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Erhardt A, Gelbrich G, Klinger-König J, Streit F, Kleineidam L, Riedel-Heller SG, Schmidt B, Schmiedek F, Wagner M, Grabe HJ, Rietschel M, Berger K, Deckert J. Generalised anxiety and panic symptoms in the German National Cohort (NAKO). World J Biol Psychiatry 2023; 24:881-896. [PMID: 34842503 DOI: 10.1080/15622975.2021.2011409] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Anxiety disorders (AD) are common in the general population, leading to high emotional distress and disability. The German National Cohort (NAKO) is a population-based mega-cohort study, examining participants in 16 German regions. The present study includes data of the first 101,667 participants and investigates the frequency and severity of generalised anxiety symptoms and panic attacks (PA). METHODS The Generalised Anxiety Disorder Symptoms Scale (GAD-7) and the first part of the Patient Health Questionnaire Panic Disorder (PHQ-PD) were filled out by NAKO participants (93,002). We examined the correlation of GAD-7 and PHQ-PD with demographic variables, stress (PHQ-Stress), depression (PHQ-9) and childhood trauma (CTS). RESULTS The total proportion of prior lifetime diagnoses of AD in the NAKO cohort reached 7.8%. Panic attacks were reported by 6.0% and possible/probable current GAD symptoms in 5.2% of the examined participants. Higher anxiety severity was associated with female sex, lower education level, German as a foreign language and younger age as well as high perceived stress and depression. CONCLUSIONS Clinically relevant GAD symptoms as well as panic attacks are frequent in the NAKO and are associated with sociodemographic factors, and high anxiety symptoms are accompanied by pronounced stress and depression levels.
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Affiliation(s)
- Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Wuerzburg, Germany
- Clinical Trial Centre Wuerzburg, University Hospital Würzburg, Wuerzburg, Germany
| | | | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Germany
| | - Florian Schmiedek
- Leibniz-Institute for Research and Information in Education, University of Frankfurt, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Germany
- Centre for Mind, Brain and Behaviour, University of Marburg and Justus Liebig University Giessen, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Klaus Berger
- Institute of Epidemiology & Social Medicine, University of Muenster, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
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Klinger-König J, Streit F, Erhardt A, Kleineidam L, Schmiedek F, Schmidt B, Investigators N, Wagner M, Deckert J, Rietschel M, Berger K, Grabe HJ. The assessment of childhood maltreatment and its associations with affective symptoms in adulthood: Results of the German National Cohort (NAKO). World J Biol Psychiatry 2023; 24:897-908. [PMID: 35302904 DOI: 10.1080/15622975.2021.2011406] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Childhood maltreatment affects 20-30% of the German population and is an important risk factor for physical and mental diseases in adult life. This study reports first results of the distribution of childhood maltreatment in the population-based mega cohort German National Cohort (NAKO) and estimates associations with affective symptoms in adulthood. METHODS The Childhood Trauma Screener (CTS), a short version of the Childhood Trauma Questionnaire, was used in 83,995 adults (age: 20-72 years; 47.3% men) of NAKO. The five-item CTS assesses the severity of three types of childhood abuse and two types of childhood neglect. RESULTS Overall, 21,131 participants (27.5%) reported at least one type of childhood maltreatment; 14,017 participants (18.3%) reported exactly one type and 250 participants (0.3%) reported all five types of childhood maltreatment. Small differences regarding age (mean absolute deviation around the mean (MAD)=0.47), sex (MAD = 0.07) and education (MAD = 0.82) were observed. The severity of childhood maltreatment was associated with more severe symptoms of depression (β = 0.23), anxiety (β = 0.21) and perceived stress (β = 0.23) in adulthood, validated particularly for emotional abuse and emotional neglect. CONCLUSIONS The distribution of childhood maltreatment in NAKO is similar to previous reports. Additionally, our results suggest differential associations with psychopathological symptoms for the five types of childhood maltreatment.
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Affiliation(s)
- Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Florian Schmiedek
- Department of Education and Human Development, DIPF | Leibniz Institute for Research and Information in Education, Frankfurt am Main, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Germany
- IDeA (Individual Development and Adaptive Education of Children at Risk) Centre, Frankfurt am Main, Germany
- Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | | | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Klaus Berger
- Institute of Epidemiology & Social Medicine, University of Muenster, Muenster, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
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Streit F, Zillich L, Frank J, Kleineidam L, Wagner M, Baune BT, Klinger-König J, Grabe HJ, Pabst A, Riedel-Heller SG, Schmiedek F, Schmidt B, Erhardt A, Deckert J, Rietschel M, Berger K. Lifetime and current depression in the German National Cohort (NAKO). World J Biol Psychiatry 2023; 24:865-880. [PMID: 34870540 DOI: 10.1080/15622975.2021.2014152] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The present study introduces the assessment of depression and depressive symptoms in the German National Cohort (NAKO), a population-based mega cohort. Distribution of core measures, and associations with sociodemographic factors are examined. METHODS The current analysis includes data from the first 101,667 participants (NAKO data freeze 100,000). Depression and depressive symptoms were assessed using a modified version of the depression section of the Mini-International Neuropsychiatric Interview (MINI), self-reported physician's diagnosis of depression, and the depression scale of the Patient Health Questionnaire (PHQ-9). RESULTS A lifetime physician's diagnosis of depression was reported by 15.0% of participants. Of those, 47.6% reported having received treatment for depression within the last 12 months. Of the subset of 26,342 participants undergoing the full depression section of the modified MINI, 15.9% were classified by the MINI with a lifetime depressive episode. Based on the PHQ-9, 5.8% of the participants were classified as currently having a major or other depression by the diagnostic algorithm, and 7.8% according to the dimensional assessment (score ≥ 10). Increased frequency of depression measures and higher depression scores were observed in women and participants with lower education level or a family history of depression. CONCLUSIONS The observed distributions of all depression measures and their associations with sociodemographic variables are consistent with the literature on depression. The NAKO represents a valuable epidemiologic resource to investigate depression, and the range of measures for lifetime and current depression allows users to select the most suitable instrument for their specific research question.
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Affiliation(s)
- Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lea Zillich
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Munster, Germany
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Florian Schmiedek
- Department of Education and Human Development, DIPF | Leibniz Institute for Research and Information in Education, Frankfurt am Main, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Germany
- Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig University, Giessen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Germany
| | - Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Klaus Berger
- Institute of Epidemiology & Social Medicine, University of Muenster, Muenster, Germany
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Morawa E, Krehbiel J, Borho A, Herold R, Lieb M, Schug C, Erim Y. Cognitive impairments and mental health of patients with post-COVID-19: A cross-sectional study. J Psychosom Res 2023; 173:111441. [PMID: 37544160 DOI: 10.1016/j.jpsychores.2023.111441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Persistent cognitive complaints belong to the most frequent symptoms after COVID-19. This study explored the neuropsychological profile, mental health and risk factors for cognitive impairment in post-COVID-19 patients. METHODS The patients were recruited consecutively in the Post COVID Center of the University Hospital of Erlangen between 12/2022 and 05/2023. They underwent an extensive neuropsychological assessment including the Verbal Learning Memory Test (VLMT), the digit span backwards from the Wechsler Memory Scale-Revised (WMS-R), the Trail Making Test (TMT) Part A and B, the d2 Test of Attention and the Regensburger Verbal Fluency Test (RWT). For each cognitive domain we calculated the frequency of age-adjusted scores below the measure-specific norms. Depressive symptoms were measured with the Patient-Health-Questionnaire-9 (PHQ-9). Logistic regression analyses were computed. RESULTS In 110 patients (mean age: 42.5 ± 11.9 years; 68.2% women), the most frequent cognitive deficits were observed for verbal fluency, working speed, delayed recall and attention. In almost every cognitive domain high education levels were associated with a decreased risk for cognitive impairment. Higher age was a risk factor for working speed and delayed recall and a protective factor for verbal fluency. Clinically relevant depressive symptoms were associated with an elevated risk for an impairment regarding some cognitive functions. CONCLUSION Cognitive dysfunctions were common among the post-COVID-19 patients. Differentiated exploration of cognitive impairments is crucial for a proper characterization of the post-COVID syndrome. In future research parameters of cognitive impairment should be correlated to alterations in biological markers of the disease like markers of immunological and microcirculation change.
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Affiliation(s)
- Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Johannes Krehbiel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; Post COVID Center of the University Hospital of Erlangen, Germany.
| | - Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Regina Herold
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Marietta Lieb
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; Post COVID Center of the University Hospital of Erlangen, Germany.
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Zhang Q, Wei JH, Fu X, Liu X, Li XY, Liu W, Liu ZL, Duan XQ, Zheng B. Can we trust computers to assess the cognition of stroke patients? A systematic review. Front Neurol 2023; 14:1180664. [PMID: 37305744 PMCID: PMC10248476 DOI: 10.3389/fneur.2023.1180664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose To summarize the classification of computerized cognitive assessment (CCA) tools for assessing stroke patients, to clarify their benefits and limitations, and to reveal strategies for future studies on CCA tools. Methods A literature review was performed using PubMed, Embase, Scopus, JAMA Network, Cochrane Library and PsycINFO databases from January 1st, 2010, to August 1st, 2022. Two authors independently screened the literature following the same criteria, evaluated the study quality, and collected data from the articles. Results A total of 8,697 papers were acquired from the six databases. A total of 74 potentially eligible articles were selected for review. Of these, 29 articles were not relevant to this research, 3 were reviews, 2 were not written in English, and 1 was on an ongoing trial. By screening the references of the reviews, 3 additional articles were included in this study. Thus, a total of 42 articles met the criteria for the review. In terms of the CCA tools analyzed in these studies, they included five types: virtual reality (VR)-based, robot-based, telephone-based, smartphone-based, and computer-based cognitive assessments. Patients' stages of the disease ranged from the subacute phase and rehabilitation phase to the community phase. A total of 27 studies supported the effectiveness of CCA tools, while 22 out of 42 articles mentioned their benefits and 32 revealed areas for future improvement of CCA tools. Conclusions Although the use of CCA tools for assessing the cognition of post-stroke patients is becoming popular, there are still some limitations and challenges of using such tools in stroke survivors. More evidence is thus needed to verify the value and specific role of these tools in assessing the cognitive impairment of stroke patients.
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Affiliation(s)
- Qi Zhang
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | | | - Xue Fu
- Changchun University of Chinese Medicine, Changchun, China
| | - Xin Liu
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, China
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Xin-Yi Li
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Wei Liu
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Zhong-Liang Liu
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Xiao-Qin Duan
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Framework and baseline examination of the German National Cohort (NAKO). Eur J Epidemiol 2022; 37:1107-1124. [PMID: 36260190 PMCID: PMC9581448 DOI: 10.1007/s10654-022-00890-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
The German National Cohort (NAKO) is a multidisciplinary, population-based prospective cohort study that aims to investigate the causes of widespread diseases, identify risk factors and improve early detection and prevention of disease. Specifically, NAKO is designed to identify novel and better characterize established risk and protection factors for the development of cardiovascular diseases, cancer, diabetes, neurodegenerative and psychiatric diseases, musculoskeletal diseases, respiratory and infectious diseases in a random sample of the general population. Between 2014 and 2019, a total of 205,415 men and women aged 19–74 years were recruited and examined in 18 study centres in Germany. The baseline assessment included a face-to-face interview, self-administered questionnaires and a wide range of biomedical examinations. Biomaterials were collected from all participants including serum, EDTA plasma, buffy coats, RNA and erythrocytes, urine, saliva, nasal swabs and stool. In 56,971 participants, an intensified examination programme was implemented. Whole-body 3T magnetic resonance imaging was performed in 30,861 participants on dedicated scanners. NAKO collects follow-up information on incident diseases through a combination of active follow-up using self-report via written questionnaires at 2–3 year intervals and passive follow-up via record linkages. All study participants are invited for re-examinations at the study centres in 4–5 year intervals. Thereby, longitudinal information on changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function is collected. NAKO is a major resource for population-based epidemiology to identify new and tailored strategies for early detection, prediction, prevention and treatment of major diseases for the next 30 years.
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