Dual factor model of mental health: Co-occurrence of positive mental health and suicide ideation in inpatients and outpatients

Positive and negative mental health are independent but correlated concepts. Yet, it is unknown whether positive mental health does co-occur with suicide ideation. The present study aimed to determine the proportion of patients who have positive mental health as well as suicide ideation. Inpatients (N=100) and outpatients (N=182) completed self-report measures of positive mental health, suicide ideation and lifetime suicide attempts. Eleven outpatients (6%) and ten inpatients (10%) with suicide ideation reported moderate to high levels of positive mental health. Lifetime suicide attempts were less likely in inpatients who suffered from suicide ideation in the presence of positive mental health. Positive mental health does co-occur with suicide ideation and should be considered as a protective factor in suicide risk assessments.

Partner-related attachment as a moderator of outcome in patients with social anxiety disorder-a comparison between short-term cognitive-behavioral and psychodynamic therapy

This study investigated whether partner-related attachment characteristics differentially predict premature treatment termination as well as posttreatment and 1-year follow-up outcome in patients with social anxiety disorder treated with a manualized cognitive-behavioral therapy (CBT) or short-term psychodynamic therapy (PDT) in the SOPHO-NET (Social Phobia Psychotherapy Network) trial. Participants were 412 patients with social anxiety disorder (57% female) with a mean age of 35.4 years (SD = 12.1) who were randomized to either CBT or PDT. Partner-related attachment characteristics were measured using the revised Experiences in Close Relationships Questionnaire (ECR-R) at pretreatment. The Liebowitz Social Anxiety Scale was administered at pretreatment, posttreatment, and a 1-year follow-up. To address our research questions, linear regression models were applied. Furthermore, we compared CBT versus PDT patients within ECR-R quartiles. Treatment dropout did not differ between CBT and PDT and was not predicted by pretreatment attachment. In both treatment conditions, there was a trend for higher attachment anxiety to be associated with a more limited reduction in symptoms if controlling for pretreatment Liebowitz Social Anxiety Scale scores. Exploratory analyses showed that patients assigned to the highest quartile of the ECR-R-Avoidance distribution showed more benefit within the CBT condition posttreatment and at follow-up than the PDT condition. Our findings suggest that it may be useful to assess attachment characteristics in patients with social anxiety disorder before psychotherapeutic treatment. Patients characterized by very high pretreatment attachment avoidance (ECR-R-Avoidance >3.87) may specifically benefit more from CBT than from PDT. However, replication studies are needed that also should investigate nonlinear effects of pretreatment attachment. (PsycINFO Database Record

Brief reasons for living inventory: a psychometric investigation

BACKGROUND

The present study aimed at validating the German version of the Brief Reasons for Living inventory (BRFL).

METHODS

Validity and reliability were established in a community (n = 339) and a clinical sample (n = 272). Convergent and discriminant validity were investigated, and confirmatory factor analyses were conducted for the complete BRFL as well as for a 10-item version excluding conditional items on child-related concerns. Furthermore, it was assessed how BRFL scores moderate the association between depression and suicide ideation.

RESULTS

Results indicated an adequate fit of the data to the original factor structure. The total scale and the subscales of the German version of the BRFL had sufficient internal consistency, as well as good convergent and divergent validity. The BRFL demonstrated clinical utility by differentiating between participants with vs. without suicide ideation. Reasons for living proved to moderate the association between depression and suicide ideation.

CONCLUSIONS

Results provide preliminary evidence that the BRFL may be a reliable and valid measure of adaptive reasons for living that can be used in clinic and research settings.

Religious beliefs buffer the impact of depression on suicide ideation

Depression and suicide ideation co-occur regularly. The present study investigated whether religious beliefs, i.e. trust in higher guidance, buffers the association between depression and suicide ideation. A total of 427 participants (n = 93 inpatients, n = 334 online sample) completed measures of suicide ideation, trust in higher guidance, and depression. Trust in higher guidance moderated the impact of depression on suicide ideation. Trust in higher guidance seems to confer resilience and should be taken into account when assessing individuals for suicide risk.

Methodenpapier zur Koordination der Datenerhebung und -auswertung an Hochschul- und Ausbildungsambulanzen für Psychotherapie (KODAP)

Zusammenfassung. Die Forschung an psychotherapeutischen Hochschulambulanzen (HSA) leistet einen entscheidenden Beitrag zur Behandlung von Menschen mit psychischen Störungen und zur Weiterentwicklung und wissenschaftlichen Fundierung von Psychotherapie im Kindes-, Jugend- und Erwachsenenalter. Durch das im Jahr 2013 gestartete Projekt zur Koordination der Datenerhebung und -auswertung an Forschungs- und Ausbildungsambulanzen für Psychotherapie (KODAP) sollen unter der Trägerschaft des Verbundes universitärer Ausbildungsgänge für Psychotherapie unith.ev ab 2018 jährlich relevante Daten aus den teilnehmenden HSA aggregiert und gemeinsam ausgewertet werden. Im vorliegenden Beitrag beschreiben wir die mit dem Projekt im Zusammenhang stehenden rechtlichen, methodischen und durchführungstechnischen Herausforderungen sowie den derzeitigen Stand des Kooperationsprojektes, einschließlich einer für das Jahr 2017 geplanten Pilotstudie.

[Fostering Resilience while Waiting for Psychotherapy: Evaluation of a Group Intervention in an Outpatient Care Setting]

Background: High untreated prevalence of mental disorders and long waiting lists for psychotherapy at the same time call for innovative intervention concepts. The positive brief intervention "Personal Model of Resilience" 1 is offered as group training and evaluated for the first time in a naturalistic clinical setting. Method: In a pre-post-design data from 84 wait-list patients are analysed via intention-to-treat (n=84) and completer analysis at 6-week-follow-up (n=54). Results: Repeated measures ANOVAs demonstrate significant improvements in psychopathology, incongruence and self-esteem. Effect sizes range from d=0.30-0.49 at follow-up. Intention-to-treat analyses support these results with significant improvements for all evaluation instruments. Discussion: The "Personal Model of Resilience" is a promising intervention module that may be offered to patients while waiting for psychotherapy.

Long-term cost-effectiveness of cognitive behavioral therapy versus psychodynamic therapy in social anxiety disorder

BACKGROUND

To determine the cost-effectiveness of cognitive behavioral therapy (CBT) versus psychodynamic therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective.

METHODS

This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves.

RESULTS

In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs.

CONCLUSIONS

If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential.

Acquired Capability for Suicide, Pain Tolerance, and Fearlessness of Pain-Validation of the Pain Tolerance Scale of the German Capability for Suicide Questionnaire

The interpersonal theory of suicide (Joiner, 2005) postulates that for a serious suicide attempt, one has to possess the acquired capability to commit suicide. Acquired capability includes higher pain tolerance, which is further assumed to comprise both an elevated physical pain tolerance and fearlessness of pain. Recently, the German Capability for Suicide Questionnaire (GCSQ) was validated. The aim of this study is further validation of the GCSQ's Pain Tolerance scale by investigating the scale's association with objective pain tolerance and fearlessness of pain in two undergraduate samples (N = 81; N = 76). Both associations were found indicating a strong criterion validity of the Pain Tolerance scale.

Short-term cost-effectiveness of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: Results from the SOPHO-NET trial

BACKGROUND

To investigate the short-term cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL).

METHODS

The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial. Patients were randomly assigned to CBT (n=209), PDT (n=207), or WL (n=79). Resource use was assessed prior and during treatment to determine direct and absenteeism costs. Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated based on remission and response rates. To visualize statistical uncertainty, cost-effectiveness acceptability curves (CEACs) were constructed based on adjusted net-benefit regression. Different values for the society׳s willingness to pay (WTP) were assumed.

RESULTS

Both interventions were more efficacious than WL but were associated with increased direct costs besides intervention costs. Unadjusted ICERs per responder were €3615 for CBT and €4958 for PDT. Unadjusted ICERs per remitted patient were €5788 and €10,733. CEACs revealed a high degree of uncertainty: applying the 97.5% probability threshold, CBT proved cost-effective at a WTP ≥€16,100 per responder and ≥€26,605 per remitted patient. Regarding PDT cost-effectiveness only was certain for response at a WTP ≥€27,290.

LIMITATIONS

The WL condition is assumed to represent untreated patients, although the expectation to start treatment in the near future probably affects symptom severity and health care utilization.

CONCLUSIONS

At the end of treatment cost-effectiveness of CBT and PDT compared to WL is uncertain and depends on the societal WTP. The interventions may induce a more adequate utilization of other health care services - involving increased costs. Development of costs and effects in the long-run should be considered.

Koordination der Forschung an Hochschulambulanzen für Psychotherapie

Zusammenfassung. Forschungsaktivitäten an psychotherapeutischen Hochschulambulanzen (HSA) können einen entscheidenden Beitrag zur Weiterentwicklung und wissenschaftlichen Fundierung von Psychotherapie leisten. Um die vielfältigen Daten, die in HSA in Deutschland gesammelt werden, besser nutzbar zu machen, erscheint eine Koordination der Datenerhebungen und Forschung perspektivisch sinnvoll. In diesem Artikel stellen wir die Ergebnisse einer Umfrage zu den Kernmerkmalen deutscher Hochschulambulanzen (z. B. Fallzahlen, diagnostische Instrumente, verwendete Software) vor und entwickeln auf Basis der Ergebnisse Vorschläge zur besseren Integration der Forschungsbemühungen. Es wurden 53 Hochschulambulanzen in Deutschland identifiziert. Diese erhielten einen Fragebogen zu den jährlichen Fallzahlen, der eingesetzten klinisch-psychologischen Diagnostik, zu den störungsübergreifenden und -spezifischen Fragebögen sowie den erhobenen Patienten- und Therapeutenvariablen und der verwendeten Software. Die Rücklaufquote lag bei 100 %. Insgesamt werden demnach in den deutschen HSA im Erwachsenen- und Kinder-Jugendlichenbereich über 10 000 neue Patienten pro Jahr behandelt. Für die strukturierte und störungsübergreifende Diagnostik werden fast ausnahmslos dieselben Verfahren genutzt. Dem steht eine große Vielfalt von störungsspezifischen Verfahren gegenüber. Die verwendete Datenbanksoftware ist heterogen und nicht vollständig miteinander kompatibel. In der Diskussion verdeutlichen wir, welche außergewöhnliche Plattform für weitere Forschung bereits gegeben ist, aber auch welche Schwierigkeiten, zum Beispiel beim Datenschutz, im Vorfeld einer besseren Forschungsintegration zu lösen sind.

The German Version of the Behavioral Activation for Depression Scale (BADS): A Psychometric and Clinical Investigation

The Behavioral Activation for Depression Scale (BADS) was developed to measure core concepts of behavioural activation for depression. A number of studies, mostly based on analogue samples, have provided initial support for the BADS. In the present study, we examined the psychometric properties of the German version of the scale more broadly, including change sensitivity and clinical treatment data. A mixed sample of students (N = 312) and depressed outpatients in partial remission undergoing cognitive-behavioural group treatment for depressive rumination (N = 59) was examined. To analyze construct validity, a set of theoretically relevant constructs such as perseverative thinking, distraction and mindfulness was also assessed. Results indicated good psychometric properties, additional evidence for construct validity of the total scale and subscales, and adequate fit of the data to the original factor structure. Furthermore, the BADS proved to be sensitive to changes in participants undergoing treatment for depression. Copyright © 2015 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Behavioural activation (BA) is an effective treatment for patients suffering from unipolar depression. The Behavioral Activation for Depression Scale (BADS) can be used to measure core elements of the BA treatment rationale. It is useful to track changes in activation within treatment. The BADS is available in different languages and has shown to possess good psychometric properties.

Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial

We examined the role of baseline patient characteristics as predictors of outcome (end-state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio-demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self-esteem, shame, interpersonal problems and attachment style) were analysed.

METHOD

Data came from the CT arm of a multicentre RCT with n = 244 patients having DSM-IV SAD. CT was conducted according to the manual by Clark and Wells. Severity of SAD was assessed at baseline and end of treatment with the Liebowitz Social Anxiety Scale (LSAS). Multiple linear regression analyses and logistic regression analyses were applied.

RESULTS

Up to 37% of the post-treatment variance (LSAS) could be explained by all pre-treatment variables combined. Symptom severity (baseline LSAS) was consistently negatively associated with end-state functioning and remission, but not with response. Number of comorbid diagnoses was negatively associated with end-state functioning and response, but not with remission. Self-esteem was positively associated with higher end-state functioning and more shame with better response. Attrition could not be significantly predicted.

CONCLUSIONS

The results indicate that the initial probability for treatment success mainly depends on severity of disorder and comorbid conditions while other psychological variables are of minor importance, at least on a nomothetic level. This stands in contrast with efforts to arrive at an empirical-based foundation for differential indication and argues to search for more potent moderators of therapeutic change rather on the process level.

KEY PRACTITIONER MESSAGE

Personality, self-esteem, shame, attachment style and interpersonal problems do not or only marginally moderate the effects of interventions in CT of social phobia. Symptom severity and comorbid diagnoses might affect treatment outcome negatively. Beyond these two factors, most patients share a similar likelihood of treatment success when treated according to the manual by Clark and Wells. Copyright © 2014 John Wiley & Sons, Ltd.

Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder

OBJECTIVE

Relatively few studies have examined the long-term outcome of psychotherapy in social anxiety disorder. The authors previously reported findings of a clinical trial comparing cognitive-behavioral therapy (CBT), psychodynamic therapy, and a wait-list control. The purpose of the present study was to follow the participants' status over the ensuing 24 months.

METHOD

Outpatients with social anxiety disorder who were treated with CBT (N=209) or psychodynamic therapy (N=207) in the previous trial were assessed 6, 12, and 24 months after the end of therapy. Primary outcome measures were rates of remission and response.

RESULTS

For both CBT and psychodynamic therapy, response rates were approximately 70% by the 2-year follow-up. Remission rates were nearly 40% for both treatment conditions. Rates of response and remission were stable or tended to increase for both treatments over the 24-month follow-up period, and no significant differences were found between the treatment conditions after 6 months.

CONCLUSIONS

CBT and psychodynamic therapy were efficacious in treating social anxiety disorder, in both the short- and long-term, when patients showed continuous improvement. Although in the short-term, intention-to-treat analyses yielded some statistically significant but small differences in favor of CBT in several outcome measures, no differences in outcome were found in the long-term.

Validation and psychometric properties of the German Capability for Suicide Questionnaire

OBJECTIVE

Our study aimed at the validation of the newly developed German Capability for Suicide Questionnaire, the GCSQ. It is supposed to assess both fearlessness of death and pain tolerance, both facets of the acquired capability to commit suicide as postulated by the interpersonal theory of suicide.

METHODS

This cross-sectional study was conducted on two clinical (n=424) and an online sample (n=532). Factor structure, convergent and discriminant validity, predictive validity as well as test-retest reliability were investigated.

RESULTS

Two factors-"Fearlessness of Death" and "Pain Tolerance"-were derived. One item, the "perceived capability" item, assesses the subject's self-perception of acquired capability. Both subscales and the "perceived capability"-item demonstrate good construct validity and a high test-retest reliability. Fearlessness of death proves to be predictive for the occurrence of suicidal behaviors, whereas the importance of pain tolerance for suicidal behaviors was not confirmed. The subject's perception of his own capability is of high predictive value for both attempt status and suicidal behaviors.

CONCLUSION

The GCSQ seems to be a useful measure of pain tolerance, fearlessness of death and the self-perception of acquired capability of suicide.

Reliability, validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with social phobia

Objective

The aim of the study was to analyse the psychometric properties of the EQ-5D in patients with social phobia.

Methods

We used a sample of 445 patients with social phobia with five measurement points over a 30 month period. The discriminative ability of the EQ-5D was analysed by comparing the patients’ responses with the general population and between different disease severity levels. For test-retest reliability we assessed the level of agreement in patients’ responses over time, when there was no change in the Liebowitz Social Anxiety Scale (LSAS). Construct validity was analysed by identifying correlations of the EQ-5D with more specific instruments. For responsiveness we compared the means of EQ VAS/EQ-5D index anchored on improved (deteriorated) health status and computed effect sizes as well as a receiver operating characteristic (ROC) curve.

Results

Compared to the general population, patients with social phobia reported more problems in the dimensions “usual activities”, “pain/discomfort”, and “anxiety/depression” and less problems in “mobility” and “self-care”. The EQ-5D was able to distinguish between different disease severity levels. The test-retest reliability was moderate (intraclass correlation coefficient > 0.6). Correlations between the EQ-5D and other instruments were mostly small except for correlations with Beck Depression Inventory. The EQ-5D index seemed to be more responsive than the EQ VAS, but with only medium effect sizes (0.5 < effect size < 0.8) in the British EQ-5D index and only significant in patients with improved health status. The ROC analysis revealed no significant results.

Conclusions

The EQ-5D was moderately reliable and responsive in patients with improved health status. Construct validity was limited.

Trial registration

Current controlled trials ISRCTN53517394

Reliability, validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with social phobia

OBJECTIVE

The aim of the study was to analyse the psychometric properties of the EQ-5D in patients with social phobia.

METHODS

We used a sample of 445 patients with social phobia with five measurement points over a 30 month period. The discriminative ability of the EQ-5D was analysed by comparing the patients' responses with the general population and between different disease severity levels. For test-retest reliability we assessed the level of agreement in patients' responses over time, when there was no change in the Liebowitz Social Anxiety Scale (LSAS). Construct validity was analysed by identifying correlations of the EQ-5D with more specific instruments. For responsiveness we compared the means of EQ VAS/EQ-5D index anchored on improved (deteriorated) health status and computed effect sizes as well as a receiver operating characteristic (ROC) curve.

RESULTS

Compared to the general population, patients with social phobia reported more problems in the dimensions "usual activities", "pain/discomfort", and "anxiety/depression" and less problems in "mobility" and "self-care". The EQ-5D was able to distinguish between different disease severity levels. The test-retest reliability was moderate (intraclass correlation coefficient > 0.6). Correlations between the EQ-5D and other instruments were mostly small except for correlations with Beck Depression Inventory. The EQ-5D index seemed to be more responsive than the EQ VAS, but with only medium effect sizes (0.5 < effect size < 0.8) in the British EQ-5D index and only significant in patients with improved health status. The ROC analysis revealed no significant results.

CONCLUSIONS

The EQ-5D was moderately reliable and responsive in patients with improved health status. Construct validity was limited.

TRIAL REGISTRATION

Current controlled trials ISRCTN53517394.

Direkte Veränderungsmessung in der Psychotherapie

Theoretischer Hintergrund: Verfahren zur direkten Veränderungsmessung bestimmen den Psychotherapieerfolg in ökonomischer Ein-Punkt-Messung. Hierzu wurde der Bochumer Veränderungsbogen-2000 (BVB-2000) als überarbeitete und gekürzte Variante des Veränderungsfragebogens des Erlebens und Verhaltens (VEV; Zielke & Kopf-Mehnert, 1978 ) entwickelt. Fragestellung: Der BVB-2000 soll einer testtheoretischen Reanalyse mit Fokus auf die konvergente Validität unterzogen werden. Kritische Veränderungswerte auf Basis der Werte einer klinischen Wartekontrollgruppe sollen die Möglichkeit bieten den Therapieerfolg auch in Einzelfällen zu bestimmen. Methode: Die Psychotherapie von N = 205 Patienten wird mit verschiedenen Instrumenten zur Therapieerfolgsmessung inklusive des BVB-2000 begleitet. Auf Basis einer Wartekontrollgruppe (N = 88) werden kritische Veränderungswerte für den BVB-2000 berechnet. Ergebnisse: Der BVB-2000 weist eine hohe interne Konsistenz auf (α = .96; 26 Items) und zeigt durchgängig statistisch bedeutsame Zusammenhänge mit anderen Therapieerfolgsmaßen vor allem der Zielerreichung. Kritische Veränderungswerte ermöglichen die Einschätzung des Therapieerfolgs im Einzelfall. Schlussfolgerungen: Der BVB-2000 ist ein verständliches, ökonomisches, reliables und valides Instrument zur Psychotherapieerfolgsmessung.