Uwe Ruhl

Drug Use Patterns in Young German Women and Association with Mental Disorders

BACKGROUND: There is a lack of data about drug use patterns in young women. Mental disorders may influence those drug use patterns. OBJECTIVE: To evaluate drug use patterns (prescribed drugs, self-medication) in general and in relation to the prevalence rates of mental disorders in young German women. METHODS: A total of 2064 women (18–24 y old), obtained in a random clustered sample, were asked about their actual and former medication use. Moreover, a structured psychological interview (Diagnostic Interview for Mental Disorders) was conducted with each woman to evaluate the prevalence of mental disorders (according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition). RESULTS: Oral contraceptives (55.9%), thyroid preparations (7.1%), respiratory system drugs (9.4%), and nervous system drugs (8%) were the most commonly used medications. Only 10% of the women with one or more mental disorders used psychotropic medication. As expected, women with mental disorders were significantly more likely to use antidepressants and psycholeptic agents (ie, sedatives/hypnotics, antipsychotics) than were women without any mental disorder. However, there were no significant differences in use of pain medication. CONCLUSIONS: The results of this study indicate an apparently inadequate supply of drugs acting on the nervous system for women with mental disorders in Germany. Further studies on different age and gender groups are needed. It is important to evaluate the prevalence of diseases and drug use at the same time so as to identify deficits in drug therapy and optimize prescription and self-medication use.

Health Beliefs and Over-the-Counter Product Use

Background Pharmacists are often consulted as medical advisors. Given this case, customers and pharmacists should interact in a trustful way (eg, in terms of responding to customers needs or recommending a different drug). Consideration of the health beliefs of the customer could improve the interaction between pharmacists and their clients and have a positive impact on medical adherence. Objective To examine the health beliefs of pharmacy customers in Germany, the impact of those beliefs on over-the-counter (OTC) medication use, and associations with sociodemographic variables. Methods By means of literature review and methodical surveys, a standardized questionnaire was designed that contained 68 items concerning health beliefs, habits of OTC product use, decision criteria that customers used when purchasing drugs, and information about the sociodemographic background of the participants. Main outcome measures were reliability (Cronbachs α) and correlations. A random sample of 58 pharmacies in Saxony, Germany (10 questionnaires per pharmacy), invited their customers to take part in our study. Results One hundred twenty-three questionnaires (response rate 53.48%) were completed and returned to us. The outcome suggests that there is a strong association between health beliefs and frequency of use or the type of OTC drug (eg, illness attributions: p < 0.05; preventive lifestyle: p < 0.05). There were no significant associations between sociodemographic variables and chosen drugs. Conclusions Health beliefs, in terms of the general attitude toward health and illness, illness attribution, prevention, and the attitude toward treatment strategies, influence the kind of remedy (conventional vs complementary medication) that consumers seek. These results may have implications for consultations in pharmacies or for product marketing.

Recognition and therapy of eating disorders in young women in primary care

ObjectiveTo evaluate the prevalence of eating disorders (ED) in a general population sample of young German women, compare those to primary care diagnoses, and investigate their medical treatments.MethodsIn a prospective epidemiological study, a representative sample of young women (n=1555, between 18 and 25 years of age) was questioned twice during a structured psychological interview (F-DIPS) for mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). At the same time, personal health insurance data were recorded and primary care physicians’ diagnoses and payments for services rendered were analyzed.ResultsThe lifetime prevalence of eating disorders was 3.3% (2.3% anorexia nervosa, 1.1% bulimia nervosa). The primary care physicians diagnosed eating disorders in only about 20% of the women concerned. Eating disorders were often overlooked, although physicians detected physical and mental complaints (e.g., menstrual cycle disorders, abnormal weight loss, flatulence, depression, anxiety disorders), which are closely related to eating disorders. If the primary care physicians had diagnosed eating disorders, they mostly recommended psychotherapeutic treatment as the only measure, or in combination with pharmacological therapy.ConclusionThe study indicates that primary care physicians need better training, particularly in diagnostic procedures for eating disorders. Screening methods and systematic assessment might be helpful in improving the detection of eating disorders in primary care

An Adaptation of the Questionnaire for Social Anxiety and Social Competence Deficits (SASKO) for Adolescents and its Evaluation in a German Student Sample

In the diagnostics of social phobia in adults the SASKO self-report questionnaire serves as an instrument that measures social anxiety and social deficits as two separate dimensions. This paper describes the development of an adaptation of the SASKO for adolescents (SASKO-J) and verifies its applicability, factor structure, and psychometric properties. The factor structure and reliability of the SASKO-J were evaluated in an unselected sample of 228 German students from grades 7 to 11 (M = 14.77 years, SD = 1.33; 50% girls). In a second sample of 115 students the validity was examined (M = 15.84, SD = 1.65; 61% girls). Confirmatory factor analysis confirmed the five-factor structure of the SASKO (two anxiety and two deficit related factors and an additional factor “loneliness”). With the exception of the subscale “information-processing deficits”, the internal consistencies were satisfactory to good (0.77≤α≤0.88). The results regarding convergent and divergent validity were also good. Students from different types of school differed in their levels of social anxiety, girls reported significantly more fear of rejection than boys, and the youngest students had the highest level of symptoms. Future research should address the optimizing of the subscale “information-processing deficits” and should examine the psychometric properties of the SASKO-J in a clinical sample.

Utilizing the new media to provide mental health services to young people

This paper reports on a project on a mental health service offered on the Web for young people, who have drug problems, especially with ecstasy. The service is offered by the Medical University of Luebeck and was developed in interdisciplinary co-operation between medicine, computer science and design. The focus of the project was on meeting user-specific needs: providing information and help for young people and for their peer-groups. A pre-condition for success is to design the medium according to the user needs, which means an adequate use of the medium. We provide some usage data, which reveal a need for that kind of Web service. Compared with other psychotherapeutic counseling-services which are common in the USA for several years and which increase in Europe as well, there are some main differences. The e-mail and counseling service is for free, although it is provided by a professional psychotherapist, who is an expert in the subject area of ecstasy addiction and works also with young drug addicts in drug clinics. The work is based on strict confidentiality as it is given in consultations outside the Web. Furthermore, the project will apply technology enabling anonymous Web use.

Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial

Background: Although social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia Psychotherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and psychodynamic therapy (PDT) compared to a waiting list (WL) in these patients. Methods: In a multicenter randomized controlled superiority trial, 107 patients, aged 14–20 years, were randomized to CBT (n = 34), PDT (n = 34), or WL (n = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. Results: Both treatments were superior to WL in the LSAS-CA (CBT: p = 0.0112, d = 0.61, 95% CI 0.14–1.08; PDT: p = 0.0261, d = 0.53, 95% CI 0.06–1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: p = 0.0009, h = 1.0; PDT: p = 0.0135, h = 0.74), response (CBT: p = 0.0004, h = 0.97; PDT: p = 0.0056, h = 0.72), and the SPAI (CBT: p = 0.0021, d = 0.75, 95% CI 0.27–1.22; PDT: p = 0.0060, d = 0.66, 95% CI 0.19–1.13). Treatment effects were stable at 6- and 12-month follow-ups. Conclusions: These results are comparable to the large SOPHO-NET trial in adults (n = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.

Epidemiological puzzle pieces

The papers on risk factors and behavioral aspects of psychosomatic illness in this issue demonstrate the importance of predictors and consequences of mental disorders. At first sight, statistical analyses and psychosomatic medicine seem to be very different areas of expertise with small intersections. However, the overlap of contents and goals is quite significant. Epidemiological research tries to establish a cause-and-effect relationship between agents or risk factors and diseases. Psychosomatic medicine tries to identify stressors and their role in the etiology, persistence, and consequences of mental health problems. The cross-sectional study by Mageroy et al., conducted in the Royal Norwegian Navy, shows associations between bullying at work and psychosocial environmental factors (e.g., fair leadership, innovative climate, inequality scales) [1]. Inoue et al. investigated other job stressors and their possible effects on DNA damage. The authors hypothesized that oxidative DNA damage (i.e., a risk factor for coronary heart disease) may play a mediating role in linking job stressors and coronary heart disease. They analyzed associations between three job stress models and urinary concentrations of 8-hydroxy-2′-deoxyguanosine, a biomarker of DNA damage, among workers of a manufacturing factory in Japan [2]. Whether being obese or showing not favorable waist–hip ratios are risk factors of mental disorders (or vice versa) cannot be clearly derived from clinical studies or epidemiological samples. The inconsistency of data is the main reason for this (e.g., cross-sectional design vs. longitudinal, multicausal etiology of mental disorders). Thus, different studies with different study designs and maybe contradictory results have to be collected and puzzled together at a later date. Obesity, mood disorders, and some physical diseases supposedly share the same or a similar pathophysiological pathway. A dysregulation of the hypothalamic–pituitary– adrenocortical axis is discussed as a common key mechanism in, among others, depression, stress, elevated waist circumferences, and obesity. Now, two more pieces can be added to the epidemiological obesity-mental-disorder puzzle. Sareen et al. [3] found that obesity was independent from physical complaints associated with psychological disorders, whereas Rivenes et al. showed an association only between waist–hip ratio and