Validität und Reliabilität der SCL-90-R: Ergebnisse der Bremer Jugendstudie

Zusammenfassung: Die Symptomcheckliste SCL-90-R ( Derogatis, 1977 ; Franke, 1995 ) quantifiziert die aktuelle Belastung durch allgemeine klinisch-psychologische Symptome. Sie findet Anwendung in unterschiedlichen Bereichen von Wissenschaft und Praxis. Im englischen Sprachraum hat sich der Einsatz der SCL-90-R auch bei Jugendlichen bewährt. Für die deutschsprachige Version fehlen bisher Daten zur Reliabilität und Validität für die Verwendung bei Jugendlichen. Im Rahmen dieser Arbeit werden verschiedene Gütekriterien und die Anwendbarkeit der SCL-90-R bei Jugendlichen anhand der Ergebnisse einer Subpopulation der Bremer Jugendstudie (N = 852) überprüft. In Vergleichen mit den Diagnosen des standardisierten diagnostischen Interviews M-CIDI (Münchener Version des Composite International Diagnostic Interview) kann eine hohe generelle Übereinstimmung zwischen erhöhten Werten der Symptomcheckliste und verschiedenen Störungsdiagnosen nach den Kriterien des DSM-IV festgestellt werden. Es zeigt sich weiterhin ein Zusammenhang zwischen der psychosozialen Beeinträchtigung der Jugendlichen sowie der Inanspruchnahme professioneller Hilfe und der mit Hilfe der SCL-90-R ermittelten Symptombelastung. Zusammenfassend zeigen die ermittelten Ergebnisse eine hohe Reliabilität und generelle Validität des Fragebogens und sprechen für die Verwendung der SCL-90-R bei Jugendlichen zur Erfassung einer allgemeinen Symptombelastung.

Frequency of panic attacks and panic disorder in adolescents

By using data from the Bremer Adolescent Study, this report presents findings on the frequency, comorbidity, and psychosocial impairment of panic disorder and panic attacks among 1,035 adolescents. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Panic disorder and other psychiatric disorders were coded based on DSM-IV criteria using the computerized-assisted personal interview of the Munich version of the Composite International Diagnostic Interview. Panic disorder occurred rather rare, with only 0.5% of all the adolescents met the DSM-IV criteria for this disorder sometimes in their live. Panic attack occurred more frequently, with 18% of the adolescents reported having had at least one panic attack. Slightly more girls than boys had panic attack and panic disorder. The occurrence of panic attack and panic disorder were the greatest among the 14-15 year olds. The experience of having a panic attack was associated with a number of problems, the most frequent being avoiding the situation for fear of having another attack. Four most common symptoms associated with a panic attack were that of palpitations, trembling/shaking, nausea or abdominal distress, and chills or hot flushes. Panic disorder comorbid highly with other psychiatric disorder covered in our study, especially with that of major depression. Among those with a panic disorder, about 40% of them were severely impaired during the worst episode of their illness. Only one out of five adolescents with panic disorder sought professional help for emotional and psychiatric problems. The implication of our findings for research and clinical practice are discussed.

Frequency, comorbidity, and psychosocial impairment of specific phobia in adolescents

Investigated the frequency, comorbidity, and psychosocial impairment of specific phobia and specific fears among 1,035 adolescents 12 to 17 years old. The adolescents were recruited from 36 schools in the province of Bremen, Germany. Specific phobia and other psychiatric disorders were coded based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria using the computerized Munich version of the Composite International Diagnostic Interview (Wittchen & Pfister, 1996). Thirty-six (3.5%) of the adolescents met DSM-IV criteria for specific phobia sometime in their life. Of all the subtypes of specific phobia, animal and natural environment phobia were the most common. More girls than boys received the diagnosis of specific phobia. One third of the adolescents with specific phobia also had depressive and somatoform disorders. Despite the high level of psychosocial impairment experienced by individuals with specific phobia both during the worst episode of their disorder and in the last 4 weeks, only a small portion of them sought professional help.

[Increasing depression in children and adolescents. Only early intervention can prevent dire outcome]

Numerous recent epidemiological studies indicate that depressive disorders in children and adolescents are quite common. Roughly 15% of adolescents admit to having suffered from such a disorder at some time or other. Depressive disorders increase with age with a preponderance of girls over boys. Risk factors that have been found to be associated with depressive disorders include parental psychopathology, familial dysfunction, and negative life events. Depression frequently occurs together with other disorders, and shows a tendency to become chronic. Finally the article discusses the implications of the latest findings for preventive and interventional strategies.

Frequency, comorbidity, and psychosocial impairment of anxiety disorders in German adolescents

The frequency, comorbidity, and psychosocial impairment of anxiety disorders among German adolescents was estimated from a survey of 1,035 students aged 12-17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Anxiety disorders and other psychiatric disorders were coded based on criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, using the computerized Munich version of the Composite International Diagnostic Interview. Anxiety disorders occurred frequently in our sample of adolescents, with a rate of 18.6%. When considering the subtypes of anxiety disorders, phobia was the most common. Posttraumatic stress disorder and obsessive-compulsive disorder occurred less frequently with rates below 2%. Panic disorder and generalized anxiety disorder were the least common, with rates well below 1%. Anxiety disorders were significantly higher in girls than in boys, and that the rates increased with age. Comorbidity occurs quite frequently, both within the anxiety disorders and also with other psychiatric disorders. The most common pattern of comorbidity was that of anxiety and depressive disorders. Although a high number of anxiety cases were psychosocially impaired, at least during the worst episode of their disorders, only a few of them sought treatment for their problems. We conclude by discussing some research priorities in the area of anxiety disorders in children and adolescents.

Häufigkeit und Komorbidität Somatoformer Störungen bei Jugendlichen: Ergebnisse der Bremer Jugendstudie

Zusammenfassung. Anhand von Daten der Bremer Jugendstudie werden in diesem Artikel Ergebnisse hinsichtlich der Häufigkeit und Komorbidität sowie psychosozialer Beeinträchtigung durch Somatoforme Störungen bei Jugendlichen dargestellt. 136 Jugendliche (13,1 %) erfüllten die Kriterien für eine Somatoforme Störung, wobei signifikant mehr Mädchen als Jungen von diesen Störungen betroffen waren. Von den Subtypen Somatoformer Störungen trat als häufigste die Undifferenzierte Somatoforme Störung auf, gefolgt von der Schmerzstörung und der Konversionsstörung. Auf der Symptomebene wurden Kopfschmerzen, das Gefühl eines Kloßes im Hals und Schmerzen im Bauchbereich am häufigsten mitgeteilt. Fast die Hälfte der Jugendlichen mit Somatoformen Störungen erfüllte die Kriterien für mindestens eine weitere Störung. Obwohl ein Drittel dieser Jugendlichen psychosozial beeinträchtigt war, wurde nur ein kleiner Teil von ihnen behandelt.

Psychologische Intervention bei depressiven Kindern und Jugendlichen

Zusammenfassung. Angesichts der Häufigkeit, Chronzität und der langfristigen negativen Konsequenzen von Depression bei Kindern und Jugendlichen wurden verschiedene psychologische Interventionsverfahren für diese Altersgruppe entwickelt. In diesem Artikel werden die zwei am häufigsten eingesetzten Verfahren dargestellt: Der “Adolescent Coping with Depression Course” und das “Primary and Secondary Control Enhancement Training Program”. Ersterer basiert auf dem Integrativen Depressionsmodell, letzteres auf dem Zwei-Prozeß-Modell. Die Hauptkomponenten dieser Programme umfassen das Training sozialer Kompetenzen, Angstreduktion, Reduzierung negativer Kognitionen und die Steigerung angenehmer Aktivitäten. Empirische Studien konnten die Wirksamkeit dieser Interventionen bei der Reduzierung depressiver Symptome zeigen.

Frequency and comorbidity of social phobia and social fears in adolescents

This report presents findings on the frequency, comorbidity and psychosocial impairment of social phobia and social fears among 1035 adolescents, aged 12-17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Social phobia and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Seventeen (1.6%) of the adolescents met the DSM-IV criteria for social phobia sometimes in their life. More girls than boys received the diagnosis of social phobia and the frequency of the disorder increased with age. The lifetime frequency of social fears were much higher than that of social phobia. The most common types of feared social situations were fear of doing something in front of other people, followed by public speaking. Social phobia comorbid highly with depressive disorders, somatoform disorders and substance use disorders. Despite the high level of psychosocial impairment experienced by cases with social phobia and those with any social fears, only a small portion of them did receive professional help.

[Anxiety disorders in children and adolescents. Epidemiology, risk factors and intervention]

The article reviews the literature on anxiety disorders in children and adolescents. Anxiety disorders represent one of the most common disorders in children and adolescents, with a life-time prevalence of about 10%. In most studies, significantly more females than males met the diagnosis of anxiety disorders. Some factors that have been commonly found to be associated with anxiety disorders include parental psychopathology, familial dysfunction, negative life events, and behavioral inhibition. Anxiety co-occurs frequently with other disorders; it has a chronic course and most of the anxiety cases are psychosocially impaired in various areas of life. The article ends by giving an overview of various types of intervention strategies commonly used to treat children and adolescents with anxiety disorders.

[Frequency, comorbidity and psychosocial correlates of attention-deficit/hyperactivity disorder. Results of a Bremen adolescent study]

Using data from the first wave of the Bremen Adolescent Study, this article presents findings on the frequency, comorbidity and correlates of Attention-Deficit/Hyperactivity Disorder (ADHD). ADHD ist the least common disorder examined in our study, with only two out of 1009 adolescents (0.2%) meeting the full DSM-IV criteria for ADHD. On the symptom level, our data show that 159 adolescents (15.8%) report at least six symptoms of inattention and/or six symptoms of hyperactivity-impulsivity. When considering those with this ADHD syndrome, our data show that about half of them have problems in school and at home, and 69.8% of them have at least one comorbid disorder. Compared to adolescents without any disorder and to those with other disorders, adolescents with only ADHD syndrome score significantly lower on control orientation (behavior conduct), perceived competence (academic, behavior, friendship subscales), and show lower emotional attachment to parents and peers. The results are discussed in terms of their implication for classification and intervention.

[Incidence of post-traumatic stress disorder in adolescents: results of the Bremen Adolescent Study]

The frequency and comorbidity of posttraumatic stress disorders (PTSD) were assessed together with the resultant psychosocial impairment in 1035 adolescents between the ages of 12 and 17 years. Posttraumatic stress disorder and other psychiatric disorders were coded on the basis of the DSM-IV criteria using the computerized personal interview of the Munich version of the Composite International Diagnostic Interview (CIDI). A total of 17 (1.6%) adolescents met the DSM-IV criteria for PTSD at some point in their life. Slightly more girls than boys met the criteria for the disorder, whose frequency increased with age. The lifetime prevalence of traumatic events is much higher still: 233 (22.5%) adolescents reported one or more traumatic events in their life. The types of traumatic events experienced by the greatest number of adolescents were: physical attack, injury, and serious accident. Boys experienced significantly more traumatic events than did girls. The occurrence of a traumatic event was mostly associated with hypervigilance and recurrent and intrusive psychological distress upon exposure to cues which symbolized the event itself or resembled an aspect thereof. PTSD occurred in highly frequent comorbidity with depressive disorders, somatoform disorders, and substance abuse. Over 90% of those with posttraumatic stress disorder were severely impaired in their daily life and activities. Despite the high-grade psychosocial impairment, only a small number sought professional help.

Komorbidität, Risikofaktoren und Verlauf aggressiven Verhaltens

Zusammenfassung. Es werden Ergebnisse aus der Bremer Jugendstudie (N=1035) zur Komorbidität, Risikofaktoren sowie zum Verlauf der Störung des Sozialverhaltens und der Störung mit Oppositionellem Trotzverhalten dargestellt. 49 Jugendliche (4,7%) erfüllten die DSM-IV-Kriterien der Störung des Sozialverhaltens, 26 (2-5%) erhielten die Diagnose einer Störung mit Oppositionellem Trotzverhalten. Von den Jugendlichen mit einer Störung des Sozialverhaltens wiesen 89,8% den Typus mit Beginn in der Adoleszenz auf. Es waren signifikant mehr Jungen als Mädchen von einer Störung des Sozialverhaltens betroffen. Jugendliche mit dieser Störung waren im Vergleich mit Altersgenossen ohne eine Störung des Sozialverhaltens einer signifikant höheren Anzahl von Lebensereignissen und Bedingungen ausgesetzt, ihre Bindung zu den Eltern sowie ihre Kontrollüberzegung war geringer, das familiäre Umfeld war signifikant häufiger dysfunktional. Fast 40% der Jugendlichen, bei denen zu T1 eine Störung des Sozialverhaltens festgestellt wurde, erfüllten auch 15 Monate später die Kriterien für die Diagnose dieser Störung. Zu den Faktoren, die mit der Stabilität der Störung zusammenhängen, gehört ein früher Beginn. Der Artikel schließt mit einer Diskussion der Implikationen der vorliegenden Ergebnisse für Prävention und Intervention.

[Substance abuse and dependence in adolescents]

This manuscript reviews literature on the prevalence/frequency, risk factors, course and outcome of substance use disorders in adolescents. Recent epidemiological studies conducted in various parts of the world have indicated a high frequency of substance use disorders in adolescents, with values ranging from 5 to 8%; the rate for alcohol abuse and dependence range from 2 to 32%, and for drugs from 5 to 10%. Substance use disorders were significantly higher in males than in females, and that they increased with age. Other risk factors commonly reported for substance use disorders include biological, familial, and social factors. Several intervention and prevention programs are presented and discussed.

[Frequency and comorbidity of social anxiety and social phobia in adolescents. Results of a Bremen adolescent study]

Using data from the Bremen Adolescent Study, this report presents findings on the frequency, comorbidity and psychosocial impairment of social phobia and social fears among 1035 German adolescents of 12-17 years of age. The adolescents were randomly selected from 36 schools in the city and provincial government area of Bremen, Germany. Social phobia and other psychiatric disorders were coded based on DSM-IV criteria using the computerized personal interview of the Munich version of the Composite International Diagnostic Interview. Seventeen (1.6%) of the adolescents had met the DSM-IV criteria for social phobia at some time in their life. More girls than boys were diagnosed as suffering from social phobia. The incidence of the disorder increased with age. The lifetime frequency of social fears is much higher. The most common types of feared social situations were fear of doing something in front of other people, followed by public speaking. Social phobia very often co-occurred with depressive disorders, somatoform disorders and disorders caused by excessive or inappropriate consumption of substances. Over 94% of those with social phobia and 54.4% with any social fears were severely impaired in their daily life during the worst episode. Despite the high level of psychosocial impairment, only a small portion of the cases received professional help.

[Symptoms of anxiety and depression in adolescents]

The main aim of the present study was to examine the frequency and correlates of anxiety and depressive symptoms. Anxiety and depressive symptoms were evaluated by means of the Revised Ontario Health Study Scales. The probands were 215 adolescents aged 11 to 19 years. An important finding was the high rates of suicidal thought in the 11-12 year old boys (23.1%) and the 17-19 year girls (26.7%). Our result also showed a significant correlation between depressive symptoms and doctor's visit and critical life events. The implication of the results for clinical practice and research were discussed.

Epidemiology of panic disorder: progress and unresolved issues

Recent epidemiological studies have consistently shown that panic disorder, according to DSM-III, occurs in adults with a lifetime prevalence of about 2% and a 6-month prevalence of about 1.2%. Panic attacks are relatively common, with a lifetime rate of about 9%. Being female and divorced and separated is associated with higher prevalence of panic disorder. The hazard rates for panic disorder were highest between the ages of 25 and 34 years for females and between the ages of 30 and 44 years for males. Panic disorder frequently co-occurs with other anxiety disorders as well as with a wide range of mental disorders such as depression and substance use disorder. Based on few epidemiological studies, panic disorder has been found to have a chronic course with rare complete remission. Subjects with panic disorder were at an increased risk of social impairment, not getting along with their partners, as well as being financially dependent, and were likely to report fair or poor global physical health, and emotional health. Cases with panic disorder had the most severe psychosocial impairment and the worst outcome as compared to other anxiety disorders. Moreover, they are high users of all types of medical services, including mental health and general medical providers. Although recent epidemiological data, with its improved methodology, have considerably increased our knowledge concerning panic attack, panic disorder and agoraphobia, there are still major questions concerning the etiology, natural history, prevention, or control of panic disorder that need to be answered. Furthermore, since panic disorder has been considered as developing in stages, our current epidemiological knowledge cannot tell us in sufficient detail about the specific role of suggested risk factors in the development of panic disorder through its various stages.

Comorbidity and mixed anxiety-depressive disorders: is there epidemiologic evidence?

Recent epidemiologic studies (i.e., studies conducted since 1980) have consistently demonstrated, on the basis of standardized diagnostic assessments, that there is a substantial overlap between different types of anxiety and depressive disorders. The current literature, however, discusses this issue primarily within the concept of comorbidity and there are some controversies about the existence of a separate disorder of mixed anxiety-depression (MAD). MAD can be defined by the presence of mixed symptoms of depression and anxiety that are below the diagnostic threshold for either one of these diagnoses. Since MAD has not been included in any of the current official classification systems, its prevalence, risk factors, course, and outcome have not been studied specifically in any of the recent epidemiologic studies even though MAD is thought to be very important, especially in primary care settings. This paper reviews recent epidemiologic studies and presents data from the Munich Follow-Up Study, which has found a prevalence of about 1% for MAD as defined by the ICD-10. Despite the lack of clear diagnostic criteria for MAD, there are some indications that: (1) this disorder might be frequent in primary care settings, and (2) patients with MAD frequently demonstrate subjective suffering, show impairment in personal and occupational functioning, and have high health service utilization rates. Current empirical evidence is still insufficient for deciding a suitable classificatory solution for this problem.

Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study

The Lifetime and 6 month DSM-III prevalence rates of mental disorders from an adult general population sample of former West Germany are reported. The most frequent mental disorders (lifetime) from the Munich Follow-up Study were anxiety disorders (13.87%), followed by substance (13.51%) and affective (12.90%) disorders. Within anxiety disorders, simple and social phobia (8.01%) were the most common, followed by agoraphobia (5.47%) and panic disorder (2.39%). Females had about twice the rates of males for affective (18.68% versus 6.42%), anxiety (18.13% versus 9.07%), and somatization disorders (1.60% versus 0.00%); males had about three times the rates of substance disorders (21.23% versus 6.11%) of females. Being widowed and separated/divorced was associated with high rates of major depression. Most disordered subjects had at least two diagnoses (69%). The most frequent comorbidity pattern was anxiety and affective disorders. Simple and social phobia began mostly in childhood or early adolescence, whereas agoraphobia and panic disorder had a later average age of onset. The majority of the cases with both anxiety and depression had depression clearly after the occurrence of anxiety. The DIS-DSM-III findings of our study have been compared with both ICD-9 diagnoses assigned by clinicians independently as well as other epidemiological studies conducted with a comparable methodology.

Anxiety disorders: similarities and differences of comorbidity in treated and untreated groups

The similarities and differences of comorbidity in treated and untreated samples with anxiety disorders were examined using data from the Munich Follow-up Study: 133 subjects with anxiety and depressive disorders and 101 former in-patients at the Max Planck Institute for Psychiatry. Diagnoses were based on the DIS, not using the optional DSM-III exclusion rules. In these epidemiological and clinical samples, 69% and 95% respectively had at least two diagnoses. The epidemiological sample was clearly differentiated from the clinical sample by age of onset. The development of both depressive episodes and substance disorders in the two samples was mostly secondary to the development of anxiety problems. The outcome for subjects with both anxiety and depressive disorders tended to be worse than that for those with anxiety alone, regardless of whether a depressive episode was present at the time of the follow-up investigation. The usefulness is underlined of the comorbidity concept based on operationalised diagnosis without the exclusion rules offered by DSM-III and DSM-III-R.

Reliability of life event assessments: test-retest reliability and fall-off effects of the Munich Interview for the Assessment of Life Events and Conditions

This paper presents the findings of two independent studies which examined the test-retest reliability and the fall-off effects of the Munich Life Event List (MEL). The MEL is a three-step interview procedure for assessing life incidents which focuses on recognition processes rather than free recall. In a reliability study, test-retest coefficients of the MEL, based on a sample of 42 subjects, were quite stable over a 6-week interval. Stability for severe incidents appeared to be higher than for the less severe ones. In the fall-off study, a total rate of 30% fall-off was noted for all incidents reported retrospectively over an 8-year period. A more detailed analysis revealed average monthly fall-off effects of 0.36%. The size of fall-off effects was higher for non-severe and positive incidents than for severe incidents. This was particularly evident for the symptomatic groups. Non-symptomatic males reported a higher overall number of life incidents than females. This was partly due to more frequent reporting of severe incidents. The findings of the fall-off study do not support the common belief that the reliability of life incident report is much worse when the assessment period is extended over a period of several years as compared to the traditional 6-month period.

Effects of parental styles on anxiety and type A behavior pattern

The present study examined the effect of reported parental styles on 35 undergraduates' anxiety and the Type A behavior pattern. The modified version of Kelly and Goodwin's Parental Control-style Questionnaire, the State-Trait Anxiety Inventory, and the student version of the Jenkins Activity Survey were administered. Analysis showed that the subjects who had autocratic parents exhibited more Type A behavior pattern as well as having higher scores on the anxiety scales than those who had either permissive or democratic parents.

Type A personality and discrepancies between self-report and heart-rate responses to stress

The present study was done to replicate previous findings on the discrepancy between Type A persons' self-reports of stress and their physiological arousal. An attempt was made to clarify whether this discrepancy was due to Type A persons' denial of their arousal or an inability to discriminate physiological change. The students' version of the Jenkins Activity Survey was administered to 30 female students, aged 19 to 43 yr., who then performed a digit recall. A Multiple Affect Adjective Check List and a self-report questionnaire were used to measure affective reactions. Analysis showed that Type A individuals had higher heart-rate responses to stress but did not report greater subjective arousal. These results replicated the previously reported discrepancy. The current findings are somewhat consistent with an explanation based on discrimination.

Heart rate perception in the Type A personality

Heart rate (HR) estimation and actual HRs were obtained from 28 Type A and 28 Type B males before and after receiving feedback about their actual HR levels, and during performance of a moderately stressful task, digit recall. Self-reports of affective arousal during digit recall were also obtained from the Anxiety scale of the Multiple Affect Adjective Check List (MAACL) and a self-report questionnaire measuring affective reactions. Type As showed significantly higher HR increases during the digit recall than did Type Bs. Type As also reported significantly more affective reactions than Type Bs on the self-report questionnaire, but not on the MAACL Anxiety scale. Type As significantly overestimated their HRs relative to Type B at rest before receiving feedback, and during the digit-recall task. These results contradict the usual assumption that Type As underestimate their arousal levels.