Markus Zenger

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 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.

Weight bias internalization, core self‐evaluation, and health in overweight and obese persons

Weight bias has strong associations with psychopathology in overweight and obese individuals. However, self‐evaluative processes, as conceptualized in the process model of self‐stigma, and implications for other health‐related outcomes, remain to be clarified.

The impact of optimism on anxiety, depression and quality of life in urogenital cancer patients

Objective: The purpose of the present study was to examine the relationship between optimism and anxiety, depression and health‐related quality of life (HRQOL). A further aim was to investigate the predictive value of optimism for anxiety, depression and HRQOL, quantified with and without controlling the corresponding base level.

The Course of Anxiety and Depression in Patients with Breast Cancer and Gynaecological Cancer

Background/Aims: The aim of this study was to assess the course of anxiety and depression in cancer patients over time and to detect determinants of the changes in the scores. Patients and Method: Women with breast cancer and gynaecological cancer (n = 367) were tested at the beginning (T1) and at the end (T2) of treatment in the hospital, 6 months later (T3), and 12 months later (T4), using the Hospital Anxiety and Depression Scale (HADS). Results: Anxiety and depression were highest at the start of the stay in the hospital. More than half of the women are at least doubtful cases in at least one of the two HADS dimensions. The mean scores declined from T1 to T4. After 1 year, depression scores are similar to those of the general population, while anxiety scores remain elevated. The decline of the HADS scores depends on treatment, time since diagnosis, and education. Conclusions: Women receiving radio- or chemotherapy (compared with surgery only), with a long time since diagnosis, and with a low educational level are at high risk of maintaining high anxiety and depression scores over time.

Weight Bias Internalization Scale: Psychometric Properties and Population Norms

Objective Internalizing the pervasive weight bias commonly directed towards individuals with overweight and obesity, co-occurs with increased psychopathology and impaired quality of life. This study sought to establish population norms and psychometric properties of the most widely used self-report questionnaire, the Weight Bias Internalization Scale (WBIS), in a representative community sample. Design and Methods In a survey of the German population, N = 1158 individuals with overweight and obesity were assessed with the WBIS and self-report measures for convergent validation. Results Item analysis revealed favorable item-total correlation of all but one WBIS item. With this item removed, item homogeneity and internal consistency were excellent. The one-factor structure of the WBIS was confirmed using confirmatory factor analysis. Convergent validity was shown through significant associations with measures of depressive and somatoform symptoms. The WBIS contributed to the explanation of variance in depressive and somatoform symptoms over and above body mass index. Higher WBIS scores were found in women than in men, in individuals with obesity than in individuals with overweight, and in those with lower education or income than those with higher education or income. Sex-specific norms were provided. Conclusions The results showed good psychometric properties of the WBIS after removal of one item. Future research is warranted on further indicators of reliability and validity, for example, retest reliability, sensitivity to change, and prognostic validity.

The relationship of quality of life and distress in prostate cancer patients compared to the general population

Background: The aim of this study is two-fold. The first part compares quality of life (QoL) data of prostate cancer patients with those of a representative and age-specific sample of the general population and analyzes the influence of cancer related as well as socio-demographic parameters on QoL. Secondly, differences in QoL depending on the experienced psychological distress will be shown both in prostate cancer patients and in the general population. Material and Methods: A sample of 265 prostate cancer patients completed both the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Hospital Anxiety and Depression Scale (HADS) during their stay in the hospital. A total HADS cut off score of 15 was used to indicate psychological distress and significant emotional concerns in patients and men of the general population. The results of the patients were compared with those of the general population (N=444). Results: Prostate cancer patients reported significantly worse levels of social and emotional functioning as well as more symptoms like insomnia, constipation and diarrhea compared to the general population. Patients and men of the general population with a total HADS score ≥15 reported lower QoL in all sub-scales except for diarrhea in comparison to people without distress. Discussion: Psychological distress is accompanied by lower QoL and therefore should be taken into consideration when QoL is assessed. Furthermore, clinicians should be trained by professionals to detect distress in their patients and to pay more attention to their emotional concerns, which are strongly associated with the patients’ well-being and QoL during their stay in hospital.

Pessimism Predicts Anxiety, Depression and Quality of Life in Female Cancer Patients

OBJECTIVE The aim of this study was to investigate the predictive value of optimism/pessimism for anxiety, depression and health-related quality of life in female cancer patients, quantified with and without controlling the corresponding base level. METHODS A total of 97 women with breast cancer and other gynaecological cancer completed the Life Orientation Test, the Hospital Anxiety and Depression Scale and the Health Survey SF-8 at three time points: during their stay in the hospital (T1), 2 weeks later (T2) and 3 months later (T3). RESULTS The degree of self-assessed pessimism at T1 was significantly associated with anxiety, depression and health-related quality of life at T3. After controlling for the base levels of anxiety, depression and health-related quality of life, only the predictive value of pessimism remained significant and substantial. CONCLUSIONS Especially, women with a high level of pessimism are at risk for higher levels of anxiety and depression in addition to lowered health-related quality of life in the course of the disease. The results indicate that it seems to be more important not to be pessimistic than to be optimistic.

The Role of Self-Compassion in Buffering Symptoms of Depression in the General Population

Self-compassion, typically operationalized as the total score of the Self-Compassion Scale (SCS; Neff, 2003b), has been shown to be related to increased psychological well-being and lower depression in students of the social sciences, users of psychology websites and psychotherapy patients. The current study builds on the existing literature by examining the link between self-compassion and depressive symptomatology in a sample representative of the German general population (n = 2,404). The SCS subscales of self-judgment, isolation, and over-identification, and the “self-coldness”, composite score, which encompass these three negative subscales, consistently differed between subsamples of individuals without any depressive symptoms, with any depressive syndromes, and with major depressive disorder. The contribution of the positive SCS subscales of self-kindness, common humanity, and mindfulness to the variance in depressive symptomatology was almost negligible. However, when combined to a “self-compassion composite”, the positive SCS subscales significantly moderated the relationship between “self-coldness” and depressive symptoms in the general population. This speaks for self-compassion having the potential to buffer self-coldness related to depression—providing an argument for interventions that foster self-caring, kind, and forgiving attitudes towards oneself.

Reliability and validity of the beck depression inventory-fast screen for medical patients in the general German population

BACKGROUND The Beck Depression Inventory Fast Screen (BDI-FS) is a self-report instrument for the detection of depression in youths and adults. It measures the severity of the depression, corresponding to the non-somatic criteria for the diagnosis of a major depression according to DSM-5. Until now the psychometric properties of the instrument have not been studied in the general population. METHODS In 2012, a survey representative for the Federal Republic of Germany was conducted. In addition to the BDI-FS, further self-rating questionnaires as well as a demographic questionnaire were administered. RESULTS Altogether, 4480 people were surveyed with a return rate of 56.1% (N=2467 persons). Approximately 53% of those surveyed were women. The average age was 49.4 years (SD=18.0), with a range of 14-91 years. For the BDI-FS total-scores, a coefficient α of .84 was determined (women: α=.83; men: α=.85). In addition, a convergent validity (r=.67) was determined with the Patient Health Questionnaire (PHQ-9). The discriminant validity of the BDI-FS can be classified as satisfactory. Based on a confirmatory factor analysis, the one-dimensionality of the BDI-FS could be confirmed, achieving very good fit indices (total sample: RMSEA=.058, CFI=.990, TLI=.986). An additional invariance analysis regarding gender, different age groups and their interaction resulted in strict invariance for the different multi-group analyses. LIMITATIONS Studies regarding stability have yet to be undertaken. A standard diagnostic interview for depression was not included. CONCLUSION The results support the reliability and validity of the BDI-FS for use with the general German population. Although in the present studies the BDI-FS was superior to the PHQ-9 in terms of its ability to discriminate between depressive and somatic symptoms, in future investigations the diagnostic efficiency of the BDI-FS should be compared with this and other depression inventories (e.g., PHQ-2, PHQ-8, and CES-D).