Gender Differences in Attachment Anxiety and Avoidance and Their Association with Psychotherapy Use—Examining Students from a German University

Depressive Symptoms Among Higher Education Students in Germany-A Systematic Review and Meta-Analysis

Objectives

Higher education students in Germany are vulnerable to depressive symptoms. Despite ample evidence, no comprehensive review has recently been conducted. Thus, our systematic review and meta-analysis aims at describing the extent to which students are affected by depressive symptoms.

Methods

We searched three databases for articles reporting the prevalence rates of depressiveness among students in Germany published between 2002 and 2023. Pooled prevalence rates were calculated using random effects models, both for the overall sample and for subgroups categorized by gender, study setting, assessment instrument, and whether the study was conducted before or during the COVID-19 pandemic.

Results

The search yielded 992 records. After screening, 60 articles remained for data extraction. About one out of five students (21.1%) exhibits depressive symptoms. Pooled prevalence rates differ between subgroups, with higher rates during the COVID-19 pandemic than before (30.6% versus 18.0%) and with females being more affected than their male counterparts (29.0% versus 23.1%).

Conclusion

This review underlines the urgency with which the mental health of students should be addressed at the (higher educational) policy level.

Clinical Trial Registration: PROPSPERO, Identifier CRD42022384066.

Toward a culturally sensitive application of Emotionally Focused Couples Therapy: A qualitative study of therapists' experience using EFT in Spanish-speaking countries/cultures

The purpose of the current study was to identify specific ways Emotionally Focused Couples Therapy (EFT; S. Johnson) could be adapted to better meet the needs of clients in Spanish-speaking countries throughout Europe and the Americas. The results were drawn from responses to a qualitative questionnaire regarding the experiences of learning and applying EFT; 103 therapists in 12 different countries where Spanish is spoken responded to the survey. Overall, the results suggest that the therapists surveyed consider EFT to be a "good fit" for many Spanish-speaking clients because of its focus on emotion, attachment theory, close interpersonal relationships, and model-specific interventions that match cultural values. Participants suggested a few culture-specific modifications regarding how to access and process emotion with men in therapy, translation of key EFT concepts and phrases into Spanish, and navigating the intersection of two cultural values (respeto and personalismo). Fewer modifications were suggested by therapists as they discussed application of the model than while learning it.

Sex Differences in the Relationship Between School Bullying Victimization and Complex Posttraumatic Stress Disorder: The Roles of Insecure Attachment

School bullying victimization is a highly concerning issue that can lead to a range of negative outcomes. Despite the research showing a significant association between bullying victimization and complex posttraumatic stress disorder (CPTSD), the internal mechanisms with its two components (i.e., posttraumatic stress disorder symptoms [PTSD] and disorders of self-organization symptoms [DSO]) remain unclear. Previous studies have indicated that attachment style may influence the development of CPTSD symptoms and that there may be sex differences in attachment styles. Thus, the present study aims to examine the mediating role of insecure attachment between school bullying victimization and CPTSD symptoms in males and females. The study assessed bullying victimization, attachment orientation, and CPTSD (i.e., PTSD symptoms and DSO symptoms) symptoms in 675 college students (65.2% females; Mage = 19.6, SD = 1.34) from China who had reported bullying experiences at two different time points, 6 months apart. For females, school bullying victimization predicted PTSD and DSO symptoms through attachment anxiety and only predicted DSO symptoms through attachment avoidance. For males, we found that school bullying victimization predicted PTSD symptoms through attachment avoidance. These findings suggest that attachment is critical in understanding how school bullying victimization may lead to CPTSD symptoms among individuals of different sexes.

Childhood Emotional Neglect and Cognitive Function Among Middle-Aged and Older Adults: Mediating Role of Social Engagement

Studies have demonstrated that childhood maltreatment and adverse experiences lead to impaired cognitive function. However, relatively few studies have examined the independent effect of childhood emotional neglect on cognitive function in middle-aged and older adults, and the role of social engagement in this relationship. Using a sample from the China Health and Retirement Longitudinal Study, the current study examined the mediating role of social engagement in the association between childhood emotional neglect and cognitive function among middle-aged and older adults. Participants were 32,540 middle-aged and older adults (Mage = 63.45, SD = 8.83). Data were analyzed using a fixed effects model for panel data and bootstrap resampling method. Results showed that participants who experienced emotional neglect had poorer cognitive function (β = -.068, p < .001). Social engagement mediated 7.55% of the association between emotional neglect and cognitive function (β = -.004, 95% CI [-0.006, -0.002], p < .05). The results indicated that interventions are required to improve awareness of emotional neglect and facilitate healthy parenting practices. Further research on how to motivate adults who experienced emotional neglect to engage in social activities is necessary.

Attachment styles and healthcare utilization: exploring the role of the patient-doctor relationship

BACKGROUND

With the purpose of improving healthcare, past research has examined the link between healthcare utilization and attachment. It is suggested that an individual's attachment style influences both the quality of their patient-physician relationship and healthcare utilization patterns. Nevertheless, most studies concentrate on the individual aspect, overlooking the dyadic dimension; specifically, the investigation of how insecure attachment relates to health behavior within patient-physician relationships. This gap leaves the role of the patient-doctor relationship in this process unclear. Therefore, to elucidate this complex interplay, we hypothesized that the correlation between attachment and healthcare utilization is mediated by the quality of the patient-physician-relationship.

METHOD

Participant selection was based on electoral districts, a random-route procedure, and the Kish selection grid. The participants were visited by a trained interviewer who collected psychometric and sociodemographic information. Participants answered the Experiences in Close Relationships-Revised questionnaire (ECR-RD8) and the Patient-Doctor Relationship Questionnaire (PDRQ-9). Additionally, participants were asked about their healthcare utilization. The final sample consisted of N = 2.275 participants.

RESULTS

In average the participants reported consulting their primary health care practitioner M(SD) = 4.44 (4.76) times in the past 12 months. Generally, the participants rated the quality of the relationship with their primary health care practitioner close to "totally appropriate" (M = 4.12 ± .69). The degree of insecure attachment manifested towards the lower extremity of the scale. The total effect of the mediation analyses was significant. Regardless, the indirect effect indicated a trend result with minimal effect sizes.

CONCLUSION

The findings of the current study bridged the gap between attachment styles and healthcare utilization. Nonetheless, our results suggested insufficient support for the mediating role of the primary care physician in the relationship between attachment style and healthcare utilization. Considering the characteristics of the sample, this outcome may not apply in a clinical context. However, further research is needed to shed light in the revealed trends and indicate implications.

Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone

Background

Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT).

Aim

This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist.

Methods

The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36.

Expected results

Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT.

Discussion

This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT05435222.