Is the end in the beginning? Child maltreatment increases the risk of non-suicidal self-injury and suicide attempts through impaired personality functioning

BACKGROUND

Child maltreatment is a risk factor for a range of mental disorders later in life, including dangerous self-harm and suicide attempts. A better understanding of the mechanisms underlying this association can inform prevention and intervention.

OBJECTIVE

To investigate personality functioning as a potential mediator of the association of childhood abuse and neglect and self-harm and suicide attempts in the general population.

PARTICIPANTS AND SETTING

Data were drawn from a representative German population sample (N = 2510).

METHODS

Participants filled out the Childhood Trauma Questionnaire (CTQ), OPD Structure Questionnaire (OPD-SQS), and items of the Self-Injurious Thoughts and Behaviors Interview (SITBI). In structural equation models, we operationalized impaired personality functioning as the mediator between childhood abuse and neglect and self-harm.

RESULTS

Individuals with a history of self-harm (combining suicide attempts, N = 47, and non-suicidal self-injury, N = 83) reported more childhood abuse and neglect (d = 1.39, p < .001) and greater impairments in personality functioning (d = 1.64, p < .001) than the rest of the population. The indirect effect via personality functioning accounted for 48.8 % of the total effect of childhood abuse and neglect on self-harm. In more differentiated analyses, emotional abuse showed the strongest association with self-harm. Only physical and sexual abuse had direct effects.

CONCLUSIONS

The results specify the relationship between child maltreatment and self-harm by demonstrating that it is partly mediated by basic functions of personality assessed using a dimensional measure. These abilities constitute modifiable risk factors that can be addressed by psychotherapy.

Zur Messqualität des Beck-Depressionsinventars (BDI-II) in unterschiedlichen klinischen Stichproben

Zusammenfassung. Theoretischer Hintergrund: Das BDI-II ist ein Selbstbeurteilungsinstrument zur Erfassung des Schweregrads einer Depression. Es liegen kaum Analysen mit Modellen aus der Item-Response-Theorie (IRT) vor. Fragestellung: Wie hoch ist die Messgenauigkeit des BDI-II über die unterschiedlichen Ausprägungen des latenten Traits (Depressivität) hinweg und sind die Kategorien der Items jeweils aufsteigend geordnet? Methode: Anhand von sechs großen Datensätzen aus verschiedenen klinischen Bereichen wurden psychometrische Analysen mit dem Graded Response Model durchgeführt. Ergebnisse: In allen Stichproben fand sich eine hohe interne Konsistenz. Die Schwellenwerte waren mit Ausnahme von Item 6 („Bestrafungsgefühle“) geordnet. Gemäß Testinformationsfunktion misst das BDI-II im mittleren bis hohen Depressionsbereich sehr gut (Reliabilität > .90) und im unteren Bereich gut. Schlussfolgerung: Für das BDI-II ergibt sich eine hohe und relativ gleichbleibende Messpräzision über einen weiten Bereich des latenten Traits, weshalb es insbesondere im klinischen, aber auch im nicht klinisch relevanten Wertebereich zur Erhebung des Schweregrades einer Depression gut geeignet ist.

Adverse childhood experiences growing up in East or West Germany or abroad

Background

Adverse childhood experiences (ACEs) are potentially traumatic events that occur before the age of 18. The term encompasses various adverse childhood experiences, e.g., physical, psychological, and sexual abuse, physical and psychological neglect, and family dysfunction. Prevalence estimates for a broad spectrum of ACEs against the background of where childhood and adolescence were spent are scarcely available in Germany. This study examines the frequencies of adverse childhood experiences, considering growing up in East or West Germany or abroad and interacting with different age cohorts and gender.

Methods

A total of 5,018 individuals (51.4% female) aged 14 years and older were retrospectively assessed on adverse childhood experiences using questionnaires "adverse childhood experiences" (ACE). Logistic regression models were used to analyze the association between birth cohort, gender, and where a person grew up. Descriptive statistics and univariate analyses were used to calculate frequencies, proportions, and unadjusted associations for each variable.

Results

37.4% (N = 1,878) of respondents reported experiencing at least one form of ACE. Individuals who grew up abroad report significantly more adverse childhood experiences than individuals in East or West Germany. Men and women who grew up in East Germany reported a lower rate of ACEs. We found significant effects for all predictors: Where childhood and adolescence were predominantly spent, year of birth, and gender. Significant differences in the prevalence of adverse childhood experiences within the gender groups were only found for sexual and physical abuse and substance dependence in the household.

Conclusion

The results suggest that the socio-political context plays an essential role in the experience of adverse childhood experiences, both in frequency and risk. Thus, child abuse and neglect studies should increasingly focus on societal risk and protection mechanisms.

Validation and standardization of the Childhood Trauma Screener (CTS) in the general population

BACKGROUND

A valid, quick and widely applicable retrospective screening tool for child maltreatment is of great importance to better adapt interventions and treatments. The Childhood Trauma Screener (CTS), derived from the Childhood Trauma Questionnaire (CTQ), is one such instrument that aims to increase the likelihood of detecting mental and physical disorders that have manifested in adulthood as a result of traumatic experiences and maltreatment in childhood and adolescence. The present study aimed to investigate the psychometric properties of the CTS and generate normative data.

METHODS

Data from two representative surveys were combined. Both surveys used identical methods. The CTS, consisting of five items, other self-report instruments, and demographic characteristics were used. Construct validity was examined using confirmatory factor analysis (CFA). A subsample was used to examine convergent validity with the Adverse Childhood Experiences Questionnaire (ACE). Normative data are reported for age groups and gender.

RESULTS

A total of 5039 study participants provided valid responses to the 5-items questionnaire (54.3% female, response rate = 78.9%). CFA showed good fit indices for a 2-factor solution. Convergent validity was generally supported by moderate intercorrelations with the ACE.

CONCLUSIONS

The results confirm the solid psychometric properties of the CTS as an easy-to-use, ultra-short retrospective measure of child maltreatment. The data can be used to compare sample or individual results with reference data provided.

Adverse childhood experiences are associated with a higher risk for increased depressive symptoms during Covid-19 pandemic - a cross-sectional study in Germany

BACKGROUND

Covid-19 pandemic has been profoundly affecting people around the world. While contact restrictions, school closures and economic shutdown were effective to reduce infection rates, these measures go along with high stress for many individuals. Persons who have experienced adverse childhood experiences (ACEs) have an increased risk for mental health problems already under normal conditions. As ACEs can be associated with a higher vulnerability to stress we aimed to assess the role of ACEs on depressive symptoms during the Covid-19 pandemic.

METHODS

In a cross-sectional online survey, 1399 participants above the age of 18 years were included during the first lockdown in Germany. Via two-way repeated measures ANOVA, differences in depressive symptoms before (retrospectively assessed) and during the pandemic were analyzed. Linear regression analyses were performed in order to identify predictors for increase of depressive symptoms.

RESULTS

Compared to prior to the Covid-19 pandemic, depressive symptoms increased among all participants. Participants with ACEs and income loss reported about a stronger increase of depressive symptoms. Other predictors for increased depressive symptoms were young age and a lack of social support.

CONCLUSIONS

Based on these results, ACEs are a significant predictor for an increase in depressive symptoms during the pandemic, indicating that personss with ACEs may be a risk group for mental health problems during the current and potential later pandemics. These findings underline the relevance of support for persons who have experienced ACEs and may help to provide more targeted support in possible scenarios due to the current or possible other pandemics. Besides, economic stability seems to be of prior importance for mental health.

Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood

Background

Adverse childhood experiences (ACEs) are associated with posttraumatic and complex posttraumatic stress disorder symptoms in adulthood (PTSD/cPTSD), as well as reduced epistemic trust (trust in the authenticity and personal relevance of interpersonally transmitted information) and impaired personality functioning. The present work aims to investigate the predictive value of epistemic trust-the capacity for social learning-on the mediating effect of personality functioning in the association of ACEs and PTSD/cPTSD.

Methods

We conducted structural equation modeling (SEM) based on representative data of the German population (N = 2,004). Personality functioning (OPD-SQS) was applied as a mediator between ACEs and PTSD/cPTSD (ITQ), while epistemic trust (ETMCQ) was added as predictor for OPD-SQS. TLI, CFI, and RMSEA (95%-CI) determined the models' fit.

Results

N = 477 (23.8%) participants reported at least one ACE and n = 218 (10.9%) reported ≥4 ACEs. Fit indices were good for both PTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.041-0.078) and cPTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.043-0.081). ACEs were significantly associated with cPTSD (β = 0.44, p < 0.001) and PTSD (β = 0.29, p < 0.001), explaining 20 and 8% of its variance. Adding personality functioning as a mediator increased the explained variance of cPTSD and PTSD to 47 and 19% while the direct association between ACEs and cPTSD/PTSD decreased (β = 0.21/β = 0.17), thus, indicating a partial mediation. Including epistemic trust substantially increased the explained variance for personality functioning (41%) compared to ACEs as a single predictor (16%).

Conclusion

We add to previous research emphasizing the association between ACEs and PTSD/cPTSD symptoms. Offering insights on underlying mechanisms, we show that epistemic trust and personality functioning are relevant mediators. Since both are modifiable by psychotherapy, knowledge about the role of these constructs can inform research on psychotherapeutic interventions and prevention.

Changes in authoritarianism before and during the COVID-19 pandemic: Comparisons of latent means across East and West Germany, gender, age, and education

Modern theories of authoritarianism have stressed the importance of threat to the expression of authoritarian attitudes and intolerance. Arguably, authoritarian tendencies may have increased during COVID-19 pandemic, a major threat to life and security. One issue arising when comparing mean scores is that of measurement invariance. Meaningful comparisons are only possible, if latent constructs are similar between groups and/or across time. This prerequisite is rarely ever tested in research on authoritarianism. In this study, we aim to analyze the short scale for authoritarianism KSA-3 by investigating its measurement invariance on two levels (three first-order and one second-order factors) and latent mean changes using two German representative samples (N = 4,905). Specifically, we look at differences before and during the pandemic (2017 vs. 2020). While measurement invariance holds across both levels in all conditions, we find a decrease in latent means in 2020, contrary to expectations and established theories. Moreover, latent means differ with regard to gender, education, and east–west Germany. We conclude that analyses of latent means and measurement invariance instead of mean comparisons with composites should become the standard. Future studies should focus on threat as a moderator between authoritarianism and intolerance, and on possible interactions with context variables.

[Burnout Symptoms Among Child and Adolescent Psychiatric/Psychotherapy Professionals During the 2020/2021 Winter Lockdown of the Covid-19 Pandemic]

Burnout Symptoms Among Child and Adolescent Psychiatric/Psychotherapy Professionals During the 2020/2021 Winter Lockdown of the Covid-19 Pandemic Abstract. Question: Professionals in clinics and Departments of Child and Adolescent Psychiatry/Psychotherapy are often confronted with stress during their daily work. Such psychological pressure can cause stress symptoms such as burnout. This article examines the consequences of burnout symptoms at the institutional level, such as staff turnover. Method: We examined the connection between burnout symptoms and the institutional consequences of presenteeism, absenteeism, turnover tendency, and reduced quality of job performance during the winter lockdown (2020/2021) of the Covid-19-pandemic at psychiatric hospitals or departments for children and adolescents in Germany using a sample of N = 172 professionals. Results: The results show that signs of burnout symptoms impact the turnover tendency, presenteeism, and job performance of professionals. In addition, evidence emerged that professionals were more stressed during the winter lockdown (2020/2021) of the Covid-19 pandemic, and that this influenced turnover tendency, presenteeism, and absenteeism as well as the quality of job performance. Conclusion: Work-related stress of professionals should be addressed early to protect clinics and departments for child and adolescent psychiatry/psychotherapy from potential consequences, and to ensure care connectivity and quality of care.

Statement of the DGGG - Recommendations on the Care and Support of Female Minors Suspected of Having Been Subjected to Acute Sexual Violence or Rape

Ziele Die vorgelegten Empfehlungen sollen zur weiteren Verbesserung und Standardisierung der ärztlichen Versorgung von Betroffenen sexualisierter Gewalt, insbes. von einer Vergewaltigung betroffenen weiblichen Minderjährigen in Deutschland beitragen. Sie wendet sich vor allem an Frauenärztinnen und Frauenärzte in der Klinik und in der Niederlassung und ergänzt die umfangreiche Kinderschutzleitlinie der Bundesrepublik Deutschland.

Methoden Unter Einbeziehung der Ergebnisse einer umfassenden selektiven Literaturrecherche wurden von einer interdisziplinär besetzten Gruppe von Expertinnen und Experten in einem 3-stufigen Verfahren im Auftrag des Vorstands der DGGG diese Empfehlungen erarbeitet und im Konsens verabschiedet.

Zusammenfassung Diese DGGG-Stellungnahme ist entsprechend dem Alter der Betroffenen (ca. 14 bis 17 Jahre/pubertär; 0 bis ca. 13 Jahre/präpubertär) zweigeteilt. Dies hat medizinische, strukturelle und forensische Gründe. Es werden zahlreiche Empfehlungen zum Umgang mit den mutmaßlich von akuter sexualisierter Gewalt bzw. einer Vergewaltigung betroffenen Minderjährigen, zur Erstversorgung, zu Versorgungsformen (z. B. Vertrauliche Spurensicherung), zur Anamneseerhebung, zur medizinisch-forensischen Untersuchung, zur medizinischen, psychischen und psychosozialen Versorgung sowie zur Nachbetreuung gegeben.

Mental Disorders Into Adulthood Among Adolescents Placed in Residential Care: A Prospective 10-Year Follow-up Study

Background

Child welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood.

Methods

Seventy adolescents in shared residential care, placed by child welfare (n = 52, mean age = 15 years) or juvenile justice (n = 18, mean age = 17 years) authorities, were followed up into adulthood (child welfare: mean age = 25 years; juvenile justice: mean age = 27 years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed.

Results

In the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples.

Conclusions

Our findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.

Supplementary data for the mediation effect of personality functioning – Gender differences, separate analyses of depression and anxiety symptoms and inferential statistics of the relationship between personality functioning and different types of child maltreatment

This article provides supplementary data for the original research article ‘The Mediation Effect of Personality Functioning Between Different Types of Child Maltreatment and the Development of Depression/Anxiety Symptoms – a German Representative Study’ [1]. The representative data were acquired as part of a broader survey on different aspects of mental health in the German population. This supplementary data article contains the statistical analyses of the relationship between the different subtypes of child maltreatment (CM) and impairments of personality functioning, which were only presented as a diagram in the original article. Additionally, the analyses conducted separately for symptoms of depression and anxiety as well as gender are provided. For the mediation analyses, the variables of depression/anxiety symptoms, personality functioning and CM types were standardized. The data may be useful for discussion, further insights and as a starting point for the development of further studies.

Maternal Sensitivity Modulates Child's Parasympathetic Mode and Buffers Sympathetic Activity in a Free Play Situation

Background

Behavioral and physiological (self-)regulation in early life is crucial for the understanding of childhood development and adjustment. The autonomic nervous system (ANS) is a main player in the regulative system and should therefore be modulated by the quality of interactive behavior of the caregiver. We experimentally investigated the ANS response of 18–36-month-old children in response to the quality of maternal behavior during a mother–child-interacting paradigm.

Method

Eighty mothers and their children came to our laboratory and took part in an experimental paradigm, consisting of three episodes: a resting phase (E1), a structured play phase (E2), and a free play situation (E3) between mothers and their child. Children’s and mother’s heart rate (HR), the sympathetic nervous system (SNS) activity via the pre-ejection period (PEP) and the left ventricular ejection time (LVET), and the parasympathetic nervous system (PNS) activity via the respiratory sinus arrhythmia (RSA) were continuously measured by an electrocardiogram. Maternal sensitivity of interactive behavior was assessed by using the Emotional Availability (EA) Scales.

Results

Children of mothers with insensitive behavior had a significantly lower RSA at baseline, showed a lack of RSA withdrawal during structured and free play, and had shorter LVET across all episodes compared to children of sensitive mothers.

Conclusion

Our findings depict the influence of low-quality maternal interaction on the child’s ANS regulation, in calm and more stressful play situations. The overall higher SNS mode with impaired PNS reactivity may negatively influence child’s ANS homoeostasis, which may result in a long-term impact on mental and physical wellbeing. Further, the maternal sensitivity may function as a buffer for the stress response of their child. These results could serve as a basis for the development of appropriate psychoeducational programs for mothers of low sensitivity in their interaction with the child.

Adverse childhood experiences and grandiose narcissism - Findings from a population-representative sample

BACKGROUND

In the development of narcissism, besides genetic factors, hostile educational conditions, including adverse childhood experiences (ACEs), are discussed as causal factors. ACE may play a causal role in the development of antagonistic behavior due to negative interpersonal experiences. However, studies assessing the role of ACEs in the etiology of narcissism are still inconsistent, particularly regarding grandiose narcissism. This may be due to the complexity of grandiose narcissism, which can be distinguished into agentic (admiration) and antagonistic (rivalry) facets. Understanding the role of early traumatic events in the etiology of grandiose narcissism may be important for psychotherapeutic treatment in both, patients with trauma history and narcissistic patients.

OBJECTIVE

We aimed to specify the role of ACEs in grandiose narcissism by differentiating between admiration and rivalry.

PARTICIPANTS AND SETTING

In a cross-sectional survey conducted from November 2017 to February 2018, a representative sample of the German population above the age of 14 (N = 2531) was selected in a random route approach.

RESULTS

Increased numbers of ACEs were associated with higher mean scores for rivalry in females (B = 0.04, p = 0.02) and males (B = 0.08, p < 0.01), while no significant associations were seen for admiration. Focusing on individual ACEs, in males, all maltreatment experiences were associated with narcissistic rivalry, with the exception of physical neglect, while in women only emotional maltreatment and emotional neglect were significant. Associations with household dysfunction were shown only in men. There were no significant associations between individual ACEs and admiration.

CONCLUSIONS

Our results suggest emotional coldness and negative relationship experiences play a role in the development of, in particular, antagonistic and unfavorable narcissistic traits, such as admiration. Therapy with individuals who have experienced ACEs should take into account possible narcissistic personality traits related to ACEs to facilitate successful treatment. Thus, our findings may help building a therapeutic alliance though a better understanding of the development of current behavioral problems for both patient and psychotherapist.

"An uncomfortable topic": Health professionals' perspectives on child protection capacities, training offers and the potential need for action in Germany

Background

Child maltreatment, due to its high prevalence and often long-lasting (health and/or psycho-social) consequences, is one of the main reasons for global health inequalities. The medical field offers many opportunities to support affected children. This gives physicians and other health professionals the opportunity to provide protective measures and therapies to affected children at an early stage. However, the level of training concerning child protection is often too low among health professionals. This can affect the quality of care as well as providing the appropriate treatment and thus, the long-term (health) burden. The present work aims to survey the state of knowledge and capacities of health professionals regarding child protection in medicine and elicit health professionals' perspectives who absolved a child protection online course on a potential need for action in Germany.

Methods

From June 2016 until February 2021, 3,360 health professionals were interviewed. Using quantitative and qualitative items, the questionnaire assessed demographic and professional background information as well as assessments regarding the awareness of child protection, abilities in child protection among health professionals and training offers in medicine.

Results

The analysis indicates that the topic of child protection in medicine is not as present as the high prevalence of child maltreatment would imply. The majority (94.0%; n = 3.159) of the health professionals stated that they need more knowledge and capacities regarding child protection in medicine. More than half of the health professionals assessed the importance of the issue of child protection as low among health professionals. The reasons cited included child protection as an uncomfortable topic, an unwillingness among managers, and a lack of training on the topic.

Conclusions

There is too little awareness and importance regarding child protection in the medical field in Germany. Hence, it is difficult to ensure adequate care for those affected. Child protection topics should be mandatory in the training curricula of all health professionals, and quality standards for prevention and intervention should be implemented in medical institutions. Furthermore, networking in child protection has to be improved, and medical campaigns should address the topic to sensitize health professionals and society to the issue and to destigmatize the topic.

The association of childhood abuse and neglect with tattoos and piercings in the population: evidence from a representative community survey

BACKGROUND

Tattoos and piercings are becoming increasingly popular in many countries around the world. Individuals seeking such body modifications have reported diverse psychological motives. Besides purely superficial considerations, tattoos and piercings can also have a deep, personal meaning. For example, they can mark and support the emotional processing of significant life events, including formative experiences from early childhood. However, there is a lack of studies that examine the links of tattoos and piercings with experiences of childhood abuse and neglect in large, population-based samples.

METHODS

We investigated the association of reports of childhood abuse and neglect with the acquisition of body modifications (tattoos and piercings) within a representative German community sample. Survey participants (N = 1060; ages 14-44 years) were questioned whether they had tattoos and piercings and filled out the 28-item Childhood Trauma Questionnaire Short Form (CTQ-SF).

RESULTS

Tattoos and piercings were more common among individuals who reported childhood abuse and neglect. The proportion of participants with tattoos and piercings increased as a function of the severity of all assessed types of abuse and neglect (emotional, physical, and sexual abuse; emotional and physical neglect). In logistic regression analyses which included the covariates age, gender, education, and income, the sum of significant kinds of childhood abuse and neglect was positively related to having tattoos and/or piercings (OR = 1.37 [95% CI 1.19-1.58]).

CONCLUSIONS

The results corroborate previous research indicating that body modifications could have special significance for individuals who have survived adversity, in particular interpersonal trauma at the hands of caregivers. These findings could inform screening procedures and low-threshold access to psychotherapeutic care.

Prevalence and 10-Year Stability of Personality Disorders From Adolescence to Young Adulthood in a High-Risk Sample

Background

With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) in early 2022, there will be a radical change in the framework and process for diagnosing personality disorders (PDs), indicating a transition from the categorical to the dimensional model. Despite increasing evidence that PDs are not as stable as previously assumed, the long-term stability of PDs remains under major debate. The aim of the current paper was to investigate the categorical and dimensional mean-level and rank-order stability of PDs from adolescence into young adulthood in a high-risk sample.

Methods

In total, 115 young adults with a history of residential child welfare and juvenile-justice placements in Switzerland were included in the current study. PDs were assessed at baseline and at a 10-year follow-up. On a categorical level, mean-level stability was assessed through the proportion of enduring cases from baseline to follow-up. Rank-order stability was assessed through Cohen's κ and tetrachoric correlation coefficients. On a dimensional level, the magnitude of change between the PD trait scores at baseline and at follow-up was measured by Cohen's d. Rank-order stability was assessed through Spearman's ρ.

Results

The prevalence rate for any PD was 20.0% at baseline and 30.4% at follow-up. The most frequently diagnosed disorders were antisocial, borderline, and obsessive-compulsive PDs, both at baseline and at follow-up. On a categorical level, the mean-level stability of any PD was only moderate, and the mean-level stability of specific PDs was low, except of schizoid PD. Likewise, the rank-order stability of any PD category was moderate, while ranging from low to high for individual PD diagnoses. On a dimensional level, scores increased significantly for most PDs, except for histrionic traits, which decreased significantly from baseline to follow-up. Effect sizes were generally low. The rank-order stability for dimensional scores ranged from low to moderate.

Conclusion

The findings indicate low to moderate stability of Pds and Pd traits from adolescence to adulthood, which supports the growing evidence that categorical diagnoses of Pds are quite unstable. This in turn, emphasizes the use of the upcoming ICD-11 that Acknowledgments Pds to be only "relatively" stable.

The Impact of the COVID-19 Pandemic on Health, Quality of Life and Intrafamilial Relations – A Population-Based Survey in Germany

The occurrence of the novel severe acute respiratory syndrome coronavirus-2 (COVID-19) at the end of 2019 comes along with many challenges. Besides worry for one’s own health and the well-being of the family, all measures applied to limit the spread of the coronavirus affected daily life. School closures, economic shutdown and contact restrictions have led to high levels of stress. The impact on health and families has been widely discussed. However, population-based data are scarce. Here, we have assessed health, quality of life and intrafamilial relations depending on the COVID-19 pandemic. Using a three-step random-route approach, a population-based sample of 2,515 persons (52.6% female, average age of 50.3 years) was recruited during the second COVID-19 wave in Germany in winter 2020/21. While the majority of participants reported no change in their health status and the relationship with their partner and children, more than half of participants reported a decreased quality of life since the beginning of the pandemic. Female gender, age above 60 years, a low household income, not living with a partner and the experience of childhood adversity were associated with a higher risk for a worsening of health, quality of life and intrafamilial relations. These had already been well-established risk factors ahead of the pandemic. In order to avoid further increase of inequality in our society and more devastating impact of the pandemic on health and intrafamilial relations, low-level support and intervention programs are urgently needed.

Different Contexts of Sexual Abuse With a Special Focus on the Context of Christian Institutions: Results From the General Population in Germany

Recent revelations of the extent of sexual abuse in the Roman Catholic Church in Germany and the United States have once more triggered the debate about sexual abuse. Those inquiries identify cases that are known to authorities or have been recorded in these institutions. However, to assess the full magnitude of the problem, data beyond recorded or known cases are needed, as it can be assumed that a vast number of cases are not reported and are hence not included in such file reviews. Therefore, representative surveys are needed. The aim of the present study was to examine the prevalence of sexual abuse by priests and in different contexts in the German population based on a representative sample. A total of 2,510 participants (54.3% female, M = 48 years) were retrospectively asked about different experiences, offenders, contexts, and so on, of child sexual abuse using questions that were used to assess child sexual abuse in prior surveys and the Childhood Trauma Questionnaire (CTQ). In sum, 0.21% (n = 7) of the participants reported child sexual abuse by a priest or pastor. 0.16% reported child sexual abuse in an institution of the Roman Catholic Church. Results also indicated that victims of sexual abuse by priests and pastors reported rather severe types of sexual abuse based on the CTQ in comparison with other contexts, such as schools. Extrapolating the data for the population, it can be assumed that the estimated number of victims is much higher than those identified by research based on recorded cases.

The mediation effect of personality functioning between different types of child maltreatment and the development of depression/anxiety symptoms - A German representative study

BACKGROUND

Child maltreatment (CM) is associated with an increased risk to develop symptoms of depression/anxiety across an individual's lifespan. Recent studies indicated that impairments in personality functioning might mediate this association. The purpose of this study is to add evidence of this mediating effect by regarding different types of CM (emotional, physical and sexual abuse as well as emotional and physical neglect) in the general population.

METHODS

A representative sample of the German population (N = 2,354) completed a set of standardized measures (OPD-SQS: Operationalized Psychodynamic Diagnosis - Structure Questionnaire Short, PHQ-4: Patient Health Questionnaire, CTQ: Childhood Trauma Questionnaire). Mediation analyses were carried out to examine the association between CM types, symptoms of depression/anxiety, and personality functioning.

RESULTS

Up to two-thirds of the associations between CM types and symptoms of depression/anxiety are mediated by personality functioning [indirect effect: emotional abuse (β = 0.219, 95%-CI: 0.187-0.251, p < .001), physical abuse (β = 0.151, 95%-CI: 0.123-0.178, p < .001), sexual abuse (β = 0.163, 95%-CI: 0.138-0.188, p < .001), emotional neglect (β = 0.131, 95%-CI: 0.104-0.159, p < .001) and physical neglect (β = 0.102, 95%-CI: 0.078-0.127, p < .001)].

LIMITATIONS

Symptoms of depression/anxiety were measured with screening instruments and results are based on cross-sectional data.

CONCLUSIONS

The present investigation expands the evidence on the mediating effect of personality functioning in the association between CM and depression/anxiety symptoms based on data of the general population. Our results show the relevance of types, as the mediating effects are slightly stronger in CM abuse types than in CM neglect types. Knowledge about impaired personality might be an angle for clinical interventions and inspire future research.

Safety and efficacy of agomelatine in children and adolescents with major depressive disorder receiving psychosocial counselling: a double-blind, randomised, controlled, phase 3 trial in nine countries

BACKGROUND

Major depressive disorder is a severe illness that frequently manifests before the age of 18 years, often recurring later in life. Paediatric medical treatment options are scarce. The melatonin receptor agonist and 5-hydroxytryptamine_2C receptor antagonist agomelatine is used to treat adults, and could offer a new therapeutic option for paediatric patients. Therefore, we aimed to investigate the short-term antidepressant efficacy and safety of agomelatine in children and adolescents with major depressive disorder.

METHODS

We performed a 12 week, randomised, double-blind, parallel-group, multicentre, phase 3 trial in 46 specialist psychiatric units or centres in Bulgaria, Finland, Hungary, Poland, Romania, Russia, Serbia, South Africa, and Ukraine. Participants (aged 7-17 years) were eligible if they were unresponsive to psychosocial therapy during the 3-week run-in period (Children's Depression Rating Scale-revised [CDRS-R] score of ≥45). Ethnicity was not recorded. We investigated short-term antidepressant efficacy of agomelatine (10 mg or 25 mg per day) versus placebo with an active control (fluoxetine 10-20 mg depending on symptom severity) after 12 weeks of treatment in children (aged 7-11 years) and adolescents (12-17 years) with major depressive disorder. Patients were randomly assigned (1:1:1:1) to agomelatine 10 mg, agomelatine 25 mg, placebo, or fluoxetine via an interactive response system with permuted-block randomisation. Standardised manualised psychosocial counselling, developed for this trial, was initiated from selection and continued throughout the study, including the open-label extension. All people involved in the conduct of the clinical trial and patients were masked to treatment allocation. Study outcomes were measured using standardised interviews at each study visit. The primary endpoint was change in CDRS-R raw score from baseline to week 12. This study is registered with EudraCT, 2015-002181-23.

FINDINGS

Between Feb 23, 2016, and Jan 14, 2020, 466 individuals were assessed for eligibility and of 400 included patients, 396 (247 [62%] girls, 149 [38%] boys; mean age 13·7 years [SD 2·7]) were analysed (full analysis set). The primary objective was met; 25 mg/day agomelatine (n=94, with n=102 receiving 10 mg/day) resulted in an improvement versus placebo (n=101) in CDRS-R raw score of 4·22 (95% CI 0·63-7·82; p=0·040) at 12 weeks, with a similar effect for fluoxetine (n=99), establishing assay sensitivity. The overall effect was confirmed in adolescents (n=317), but not in children (n=79). No unexpected safety signals were observed with agomelatine, with no significant weight gain or effect on suicidal behaviours.

INTERPRETATION

This first study in a paediatric population supports the efficacy of 25 mg/day agomelatine, in addition to psychosocial counselling, in treating adolescent patients with major depressive disorder, with no unexpected safety signals. This medication could provide another option in the limited psychopharmaceutical repertoire for management of major depressive disorder.

FUNDING

Servier. VIDEO ABSTRACT.

The Predictors of Awareness of Sexual Abuse and Sexual Violence in the Media and the Influence on Actions of the Individuals

Introduction: The number of reportings on sexual abuse (SA), sexual violence (SV) cases covered in the media has risen a significant amount with most cases involving women and children. The aim of the study is to explore the questions: Are people aware of sexual abuse and sexual violence in the media? What are the predictors of awareness of sexual abuse and sexual violence? Does the awareness of sexual abuse and sexual violence in the media affect the actions of the individuals? Methods: A representative survey of the German-speaking resident population (2020) on physical and mental well-being was used. The participants (N = 2,503: females = 50.9%) were between the ages of 14 and 97 (M = 49.81). The German version of the Adverse Childhood Experiences Questionnaire, The General Habitual Well-Being Questionnaire and questions about own experiences of sexual harassment on the internet, experiences of domestic sexual abuse and different socio-economic variables were used. The outcome variables regarding the awareness of SA and SV in the media, different types of scandals (church, pedophile, USA), #MeToo-debate and the change in actions were used. Frequency analyses and binary regressions were conducted. Results: One thousand five hundred and fifty-five (62.6%) respondents answered yes to being aware of SA and SV in the media. The results show that females, aging, number of children in household, Protestant and Catholic religion, school graduation, own experience(s) of sexual harassment on the internet, own experience(s) of SA in childhood, and Adverse Childhood Experiences have a significant higher association to the awareness of SA and SV in the media. German nationality and Muslim religion have a significant lower association. The variables that most commonly affected the awareness of SA and SV, scandals, debate and the individual actions were age, own experiences of sexual harassment on the internet and the Protestant religion. Conclusion: Advertising more support centers, hotlines and linking this information to sexual abuse cases covered in the media should be considered. Media bystander interventions could be helpful to train people to react appropriately. Further investigation that considers the different types of media and its influence on the awareness of SA and SV is needed.