Oliver Decker

Validation and Standardization of the Generalized Anxiety Disorder Screener (gad-7) in the General Population

Background:The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available. Objectives:To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data. Research Design:Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006. Subjects:Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years. Measures:The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics. Results:Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (α = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = −0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater. Conclusions:Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subjects GAD-7 score with those determined from a general population reference group.

Life satisfaction, distress, and resiliency across the life span of women.

Objective: This study aimed to determine (1) the relationship between life satisfaction, mental disorders, and aging in the female community and (2) to identify the impact of vulnerability factors, personal (resilience, self-esteem), and social resources on life satisfaction and distress. Methods: A stratified random sample of the German female population (N = 2,540) was investigated using standardized questionnaires of life satisfaction (Questions on Life Satisfaction), depression, anxiety (Patient Health Questionnaire), resilience scale (RS-11), and self-esteem (Rosenberg Self-Esteem Scale). Results: When participants were divided into six age groups (18-30, 31-40, 41-50, 51-60, 61-70, and >70 y), we found lower life satisfaction, satisfaction with partnership, and sexuality beyond the age of 50 years. Satisfaction with health was decreased already at early adulthood. Although the importance of partnership/sexuality was reduced around midlife, the importance of health increased. Depression was highest in the oldest group, whereas anxiety remained fairly stable across the cohorts. Life satisfaction was strongly associated with resilience, a good household income, the presence of a partnership, absence of anxiety and depression, lack of unemployment, positive self-esteem, religious affiliation, and-least-age. Conclusions: Personal and social resources and the absence of anxiety and depression are of crucial importance for the maintenance of life satisfaction in aging women.

Deep impact - evaluation in the sciences

SummaryThe purpose of the paper is to evaluate the psychometric properties of the impact factor as an assessment procedure. Detailed criteria regarding theoretical underpinnings, test administration, scoring and interpretation are applied. The impact factor appears to be of limited use for deciding which journals to subscribe. It is not suitable for evaluating achievements of individual scientists and research groups. The impact factor contains serious sources of errors and flaws resulting in strong biases against culture- and language-bound medical subspecialties and non-Anglo-American countries. Possible alternatives are discussed.

Between commodification and altruism: gender imbalance and attitudes towards organ donation. A representative survey of the German community

The German transplant law (TGP) of 1997 only recognises organ donation if the donor agrees (‘extended consent’) and if done for altruistic reasons. Several alternatives will be discussed here, including incentives and passive agreement. Based upon a representative survey, the authors examined the attitudes of Germans towards several European models of organ donation and their attitude towards organ donation in general whilst living and after death. The acceptance of possible compensation systems was also explored. In Germany the majority do not favour compensation systems, but rather passive agreement. There is evidence of gender difference with respect to this attitude. Men tend to favour compensation systems, women do not.

eXistenZ und transCendenZ: Kommodifizierung des Körpers

Xenotransplantation, das ist jene Behandlung des terminalen Organversagens, die auf der Nachzucht von Organen in genetisch manipulierten Tieren basiert. Im genetisch veranderten Schwein herangewachsen, soll etwa eine Niere die Artengrenzen uberspringen und, auf den Empfanger ubertragen, die Aufgabe des erkrankten Organs ersetzen. Die Forscher kundigen an, die Xenotransplantation stehe kurz vor dem Durchbruch. Da steht sie allerdings schon seit 20 Jahren. Nur sollte dieser Befund die Skeptiker weniger beruhigen als warnen: Die Dauer des Versprechens zeigt den Bedarf an. Warum sonst sollte diese Forschung auch bezahlt werden? Genauso, wie seit einigen Jahren immer mehr Anstrengungen – und das heist auch: steigende finanzielle Mittel – in die regenerative Medizin fliesen. Hier wachst die Hoffnung in der Petrischale, das „Tissue Engineering“ verspricht nachgewachsene Organe aus dem Bioreaktor – dank manipulierter Zellen sollen in einer Nahrlosung auch HLA-identische Herzen gedeihen.

Mal d’Archive? Die elektronische Patientenakte

Ausgehend von Uberlegungen zur elektronischen Gesundheitskarte (Decker 2005) wird die Wirkung der elektronischen Patientenakte auf die arztliche Tatigkeit untersucht. Ein Panoptismus Benthamscher Pragung setzt an der Uberwachung an, die immer oder nie stattfinden kann und dennoch die Uberwachten sublim in ihre Kontrolle einbindet (Decker/Grave 2009). Foucault griff das Panoptikum als Metapher fur das Regieren im Liberalismus auf. Fur die Insassen des Panoptikums ist nicht einsehbar, wann und von wem sie beobachtet werden und so ergeht es den Patienten – und dem Arzt. Ihnen ist nicht zuganglich, wann ihre elektronische Patientenakte von wem ausgewertet wird. Die Gesundheitstelematik braucht einen Zulieferer der Informationen, die dann auch der Beobachtung seiner Tatigkeit zuganglich sind: den Arzt. Der Arzt dokumentiert seine Behandlung; diese Archivierung ist eng mit der Professionalisierung der arztlichen Tatigkeit verbunden und war auch immer schon Kontrolle der Abweichung, der Krankheit – nun verandert sich aber die Position des Arztes im Medizinalsystem.