BACKGROUND To determine the prevalence of posttraumatic stress, depression and anxiety in adults who have survived cancer (5 years) diagnosed in adolescence, as compared to healthy controls. PATIENTS AND METHODS Survivors (n=820) of cancer during adolescence (age M=30.4+/-6.0 years; M=13.7+/-6.0 years since diagnosis) and 1027 matched controls without history of cancer (age M=31.5+/-6.9 years) completed standardised questionnaires measuring posttraumatic stress, depression and anxiety. Additionally, sub-groups of 202 survivors and 140 controls with elevated scores received structured interviews to ascertain DSM-IV-diagnoses. RESULTS A total of 22.4% of the survivors reported clinically relevant symptoms of posttraumatic stress, anxiety and/or depression compared to 14.0% of the controls (odds ratios [ORs] 1.77; 95% confidence interval [CI] 1.39-2.26). The odds of posttraumatic stress symptoms in male (OR 3.92, 95% CI 1.80-8.51) and female (OR 3.83, 95% CI 2.54-5.76) survivors were more than three times those in the controls. However, only female survivors reported symptoms of depression and anxiety significantly more often (respectively: OR 2.12, 95% CI 1.16-3.85; and OR 1.86, 95% CI 1.33-2.59) than the controls. A relevant subgroup of 24.3% of the survivors met DSM-IV criteria for at least one mental disorder compared to 15.3% of the controls. CONCLUSION Survivors of cancer during adolescence show an elevated risk of presenting symptoms of posttraumatic stress, anxiety and/or depression during adulthood which is also reflected in a greater number of DSM-IV diagnoses when compared to controls. Comprehensive follow-up assessments should include the examination of possible psychological late effects of a cancer diagnosis in adolescence in order to identify survivors needing psychosocial interventions even years after the completion of successful medical treatment.

Prevalence of Symptoms of Anxiety and Depression in German Patients With Cystic Fibrosis

BACKGROUND Chronic illness is a significant risk factor for the development of internalizing psychopathology; however, evidence for the prevalence of these symptoms in patients with cystic fibrosis (CF) is limited. We investigated the prevalence of symptoms of anxiety and depression in German-speaking patients with CF and the association of these symptoms to physical health status. METHODS A representative sample of German patients with CF (N = 670; age range, 12-64 years; 52.7% men) completed the Hospital Anxiety and Depression Scale. Their medical data were taken from the German CF registry. Data on the study sample were compared with data on a control group from the German general population. RESULTS Elevated anxiety scores were found in 20.6% of the patients with CF, and 9.6% reported high levels of symptoms of depression. Adult patients with CF reported more elevated symptoms of anxiety than healthy control subjects, whereas no age group of patients was more or less depressed than the general population. Younger patients reported fewer symptoms of anxiety and depression than older patients, and women reported more symptoms of anxiety than men. Recent hemoptysis/pneumothorax and recent diagnosis of diabetes were associated with anxiety, whereas impaired lung function and transplant listing status were associated with depression. CONCLUSIONS Anxiety in particular is an important issue for a large proportion of patients with CF. The risk of depression increased with greater impairment in pulmonary function. Annual screening of symptoms of anxiety and depression as well as appropriate referrals for those in the clinically elevated range are recommended.

Social outcomes of long-term survivors of adolescent cancer

Objectives: The study investigates psychosexual and family outcomes among German long‐term survivors of adolescent cancer.

The impact of the severity of disease and social disadvantage on quality of life in families with congenital cardiac disease.

OBJECTIVE Increasing rates of survival have raised the question of medical and psychosocial factors contributing to quality of life of patients with congenital cardiac disease. We investigated the impact of the severity of disease, and social disadvantage, on the quality of life of patients and their primary caregivers. METHODS One hundred and thirty two families participated in a computer-assisted evaluation of their quality of life in a German outpatient centre for paediatric cardiac diseases. Quality of life for the patients was evaluated by a multi-dimensional proxy-measure. The quality of life of the caregivers was evaluated by a multi-dimensional self-reporting measure. Severity of the disease was evaluated by the responsible paediatrician. Social disadvantage was defined as single-parent status, ethnic minority status, unfinished parental education or professional training, and/or unemployment. Analyses of variance were calculated with mild, moderate, or severe forms of disease, and risk as opposed to no risk for social status, both factors being treated independently, and the quality of life of the patients and their caregivers as dependent variables. RESULTS We demonstrated significant effects of the severity of disease on the quality of life of the children, and of social disadvantage on the quality of life of both the children and their parents. A significant interactive effect indicated a cumulative negative impact of the severity of the disease and social disadvantage on the quality of life of the patients. CONCLUSION Programmes providing psychosocial support for children with cardiac disease and their caregivers should consider risk factors which are both medical and social.

Educational and vocational achievement among long-term survivors of adolescent cancer in Germany†

Adolescence involves graduating from school and preparing ones professional career. The accomplishment of these tasks may be hampered by the experience of cancer. This study investigates the educational and professional achievements of German long‐term survivors of adolescent cancer.