Somatic symptom load in men and women from middle to high age in the Gutenberg Health Study - association with psychosocial and somatic factors

Chronic fatigue in long-term survivors of head and neck cancer treated with radiotherapy

BACKGROUND

There is lack of evidence on chronic fatigue (CF) following radiotherapy (RT) in survivors of head and neck cancer (HNC). We aimed to compare CF in HNC survivors > 5 years post-RT with a reference population and investigate factors associated with CF and the possible impact of CF on health-related quality of life (HRQoL).

MATERIAL AND METHODS

In this cross-sectional study we included HNC survivors treated in 2007-2013. Participants filled in patient-reported outcome measures and attended a one-day examination. CF was measured with the Fatigue Questionnaire and compared with a matched reference population using t-tests and Cohen's effect size. Associations between CF, clinical and RT-related factors were investigated using logistic regression. HRQoL was measured with the EORTC Quality of Life core questionnaire.

RESULTS

The median age of the 227 HNC survivors was 65 years and median time to follow-up was 8.5 years post-RT. CF was twice more prevalent in HNC survivors compared to a reference population. In multivariable analyses, female sex (OR 3.39, 95 % CI 1.82-6.31), comorbidity (OR 2.17, 95 % CI 1.20-3.94) and treatment with intensity-modulated RT (OR 2.13, 95 % CI 1.16-3.91) were associated with CF, while RT dose parameters were not. Survivors with CF compared to those without, had significantly worse HRQoL.

CONCLUSIONS

CF in HNC survivors is particularly important for female patients, while specific factors associated with RT appear not to play a role. The high CF prevalence in long-term HNC survivors associated with impaired HRQoL is important information beneficial for clinicians and patients to improve patient follow-up.

Somatic and Posttraumatic Stress Symptoms in Children and Adolescents in France

Importance

Somatic symptoms are a major concern among the pediatric population because of frequency and burden. The association between adverse childhood experiences and somatic symptoms in adults is well established but less is known concerning somatic symptoms in young people.

Objective

To explore the frequency and intensity of somatic symptoms in children and adolescents exposed to traumatic events.

Design, Setting, and Participants

This cross-sectional study was conducted from January 1 to December 31, 2021, at the Nice Pediatric Psychotrauma Referral Center in Nice, France. Participants included pediatric outpatients, aged 7 to 17 years, who were referred to the center. Statistical analysis was performed in January 2022.

Exposure

All participants experienced at least 1 traumatic event during life.

Main Outcome and Measure

Somatic and posttraumatic stress symptoms were assessed using the Patient Health Questionnaire-13 (PHQ-13) and Child PTSD Checklist (CPC). Posttraumatic stress disorder (PTSD) and non-PTSD groups were defined based on CPC symptoms severity score. In the hypothesized association between somatic symptoms and posttraumatic stress symptoms (PTSS), PTSD and non-PTSD groups were compared, correlations between PTSS and severity of CPC were analyzed, and a regression model was performed.

Results

There were 363 participants included (mean [SD] age, 13.58 [0.25] years; 174 [47.9%] female, 189 [52.1%] male). Compared with the non-PTSD group, the PTSD group presented with a higher mean (SD) number of somatic symptoms (7.0 [2.5] vs 4.0 [2.5] symptoms; t360 = 11.7; P < .001), and higher mean (SD) intensity (10.4 [4.6] vs 4.8 [3.7] points; t360 = 12.6; P < .001). Most of the explored somatic symptoms positively correlated with the intensity of PTSS and their functional alterations (eg, PTSS intensity correlated with stomach pain symptoms [r = .30; P < .001]; and with headaches symptoms [r = .44; P < .001]). In the regression model, the combination of migraines, palpitation, nausea, tiredness, and sleep disorders explained 6.5% of the variance in the PTSD group. (F1,341 = 22.651; P < .001).

Conclusions and Relevance

In this cross-sectional study, somatic symptoms were positively correlated with PTSS both in frequency and intensity among youths. These results suggest that the systematic screening for somatic symptoms in youths with traumatic exposure should be a routine evaluation procedure.

Psychobehavioral B-Criteria of Somatic Symptom Disorder Are Associated with Somatic Symptom Reporting in a Large Sample of Psychosomatic Outpatients

Introduction

Somatic symptom disorder (SSD) as introduced by the DSM-5 is characterized by chronic somatic symptoms not fully explained by underlying pathology and accompanied by psychological factors, the diagnostic B-criteria. These cognitive, affective, and behavioral disturbances are related to increased attention to somatic symptoms. However, there is a lack of empirical evidence regarding the association between the B-criteria and high symptom reporting in clinical settings.

Methods

This 12-year retrospective, cross-sectional, observational study examined 6,491 patients from a German psychosomatic outpatient center. The somatoform subscale of HEALTH-49 was used to evaluate somatic symptom reporting. Excessive health concerns and other potential criteria associated with symptom reporting were determined using the ICD-10-Symptom Rating and other HEALTH-49 subscales.

Results

Regression analysis revealed that the established B-criteria for SSD were the strongest factors associated with somatic symptom reporting, with a standardized beta-coefficient of β = 0.31 (R2 = 0.428, df = 24, F = 187.886). Other psychobehavioral factors were clearly less associated with somatic symptom reporting, such as depressive symptoms with β = 0.15 and impaired activity and participation with β = 0.12. Sociodemographic factors, such as age (β = 0.16) and gender (β = 0.12), were also independently associated with somatic symptom reporting.

Conclusion

This study provides evidence for the concept of SSD related to specific B-criteria associated with somatic symptom reporting, based on a large patient sample. These results point to an important role of psychological symptomatology in patients with somatic symptoms. The findings also suggest that additional factors contribute to the reporting of somatic symptoms. Our results may inform future diagnostic criteria for SSD.

The distribution of somatic symptom disorder and bodily distress syndrome in general hospital outpatients in China: A multicenter cross-sectional study

OBJECTIVE

To investigate the distribution of somatic symptom disorder (SSD) and bodily distress syndrome (BDS) and analyze the differences in psychosocial characteristics of patients with the two diagnoses.

METHODS

A total of 694 general hospital outpatients completed the diagnostic interviews for SSD and BDS, and a set of questionnaires evaluating their psychosocial characteristics. A secondary analysis of these data is done.

RESULTS

SSD and BDS had a moderate overlap (kappa value = 0.43). Patients who fulfilled both SSD and BDS diagnosis showed significantly higher levels of symptom-related psychological distress (SSD-12), somatic symptom severity (PHQ-15), depression (PHQ-9), and general anxiety (GAD-7), as well as lower mental and physical quality of life (SF-12) compared to patients with neither diagnosis and patients with only one diagnosis. Patients with either diagnosis were associated with significantly higher psychosocial impairments as compared to those with neither diagnosis. Patients who only met SSD had higher SSD-12 scores, whereas those with only BDS had higher PHQ-15 scores (p<0.001).

CONCLUSIONS

SSD and BDS appear to represent somewhat different psychopathologies, with SSD more associated with psychological distress and BDS associated with greater experience of somatic symptoms. Patients fulfilling both diagnosis show higher symptom severity in various psychosocial aspects.

Posttraumatic stress among trauma-exposed Hispanic/Latinx adults: relations to mental health

Latinx persons are exposed to higher rates of traumatic events and conditional risks for developing posttraumatic stress disorder (PTSD) symptoms and comorbid mental health symptoms compared to other minority groups. The study evaluated PTSD symptom severity for global and specific cluster severity relating to co-occurring anxiety, social anxiety, depression, and suicidal ideation among 326 Latinx adults who endorsed trauma exposure. Results indicated that global PTSD symptom severity was significantly related to greater social anxiety, anxious arousal, depression, and suicidal ideation symptoms. PTSD arousal and reactivity symptom cluster had the strongest relation to anxious arousal, social anxiety, and depression, whereas negative alterations in cognitions and mood symptoms had the strongest association with social anxiety, depression, and suicidal ideation. The findings suggest that global PTSD symptom severity, alongside arousal and reactivity and negative alterations in cognitions and mood, are related to a range of concurrent negative mental health symptoms among trauma exposed Latinx young adults.

Associations between parental well-being and early learning at home before and during the COVID-19 pandemic: observations from the China Family Panel Studies

Background

COVID-19-related lockdowns and preschool closures resulted in many young children spending all their time at home. Some parents had to manage child care while working from home, and increased demands may have led them to experience considerable stress. Evidence indicates that among parents with young children, those who had pre-existing mental and physical conditions adapted less well than other parents. We considered associations between parental well-being and the home learning environment for young children.

Method

We leveraged data from the nationally representative China Family Panel Studies. We analyzed longitudinal data collected before (2018) and during (2020) the pandemic. Participants were parents of 1,155 preschoolers (aged 3-5 years in 2020). Moderated mediation models were conducted. Maternal and paternal psychological well-being, depression, physical health, and physical illness in 2018 and 2020 were predictors. The frequency of marital and intergenerational conflicts in 2020 were mediators. Primary caregiver-reported engagement in home learning activities and family educational expenditure and parent-reported time spent on child care in 2020 were outcome variables. The number of COVID-19 cases in each province 3 months before the 2020 assessment was the moderator. Child, parental, and household characteristics and urbanicity were covariates.

Results

Controlling for covariates, improvements in parental psychological well-being predicted more home learning activities and increases in paternal depression predicted less time spent by fathers on child care. Negative changes in maternal physical health predicted less family educational expenditure and mothers spending more time on child care. Family conflicts mediated the association between maternal physical illness in 2018 and family educational expenditure. The number of COVID-19 cases in a province (i) was positively associated with mothers spending more time on child care, (ii) moderated the association of improvements in maternal physical health and mothers spending less time on child care, and (iii) moderated the association of family conflicts and more family educational expenditure.

Conclusion

The findings indicate that decreased parental psychological and physical well-being foretells reductions in monetary and non-monetary investment in early learning and care at home. Regional pandemic risk undermines maternal investment in early learning and care, especially for those with pre-existing physical conditions.

Social inequalities in aggravating factors of somatic symptom persistence (SOMA.SOC): study protocol for a mixed-method observational study focusing on irritable bowel syndrome and fatigue

INTRODUCTION

Some studies indicate that persistent somatic symptoms (PSS) are more prevalent among individuals with a low socioeconomic status (SES) and a migration background. However, factors explaining social inequalities in PSS are largely unknown. It is expected that aggravating factors of PSS like illness perception, illness beliefs (health literacy, stigma), illness behaviour and health anxiety may play an important role for this explanation. The SOMA.SOC study will examine social inequalities (according to SES and migration) in factors contributing to symptom persistence in irritable bowel syndrome (IBS) and fatigue.

METHODS AND ANALYSIS

The project will collect both quantitative and qualitative data. Quantitative data will be gathered via a representative telephone survey in Germany (N=2400). A vignette design will be used depicting patients varying in sex, condition (IBS/fatigue), occupational status (low/high) and migration (yes/no). In the survey, we will assess public knowledge and beliefs (eg, health literacy), attitudes (stigma) and personal experiences with the condition (eg, somatic symptom burden). Complementary, longitudinal qualitative interviews will be conducted with patients (n=32 at three time points, resulting in N=96 interviews) who will also vary according to sex, condition, occupational status and migration. Patients will be recruited from primary care practices in Hamburg. The interviews will cover origin and development of the condition, coping and help-seeking as well as social interactions and perception of the disease by others (eg, perceived stigma). SOMA.SOC is part of the interdisciplinary SOMACROSS (Persistent SOMAtic Symptoms ACROSS Diseases) research unit.

ETHICS AND DISSEMINATION

The study protocol was approved by the Ethics Committee of the Hamburg Medical Association on 25 January 2021 (reference number: 2020-10194- BO-ff). Informed consent will be obtained from all participants. The main findings will be submitted for publication in peer-reviewed journals within 12 months of study completion.

Anxiety Sensitivity Among Non-Hispanic Black Adults: Relations to Mental Health and Psychosomatic States

The non-Hispanic Black adult population has notable disparities in mental and physical health compared to several other racial/ethnic groups. Yet, there is a lack of scientific knowledge about psychologically based individual difference factors that may be associated with an exacerbation of common mental and physical health symptoms among non-Hispanic Black persons. The present investigation sought to build on the limited knowledge about anxiety sensitivity among non-Hispanic Black adults by exploring whether this construct was uniquely associated with a range of prevalent mental health and psychosomatic symptoms commonly tied to disparities among this population. Participants included non-Hispanic Black adults (N = 205; Mage = 21.67 years; SDage = 5.39; age range: 18-60 years; 82.0% female). Results indicated that anxiety sensitivity was positively related to anxious arousal, general depression, insomnia, fatigue severity, and somatic symptom severity; effects were evident above and beyond the variance explained by a range of covariates, including age, sex, education, subjective social status, and neuroticism. Overall, the present findings uniquely build from past research on anxiety sensitivity and non-Hispanic Black adults by demonstrating that individual differences in this construct are consistently and relatively robustly associated with a wide range of mental health and psychosomatic symptoms. Future research that builds from this work may benefit from consideration of intervention programming targeting anxiety sensitivity reduction to offset mental and physical health impairments among the non-Hispanic Black population.

Injury, illness, and emotion: A review of the motivational continuum from trauma through recovery from an ecological perspective

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Somatic burden in Russia during the COVID-19 pandemic

Somatic burden has become one of the most common psychological reactions to the COVID-19 pandemic worldwide. This study examined the prevalence of somatic burden, latent profiles, and associated factors of somatic symptoms during the pandemic in a large sample of Russians. We used cross-sectional data from 10,205 Russians collected during October-December, 2021. Prevalence of somatic burden was assessed with the Somatic Symptom Scale-8. Latent profiles of somatic burden were identified using latent profile analysis. Multinomial logistic regression was used to examine demographic, socioeconomic, and psychological associated factors of somatic burden. Over one-third (37%) of the Russians reported being somatised. We selected the three-latent profile solution with high somatic burden profile (16%), medium somatic burden profile (37%), and low somatic burden profile (47%). The associated factors of greater somatic burden were female gender, lower education, history of COVID-19 disease, refusing vaccination against SARS-CoV-2 infection, poorer self-rated health, greater fear of COVID-19 pandemic, and living in regions with higher excess mortality. Overall, this study contributes to knowledge about the prevalence, latent profiles, and associated factors of somatic burden during the COVID-19 pandemic. It can be useful to researchers in psychosomatic medicine and practitioners in the health care system.

Posttraumatic growth after childhood cancer: Psychometric evaluation of a five-item short form and associations with mental health

OBJECTIVE

Research has described positive psychological outcomes after severe illness, including posttraumatic growth. The aim of the present research was to evaluate a short scale assessing posttraumatic growth within a sample of cancer survivors to provide an efficient instrument for research and care settings.

METHODS

Using data of a registry-based sample of N = 633 childhood cancer survivors (CCS) more than 25 years after diagnosis, we conducted an investigation of a five-item short form of the established Posttraumatic Growth Inventory (PTGI), the PPR-5 (PPR stands for "Posttraumatische Persönliche Reifung", the German expression for posttraumatic growth). We performed a confirmatory factor analysis, tested the PPR-5's internal consistency, and investigated associations with cancer-related, sociodemographic, and mental health variables (assessed using psychometrically tested screening instruments) using group comparisons and correlation analyses within a cross-sectional design.

RESULTS

Findings supported a unidimensional structure of the PPR-5. It also showed good reliability (ω = 0.81). CCS especially endorsed Relating to others and Personal strength. The PPR-5's sum score was negatively associated with current depression, anxiety, and sleep disorder symptoms, intake of antidepressants, and lifetime diagnoses of depression and anxiety disorders. It showed positive associations with resilient coping, higher age at diagnosis, partnership, and parenthood.

CONCLUSION

The PPR-5 allows for a brief assessment of posttraumatic growth. As it indicates aspects that support positive psychological adaptation to life as a (cancer) survivor, it could inform research and practice (e.g., as a screening measure, or in psychotherapy/counseling settings).

Prevalence and Predictors of Somatization in Peruvian Undergraduate Students during the COVID-19 Pandemic

The COVID-19 pandemic had a strong impact on mental health. Multiple studies report the alarming prevalence of depression, anxiety, and stress-related conditions due to the lockdown measures. Nevertheless, somatization has been an overlooked topic in current literature despite its strong relationship with most mental health conditions. The aim of this study was to describe the prevalence of somatic symptoms and their associated factors in a sample of 3218 undergraduate students from Lima, Peru. A cross-sectional design was carried out. The prevalence of somatic symptoms was measured with the PHQ-15. As predictors of somatic symptom severity, we included psychopathological (depression, anxiety, and stress), psychological (perceived social support, resilience, satisfaction with life, and academic self-efficacy), and sociodemographic (e.g., age, sex, employment status, relationship status, daily hours of sleep) variables. A generalized linear model from a binomial family and a logit link function were applied based on a Factor Score Regression approach, with half of the sample presenting moderate-to-severe somatic symptoms. Anxiety was the strongest predictor of somatic symptom severity, followed by academic self-efficacy. Significant differences were found regarding sex, relationship status, daily hours of sleep and COVID-19 risk-related variables. In conclusion, interventions on reducing anxiety and promoting academic self-efficacy may have a stronger impact on somatic symptom severity and should focus on more vulnerable specific demographic groups such as females.

A multicenter study of bodily distress syndrome in Chinese outpatient hospital care: prevalence and associations with psychosocial variables

BACKGROUND

Bodily distress syndrome (BDS) is a new, empirical-based diagnosis of functional somatic symptoms. This study aimed to explore the prevalence of BDS and its association with psychosocial variables in a Chinese clinical population.

METHODS

A multicentre cross-sectional study of 1269 patients was conducted in 9 different Chinese tertiary outpatient hospitals. The BDS was identified by trained interviewers face-to face, based on a brief version of the Schedules for Assessment in Neuropsychiatry (RIFD) and the BDS Checklist-25. Sociodemographic data and further information were characterised from psychometric questionnaires (The Patient Health Questionnaire-15, the Patient Health Questionnaire-9, the General Anxiety Disorder-7, the Whiteley scale-8) .

RESULTS

Complete data were available for 697 patients. The prevalence of BDS was 26.8% (95% confidence interval (CI): 23.5-30.1). Among the participants, 5.8% (95% CI: 4.1-7.6) fulfilled the criteria for single-organ BDS, while 20.9% (95%CI: 17.9-24.0) had multi-organ BDS. Comparison of the PHQ-15, PHQ-9, GAD-7, and WI-8 scores revealed higher scores on all dimensions for patients with BDS. In a binary logistic regression analysis, BDS was significantly associated with increased health-related anxiety (WI-8) and depression (PHQ-9). The explained variance was Nagelkerke's R² = 0.42.

CONCLUSIONS

In China, the BDS is a common clinical condition in tertiary outpatient hospital settings with high prevalence, and is associated with health anxiety and depressive symptoms. In this clinical population, the severe multi-organ subtype of BDS was the most frequent.

Stability and predictors of somatic symptoms in men and women over 10 years: A real-world perspective from the prospective MONICA/KORA study

OBJECTIVE

To assess the stability of somatic symptoms in community-dwelling participants.

METHODS

The study included 2472 participants (1190 men, 1282 women; mean age 44.3 ± 10.9) from the prospective population-based MONICA-S3 cohort (1994/95) and the 10-year follow-up KORA-F3 cohort. Somatic symptoms were assessed by an adapted version of the Somatic Symptom Scale-8 (SSS-8a) with scores ranging from 0 to 24. Somatic symptom stability was assessed by weighted kappa values (κ). Generalized Estimating Equation models assessing symptom stability were adjusted for sociodemographic, lifestyle, clinical and psychosocial risk factors, as well as pre-existing medical conditions.

RESULTS

The mean (±SD) SSS-8a was lower in men (S3: 6.88 ± 3.87, F3: 6.60 ± 3.86) than women (S3: 8.43 ± 4.0, F3: 8.31 ± 4.2) at both time points. However, somatic symptoms remained moderately stable in both genders over 10 years (κ =0.42 in men and κ = 0.48 in women), with the largest stability observed in trouble sleeping for men (κ =0.41) and pain in the joints for women (κ =0.41). Pre-existing somatic symptoms were significantly associated with increasing symptoms at follow-up [men: β = 0.82 (SE 0.12), women: β = 0.85 (SE 0.12)], followed by age and psychosocial factors, whereas higher education and recent health care utilization were inversely associated with increasing symptoms. Although hypertension and obesity were associated with increasing somatic symptoms in men, pre-existing medical conditions were not associated with increasing somatic symptoms in men nor women.

CONCLUSIONS

The current findings indicate that somatic symptoms remain moderately stable in the general population during 10 years of follow-up, mainly driven by sociodemographic and psychosocial factors.

Brief Report: Child Sexual Abuse and Somatic Symptoms in Older Adulthood for Men

Somatic symptom disorders are often misdiagnosed or minimized among men, especially in middle and older adulthood. Previous research investigating links between somatic disorders and early trauma, such as childhood sexual abuse (CSA), have mostly been based on small, non-representative, female samples using cross-sectional designs. The current study used data from the Wisconsin Longitudinal Study to assess associations between CSA and somatic symptom severity among men in middle- and late-adulthood (mid-50s to early 70s) with histories of CSA (n = 129) and a matched, non-abused comparison group (n = 2,322). Childhood (e.g., co-occurring adversities and parental education) and demographic background variables (e.g., marital status, self-rated health, and income) were controlled. Growth curve modeling was used to explore trajectories of somatic symptoms over time. Results indicated that the CSA group had higher somatic symptom severity than the non-abused group (γ01 = .10, p < .05); symptoms decreased over time for both groups with no significant differences in the rate of change. Healthcare providers should include CSA in assessments for men. Because contemporary somatic symptoms may represent unresolved early life course trauma, mental health support services should be expanded for this population. Future research should explore gender-appropriate treatment modalities for older men with histories of CSA.

Gender specific somatic symptom burden and mortality risk in the general population

Gender specific all-cause mortality risk associated with a high somatic symptom burden (SSB) in a population-based cohort was investigated. The study population included 5679 women and 5861 men aged 25-74 years from the population-based MONICA/KORA Cohort. SSB was assessed following the Somatic Symptom Scale-8 and categorized as very high (≥ 95th percentile), high (60-95th percentile), moderate (30-60th percentile), and low (≤ 30th percentile). The impact of SSB on all-cause mortality risk within a mean follow-up period of 22.6 years (SD 7.1; 267,278 person years) was estimated by gender-specific Cox regression models adjusted for sociodemographic, lifestyle, somatic and psychosocial risk factors, as well as pre-existing medical conditions. Approximately 5.7% of men and 7.3% of women had very high SSB. During follow-up, 3638 (30.6%) mortality cases were observed. Men with a very-high SSB had 48% increased relative risk of mortality in comparison to men with a low SSB after adjustment for concurrent risk factors (1.48, 95% CI 1.20-1.81, p < .0001), corresponding to 2% increased risk of mortality for each 1-point increment in SSB (1.02; 95% CI 1.01-1.03; p = 0.03). In contrast, women with a very high SSB had a 22% lower risk of mortality (0.78, 95% CI 0.61-1.00, p = 0.05) and women with high SSB had an 18% lower risk of mortality (0.82; 95% CI 0.68-0.98, p = 0.03) following adjustment for concurrent risk factors. The current findings indicate that an increasing SSB is an independent risk factor for mortality in men but not in women, pointing in the direction of critical gender differences in the management of SSB, including women's earlier health care utilization than men.

Exploring Fatigue Sensitivity in terms of Mental Health and Fatigue Severity among a Racially and Ethnically Diverse Sample with Severe Fatigue

Background

Fatigue sensitivity, or the misattribution that fatigue symptoms will lead to negative personal consequences, is one individual difference factor related to adverse behavioral health consequences.

Methods

The current study investigated whether fatigue sensitivity was related to panic symptoms, depression, as well as fatigue severity among 166 persons of diverse racial/ethnic backgrounds with severe fatigue.

Results

As hypothesized, fatigue sensitivity was statistically significantly related to greater panic symptoms, general depression, and fatigue severity. These results were evident over the variance explained by age, sex, neuroticism, and somatic symptoms.

Conclusions

This work is the first to evaluate fatigue sensitivity in terms of behavioral health outcomes among a racial/ethnically diverse sample with severe fatigue.

[Functional cardiovascular symptoms]

This review provides an update on the diagnosis, differential diagnosis and management of functional cardiovascular symptoms. Typical heart-related symptoms like non-cardiac chest pain and palpitations are frequently complemented by other symptoms like dyspnea, sweating, trembling, dizziness and also further somatic symptoms like pain and fatigue. Functional cardiac symptoms are frequent, with rates of up to 30 % in chest pain units. The differential diagnosis comprises gastrointestinal disorders like gastro-esophageal reflux disease and also mental disorders, particularly panic and other anxiety disorders. Successful management depends on an attitude of realizing and confirming the reality and seriousness of the symptoms despite the absence of a clear structural organic cause. Good cooperation with psychotherapists is helpful for stepped care strategies that start with supportive communication with the patient and biopsychosocial self-help activities, leading, if necessary, to formal psychotherapy.

Social Media Use and Its Link to Physical Health Indicators

Social media use has become an integral part of many young adults' daily lives. Although much research has examined how social media use relates to psychological well-being, little is known about how it relates to physical health. To address this knowledge gap, the present research investigated how the amount of social media people use relates to various indices of physical health. Young adults provided a blood sample that was analyzed for C-reactive protein (CRP), a marker of chronic inflammation. They also completed self-report measures of social media use, somatic symptoms, illness-related physician or health center visits, and whether they sought medical care for infection-related illnesses in the last 3 months. Social media use was positively correlated with higher levels of CRP, more somatic symptoms, and more visits to the doctor or health centers for an illness. Although directionally consistent, the correlation with likelihood of seeking medical care for infection-related illnesses was nonsignificant (p = 0.061). All of these results held after controlling for factors such as sociodemographic information and depressive symptoms. Given the prevalence of social media use in daily life, these findings underscore the need for more research examining how social media use relates to physical health.

Families With Violence Exposure and the Intergenerational Transmission of Somatization

INTRODUCTION

Adults who have histories of childhood trauma have been noted to display greater somatization, dissociative symptoms and affect dysregulation. What happens in the parent-child relationship when those traumatized children become parents? A potential link to somatization in the child has been suggested by several prior studies. Children who have early attachment disturbances had more physical complaints if their mothers displayed less maternal sensitivity during observed parent-child interactions. Yet, the intergenerational link between maternal and child somatization has not been sufficiently explored in a longitudinal study in order to understand the potential impact of maternal trauma history and related psychopathology on subsequent child somatization and psychopathology.

METHODS

This paper examined prospective, longitudinal data of 64 mother-toddler dyads (mean age = 2.4 years, SD = 0.7) who were later studied when children had a mean age of 7 years. Mothers with and without histories of interpersonal violence (IPV; physical/sexual abuse and/or family violence exposure) were included. Mothers with IPV histories were oversampled. Linear and Poisson regression models were used to test the associations between maternal IPV-related post-traumatic stress disorder (PTSD) with maternal somatization severity when children were toddlers, and between maternal somatization and maternal interactive behaviors with child somatization by maternal report and clinician-rated assessment at school-age.

RESULTS

Maternal PTSD severity was significantly associated with increased maternal somatization severity (p = 0.031). Maternal somatization severity during the child's early childhood predicted both maternal report of child somatization (p = 0.011) as well as child thought problems (p = 0.007) when children were school-aged. No association was found between maternal somatization and child-reported psychopathology. The study did not find that maternal alexithymia, caregiving behaviors or child exposure to violence contributed significantly to the model examining the association between maternal and child somatization.

CONCLUSION

The results are in line with the hypothesis of intergenerational transmission of somatization in the context of IPV and related maternal PTSD during formative early development. We interpret this as an expression of psychological distress from mother to child, as maternal trauma and pathology affect the caregiving environment and, thus, the parent-child relationship. The authors conclude with a discussion of implications for parent-infant and early childhood intervention.

Differences of medically unexplained symptoms among patients of different ages and sexes in the psychological clinic of a general hospital and the influencing factors of MUS: A cross-sectional study

OBJECTIVE

To analyse differences in sex, age, depression, insomnia, psychological stress, resilience, and perceived social support among patients with medically unexplained symptoms (MUS) in a psychological clinic of a general hospital, and to explore the influencing factors of MUS.

METHODS

This is a cross-sectional study. Seven hundred forty-six first-time patients were assessed with the integrated psychosomatic comprehensive evaluation system (IPS) to evaluate their MUS, depression, insomnia, psychological stress, resilience, and perceived social support. The psychological characteristics were compared with regard to sex and age group (<25 years, low age group; 26-44 years, middle age group; >45 years, high age group). The relationships between age and MUS were explored, and how psychological stress affects MUS was analyzed using the mediator effect model.

RESULTS

Different age groups had significant differences in sex, MUS, depression, psychological stress, resilience, and perceived social support. In further pairwise comparison, no significant difference existed in depression, psychological stress, resilience and perceived social support in the middle and low age groups, depression and psychological stress were higher than those in the high age group, resilience and perceived social support were lower than those of the high age group. MUS were higher in the middle age group than in the low age group. No significant difference existed between the two groups and the high age group. Age, severity of MUS, and perceived social support were significantly different between the sexes. Differences in MUS between men and women in different age groups were analyzed using two-factor analysis of variance. It revealed no interaction between sex and different age groups on MUS. The main effect analysis showed that the effects of different age groups on MUS were statistically significant. Based on pairwise comparative analysis, the MUS score in the low age group was lower than that in the middle age group. To clarify a nonlinear relationship between age and MUS, threshold effect analysis was conducted. The results indicated that the piecewise linear regression model could better depict the relationship between age and MUS. The inflection point was at the age of 60 years. Before the age of 60 years, MUS increased with age. No significant correlation existed between age and MUS after the age of 60 years. To understand the influencing factors of MUS, the intermediary effect model was analyzed using MUS as the dependent variable, psychological stress as the independent variable, resilience as mediator variable M1, perceived social support as mediator variable M2, and depression as mediator variable M3. Resilience, perceived social support, and depression had significant mediator effects on the effects of psychological stress on MUS with a total indirect effect of 69.81%.

CONCLUSION

The middle age group had greater MUS than the low age group. Before the age of 60 years, MUS increased with increasing age. Women had more severe MUS than men. Resilience, perceived social support, and depression had significant mediating effects on the effects of perceived stress on MUS. These findings suggest that clinicians should make more comprehensive and detailed evaluations and timely intervention for middle-aged and female patients. Improving psychological resilience and social support can reduce the impact of psychological stress on MUS. Therefore, psychotherapy and multidisciplinary comprehensive treatment are very important for patients is very important for patients.

Measurement of Somatic Symptoms in the General Population: Standardization of the Russian PHQ-15

<p>The Patient Health Questionnaire (PHQ-15) is a self-report measure assessing presence and severity of somatic symptoms [15]. The aim of this study was to standardize the Russian version of PHQ-15. The study included 1157 respondents from the general population aged 18 to 71. In addition to the PHQ-15, the participants completed the Russian Depression, Anxiety, and Stress Scales-21 (DASS-21), evaluating the psychological distress symptoms. The results showed that 91% of the respondents reported at least one symptom bothering them in the past four weeks. Regarding gender and age specifics of somatization, the most predisposed to the psychosomatic burden were females and persons aged 35-49 years. Moreover, 28.2% of the respondents demonstrated a high level of somatization, as well as increased scores of depression, anxiety, and stress compared to the participants with low and moderate psychosomatic burden. In conclusion, the Russian version of PHQ-15 has been successfully standardized and can be recommended for screening and monitoring of medically unexplained symptoms.</p>

Psychological consequences of lockdown on dental professionals during the early phase of the COVID-19 pandemic

BACKGROUND

Severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, mainly spreads through respiratory droplets. The dental profession is particularly at risk. Routine dental care was suspended after the announcement of the first lockdown in India. This makes the group vulnerable to psychosocial consequences. The present study aims to evaluate the psychosocial issues among dental professionals during COVID-19 pandemic.

MATERIALS AND METHODS

A cross-sectional study was conducted among 627 dental professionals of India, using online Google Forms from April 23, 2020, through April 30, 2020. Participants were evaluated using self-constructed and self-administered personal and professional hardship and fear checklist specifically developed for this study. The 9-item Patient Health Questionnaire (PHQ-9) Depression Scale and 7-item Generalized Anxiety Disorder Scale and PHQ-15 were used to assess the depression, anxiety, and somatic symptoms.

RESULTS

Fear had a remarkable impact on 80.7% of responders. Among the participants, 40.5%, 24.5%, and 30.6% reported symptoms of depression, anxiety, and somatic symptoms, respectively. Somatic symptoms were significantly associated with gender (P = 0.000). Work setting was significantly associated with depression (P = 0.011) and anxiety symptoms (P = 0.001). Concern, worry, and fear due to COVID-19 were significantly associated with depression (P = 0.000), anxiety (P = 0.033), and somatic symptoms (P = 0.009). There was a positive correlation between depression and anxiety symptoms (P = 0.01) and between age and somatic symptoms (P = 0.5).

CONCLUSIONS

This group reported a high level of depression, anxiety, and somatic symptoms. Female dental professionals and private practitioners had more depression, anxiety, and somatic symptoms. Immediate and special intervention is needed for this group. Further exploration into the nature and its effects of the psychological symptoms may be required.

Integrated neuroimmune processing of threat, injury, and illness: An ecological framework mapping social alienation onto lifetime health vulnerability

Social alienation is a pre-eminent ecological threat for humans. In clinical and social care settings its impact is acknowledged in conditions as diverse as severe mood disturbance, chronic pain, and metabolic non-communicable diseases. An integrated psychoneuroimmune perspective shows how threat, injury, healing, and recovery follow through as a continuous process, but accepted cultural and clinical paradigms separating mental from physical illness provide little common ground on which to analyse and apply this continuum in practice. By reviewing the ecological relationships between emotional threat, tissue dyshomeostasis and injury, infection, pain, and mood this article explores not only how primeval somatic responses underpin the evolutionary foundations of depression and somatisation, but also links them to escalating physical non-communicable disease through archived socioeconomic adversity (allostatic load). Social alienation (in the absence of trauma) may prime and activate this ancient repertoire in which sensitised responses lay the foundation for persistent maladaptive states of aversive sensory misinterpretation, behavioural avoidance, anhedonia, and neuroinflammation presenting as widespread non-nociceptive pain, non-pain somatisation, and severe depression. The ecological perspective illuminates perverse clinical presentations, shows how some approaches to care may facilitate self-reinforcement in maladaptive syndromes, and offers pointers for inclusive rehabilitative clinical and social care.

Effects of Somatic, Depression Symptoms, and Sedentary Time on Sleep Quality in Middle-Aged Women with Risk Factors for Cardiovascular Disease

Cardiovascular disease (CVD) is the second leading cause of death among Korean women, and its incidence is dramatically elevated in middle-aged women. This study aimed to identify the predictors of sleep quality, a CVD risk factor, in middle-aged women with CVD risk factors to provide foundational data for developing intervention strategies for the prevention of CVD. The subjects, 203 middle-aged women (40–65 years old) with one or more CVD risk factors were selected through convenience sampling and included in this descriptive correlational study. The effects of somatic symptoms, depression symptoms, and sedentary time on sleep quality were examined. CVD-related characteristics were analyzed using descriptive statistics, whereas the mean values of the independent variables were analyzed using t-tests and analysis of variance. Predictors of sleep quality were analyzed using multiple regression analysis. The results showed that sleep quality increased with decreasing somatic symptoms (β = −0.36, p < 0.001), depression symptom score (β = −0.17, p = 0.023), and daily sedentary time (β = −0.13, p = 0.041), and the regression model was significant (F = 19.80, p < 0.001). Somatic symptoms are the most potent predictors of sleep quality in middle-aged women. Thus, intervention strategies that improve somatic symptoms are crucial for the enhancement of sleep quality, which deteriorates with advancing age.

The association of childhood maltreatment, somatization and health-related quality of life in adult age: Results from a population-based cohort study

BACKGROUND

Population-based data regarding the relationship between childhood maltreatment (CM), somatization and health-related quality of life (HRQoL) in adults are limited.

OBJECTIVE

To investigate the association of CM history (emotional and physical abuse and neglect, sexual abuse) with somatization and with physical and mental HRQoL in adults.

PARTICIPANTS AND SETTING

Data from 2305 participants from the population-based Study of Health in Pomerania were analyzed (aged 20 to 80 years).

METHODS

We applied the Childhood Trauma Questionnaire. Somatoform disorders were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) in a clinical interview. Using a self-administered questionnaire, we assessed the number of somatic symptoms and physical and mental HRQoL.

RESULTS

Sexual abuse was related to the diagnosis of a somatoform disorder (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.29, 2.69). Emotional abuse and physical neglect were associated with the number of somatic symptoms (B = 0.93; 95% CI 0.42, 1.45 and B = 0.50; 95% CI 0.17, 1.83, respectively). Sexual abuse and physical neglect were related to lower physical HRQoL (B = -1.87; 95% CI -3.17, -0.57 and B = -1.26; 95% CI -2.02, -0.49, respectively), and emotional abuse was associated with lower mental HRQoL (B = -2.83; 95% CI -4.03, -1.62).

CONCLUSIONS

A history of CM, in particular sexual abuse, emotional abuse and physical neglect, is a risk factor for somatization and impaired HRQoL in adults. Individuals with somatic symptoms are an important target group for CM screening. Addressing HRQoL might be significant in psychotherapy for individuals with CM experience.

Association between mental health trajectories and somatic symptoms following a second lockdown in Israel: a longitudinal study

OBJECTIVES

To identify mental health prospective trajectories before and after a second lockdown during the COVID-19 pandemic and their associations with somatic symptoms.

DESIGN

Prospective Study.

SETTING

Population-based study drawn from a probability-based internet panel of over 100 000 Israelis.

PARTICIPANTS

Adults aged 18 years or more, representative of the adult Israeli population. The participants were measured at two time points (time 1 (T1) pre-second lockdown N=1029; response rate=76.17%; time 2 (T2) post-second lockdown N=764; response rate=74.24%).

MAIN OUTCOME MEASURES

Trajectories of anxiety and adjustment disorder based on clinical cut-off score for probable diagnoses across T1-T2, somatic symptoms at T2. The four trajectories: stable-low, (no probable diagnosis), stable-high (stable probable diagnosis), exacerbation (no probable diagnosis at T1, probable diagnosis at T2), recovery (probable diagnosis at T1, no probable diagnosis at T2).

RESULTS

Three anxiety trajectories predicted probable somatic symptoms (stable-high OR=6.451; exacerbation OR=5.379; recovery OR=2.025) compared with the stable-low trajectory. The three adjustment disorder trajectories also predicted somatic symptoms (stable-high OR=4.726; exacerbation OR=6.419; recovery OR=4.666) compared with the stable-low trajectory.

CONCLUSIONS

Our data show elevated somatic symptoms among those whose mental health trajectories were poor, exacerbated and those who recovered following the second lockdown. The presentation of somatic symptoms may mask psychological vulnerabilities, even among those who appear to have recovered from the stressor. This indicates that lockdown may be a double-edged sword and should be carefully administered given these populations vulnerabilities.

Predictors of psychological distress in Syrian refugees with posttraumatic stress in Germany

Syria has been the main country of citizenship of refugees in Germany since 2013. Syrians face numerous human rights violations in their country that can be accompanied by the experience of potentially traumatic events, loss and displacement. Along the migration process, refugees are exposed to various factors that can have an impact on mental health. The aim of this study is to investigate sociodemographic, war- and flight-related as well as post-migration factors as predictors of posttraumatic stress, depression, somatization and anxiety in Syrian refugees with posttraumatic stress symptoms based in Germany. Data were based on the baseline sample of the "Sanadak" randomized-controlled trial. A total of 133 adult Syrian refugees participated in the study. A questionnaire covered sociodemographic and flight-related questions as well as standardized instruments for symptoms of PTSD (PDS-5), depression (PHQ-9), somatization (PHQ-15), anxiety (GAD-7), generalized self-efficacy (GSE), religiousness (Z-Scale), social support (ESSI) and mental health stigma (SSMIS-SF). Linear regression models were executed to predict mental health outcomes. Sociodemographic predictors (i.e., female sex, higher education) and flight-related predicting factors (i.e., variability of traumatic events) have a negative impact on mental health in Syrian refugees with posttraumatic stress symptoms in Germany. Mental health stigma predicts worse mental health outcomes. Post-migration factors have a major impact on mental health, such as low income, lack of social support, low life satisfaction or a strongly felt connection to Syria. Somatization is an important manifestation of mental distress in Syrian refugees with posttraumatic stress symptoms. Our study showed a range of factors predicting the mental health of Syrian refugees with posttraumatic stress symptoms. Measures to foster mental health could be securing financial security, promoting gender equality and tailored psychosocial programs addressing mental health stigma, loss and social support networks.

Fatigue as the Chief Complaint – Epidemiology, Causes, Diagnosis, and Treatment

BACKGROUND

Fatigue is a main or secondary reason for 10-20% of all consultations with a primary care physician.

METHODS

This review is based on pertinent publications retrieved by a comprehensive, selective literature search on the epidemiology, etiology, and diagnostic evaluation of fatigue as a leading symptom of disease, as well as on the treatment of its common causes. Information was also included from the literature search we conducted for the German clinical practice guideline on fatigue that was issued by the German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, DEGAM).

RESULTS

Fatigue can be due to any of a broad spectrum of diseases, including decompensation of already known conditions. Sleep disorders and sleep-related disorders of breathing, depression (18.5%), and excessive psychosocial stress are the most common causes of persistent fatigue. Previously undiagnosed cancer is a rare cause, accounting for only 0.6% of cases (95% confidence interval [0.3; 1.3]). Anemia and other organic causes are rare as well (4.3% [2.7; 6.7]). Investigations beyond the history, physical examination, and simple laboratory tests are needed only in the presence of additional symptoms or findings. If the diagnosis remains unclear, watchful waiting and regularly scheduled follow-up help prevent an excessive focus on somatic causes, leading to overdiagnosis. Irrespective of specific causes, psychoeducative and psychotherapeutic approaches should be discussed with the patient, as well as an individually adapted exercise program.

CONCLUSION

The work-up of fatigue as a chief complaint should be guided by investigating common and/or potentially dangerous disorders. Since the latter are rare, an exclusively somatic focus should be avoided in order to prevent overdiagnosis.

Somatic symptom disorders and utilization of health services among Palestinian primary health care attendees: a cross-sectional study

BACKGROUND

Many primary health care (PHC) clients come in with medically unexplained complaints, leading to frequent consultations and high usage of services and healthcare costs. This study aimed to determine the prevalence of somatic symptom disorder (SSD) among PHC attendees and explore its relation to other mental conditions and risk factors.

METHODS

A cross-sectional design was used to interview 400 attendees. Men and women aged over 18 years old without a psychiatric diagnosis were invited to participate. The Somatization scale of the Four-Dimensional Symptom Questionnaire was used to assess somatic symptom disorders. It is a valid tool to be used in a PHC setting. We used the Chi-square test and multivariable logistic regression to explore determinant variables.

RESULTS

Prevalence of SSD was 32.5% (95%CI = 27.9-37.1%). The most common symptoms were painful muscles (61.5%) followed by back pain (52.3%). Female gender [adjusted OR = 2.1 (95% CI = 1.2-3.7)], chronic diseases [adjusted OR = 2.4 (95%CI = 1.3-4.5)], depression [adjusted OR = 3.3 (95%CI = 2.0-5.5)], and anxiety [adjusted OR = 2.1 (95%CI = 1.2-3.6)] were all associated with SSD. In addition, frequent primary health care attendance was found to be associated with SSD [adjusted OR = 2.4 (95%CI = 1.4-4.1)].

CONCLUSIONS

SSD significantly higher among females, patients with chronic diseases, clients with anxiety and depressive disorders, and patients with frequent doctors' visits. Painful muscles and back pain are the most common symptom presented by patients, and this could be used initially by PHC physicians as a signal to consider for screening.

[Occupational Participation of Syrian Refugees with Posttraumatic Stress in Germany]

OBJECTIVE

Description of employment situation and search for determinants of employment depending on symptom severity in refugees with posttraumatic stress.

METHODS

Standardized interviews with 133 Syrian refugees (18 to 65 years) living in Germany with posttraumatic stress symptoms and exploratory data analysis.

RESULTS

27.1 % of the participants were employed; including 13.9 % women and 86.1 % men (p = 0.001). Links between mental health and employment can be shown (posttraumatic stress p = 0.039, depressiveness p = 0.020, somatisation p = 0.026). With regard to social support and type of trauma, as well as residence status and duration of residence, there were no differences between refugees with and without employment.

CONCLUSION

The current analysis on the employment situation of a circumscribed group of Syrian refugees focuses on the importance of psychological symptom burden.

Similarities and Differences of Mental Health in Women and Men: A Systematic Review of Findings in Three Large German Cohorts

In Germany, large, population-based cohort studies have been implemented in order to identify risk and protective factors for maintaining health across the life span. The purpose of this systematic review is to analyse findings from three large ongoing cohorts and to identify sex-specific prevalence rates, risk and protective factors for mental health. Published studies from the Cooperative Health Research in the Region Augsburg (KORA), the Study of Health in Pomerania (SHIP) and the Gutenberg Health Study (GHS)), representing the southern, north-eastern and middle parts of Germany, were identified through searches of the databases PubMed and Web of Science. A total of 52 articles was identified from the start of each cohort until June 2019. Articles reporting prevalence rates of mental health [N = 22], explanatory factors for mental health [N = 25], or both [N = 5] were identified. Consistent across cohorts, higher prevalence rates of internalizing disorders were found for women and more externalizing disorders for men. Risk and protective factors for mental health included social factors, lifestyle, physical health, body mass index (BMI), diabetes, genetic and biological factors. In all areas, differences and similarities were found between women and men. The most evident were the sex-specific risk profiles for depression with mostly external risk factors for men and internal risk factors for women. Gender was not assessed directly, therefore we examined whether socioeconomic and family-related factors reflecting gender roles or institutionalized gender could be used as a proxy for gender. Overall, this systematic review shows differences and similarities in prevalence rates and determinants of mental health indicators between women and men. They underline the importance of focussing on sex specific approaches in mental health research and in the development of prevention measures. Current research on mental health still lacks focus on gender aspects. Therefore, an increased focus on sex and gender in mental health research is of great importance.

[Psychosomatic medicine in the Gutenberg Health Study (GHS) - research questions, measurement instruments, selected results]

Psychosomatic medicine in the Gutenberg Health Study (GHS) - research questions, measurement instruments, selected results Goal: Main questions from the Gutenberg Health Study (GHS) related to psychosomatic medicine are presented: (1) Prevalence and incidence of mental illnesses, (2) Sex-specific risk- and protective factors for mental health, (3) Interplay between psychological and somatic diseases and (4) methodical-psychometric developments. Methods: The GHS is an ongoing, prospective and interdisciplinary cohort study in Mainz. The comprehensive examinations include psychological characteristics and clinical and laboratory tests. 15010 respondents were selected in the baseline study from 2007 until 2012 and re-examined after 2.5 years and 5 years. Results: Of the first 5000 respondents in the baseline study 413 women (8.7 %) and 276 men (5.8 %) indicated depressive symptoms (PHQ-9 > = 10). After five years, half of the participants with depressive symptoms at baseline also indicated depressive symptoms five years later. Risk factors for men were a lack of social support, for women smoking and Type D personality. The proportion of new cases of depression at follow-up was 4.4 %. Risk factors were symptoms of anxiety, Type D, smoking and comorbid cancer. Protective were age and social support. Findings on the association of physical and mental disorders and their behavioral and biological links (atherosclerosis, inflammation) are presented. Conclusions: Prospective assessment of biological, psychological and social parameters offers the possibility to study their interplay in the development of mental and somatic illnesses.

The association of chronic anxiousness with cardiovascular disease and mortality in the community: results from the Gutenberg Health Study

In a large German community sample of adults, we investigated the association of chronic anxiousness with cardiovascular disease and mortality. Self-reported anxiousness from 11,643 German adults between 40 and 80 years of age from the Gutenberg Health Study (GHS) was analyzed over 5 years. Multivariable regression modeling assessed the relation between the variables, cardiovascular disease and mortality. Twelve percent of the participants reported consistently raised (chronic) anxiousness over at least 2.5 years. Anxiousness was more often reported by female, younger participants with a lower socioeconomic status, smokers and those with a family history of stroke and myocardial infarction. New onset of cardiovascular disease was linked to chronic anxiousness in men and new onset of anxiousness in women. However, chronic anxiousness did not predict all-cause mortality. Our results revealed that anxiousness is highly prevalent in German adults from middle to old age, affecting women in particular. In our study, we found sex-specific associations between new onset of cardiovascular disease and different forms of anxiousness in men and women. We suggest that even subclinical levels of anxiety need to be considered as cardiovascular risk factors. To elucidate potential harm of anxiousness for mental and physical health, we propose sex-specific analyses in further research studies, taking age and the course of anxiousness into account.

Frequency of stressful life events and associations with mental health and general subjective health in the general population

Aim

We aim to determine the frequency of stressful life events (SLEs) and investigate the association of single and aggregated SLEs with mental health and general subjective health, which has not been reported for an aging representative sample to date.

Subjects and methods

A total of 12,947 participants (35–74 years old) of the Gutenberg Health Study (GHS) in Germany were analyzed. SLEs were analyzed at the item and aggregated level with unweighted and weighted sum scores. Additionally, the survey included measures of mental health, general subjective health and demographics. Descriptive analyses were stratified by sex, age and socioeconomic status.

Results

Multivariate analyses of variance with SLE at the item level revealed large main effects for sex (ηp2 = 0.30) and age (ηp2 = 0.30); a moderate effect was found for socioeconomic status (ηp2 = 0.08). Interaction effects of sex with age and SES were also significant, but with negligible effect sizes. Regression analyses revealed similar results for unweighted and weighted SLE sum scores controlling for sociodemographic variables, supporting the detrimental relations among cumulated SLEs, depression (β = 0.18/0.19) and anxiety (β =0.17/0.17), but not general health. Mental health indicators showed the highest correlations with single SLEs such as change of sleep habits or personal finances. Severe SLEs according to proposed weight scores showed no or only weak associations with mental health.

Conclusion

Representative data support a more distinct impact of SLEs on mental health than on general health. Single SLEs show strong associations with mental health outcome (e.g., change of sleep habits). The low associations between severe single SLEs and mental health merit further attention.