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Dückert S, Bart S, Gewohn P, König H, Schöttle D, Konnopka A, Rahlff P, Erik F, Vogeley K, Schulz H, David N, Peth J. Health-related quality of life in family caregivers of autistic adults. Front Psychiatry 2023; 14:1290407. [PMID: 38193135 PMCID: PMC10773769 DOI: 10.3389/fpsyt.2023.1290407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL. Methods N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL. Results Family caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05). Discussion Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL.
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Affiliation(s)
- Sophia Dückert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Bart
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department Health Sciences, Faculty Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Petia Gewohn
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pascal Rahlff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Erik
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole David
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Dückert S, Gewohn P, König H, Schöttle D, Konnopka A, Rahlff P, Erik F, Vogeley K, Schulz H, David N, Peth J. Barriers and needs in mental healthcare of adults with autism spectrum disorder in Germany: a qualitative study in autistic adults, relatives, and healthcare providers. BMC Psychiatry 2023; 23:528. [PMID: 37479974 PMCID: PMC10362719 DOI: 10.1186/s12888-023-05026-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Autism refers to a neurodevelopmental condition with characteristic impairments in social interaction and communication, restrictive and repetitive behaviors, as well as difficulties in sensory information processing and daily living skills. Even though symptoms persist from early childhood throughout the lifespan and often require long-term support, there is a lack of mental health services that sufficiently meet the needs of autistic adults. Previous evidence suggested individual, professional and structural barriers to healthcare for autistic adults. Here, using a peer research approach, we sought to systematically investigate barriers and needs in mental healthcare of autistic adults in Germany at the three relevant levels (individual, professional, structural) and from three relevant perspectives (autistic adults, relatives and healthcare providers), in order to obtain specific recommendations for optimized healthcare. METHODS Maximum variation sampling was used to account for the complexity of the research field. Semi-structured, open-ended interviews were conducted with autistic adults (n = 15) and focus groups with relatives/partners (n = 12), and healthcare providers of several professions (n = 15). Data analysis was performed using the codebook approach of thematic analysis. RESULTS Poor mental healthcare of autistic adults in Germany was characterized by six central and overarching themes: (i) lack of knowledge about autism, (ii) a need for increased participation/involvement, (iii) consideration of autism-specific needs in treatment, (iv) lack of services, (v) limited access to services, and (vi) improvement of stakeholder collaboration. Themes were similarly reported across participants, emphasizing dissatisfaction in all stakeholders. CONCLUSIONS We identified major barriers to mental healthcare for autistic adults in Germany that affect autistic adults, but are also of concern to relatives and healthcare providers. Our results point to specific and generic areas for improvement, independent of stakeholder perspectives, which could guide future development of needs- and evidence-based services, recommendations and guidelines of mental healthcare for people with autism across the lifespan. TRIAL REGISTRATION This study protocol was preregistered at the Open Science Framework ( https://osf.io/5x8pg ).
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Affiliation(s)
- Sophia Dückert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Petia Gewohn
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pascal Rahlff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Frank- Erik
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nicole David
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Judith Peth
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Scheunemann J, Kühn S, Biedermann SV, Lipp M, Peth J, Gallinat J, Jelinek L. Implicit cognitions on self-injurious and suicidal behavior in borderline personality disorder. J Behav Ther Exp Psychiatry 2023; 79:101836. [PMID: 36709601 DOI: 10.1016/j.jbtep.2023.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Performance on implicit measures of suicidality has been associated with suicidal and nonsuicidal self-injury. Despite the high prevalence of self-harm in patients with borderline personality disorder (BPD), no previous study has assessed implicit measures in this patient group. METHODS Forty patients with BPD and 25 healthy controls completed three implicit association tests (IATs) (Death words - Me/Others words, Self-Harm pictures - Me/Others, and Self-Harm pictures - Good/Bad words) and a subliminal priming task (effect of the primes "dying"/"growing" on the categorization speed of positive/negative adjectives) as well as measures of psychopathology (suicidal ideation, previous nonsuicidal self-injury, borderline symptomatology, depression, and hopelessness). RESULTS Patients with BPD had higher scores on all three IATs than healthy controls. The subliminal priming procedure did not reveal group differences. Correlations between implicit measures and psychopathology among patients with BPD were mostly weak and nonsignificant with a few exceptions: Positive correlations were observed between IAT Self-Harm - Good/Bad and lifetime frequency of nonsuicidal self-injury, between IAT Self-Harm - Me/Others and depression, and between IAT Death - Me/Others and depression. Correlations between implicit measures were weak to moderate. LIMITATIONS The study was cross-sectional only, and the study had reduced power as the sample size was limited. CONCLUSIONS As expected, patients with BPD had higher scores than healthy controls on the IATs, which indicates higher implicit self-identification with self-harm and death as well as stronger implicit positive attitudes towards self-harm. The mostly weak correlations between implicit and explicit measures speak against the discriminative value of IATs in patients with BPD.
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Affiliation(s)
- Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany; Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Michael Lipp
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Judith Peth
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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David N, Dückert S, Gewohn P, König H, Rahlff P, Erik F, Vogeley K, Schöttle D, Konnopka A, Schulz H, Peth J. Mixed-methods investigation of barriers and needs in mental healthcare of adults with autism and recommendations for future care (BarrierfreeASD): study protocol. BMJ Open 2022; 12:e061773. [PMID: 35998965 PMCID: PMC9403111 DOI: 10.1136/bmjopen-2022-061773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Autism refers to an early-onset neurodevelopmental condition with characteristic impairments and difficulties in practical living skills, which persist across the lifespan such that adults with autism often require substantial support and comprehensive care. Yet, mental health and other services are frequently unavailable for adults with autism despite considerable need for mental healthcare and individual, familial and socioeconomic burdens. This study will (1) examine current needs, barriers and burdens related to ineffective healthcare of adults with autism in Germany, (2) develop specific recommendations for a need-oriented mental healthcare model and (3) evaluate its future implementation. METHODS AND ANALYSIS A mixed-methods design with three phases will be conducted. In phase 1, current mental healthcare for adults with autism will be assessed at three levels (individual, structural and professional) and from three perspectives (adults with autism, relatives and healthcare providers) using (1) focus groups/interviews (qualitative data) and (2) large-scale online surveys (quantitative data). Furthermore, service utilisation and related costs will be estimated. In phase 2, recommendations for a future healthcare model will be derived based on phase 1, considering the heterogeneous and complex needs within the autism spectrum and specifying indications for recommended services. In phase 3, these will again be evaluated by the three stakeholder groups using mixed-methods and analysed regarding feasibility of implementation and cost-effectiveness. Our study will, thus, contribute to a better translation of recommendations into practice to reduce disability, burden and costs related to ineffective healthcare and improve mental health outcomes for adults with autism and those who support them. ETHICS AND DISSEMINATION This study was approved by the Local Psychological Ethics Commission of the Center for Psychosocial Medicine at the University Medical Center Hamburg-Eppendorf (LPEK-0227). Findings will be disseminated via scientific meetings and peer-reviewed journals. Cooperating partners and associations will be informed about the study's course and findings by regular newsletters and meetings. TRIAL REGISTRATION NUMBER This study protocol was preregistered at the Open Science Framework (osf.io/5x8pg).
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Affiliation(s)
- Nicole David
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophia Dückert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petia Gewohn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pascal Rahlff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Erik
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department Psychology, Medical School Hamburg, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Miegel F, Peth J, Rubel J, Runde A, Arlt S, Gallinat J, Jelinek L. Session-Specific Effects on Suicidality in Group Therapy: No Evidence for Contagion. Arch Suicide Res 2022; 27:540-553. [PMID: 34989312 DOI: 10.1080/13811118.2021.2022051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Explicitly addressing suicidality in group therapy is often avoided due to the fear of contagion effects. However, there is some evidence that this fear is not valid. Therefore, the present study aims at contributing to this question by investigating the session-specific effects of two modules on suicidality that are part of the Metacognitive Training for Depression (D-MCT/S). METHODS Forty-four patients with depression participated in the two modules on suicidality of the D-MCT/S. Before and after each group session, patients filled out a questionnaire asking for symptoms of suicidality, associated cognitions (e.g., hopelessness), and associated emotions (e.g., anger). Data were analyzed by linear mixed-effect models. RESULTS Approximately 84% of the patients had experienced lifetime suicidal ideation. No within- or between-session effects were found for the modules on suicidality. Sample size was large enough to find small to medium effects (within-session analyses) and medium to large effects (between-session analyses). CONCLUSION The modules on suicidality did not specifically change suicidal symptoms or associated cognitions and emotions immediately or by the next session. Most importantly, our results disconfirm evidence on deterioration when suicidality is addressed in a highly structured group setting. Whether the current findings also apply to other forms of group therapies needs to be investigated in future studies. HIGHLIGHTSSession-specific investigations allow a thoroughly examination of an interventionMetacognitive Training for Depression showed no contagion effect on suicidality.
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Thom J, Mauz E, Peitz D, Kersjes C, Aichberger M, Baumeister H, Bramesfeld A, Daszkowski J, Eichhorn T, Gaebel W, Härter M, Jacobi F, Kuhn J, Lindert J, Margraf J, Melchior H, Meyer-Lindenberg A, Nebe A, Orpana H, Peth J, Reininghaus U, Riedel-Heller S, Rose U, Schomerus G, Schuler D, von Rüden U, Hölling H. Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set. J Health Monit 2021; 6:34-63. [PMID: 35146320 PMCID: PMC8734140 DOI: 10.25646/8861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022]
Abstract
In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action 'Mental health promotion and prevention' indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders.
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Affiliation(s)
- Julia Thom
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Elvira Mauz
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Diana Peitz
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Christina Kersjes
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Marion Aichberger
- Department of Psychiatry and Psychotherapy at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin
| | - Harald Baumeister
- University of Ulm, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy
| | - Anke Bramesfeld
- Ministry for Social Affairs, Health and Equal Opportunities of Lower Saxony
- Hannover Medical School (MHH), Institute for Epidemiology, Social Medicine and Health System Research
| | | | | | - Wolfgang Gaebel
- WHO Collaborating Centre DEU-131; Rhineland Regional Council (LVR) - Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität Düsseldorf
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Medical Psychology
- German Network Health Services Research
| | - Frank Jacobi
- Psychologische Hochschule Berlin, Department of Clinical Psychology and Psychotherapy
| | | | - Jutta Lindert
- University of Applied Sciences Emden/Leer
- European Public Health Association, Section Public Mental Health
| | - Jürgen Margraf
- Ruhr-University Bochum, Mental Health Research and Treatment Center
| | - Hanne Melchior
- National Association of Statutory Health Insurance Physicians
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Medical Faculty Mannheim, Universität Heidelberg
- German Association for Psychiatry, Psychotherapy and Psychosomatics e.V
| | | | | | - Judith Peth
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Medical Psychology
| | - Ulrich Reininghaus
- Central Institute of Mental Health, Medical Faculty Mannheim, Universität Heidelberg
| | - Steffi Riedel-Heller
- University of Leipzig, Faculty of Medicine, Institute of Social Medicine, Occupational Health and Public Health
- German Association for Psychiatry, Psychotherapy and Psychosomatics e.V
| | - Uwe Rose
- Federal Institute for Occupational Safety and Health
| | - Georg Schomerus
- University of Leipzig, Medical Faculty, University of Leipzig Medical Center, Department of Psychiatry and Psychotherapy
| | | | | | - Heike Hölling
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
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Scheunemann J, Jelinek L, Peth J, Runde A, Arlt S, Gallinat J, Kühn S. Do implicit measures improve suicide risk prediction? An 18-month prospective study using different tasks. Suicide Life Threat Behav 2021; 51:993-1004. [PMID: 34196996 DOI: 10.1111/sltb.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/12/2020] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is accumulating evidence that implicit measures improve the prediction of suicidality within a 6-month follow-up period in psychiatric populations. Building upon these results, we set out to expand the follow-up period and to investigate various implicit methods. METHODS Seventy-nine inpatients completed the Beck Scale for Suicidal Ideation (BSS) and a range of implicit measures: three implicit association tests (IATs: Death; Self-harm-Me/Others; Self-Harm-Good/Bad) and a subliminal priming task (with separate scores for negative and positive adjectives, each indicating the association between the primes "dying" and "growing"). After 18 months, we reached n = 52 patients and reassessed suicidal ideation, plans, and attempts. RESULTS In a hierarchical regression, the five implicit task indices were entered after the patient's age, gender, and BSS score at baseline. The implicit scores improved prediction of BSS scores after 18 months compared to prediction based on age, gender, and BSS score at baseline alone. However, none of the implicit measures was associated with suicide plans or attempts during the follow-up period. CONCLUSION Results suggest that implicit measures can be a useful assessment tool for the prediction of suicidal ideation, even beyond the BSS. However, long-term prediction of suicide plans or attempts using implicit measures seems limited.
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Affiliation(s)
- Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Runde
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Lise-Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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Jelinek L, Peth J, Runde A, Arlt S, Scheunemann J, Gallinat J. Metacognitive Training for Depression: Feasibility, safety and acceptability of two new treatment modules to reduce suicidality. Clin Psychol Psychother 2020; 28:669-681. [PMID: 33169467 DOI: 10.1002/cpp.2529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/03/2020] [Accepted: 10/28/2020] [Indexed: 01/22/2023]
Abstract
Recent evidence favours psychological interventions explicitly targeting suicidality; however, group treatments on suicidality are rare and are assumed to have unfavourable effects. We developed two modules specifically addressing suicidality that replace two existing modules in the Metacognitive Training for Depression (D-MCT). The aim of the current study was to examine the feasibility, safety, and acceptability of this intervention (D-MCT/S). Forty-eight inpatients with depression received eight sessions of D-MCT/S over 4 weeks in addition to standard treatment. Patients were assessed before the training, 4 and 8 weeks later regarding suicidality (primary outcome: Beck Suicide Scale [BSS]), hopelessness, depression (e.g. Hamilton Depression Rating Scale [HDRS]), dysfunctional attitudes, and self-esteem. Negative effects of the modules and subjective appraisal were assessed. Suicidality, hopelessness, and depression decreased over time. Whereas the effects on the BSS only reached trend level, a large effect was observed when the suicide item of the HDRS was used. Two of the 46 patients (4%) reported a deterioration in their symptoms, but this was not associated with the D-MCT/S. Negative effects of the general training were rather low, and acceptability was high. In general, patients evaluated the two new modules on suicidality similarly to the established modules. However, both modules were assessed as distressing by 39% of the patients. When we addressed suicidality in the D-MCT/S, we did not observe any contagious effects. In fact, the pilot versions of the two modules on suicidality are promising in terms of feasibility, safety, and acceptability. The results will be used to improve current shortcomings. The trial was registered with the German Clinical Trials Register (#DRKS-ID: DRKS00010543) on 23 August 2016.
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Affiliation(s)
- Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Runde
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Evangelical Hospital Alsterdorf, Hamburg, Germany
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lambert M, Karow A, Gallinat J, Lüdecke D, Kraft V, Rohenkohl A, Schröter R, Finter C, Siem AK, Tlach L, Werkle N, Bargel S, Ohm G, Hoff M, Peter H, Scherer M, Mews C, Pruskil S, Lüke J, Härter M, Dirmaier J, Schulte-Markwort M, Löwe B, Briken P, Peper H, Schweiger M, Mösko M, Bock T, Wittzack M, Meyer HJ, Deister A, Michels R, Herr S, Konnopka A, König H, Wegscheider K, Daubmann A, Zapf A, Peth J, König HH, Schulz H. Study protocol for a randomised controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER). BMJ Open 2020; 10:e036021. [PMID: 32371520 PMCID: PMC7223141 DOI: 10.1136/bmjopen-2019-036021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Healthcare systems around the world are looking for solutions to the growing problem of mental disorders. RECOVER is the synonym for an evidence-based, stepped and cross-sectoral coordinated care service model for mental disorders. RECOVER implements a cross-sectoral network with managed care, comprehensive psychological, somatic and social diagnostics, crisis resolution and a general structure of four severity levels, each with assigned evidence-based therapy models (eg, assertive community treatment) and therapies (eg, psychotherapy). The study rationale is the investigation of the effectiveness and efficiency of stepped and integrated care in comparison to standard care. METHODS AND ANALYSIS The trial is conducted in accordance to the Standard Protocol Items: Recommendations for Interventional Trials Statement. The study aims to compare the RECOVER model with treatment as usual (TAU). The following questions are examined: Does RECOVER reduce healthcare costs compared with TAU? Does RECOVER improve patient-relevant outcomes? Is RECOVER cost-effective compared with TAU? A total sample of 890 patients with mental disorders will be assessed at baseline and individually randomised into RECOVER or TAU. Follow-up assessments are conducted after 6 and 12 months. As primary outcomes, cost reduction, improvement in symptoms, daily functioning and quality of life as well as cost-effectiveness ratios will be measured. In addition, several secondary outcomes will be assessed. Primary and secondary outcomes are evaluated according to the intention-to-treat principle. Mixed linear or logistic regression models are used with the direct maximum likelihood estimation procedure which results in unbiassed estimators under the missing-at-random assumption. Costs due to healthcare utilisation and productivity losses are evaluated using difference-in-difference regressions. ETHICS AND DISSEMINATION Ethical approval from the ethics committee of the Hamburg Medical Association has been obtained (PV5672). The results will be disseminated to service users and their families via the media, to healthcare professionals via professional training and meetings and to researchers via conferences and publications. TRIAL REGISTRATION NUMBER AND REGISTRY NAME ClinicalTrials.gov (NCT03459664), RECOVER PROTOCOL VERSION: 19 March 2020 (V.3.0).
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Affiliation(s)
- Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Lüdecke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Romy Schröter
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Constanze Finter
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna-Katharina Siem
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Tlach
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nathalie Werkle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susann Bargel
- Department of Strategic Business Development, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunda Ohm
- Department of Strategic Business Development, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hoff
- Department of Strategic Business Development, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helmut Peter
- Ambulatory Healthcare Center for Psychotherapy, Psychiatry and Psychosomatic, Cognitive-Behavioral Therapy Falkenried MVZ GmbH, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Mews
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Pruskil
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Lüke
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child- and Youth Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heike Peper
- Chamber for Psychotherapists Hamburg, Hamburg, Germany
| | - Michael Schweiger
- Service Provider for vocational rehabilitation, ARINET GmbH, Hamburg, Hamburg, Germany
| | - Mike Mösko
- Department of Medical Psychology, Research Group on Migration and Psychosocial Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bock
- Irre Menschlich Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Martin Wittzack
- Regional Psychiatric Patient Association Hamburg e.V, Hamburg, Germany
| | - Hans-Jochim Meyer
- Regional Psychiatric Relative Association Hamburg e.V, Hamburg, Germany
| | - Arno Deister
- Center for Psychosocial Medicine, Klinikum Itzehoe, Itzehoe, Schleswig-Holstein, Germany
| | - Rolf Michels
- Center for Psychosocial Medicine, Klinikum Itzehoe, Itzehoe, Schleswig-Holstein, Germany
| | - Stephanie Herr
- Center for Psychosocial Medicine, Klinikum Itzehoe, Itzehoe, Schleswig-Holstein, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Medical Psychology, Professorship Clinical Healthcare Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, Professorship Clinical Healthcare Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Moritz S, Schneider BC, Peth J, Arlt S, Jelinek L. Metacognitive Training for Depression (D-MCT) reduces false memories in depression. A randomized controlled trial. Eur Psychiatry 2018; 53:46-51. [DOI: 10.1016/j.eurpsy.2018.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/08/2018] [Accepted: 05/24/2018] [Indexed: 01/04/2023] Open
Abstract
AbstractMetacognitive Training for Depression (D-MCT) is a highly standardized group program targeted at depression-related (“Beckian”) emotional as well as cognitive biases, including mood-congruent and false memory. While prior results are promising with respect to psychopathological outcomes (depression), it is unclear whether D-MCT also meets its goal of improving cognitive biases, such as false memories.In the framework of a randomized controlled trial (registered trial, DRKS00007907), we investigated whether D-MCT is superior to an active control condition (health training, HT) in reducing the susceptibility of depressed patients for false memories. False memories were examined using parallel versions of a visual variant of the Deese-Roediger McDermott paradigm.Both groups committed less false memories at post assessment after 4 weeks compared to baseline. Relative to HT, D-MCT led to a significant decrease in high-confident false memories over time.The study presents first evidence that D-MCT decreases the susceptibility of depressed patients for false memories, particularly for errors made with high confidence that are presumably the most “toxic” in terms of mood-congruent memory distortions.
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Peth J, Jelinek L, Nestoriuc Y, Moritz S. [Adverse Effects of Psychotherapy in Depressed Patients - First Application of the Positive and Negative Effects of Psychotherapy Scale (PANEPS)]. Psychother Psychosom Med Psychol 2018; 68:391-398. [PMID: 29631298 DOI: 10.1055/s-0044-101952] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Positive and Negative Effects of Psychotherapy Scale (PANEPS), a self report questionnaire to measure positive effects (PE) and unwanted events (UE) during the last psychotherapy (PT), was applied for the first time within a sample of patients with depression. The questionnaires applicability was tested and delivered first empirical results about PE and UE of a PT within this population. METHODS The 43 items of the PANEPS were completed during an online survey by 135 persons with a current or previous depressive disorder. UE were further divided into side effects (SE), malpractice (MP) and unethical misconduct (UM). In addition, sociodemographic information (age, sex, state of relationship), details about previous psychotherapeutic treatment and the last therapy were collected. The PANEPS was tested and revised using a principal components analysis with varimax rotation. RESULTS A four-factor solution was determined, reflecting the previously defined scales (PE, SE, MP, UM) and allowed for further reduction of the PANEPS. The final version of the PANEPS showed satisfactory to excellent internal consistency with Cronbach's α between 0.72 and 0.92 A total of 95.6% of the participants reported at least one PE (range=0-5, M=3.3, SD=1.4) and 52.6% at least one UE (range=0-14, M=1.8, SD=2.9). From the sample, 38.5% reported at least one SE (range=0-6, M=0.8, SD=1.3), 26.7% at least one experience of MP (range=0-10, M=0.9, SD=1.9) und 8.1% at least one case of UM (range=0-4, M=0.1, SD=0.5). PE were negatively correlated with MP, but not with SE and UM. We found associations between characteristics of the sample and occurrence of WE and UE. DISCUSSION Over half of the participants in our study confirmed presence of at least one UE as measured with the PANEPS, with unexpected high approval of at least one MP or UM. Especially the current symptomatology (PHQ-9) seems to be relevant for the approval of PE and UE of a PT. The negative association between PE and MP underlines the importance of guideline-oriented treatment for successful psychotherapy. CONCLUSION Side effects of psychotherapy are common in patients with depression and should be measured regularly.
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Affiliation(s)
- Judith Peth
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Arbeitsgruppe Klinische Neuropsychologie, Hamburg
| | - Lena Jelinek
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Arbeitsgruppe Klinische Neuropsychologie, Hamburg
| | - Yvonne Nestoriuc
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Schön Klinik Hamburg Eilbek, Universitätsklinikum Eppendorf Hamburg und Universitäre Klinik für Psychosomatische Medizin und Psychotherapie, Hamburg
| | - Steffen Moritz
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Arbeitsgruppe Klinische Neuropsychologie, Hamburg
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Peth J, Suchotzki K, Gamer M. Influence of countermeasures on the validity of the Concealed Information Test. Psychophysiology 2016; 53:1429-40. [DOI: 10.1111/psyp.12690] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 05/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Judith Peth
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | | | - Matthias Gamer
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Department of Psychology; University of Würzburg; Würzburg Germany
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Suchotzki K, Verschuere B, Peth J, Crombez G, Gamer M. Manipulating item proportion and deception reveals crucial dissociation between behavioral, autonomic, and neural indices of concealed information. Hum Brain Mapp 2014; 36:427-39. [PMID: 25277495 DOI: 10.1002/hbm.22637] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 11/11/2022] Open
Abstract
Developed as an alternative to traditional deception detection methods, the concealed information test (CIT) assesses recognition of critical (e.g., crime-relevant) "probes." Most often, recognition has been measured as enhanced skin conductance responses (SCRs) to probes compared to irrelevant foils (CIT effect). More recently, also differentially enlarged reaction times (RTs) and increased neural activity in the bilateral inferior frontal gyrus, the right middle frontal gyrus, and the right temporo-parietal junction have been observed. The aims of the current functional magnetic resonance imaging (fMRI) study were to (1) investigate the boundary conditions of the CIT effects in all three measures and thereby (2) gain more insight into the relative contribution of two mechanisms underlying enhanced responding to concealed information (i.e., orienting versus response inhibition). Therefore, we manipulated the proportion of probe versus irrelevant items, and whether suspects were instructed to actively deny recognition of probe knowledge (i.e., deceive) during the test. Results revealed that whereas overt deception was not necessary for the SCR CIT effect, it was crucial for the RT and the fMRI-based CIT effects. The proportion manipulation enhanced the CIT effect in all three measures. The results indicate that different mental processes might underlie the response pattern in the CIT. While skin conductance responding to concealed information may best be explained by orienting theory, it seems that response inhibition drives RT and blood oxygen level dependent responding to concealed information.
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Affiliation(s)
- Kristina Suchotzki
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium; Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Peth J, Kim JS, Gamer M. Fixations and eye-blinks allow for detecting concealed crime related memories. Int J Psychophysiol 2013; 88:96-103. [DOI: 10.1016/j.ijpsycho.2013.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 03/06/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
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Peth J, Regen F, Bajbouj M, Heuser I, Anghelescu I, Hornung OP. The influence of daytime napping versus controlled activity on the subjective well-being of patients with major depression. Psychiatry Res 2012; 200:368-73. [PMID: 22789840 DOI: 10.1016/j.psychres.2012.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 06/13/2012] [Accepted: 06/15/2012] [Indexed: 11/25/2022]
Abstract
While the impact of sleep on cognitive functions such as memory is under extensive study, the role of sleep in modulating a persons' subjective well-being remains largely uncharacterized, especially in groups with psychiatric disorders. To gather more information on this topic a study was conducted with 20 patients suffering from Major Depression (MD) and 20 healthy controls, matched for age, gender and education. All subjects rated their subjective well-being at 10a.m. in the morning. Half of the subjects in each experimental group were given the opportunity to nap in the afternoon between 2p.m. and 3.30p.m., while the other half stayed awake accompanied by controlled activity. All subjects rated their subjective well-being again at 4p.m. Only the group of patients with MD who were given the opportunity to sleep during the day showed a significant improvement in subjective well-being from morning to afternoon. All the other subgroups showed no significant changes across the time interval. The results of this study suggest that depressive patients benefit from daytime naps with regard to their subjective well-being. Further research is needed to determine the exact mechanisms of this improvement.
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Affiliation(s)
- Judith Peth
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany.
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Peth J, Vossel G, Gamer M. Emotional arousal modulates the encoding of crime-related details and corresponding physiological responses in the Concealed Information Test. Psychophysiology 2011; 49:381-90. [DOI: 10.1111/j.1469-8986.2011.01313.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 08/24/2011] [Indexed: 12/01/2022]
Affiliation(s)
- Judith Peth
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg; Germany
| | - Gerhard Vossel
- Department of Psychology, Interdisciplinary Research Group Forensic Psychophysiology; Johannes Gutenberg-University Mainz; Mainz; Germany
| | - Matthias Gamer
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg; Germany
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