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Strumberger MA, Häberling I, Emery S, Albermann M, Baumgartner N, Pedrett C, Wild S, Contin-Waldvogel B, Walitza S, Berger G, Schmeck K, Cajochen C. Inverse association between slow-wave sleep and low-grade inflammation in children and adolescents with major depressive disorder. Sleep Med 2024; 119:103-113. [PMID: 38669833 DOI: 10.1016/j.sleep.2024.04.007] [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: 12/30/2023] [Revised: 03/09/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To investigate the relationship between both self-reported and objective sleep variables and low-grade inflammation in children and adolescents with major depressive disorder (MDD) of moderate to severe symptom severity. METHODS In this cross-sectional study, we examined twenty-nine children and adolescents diagnosed with MDD and twenty-nine healthy controls (HC). Following a one-week actigraphy assessment, comprehensive sleep evaluations were conducted, including a one-night sleep EEG measurement and self-reported sleep data. Plasma high-sensitivity C-reactive protein (hsCRP) was employed as a marker to assess low-grade inflammation. RESULTS No significant difference in hsCRP levels was observed between participants with MDD and HC. Furthermore, after adjusting for sleep difficulties, hsCRP exhibited no correlation with the severity of depressive symptoms. In HC, levels of hsCRP were not linked to self-reported and objective sleep variables. In contrast, depressed participants showed a significant correlation between hsCRP levels and increased subjective insomnia severity (Insomnia Severity Index; r = 0.41, p < 0.05), increased time spent in the N2 sleep stage (r = 0.47, p < 0.01), and decreased time spent in slow-wave sleep (r = - 0.61, p < 0.001). Upon additional adjustments for body mass index, tobacco use and depression severity, only the inverse association between hsCRP and time spent in slow-wave sleep retained statistical significance. Moderation analysis indicated that group status (MDD vs. HC) significantly moderates the association between slow-wave sleep and hsCRP. CONCLUSION Our findings suggest that alterations in the architecture of slow-wave sleep may have a significant influence on modulating low-grade inflammatory processes in children and adolescents with MDD.
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Affiliation(s)
- Michael A Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric Hospital of the University of Basel, Wilhelm-Klein-Str. 27, 4002, Basel, Switzerland; Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Wilhelm-Klein-Str. 27, 4002, Basel, Switzerland; Psychiatric Services Lucerne, Lucerne, Switzerland
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, University of Zurich, Neumünsterallee 9, 8032, Zurich, Switzerland
| | - Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, University of Zurich, Neumünsterallee 9, 8032, Zurich, Switzerland
| | - Mona Albermann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, University of Zurich, Neumünsterallee 9, 8032, Zurich, Switzerland
| | | | - Catrina Pedrett
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, University of Zurich, Neumünsterallee 9, 8032, Zurich, Switzerland
| | - Salome Wild
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, University of Zurich, Neumünsterallee 9, 8032, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, University of Zurich, Neumünsterallee 9, 8032, Zurich, Switzerland
| | - Klaus Schmeck
- Department of Clinical Research, Medical Faculty, University of Basel, Basel, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Wilhelm-Klein-Str. 27, 4002, Basel, Switzerland.
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Osuna E, Baumgartner J, Wunderlin O, Emery S, Albermann M, Baumgartner N, Schmeck K, Walitza S, Strumberger M, Hersberger M, Zimmermann MB, Häberling I, Berger G, Herter-Aeberli I. Iron status in Swiss adolescents with paediatric major depressive disorder and healthy controls: a matched case-control study. Eur J Nutr 2024; 63:951-963. [PMID: 38265750 PMCID: PMC10948461 DOI: 10.1007/s00394-023-03313-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE Depression is associated with low-grade systemic inflammation and impaired intestinal function, both of which may reduce dietary iron absorption. Low iron status has been associated with depression in adults and adolescents. In Swiss adolescents, we determined the associations between paediatric major depressive disorder (pMDD), inflammation, intestinal permeability and iron status. METHODS This is a matched case-control study in 95 adolescents with diagnosed pMDD and 95 healthy controls aged 13-17 years. We assessed depression severity using the Children's Depression Rating Scale-Revised. We measured iron status (serum ferritin (SF) and soluble transferrin receptor (sTfR)), inflammation (C-reactive protein (CRP) and alpha-1-acid-glycoprotein (AGP)), and intestinal permeability (intestinal fatty acid binding protein (I-FABP)). We assessed history of ID diagnosis and treatment with a self-reported questionnaire. RESULTS SF concentrations did not differ between adolescents with pMDD (median (IQR) SF: 31.2 (20.2, 57.0) μg/L) and controls (32.5 (22.6, 48.3) μg/L, p = 0.4). sTfR was lower among cases than controls (4.50 (4.00, 5.50) mg/L vs 5.20 (4.75, 6.10) mg/L, p < 0.001). CRP, AGP and I-FABP were higher among cases than controls (CRP: 0.16 (0.03, 0.43) mg/L vs 0.04 (0.02, 0.30) mg/L, p = 0.003; AGP: 0.57 (0.44, 0.70) g/L vs 0.52 (0.41, 0.67) g/L, p = 0.024); I-FABP: 307 (17, 515) pg/mL vs 232 (163, 357) pg/mL, p = 0.047). Of cases, 44% reported having a history of ID diagnosis compared to 26% among controls (p = 0.020). Finally, 28% of cases had iron treatment at/close to study inclusion compared to 14% among controls. CONCLUSION Cases had significantly higher systemic inflammation and intestinal permeability than controls but did not have lower iron status. Whether this is related to the higher rate of ID diagnosis and iron treatment in adolescents with depression is uncertain.
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Affiliation(s)
- Ester Osuna
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Jeannine Baumgartner
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
- Department of Nutritional Sciences, King's College London, London, UK
| | - Olivia Wunderlin
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Mona Albermann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Noemi Baumgartner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Psychiatry St. Gallen, Wil SG, Switzerland
| | - Klaus Schmeck
- Department of Clinical Research, Medical Faculty, University of Basel, Basel, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Michael Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Basel, Switzerland
| | - Martin Hersberger
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland.
- Laboratory of Nutrition and Metabolic Epigenetics, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.
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Spiegel R, Notter M, Lazari O, Schmeck K, Herbrecht E. Clinical utility of the standardized observation tool Autism Behavior Coding System for early intervention research in autism spectrum disorder. Autism Res 2023; 16:2415-2431. [PMID: 37937753 DOI: 10.1002/aur.3047] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/14/2023] [Indexed: 11/09/2023]
Abstract
The Autism Behavior Coding System (ABCS) was developed to help evaluating the effectiveness of early intensive interventions in children with autism spectrum disorder (ASD). The video-based ABCS assesses eight core autistic behavioral variables during therapist-child interaction using standardized quantitative criteria, four behaviors according to their frequency of occurrence, four according to their duration. The present study focuses (1) on the correspondence of ABCS scores with scores on two standard clinical instruments (the ADOS-2 and an ASD-adaptation of the Children's Global Assessment Scale, DD-CGAS), (2) on the sensitivity to change of ABCS scores by the end of an intensive 18 days intervention period (EIP) and (c) on the predictability of short- and longer-term changes in social and repetitive behaviors from ABCS scores at baseline and EIP. Data from 51 children (42 M, 9 F; median age 45 months) followed over 1 year were available. There were significant correlations at baseline between several ABCS scores and ADOS-2 as well as DD-CGAS scores. Correlations at EIP between some ABCS and DD-CGAS scores were highly significant. Four ABCS scores reflected significant changes from baseline to EIP. Several baseline ABCS scores were predictive of DD-CGAS and ADOS-2 scores at EIP and Year 1. However, associations between ABCS score changes from baseline to EIP and the clinical scale changes by Year 1 were not significant. It is concluded that several ABCS scores have adequate clinical validity and sensitivity to change. The short-term changes in ABCS scores and their relationship to longer-term clinical changes need further study.
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Affiliation(s)
- René Spiegel
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Marianne Notter
- Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Olga Lazari
- Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Evelyn Herbrecht
- Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
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Boonmann C, Bürgin D, Jenkel N, Schmeck K, Schmid M. Limited prosocial emotions (LPE) specifier in conduct disorder and offending behavior: findings from a 10-year prospective longitudinal study of juveniles in residential care. Child Adolesc Psychiatry Ment Health 2023; 17:132. [PMID: 38017567 PMCID: PMC10685542 DOI: 10.1186/s13034-023-00676-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Since the introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, a limited prosocial emotion (LPE) specifier has been added to the conduct disorder (CD) diagnosis in addition to the age of onset specifier. It was suggested that this would identify a subgroup with severe antisocial and/or aggressive behavior with serious current and future (mental health) impairment. Research in recent years has shown that this is indeed a subgroup with severe antisocial behavior; however, mental health problems do not appear to differ from those of youth with CD without LPE. Most research to date has been cross-sectional. However, longitudinal research is urgently needed to better understand the predictive value of the LPE specifier. The aim of the current longitudinal study is to examine future offending behavior of youth with CD with compared to youth without the LPE specifier. In addition, the predictive value of the categorical LPE specifier and the dimensional LPE score will be examined beyond factors that are strongly associated with future offending (i.e., gender, age, and prior offending). METHODS Adolescents and young adults (12-25) with CD (assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]) with (N = 61) and without (N = 75) the LPE specifier (assessed with the Callous-Unemotional [CU] dimension of the Youth Psychopathic traits Inventory [YPI]) (in line with Jambroes et al., 2016) were compared on sociodemographic characteristics, mental health problems and offending behavior. Future (general and violent) offending was based on official conviction data. RESULTS Our results showed that youth with CD with and without the LPE specifier did not differ in self-reported and informant-reported mental health problems. However, youth with CD with the LPE specifier showed more offending behavior and personality pathology at baseline. In addition, the categorical LPE specifier was associated with future general offending, but not with future violent offending. The dimensional LPE score was associated with both future general and violent offending. However, after adjustment for gender, age, and prior delinquency, these associations disappeared, with the exception of the association between the dimensional LPE score and violent offending, which remained significant even after controlling for gender, age, and prior violent offending. DISCUSSION In conclusion, there seems to be evidence of a relationship between limited prosocial emotions and future offending behavior in youth with CD. This relationship, however, should not be overestimated, as there are other (static) factors (e.g. gender and prior offending behavior) that also have a strong influence on future (violent) offending behavior. Still, from a clinical point of view, a dynamic factor like prosocial emotional skills is a good focus for reducing the risk of future offending behavior.
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Affiliation(s)
- Cyril Boonmann
- Department of Child and Adolescent Psychiatry, University Psychiatric Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Hospitals, University of Basel, Basel, Switzerland.
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - David Bürgin
- Department of Child and Adolescent Psychiatry, University Psychiatric Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Nils Jenkel
- Department of Child and Adolescent Psychiatry, University Psychiatric Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry, University Psychiatric Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Marc Schmid
- Department of Child and Adolescent Psychiatry, University Psychiatric Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
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5
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Steppan M, Zimmermann R, Fürer L, Southward M, Koenig J, Kaess M, Kleinbub JR, Roth V, Schmeck K. Machine Learning Facial Emotion Classifiers in Psychotherapy Research: A Proof-of-Concept Study. Psychopathology 2023:1-10. [PMID: 38011846 DOI: 10.1159/000534811] [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: 09/06/2022] [Accepted: 10/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND New advances in the field of machine learning make it possible to track facial emotional expression with high resolution, including micro-expressions. These advances have promising applications for psychotherapy research, since manual coding (e.g., the Facial Action Coding System), is time-consuming. PURPOSE We tested whether this technology can reliably identify in-session emotional expression in a naturalistic treatment setting, and how these measures relate to the outcome of psychotherapy. METHOD We applied a machine learning emotion classifier to video material from 389 psychotherapy sessions of 23 patients with borderline personality pathology. We validated the findings with human ratings according to the Clients Emotional Arousal Scale (CEAS) and explored associations with treatment outcomes. RESULTS Overall, machine learning ratings showed significant agreement with human ratings. Machine learning emotion classifiers, particularly the display of positive emotions (smiling and happiness), showed medium effect size on median-split treatment outcome (d = 0.3) as well as continuous improvement (r = 0.49, p < 0.05). Patients who dropped out form psychotherapy, showed significantly more neutral expressions, and generally less social smiling, particularly at the beginning of psychotherapeutic sessions. CONCLUSIONS Machine learning classifiers are a highly promising resource for research in psychotherapy. The results highlight differential associations of displayed positive and negative feelings with treatment outcomes. Machine learning emotion recognition may be used for the early identification of drop-out risks and clinically relevant interactions in psychotherapy.
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Affiliation(s)
- Martin Steppan
- Faculty of Psychology, University of Basel, Basel, Switzerland
- Psychiatric University Hospital, Basel, Switzerland
| | - Ronan Zimmermann
- Faculty of Psychology, University of Basel, Basel, Switzerland
- Psychiatric University Hospital, Basel, Switzerland
| | - Lukas Fürer
- Psychiatric University Hospital, Basel, Switzerland
| | - Matthew Southward
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Johann Roland Kleinbub
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Volker Roth
- Department of Mathematics and Informatics, University of Basel, Basel, Switzerland
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Bürgin D, Witt A, Seker S, d'Huart D, Meier M, Jenkel N, Boonmann C, Schmeck K, Fegert JM, Schmid M. Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis. Dev Psychopathol 2023:1-16. [PMID: 37990404 DOI: 10.1017/s0954579423001426] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.
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Affiliation(s)
- David Bürgin
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Andreas Witt
- Department of Child and Adolescent Psychiatry, University Psychiatric Services Berne, Berne, Switzerland
| | - Süheyla Seker
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Delfine d'Huart
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Maria Meier
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Constance, Germany
| | - Nils Jenkel
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry - LUMC Curium, Leiden University Medical Center, Leiden, The Netherlands
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm, Ulm, Germany
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
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Osuna E, Herter-Aeberli I, Probst S, Emery S, Albermann M, Baumgartner N, Strumberger M, Ricci C, Schmeck K, Walitza S, Hersberger M, Zimmermann MB, Häberling I, Berger G, Baumgartner J. Associations of n-3 polyunsaturated fatty acid status and intake with paediatric major depressive disorder in Swiss adolescents: A case-control study. J Affect Disord 2023; 339:355-365. [PMID: 37437731 DOI: 10.1016/j.jad.2023.07.046] [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: 02/13/2023] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Observational studies suggest a link between n-3 polyunsaturated fatty acid (PUFA) intake, n-3 PUFA status, and depression in adults, but studies in adolescents are scarce. This study aimed to determine associations of n-3 PUFA status and intake with paediatric major depressive disorder (pMDD) in Swiss adolescents. METHODS We conducted a matched case-control study in 95 adolescents diagnosed with pMDD and 95 healthy controls aged 13 to <18 years. We analysed red blood cell (RBC) fatty acid (FA) composition (% of total FA). n-3 PUFA intake was assessed using a focused food frequency questionnaire and depression severity was assessed by the Children's Depression Rating Scale-Revised (CDRS-R). RESULTS Mean RBC eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were lower in cases than controls (EPA: 0.41 ± 0.11 vs 0.46 ± 0.12, p < 0.001; DHA: 4.07 ± 1.04 vs 4.73 ± 1.04, p < 0.001). Subsequently, the mean RBC n-3 index was lower (4.51 ± 1.10 vs 5.20 ± 1.11, p < 0.001) and the n-6/n-3 PUFA ratio higher (5.51 ± 1.25 vs 4.96 ± 1.08, p < 0.001) in cases than controls. Adolescents with a higher n-3 index had lower odds for depression (OR = 0.49 [95% CI: 0.32-0.71]). In contrast, the n-6/n-3 PUFA ratio was associated with higher odds for depression (OR = 1.58 [95% CI: 1.14-2.25]). Intake of alpha-linolenic acid, EPA and DHA did not differ between cases and controls. CONCLUSION Our results suggest that a higher RBC n-3 PUFA status during adolescence is associated with a lower risk for pMDD, whereas a higher n-6/n-3 PUFA ratio is associated with a higher risk for pMDD. Differences in n-3 PUFA intake did not explain the observed differences in n-3 PUFA status.
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Affiliation(s)
- Ester Osuna
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Switzerland
| | - Silvia Probst
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Switzerland
| | - Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Switzerland
| | - Mona Albermann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Switzerland
| | - Noemi Baumgartner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Switzerland; Psychiatry St. Gallen, Wil, SG, Switzerland
| | - Michael Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Switzerland
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHER), North-West University, Potchefstroom, South Africa
| | - Klaus Schmeck
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Switzerland
| | - Martin Hersberger
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich, University of Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Switzerland
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Switzerland
| | - Jeannine Baumgartner
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Switzerland; Department of Nutritional Sciences, King's College London, London, United Kingdom.
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8
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Strumberger MA, Häberling I, Emery S, Albermann M, Baumgartner N, Bucher N, Erb S, Bachmann S, Wöckel L, Müller-Knapp U, Contin-Waldvogel B, Rhiner B, Walitza S, Berger G, Cajochen C, Schmeck K. Sleep disturbance, but not depression severity, is associated with inflammation in children and adolescents. J Clin Sleep Med 2023; 19:1775-1784. [PMID: 37323001 PMCID: PMC10545993 DOI: 10.5664/jcsm.10678] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
STUDY OBJECTIVES We aimed to examine the association between self-rated and clinician-rated sleep disturbances and C-reactive protein (CRP), an objective marker of inflammation, in pediatric depression. METHODS Two hundred fifty-six children and adolescents (15.2 ± 1.6 y, 72.3% female) with moderate to severe symptoms of depression participated in the study. Sleep disturbances were assessed by self-reports (Insomnia Severity Index) and clinician ratings (Kiddie-Schedule for Affective Disorder and Schizophrenia), inflammation by plasma CRP levels. RESULTS Higher levels of CRP correlated positively with clinician-rated middle insomnia and hypersomnia. After adjusting for control variables (body mass index, tobacco, alcohol, stress, age, sex, antidepressants, sleep medication, depression severity), regression models confirmed the significant association of clinician-rated hypersomnia and middle insomnia symptoms with elevated CRP levels. In the adjusted regression models, other clinician-rated manifestations of sleep disturbance (eg, initial insomnia) and insomnia self-ratings were not significantly associated with CRP. Body mass index correlated positively with CRP, but body mass index had no mediating effect on the associations between sleep disturbances and CRP. We did not find an association between depression severity, assessed by the Children's Depression Rating Scale-Revised, and CRP. CONCLUSIONS Results of the present study indicate a significant association of hypersomnia and middle insomnia symptoms with CRP in pediatric depression, not linked to alterations in the body mass index. CITATION Strumberger MA, Häberling I, Emery S, et al. Sleep disturbance, but not depression severity, is associated with inflammation in children and adolescents. J Clin Sleep Med. 2023;19(10):1775-1784.
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Affiliation(s)
- Michael A. Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Mona Albermann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | | | - Naïma Bucher
- Research Department of Child and Adolescent Psychiatry, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Suzanne Erb
- Child and Adolescent Psychiatric Services St. Gallen, St. Gallen, Switzerland
| | - Silke Bachmann
- Department of Psychiatry, University Hospitals of Geneva, Thônex, Switzerland
- Department of Psychiatry Psychotherapy, Psychosomatic Medicine, Medical Faculty of Martin Luther University, Halle, Germany
| | - Lars Wöckel
- Research Department of Child and Adolescent Psychiatry, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Clienia Littenheid AG, Littenheid, Switzerland
| | | | | | - Bruno Rhiner
- Child and Adolescent Psychiatric Services Thurgau, Münsterlingen, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Research Department of Child and Adolescent Psychiatry, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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Mazreku G, Birkhölzer M, Cosgun S, Kerber A, Schmeck K, Goth K. Impaired Personality Functioning in Children and Adolescents Assessed with the LoPF-Q 6-18 PR in Parent-Report and Convergence with Maladaptive Personality Traits and Personality Structure in School and Clinic Samples. Children (Basel) 2023; 10:1186. [PMID: 37508683 PMCID: PMC10378110 DOI: 10.3390/children10071186] [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] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
To investigate if the Personality Disorder (PD) severity concept (Criterion A) of the ICD-11 and DSM-5 AMPD is applicable to children and adolescents, following the ICD-11 lifespan perspective of mental disorders, age-specific and informant-adapted assessment tools are needed. The LoPF-Q 6-18 PR (Levels of Personality Functioning Questionnaire Parent Rating) was developed to assess Impaired Personality Functioning (IPF) in children aged 6-18 in parent-reported form. It is based on the established self-report questionnaire LoPF-Q 12-18. Psychometric properties were investigated in a German-speaking clinical and school sample containing 599 subjects. The final 36-item version of LoPF-Q 6-18 PR showed good scale reliabilities with 0.96 for the total scale IPF and 0.90-0.87 for the domain scales Identity, Self-direction, Empathy, and Intimacy/Attachment and an acceptable model fit in a hierarchical CFA with CFI = 0.936, RMSEA = 0.078, and SRMR = 0.068. The total score discriminated significantly and with large effect sizes between the school population and (a) adolescent PD patients (d = 2.7 standard deviations) and (b) the younger patients (6-11-year-olds) with internalizing and externalizing disorders (d = 2.2 standard deviations). Informant agreement between parent and self-report was good at 0.47. Good construct validity can be assumed given sound covariation with related measures of psychopathology (CBCL 4-18, STiP-5.1, OPD-CA2-SQ PR) and maladaptive traits (PID5BF+ M CA IRF) in line with theory and matching the result patterns obtained in older samples in self-report. The results suggest that parent-reported assessments of IPF and maladaptive traits are equivalent to self-reported measures for Criterion A and B. Assessing IPF as early as age six might be a valuable step to foster early detection of PD, or maladaptive personality development, respectively individuals at risk.
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Affiliation(s)
- Gresa Mazreku
- Department of Forensic Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, 4002 Basel, Switzerland
| | - Marc Birkhölzer
- Department of Forensic Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, 4002 Basel, Switzerland
| | | | - André Kerber
- Department of Clinical Psychological Intervention, Freie Universität Berlin, 14195 Berlin, Germany
| | - Klaus Schmeck
- Department of Clinical Research, Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Kirstin Goth
- Department of Forensic Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, 4002 Basel, Switzerland
- Department of Child and Adolescent Psychiatry, University Clinics Saarland (UKS), 66421 Homburg, Germany
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10
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Albermann M, Emery S, Baumgartner N, Strumberger M, Erb S, Wöckel L, Müller-Knapp U, Rhiner B, Contin-Waldvogel B, Bachmann S, Schmeck K, Berger G, Häberling I. Executive functions and borderline personality features in adolescents with major depressive disorder. Front Hum Neurosci 2023; 17:957753. [PMID: 37425294 PMCID: PMC10325791 DOI: 10.3389/fnhum.2023.957753] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background Executive functions (EF) consolidate during adolescence and are impaired in various emerging psychiatric disorders, such as pediatric Major Depressive Disorder (pMDD) and Borderline Personality Disorder. Previous studies point to a marked heterogeneity of deficits in EF in pMDD. We examined the hypothesis that deficits in EF in adolescents with pMDD might be related to comorbid Borderline Personality features (BPF). Methods We examined a sample of 144 adolescents (15.86 ± 1.32) diagnosed with pMDD. Parents rated their child's EF in everyday life with the Behavior Rating Inventory of Executive Function (BRIEF) and BPF with the Impulsivity and Emotion Dysregulation Scale (IED-27). The adolescents completed equivalent self-rating measures. Self- and parent-ratings of the BRIEF scores were compared with paired t-Tests. Correlation and parallel mediation analyses, ICC, and multiple regression analyses were used to assess symptom overlap, parent-child agreement, and the influence of depression severity. Results Over the whole sample, none of the self- or parent-rated BRIEF scales reached a mean score above T > 65, which would indicate clinically impaired functioning. Adolescents tended to report higher impairment in EF than their parents. Depression severity was the strongest predictor for BPF scores, with Emotional Control predicting parent-rated BPF and Inhibit predicting self-rated BPF. Furthermore, the Behavioral Regulation Index, which includes EF closely related to behavioral control, significantly mediated the relationship between depression severity and IED-27 factors emotional dysregulation and relationship difficulties but not non-suicidal self-injuries. Conclusion On average, adolescents with depression show only subtle deficits in executive functioning. However, increased EF deficits are associated with the occurrence of comorbid borderline personality features, contributing to a more severe overall psychopathology. Therefore, training of executive functioning might have a positive effect on psychosocial functioning in severely depressed adolescents, as it might also improve comorbid BPF. Clinical trial registration www.ClinicalTrials.gov, identifier NCT03167307.
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Affiliation(s)
- Mona Albermann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zürich, Switzerland
| | - Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zürich, Switzerland
| | | | - Michael Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Basel, Switzerland
| | - Suzanne Erb
- Child and Adolescent Psychiatric Services St. Gallen, St. Gallen, Switzerland
| | - Lars Wöckel
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Basel, Switzerland
- Clienia Littenheid AG, Littenheid, Switzerland
| | | | - Bruno Rhiner
- Child and Adolescent Psychiatry Thurgau, Weinfelden, Switzerland
| | | | - Silke Bachmann
- University Clinic of the Martin-Luther University Halle – Wittenberg’s Medical Faculty, Halle, Germany
- Département de Psychiatrie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Klaus Schmeck
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Basel, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zürich, Switzerland
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zürich, Switzerland
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11
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d’Huart D, Seker S, Bürgin D, Birkhölzer M, Boonmann C, Schmid M, Schmeck K, Bach B. Key insights from studies on the stability of personality disorders in different age groups. Front Psychiatry 2023; 14:1109336. [PMID: 37398598 PMCID: PMC10309036 DOI: 10.3389/fpsyt.2023.1109336] [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: 11/27/2022] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
While for decades, temporal stability has been conceived as a defining feature of personality disorders (PDs), cumulative findings appear to question the stability of PDs and PD symptoms over time. However, stability itself is a complex notion and findings are highly heterogenous. Building upon a literature search from a systematic review and meta-analysis, this narrative review aims to capture key findings in order to provide critical implications, both for clinical practice and future research. Taken together, this narrative review revealed that unlike previous assumptions, stability estimates in adolescence are comparable to stability estimates in adulthood and PDs and PD symptoms are not that stable. The extent of stability itself depends yet on various conceptual, methodological, environmental, and genetic factors. While findings were thus highly heterogenous, they all seem to converge in a notable trend towards symptomatic remission, except for high-risk-samples. This challenges the current understanding of PDs in terms of disorders and symptoms and argues instead in favor of the AMPD and ICD-11 reintroducing the idea of self and interpersonal functioning as the core feature of PDs.
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Affiliation(s)
- Delfine d’Huart
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Marc Birkhölzer
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
- LUMC Curium—Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Bo Bach
- Center of Excellence on Personality Disorder, Psychiatric Research Unit, Region Zealand, Slagelse Psychiatric Hospital, Slagelse, Denmark
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12
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d'Huart D, Seker S, Bürgin D, Birkhölzer M, Boonmann C, Schmid M, Schmeck K. The stability of personality disorders and personality disorder criteria: A systematic review and meta-analysis. Clin Psychol Rev 2023; 102:102284. [PMID: 37116251 DOI: 10.1016/j.cpr.2023.102284] [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] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/29/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
The aim of this systematic review and meta-analysis was to investigate the diagnostic, the dimensional mean-level, and rank-order stability of personality disorders (PDs) and PD criteria over time. EMBASE, PsycInfo, PubMed, and Web of Science were searched for peer-reviewed studies published in either English, German, or French between the first publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 and December 20, 2022. Inclusion criteria were a prospective longitudinal study design, assessing the stability of PDs or PD criteria over at least two measurement occasions at least one month apart, and using the same assessment at baseline and follow-up. Effect sizes included proportion of enduring cases (i.e., diagnostic stability), test-retest correlations (i.e., dimensional rank-order stability), and within-group standardized mean differences (i.e., dimensional mean-level stability), based on the first and last available measurement occasion. From an initial pool of 1473 studies, 40 were included in our analyses, covering 38,432 participants. 56.7% maintained the diagnosis of any PD, and 45.2% maintained the diagnosis of borderline PD over time. Findings on the dimensional mean-level stability indicate that most PD criteria significantly decreased from baseline to follow-up, except for antisocial, obsessive-compulsive, and schizoid PD criteria. Findings on the dimensional rank-order stability suggested moderate estimates, except for antisocial PD criteria, which were found to be high. Findings indicated that both PDs and PD criteria were only moderately stable, although between study heterogeneity was high, and stability itself depended on several methodological factors.
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Affiliation(s)
- Delfine d'Huart
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland. Delfine.d'
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Marc Birkhölzer
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland; Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland; LUMC Curium - Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Clinical Research, Medical Faculty, University of Basel, Basel, Switzerland
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13
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Davanzo A, D Huart D, Seker S, Moessner M, Zimmermann R, Schmeck K, Behn A. Study Features and Response Compliance in Ecological Momentary Assessment Research in Borderline Personality Disorder: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e44853. [PMID: 36920466 PMCID: PMC10131785 DOI: 10.2196/44853] [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] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity, and interpersonal relationships, which typically result in significant and negative deterioration of the person's overall functioning and well-being. Measuring and characterizing the rapidly changing patterns of instability in BPD dysfunction as they occur in a person's daily life can be challenging. Ecological momentary assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research and, thus, is well suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are characterized by frequent repeated assessments that are delivered to participants in real-life, real-time settings using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant, considering all planned prompts sent. Low compliance with prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated, and estimated. OBJECTIVE This systematic meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD. METHODS A systematic review was conducted on November 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features. RESULTS In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates. CONCLUSIONS Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can be aggregated and interpreted jointly.
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Affiliation(s)
- Antonella Davanzo
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | - Delfine D Huart
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Markus Moessner
- University Hospital Heidelberg, Center for Psychotherapy Research, Heidelberg, Germany
| | - Ronan Zimmermann
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Alex Behn
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
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14
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Schmeck K, Weise S, Schlüter-Müller S, Birkhölzer M, Fürer L, Koenig J, Krause M, Lerch S, Schenk N, Valdes N, Zimmermann R, Kaess M. Effectiveness of adolescent identity treatment (AIT) versus DBT-a for the treatment of adolescent borderline personality disorder. Personal Disord 2023; 14:148-160. [PMID: 35587408 DOI: 10.1037/per0000572] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality disorder (BPD) is among the most severe mental health problems with long-lasting deterioration of functioning. According to a Cochrane review, evidence for methods focused on treatment for adolescent BPD patients is very limited. Aims of the study were to demonstrate the noninferiority of adolescent identity treatment (AIT) compared with dialectical behavior therapy for adolescents (DBT-A), and that intensive early treatment of BPD leads to significant improvement of psychosocial and personality functioning in adolescent patients. In a nonrandomized controlled trial using a noninferiority approach, we compared 37 patients treated with DBT-A with 23 patients treated with AIT. Both treatments included 25 weekly individual psychotherapy sessions and five to eight family sessions. Patients were assessed at four timepoints: baseline, posttreatment, 1- and 2-year follow-up. Primary outcome was psychosocial functioning at 1-year follow-up. We performed both intention-to-treat analyses and per-protocol analyses (completers). Baseline characteristics of both groups were not significantly different except for age and self-injurious behavior. In all, six AIT patients (26%) and 10 DBT-A patients (27%) dropped out of treatment. Both DBT-A and AIT significantly improved adolescents' psychosocial functioning (AIT: d = 1.82; DBT-A: d = 1.73) and personality functioning. BPD criteria and depression were significantly reduced by both treatments. Overall, AIT was found to be not inferior to DBT-A and even more efficient in reducing BPD criteria. Both treatments are highly effective in improving psychosocial functioning and personality functioning in adolescent BPD patients. AIT is a promising approach and not inferior to DBT-A in respect to treatment efficiency. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Klaus Schmeck
- Child and Adolescent Psychiatric Research Department
| | - Sindy Weise
- Department of Child and Adolescent Psychiatry
| | | | | | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy
| | - Mariane Krause
- Millennium Institute for Research in Depression and Personality
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy
| | | | - Nelson Valdes
- Millennium Institute for Research in Depression and Personality
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15
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Bäumer AV, Fürer L, Birkenberger C, Wyssen A, Steppan M, Zimmermann R, Gaab J, Kaess M, Schmeck K. The impact of outcome expectancy on therapy outcome in adolescents with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:30. [PMID: 36464739 PMCID: PMC9721041 DOI: 10.1186/s40479-022-00200-1] [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: 05/17/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Outcome expectancy has been found to be a significant predictor of psychotherapy outcome. However, given that severity, chronicity and comorbidity are moderators of outcome expectancy, it is important to provide evidence of whether the same holds true in clinical conditions marked by these attributes, such as in borderline personality disorder (BPD). The aim of the present study was to investigate the role of patients' outcome expectancy in adolescents undergoing early intervention for BPD using pre-post difference of psychosocial functioning as outcome. METHODS Forty-four adolescent BPD patients were treated with Dialectical Behavior Therapy for Adolescents (DBT-A) or Adolescent Identity Treatment (AIT). We investigated the effect of outcome expectancy on outcome with type of treatment as moderator. Based on the relevant literature, we assess the correlation between outcome expectancy and pretreatment symptomatology, namely BPD severity, personality functioning, childhood trauma and depression. RESULTS The results showed a significant effect of expectancy on outcome (stand. β = 0.30, p = 0.020) above autoregression. ANOVA analysis revealed no difference between the two treatments. Further, results indicate that pretreatment symptomatology, i.e., depression, childhood trauma and personality functioning dimensions self-direction and intimacy, are associated with early treatment expectancy. CONCLUSION Outcome expectancy as a common factor plays a key role in successful psychotherapy with adolescent BPD patients. Elevated pretreatment depression, childhood trauma and impairment in personality functioning dimensions self-direction and intimacy are risk factors associated with lower expectancy. Low outcome expectancy should be addressed in early psychotherapy to improve the therapeutical process.
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Affiliation(s)
- Anna-Valeska Bäumer
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland.
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland
| | - Carolin Birkenberger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Martin Steppan
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland.,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland
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16
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Aebi M, Krause C, Barra S, Vogt G, Vertone L, Manetsch M, Imbach D, Endrass J, Rossegger A, Schmeck K, Bessler C. What Kind of Therapy Works With Juveniles Who Have Sexually Offended? A Randomized-Controlled Trial of Two Versions of a Specialized Cognitive Behavioral Outpatient Treatment Program. Sex Abuse 2022; 34:973-1002. [PMID: 35230203 DOI: 10.1177/10790632211070804] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There is ongoing debate about whether specialized treatment is effective to reduce sexual recidivism in juveniles who have sexually offended (JSOs). Although most treatment programs are based on cognitive behavioral therapy principles for preventing sexual offending, accordant scientific evidence is poor. Following CONSORT guidelines, the present study aimed to evaluate two versions of a short-term outpatient treatment program for JSOs in Switzerland: (a) the Therapy Program for Adequate Sexual Behaviors Version 1 (ThePaS-I), which included offending-specific skills training; (b) the ThePaS-II, which included general socioemotional skills training. Based on changes in self-reported mental health, sexual behaviors, victim empathy, and therapist-rated risk, as well as comprehensive data on sexual and general recidivism, we found some similarities regarding the effects of the two treatments. ThePaS-II showed better short-term changes in self-reported mental health than the ThePaS-I. However, JSOs in the ThePaS-I showed lower rates of sexual reoffending (but not general reoffending) after treatment than those in the ThePaS-II. Despite some methodological limitations, the current findings favor offending-specific skills-based therapy over general skills-based ones for preventing sexual reoffenses. The findings may encourage further methodologically sound studies to examine different treatment approaches for juveniles and adults who have committed criminal offenses.
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Affiliation(s)
- Marcel Aebi
- Department of Justice and Home Affairs, Research & Development, Corrections and Rehabilitation, Canton of Zurich, Zurich, Switzerland
- Department of Forensic Psychiatry, Child and Adolescent Forensic Psychiatry, 363320University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Chiara Krause
- Department of Forensic Psychiatry, Child and Adolescent Forensic Psychiatry, 363320University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Steffen Barra
- Institute for Forensic Psychology and Psychiatry, Neurocenter - Saarland University Medical Center, Homburg/Saar, Homburg/Saar, Germany
| | - Gunnar Vogt
- Department of Justice and Home Affairs, Psychiatric-Psychological Services, Corrections and Rehabilitation, Canton of Zurich, Zurich, Switzerland
| | - Leonardo Vertone
- Department of Forensic Psychiatry, Child and Adolescent Forensic Psychiatry, 363320University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Madleina Manetsch
- Department of Forensic Child and Adolescent Psychiatry, Forensic Psychiatric Clinic, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | | | - Jérôme Endrass
- Department of Justice and Home Affairs, Research & Development, Corrections and Rehabilitation, Canton of Zurich, Zurich, Switzerland
- Department of Forensic Psychology, University of Konstanz, Konstanz, Germany
| | - Astrid Rossegger
- Department of Justice and Home Affairs, Research & Development, Corrections and Rehabilitation, Canton of Zurich, Zurich, Switzerland
- Department of Forensic Psychology, University of Konstanz, Konstanz, Germany
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Cornelia Bessler
- Department of Justice and Home Affairs, Research & Development, Corrections and Rehabilitation, Canton of Zurich, Zurich, Switzerland
- Department of Forensic Psychiatry, Child and Adolescent Forensic Psychiatry, 363320University Hospital of Psychiatry Zurich, Zurich, Switzerland
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d'Huart D, Hutsebaut J, Seker S, Schmid M, Schmeck K, Bürgin D, Boonmann C. Personality functioning and the pathogenic effect of childhood maltreatment in a high-risk sample. Child Adolesc Psychiatry Ment Health 2022; 16:95. [PMID: 36451183 PMCID: PMC9710065 DOI: 10.1186/s13034-022-00527-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND While the psychopathological sequalae of childhood maltreatment are widely acknowledged, less is known about the underlying pathways by which childhood maltreatment might lead to an increased risk for mental health problems. Recent studies indicated that impaired personality functioning might mediate this relationship. The aim of the present paper was to extend the current literature by investigating the mediating effect of impaired personality functioning between different types of childhood maltreatment and self-reported mental health problems in a high-risk sample. METHODS Overall, 173 young adults (mean age = of 26.61 years; SD = 3.27) with a history of residential child welfare and juvenile justice placements in Switzerland were included in the current study. The Childhood Trauma Questionnaire (CTQ-SF), Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1) and the self-report questionnaires of the Achenbach System of Empirically Based Assessment scales (ASEBA) were used. Mediation analyses were conducted through structural equation modeling. RESULTS Overall, 76.3% (N = 132) participants indicated at least one type of childhood maltreatment, with emotional neglect being most commonly reported (60.7%). A total of 30.6% (N = 53) participants self-reported mental health problems. Emotional abuse (r = 0.34; p < .001) and neglect (r = 0.28; p < .001) were found to be most strongly associated with mental health problems. In addition, impaired personality functioning was fond to be a significant mediator for overall childhood maltreatment (β = 0.089; p = 0.008) and emotional neglect (β = 0.077; p = 0.016). Finally, impaired self-functioning was found to be a significant mediator when both self-functioning and interpersonal functioning were included as potential mediators in the relationship between overall childhood maltreatment (β1 = 0.177, p1 = 0.007) and emotional neglect (β1 = 0.173, p1 = 0.003). CONCLUSION Emotional neglect may be particularly important in the context of childhood maltreatment, personality functioning, and mental health problems and, therefore, should not be overlooked next to the more "obvious" forms of childhood maltreatment. Combining interventions designed for personality functioning with trauma-informed practices in standard mental health services might counteract the psychopathological outcomes of maltreated children and adolescents.
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Affiliation(s)
- Delfine d'Huart
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland.
| | - Joost Hutsebaut
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Viersprong Institute for Studies on Personality Disorders, De Viersprong, Halsteren, The Netherlands
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
- LUMC Curium - Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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18
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Schröder M, Seker S, d’Huart D, Izat Y, Bolten M, Schmeck K, Schmid M. The Relationship of Temperament and Character, Parental Stress, and Mental Health Problems with Attachment Disorders among Children. Int J Environ Res Public Health 2022; 19:15458. [PMID: 36497530 PMCID: PMC9737910 DOI: 10.3390/ijerph192315458] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
According to Cloninger's model, personality is conceptualized in temperament and character traits contributing to a child's psychosocial development. Additionally, parent-child interaction is important for the child's socio-emotional development. To date, the relationship between attachment and temperament and character for child mental health development and its effects on parents remains mostly unclear. The aim of the present study was thus to examine the relationship of attachment, temperament and character, parental stress, and mental health problems among 125 children (mean age = 7.14 years) in Switzerland. Temperament and character, attachment disorder (symptoms), parental stress, and mental health problems were assessed with psychometric questionnaires; attachment was assessed with an additional observational measure. Descriptive characters of the sample were presented, and group differences and correlations were computed. For temperament traits, results revealed significant group differences for novelty seeking and persistence and attachment disorder types. For character traits, the findings showed significant group differences for self-directedness and cooperativeness and attachment disorder types. Moderate effect sizes for groups differences were found. Further, the mixed-type (inhibited and disinhibited) and inhibited attachment disorder type were the most burdened groups. The present findings suggest that temperament and character traits, as well as parental stress and mental health problems are associated with the occurrence of attachment disorders among children. Future longitudinal studies with larger samples are needed to examine the causal relationships of temperament and character with attachment, including person-related and environmental factors among children.
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Affiliation(s)
- Martin Schröder
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
| | - Delfine d’Huart
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
| | - Yonca Izat
- Vivantes Clinic Friedrichshain, Child and Adolescent Psychiatry Berlin, 10249 Berlin, Germany
| | - Margarete Bolten
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
| | - Marc Schmid
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
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Zimmermann R, Steppan M, Zimmermann J, Oeltjen L, Birkhölzer M, Schmeck K, Goth K. A DSM-5 AMPD and ICD-11 compatible measure for an early identification of personality disorders in adolescence–LoPF-Q 12–18 latent structure and short form. PLoS One 2022; 17:e0269327. [PMID: 36129913 PMCID: PMC9491532 DOI: 10.1371/journal.pone.0269327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
The LoPF-Q 12–18 (Levels of Personality Functioning Questionnaire) was designed for clinical use and to promote early detection of personality disorder (PD). It is a self-report measure with 97 items to assess personality functioning in adolescents from 12 years up. It operationalizes the dimensional concept of personality disorder (PD) severity used in the Alternative DSM-5 Model for Personality Disorders and the ICD-11. In this study, we investigated the factorial structure of the LoPF-Q 12–18. Additionally, a short version was developed to meet the need of efficient screening for PD in clinical and research applications. To investigate the factorial structure, several confirmatory factor analysis models were compared. A bifactor model with a strong general factor and four specific factors showed the best nominal fit (CFI = .91, RMSEA = .04, SRMR = .07). The short version was derived using the ant colony optimization algorithm. This procedure resulted in a 20-item version with excellent fit for a hierarchical model with four first order factors to represent the domains and a secondary higher order factor to represent personality functioning (CFI = .98, RMSEA = .05, SRMR = .04). Clinical validity (effect size d = 3.1 between PD patients and controls) and clinical utility (cutoff ≥ 36 providing 87.5% specificity and 80.2% sensitivity) for detecting patients with PD were high for the short version. Both, the long and short LoPF-Q 12–18 version are ready to be used for research and diagnostic purposes.
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Affiliation(s)
- Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- * E-mail:
| | - Martin Steppan
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
- Division of Developmental and Personality Psychology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | - Lara Oeltjen
- Department of Psychological Methods, Institute of Psychology, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Marc Birkhölzer
- Juvenile Forensic Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Kirstin Goth
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
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20
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Sharp C, McLaren V, Musetti A, Vanwoerden S, Hernandez Ortiz J, Schmeck K, Birkhoelzer M, Goth K. The Assessment of Identity Development in Adolescence (AIDA) Questionnaire: First Psychometric Evaluation in Two North American Samples of Young People. J Pers Assess 2022:1-12. [PMID: 36121311 DOI: 10.1080/00223891.2022.2119860] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The Assessment of Identity Development in Adolescence (AIDA) is a recently developed measure of identity diffusion in young people. Originally validated in Switzerland, the English version has not yet been validated. Our aim was to evaluate the AIDA's internal factor structure, internal consistency, incremental validity, and relations to other variables in adolescents and young adults and derive clinical cutoffs for use in clinical settings. Study 1, involving 2,119 undergraduate students between the ages of 18-25 years, confirmed the expected bi-factor structure for the AIDA. Study 2 involved the recruitment of 122 adolescent inpatients (ages 12-17), of whom 36 met full DSM-based criteria for Borderline Personality Disorder, in addition to 164 adolescents of the same age, recruited from public schools (total 286 adolescents). Results of both studies demonstrated strong internal consistency and correlations of the expected magnitude and direction with other self-report measures of personality pathology. In addition, Study 2 demonstrated that the AIDA could successfully discriminate between adolescent inpatients with and without BPD, as well as healthy controls, and established preliminary clinical cutoffs that should be replicated in future studies. In all, these studies provide support for further validation and use of the AIDA in young people.
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21
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Manetsch M, Aebi M, Barra S, Goth K, Boonmann C, Schmeck K, Bessler C, Plattner B. Temperament and Offending Behaviors in Male Adolescents. Int J Offender Ther Comp Criminol 2022:306624X221113532. [PMID: 35899744 DOI: 10.1177/0306624x221113532] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of the current paper was to examine temperament profiles and temperament dimensions as risk factors for persistent criminal behavior in juveniles who offended (JOs). A sample of 137 male adolescents from a Swiss detention center and 137 age and sex matched community controls were included in the present study. Temperament was measured with the Junior Temperament and Character Inventory (JTCI). Using Latent Profile Analysis (LPA), three temperament profiles were found, a "moderate," an "adventurous-disinhibited" (higher levels of novelty seeking, lower levels of harm avoidance, reward dependence, and persistence), and a "worried-passive" profile (higher levels of harm avoidance, low persistence). None of the profiles and dimensions were associated with detention sample (i.e., JO) status. In JOs, the "novelty seeking" scale predicted recidivism after release from detention even when controlling for other covariates. Further research should address temperament profiles and temperament dimensions in larger samples of JOs to elaborate their relation to previous and future offending behavior.
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Affiliation(s)
- Madleina Manetsch
- Psychiatric University Hospitals Basel, University of Basel, Switzerland
| | - Marcel Aebi
- University of Zurich, Zurich, Switzerland
- Canton of Zurich, Zurich, Switzerland
| | | | - Kirstin Goth
- Psychiatric University Hospitals Basel, University of Basel, Switzerland
| | - Cyril Boonmann
- Psychiatric University Hospitals Basel, University of Basel, Switzerland
| | - Klaus Schmeck
- Psychiatric University Hospitals Basel, University of Basel, Switzerland
| | | | - Belinda Plattner
- University Clinics for Child and Adolescent Psychiatry and Psychotherapy, Salzburger Landeskliniken, Paracelsus Medical University, Salzburg, Austria
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22
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Hachtel H, Jenkel N, Schmeck K, Graf M, Fegert JM, Schmid M, Boonmann C. Stability of self-reported psychopathic traits in at-risk adolescents in youth welfare and juvenile justice institutions. Child Adolesc Psychiatry Ment Health 2022; 16:55. [PMID: 35765005 PMCID: PMC9241249 DOI: 10.1186/s13034-022-00487-6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the self-reported stability of psychopathic traits in adolescents in residential care (both child welfare and juvenile justice placed juveniles) and potential influencing factors. METHODS We applied the Youth Psychopathic traits Inventory (YPI) in a sample of 162 adolescents (M = 15.0 years, SD = 1.3) over a mean time interval of 11 months (min. 6, max. 21 months, SD = 3.14). RESULTS There was no significant difference in YPI total score nor in the three underlying dimensions Grandiose-Manipulative (GM), Callous-Unemotional (CU), and Impulsive-Irresponsible (II) between t1 and t2. Furthermore, approximately 70% of the adolescents showed no clinically significant reliable change on the YPI total score (as measured with the reliable change index), 15% improved, 15% deteriorated. The strongest predictor for psychopathic traits at t2 were psychopathic traits at t1. Additional predictors for higher levels of general psychopathic traits was male sex, for CU-traits male sex and lower levels of internalizing mental health problems, and for II-traits higher levels of externalizing mental health problems. Generally, the three reliable change groups (increase, no change, decrease) did not seemed to differ on relevant factors. CONCLUSIONS Our results add to the findings that psychopathic traits are relatively stable in this at-risk group over approximately a 1-year time interval. Research with a longer follow-up time and more time points is warranted to better interpret these results.
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Affiliation(s)
- H. Hachtel
- grid.412556.10000 0004 0479 0775Department of Forensic Psychiatry, Psychiatric University Hospitals (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - N. Jenkel
- grid.412556.10000 0004 0479 0775Child and Adolescent Research Department, Psychiatric University Hospitals (UPK) Basel, Basel, Switzerland
| | - K. Schmeck
- grid.412556.10000 0004 0479 0775Child and Adolescent Research Department, Psychiatric University Hospitals (UPK) Basel, Basel, Switzerland
| | - M. Graf
- grid.412556.10000 0004 0479 0775Department of Forensic Psychiatry, Psychiatric University Hospitals (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - J. M. Fegert
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - M. Schmid
- grid.412556.10000 0004 0479 0775Child and Adolescent Research Department, Psychiatric University Hospitals (UPK) Basel, Basel, Switzerland
| | - C. Boonmann
- grid.412556.10000 0004 0479 0775Department of Forensic Psychiatry, Psychiatric University Hospitals (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland ,grid.412556.10000 0004 0479 0775Child and Adolescent Research Department, Psychiatric University Hospitals (UPK) Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Psychology, University of Basel, Basel, Switzerland
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23
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Seker S, Boonmann C, d'Huart D, Bürgin D, Schmeck K, Jenkel N, Steppan M, Grob A, Forsman H, Fegert JM, Schmid M. Mental Disorders Into Adulthood Among Adolescents Placed in Residential Care: A Prospective 10-Year Follow-up Study. Eur Psychiatry 2022; 65:e40. [PMID: 35730184 PMCID: PMC9280920 DOI: 10.1192/j.eurpsy.2022.30] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Child welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood. Methods Seventy adolescents in shared residential care, placed by child welfare (n = 52, mean age = 15 years) or juvenile justice (n = 18, mean age = 17 years) authorities, were followed up into adulthood (child welfare: mean age = 25 years; juvenile justice: mean age = 27 years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed. Results In the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples. Conclusions Our findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.
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Affiliation(s)
- Süheyla Seker
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Delfine d'Huart
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland.,Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Nils Jenkel
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Martin Steppan
- Division of Developmental and Personality Psychology, University of Basel, Basel, Switzerland
| | - Alexander Grob
- Division of Developmental and Personality Psychology, University of Basel, Basel, Switzerland
| | - Hilma Forsman
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Marc Schmid
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
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24
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Cottin M, Blum K, Konjufca J, Quevedo Y, Kaaya S, Behn A, Schmeck K, Sharp C, Zimmermann R. Digital use of standardised assessment tools for children and adolescents: can available paper-based questionnaires be used free of charge in electronic format? BMC Psychiatry 2022; 22:379. [PMID: 35659275 PMCID: PMC9166519 DOI: 10.1186/s12888-022-04023-w] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
QUESTION Most adolescents live in low- and middle-income countries (LMIC), and about 10% of them face mental problems. The mental health provision gap in low- and middle-income countries could be addressed by evidence-based practices, however costs are implementational barriers. Digitalization can improve the accessibility of these tools and constitutes a chance for LMIC to use them more easily at a low cost. We reviewed free and brief evidence-based mental health assessment tools available for digital use to assess psychopathology across different domains in youth. METHODS For the current study, instruments from a recent review on paper-based instruments were re-used. Additionally, a systematic search was conducted to add instruments for the personality disorder domain. We searched and classified the copyright and license terms available from the internet in terms of free usage and deliverability in a digital format. In the case that this information was insufficient, we contacted the authors. RESULTS In total, we evaluated 109 instruments. Of these instruments, 53 were free and digitally usable covering 11 mental health domains. However, retrieving information on copyright and license terms was very difficult. CONCLUSIONS Free and digitally adaptable instruments are available, supporting the strategy of using instruments digitally to increase access. The instrument's authors support this initiative, however, the lack of copyright information and the difficulties in contacting the authors and licence holders are barriers to using this strategy in LMIC. A comprehensive, online instrument repository for clinical practice would be an appropriate next step to make the instruments more accessible and reduce implementation barriers.
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Affiliation(s)
- Marianne Cottin
- grid.488997.3Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile ,grid.443909.30000 0004 0385 4466Department of Psychiatry East Campus, Faculty of Medicine, University of Chile, Santiago, Chile ,grid.440629.d0000 0004 5934 6911School of Psychology, Finis Terrae University, Santiago, Chile ,grid.7870.80000 0001 2157 0406School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Kathrin Blum
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Jon Konjufca
- grid.449627.a0000 0000 9804 9646University of Prishtina, Pristina, Kosovo ,grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Yamil Quevedo
- grid.488997.3Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile ,grid.443909.30000 0004 0385 4466Department of Psychiatry East Campus, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sylvia Kaaya
- grid.25867.3e0000 0001 1481 7466Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania ,grid.266436.30000 0004 1569 9707Department of Psychology, University of Houston, Houston, TX USA
| | - Alex Behn
- grid.488997.3Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile ,grid.7870.80000 0001 2157 0406School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Klaus Schmeck
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Carla Sharp
- grid.266436.30000 0004 1569 9707Department of Psychology, University of Houston, Houston, TX USA
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland. .,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
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Schmeck K. Debate: Should CAMHs professionals be diagnosing personality disorder in adolescents - 'No rationale to deprive adolescents of effective treatment'. Child Adolesc Ment Health 2022; 27:192-193. [PMID: 35297543 DOI: 10.1111/camh.12553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
Personality disorders (PD) are among the most severe mental disorders, leading to high clinical, familial and societal burden. In contrast to former perceptions, PDs are not a life-long destiny, but treatable with specialized treatment approaches. The current reluctance of clinicians to use this diagnosis in younger age groups obstructs the correct choice of treatment options for young people. Not diagnosing PD at an early stage means to deprive adolescents of effective treatments, thus increasing their risk of fatal outcome. In the upcoming ICD-11, a life-span perspective on mental disorders has been adopted that facilitates the use of the diagnosis PD in young people. Future research will show if the use of the new ICD-11 diagnosis of complex posttraumatic stress disorder will be helpful in a proportion of patients with a history of severe childhood traumatization.
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Affiliation(s)
- Klaus Schmeck
- Department of Clinical Research, Medical Faculty, University of Basel, Basel, Switzerland
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d’Huart D, Steppan M, Seker S, Bürgin D, Boonmann C, Birkhölzer M, Jenkel N, Fegert JM, Schmid M, Schmeck K. Prevalence and 10-Year Stability of Personality Disorders From Adolescence to Young Adulthood in a High-Risk Sample. Front Psychiatry 2022; 13:840678. [PMID: 35401274 PMCID: PMC8987201 DOI: 10.3389/fpsyt.2022.840678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) in early 2022, there will be a radical change in the framework and process for diagnosing personality disorders (PDs), indicating a transition from the categorical to the dimensional model. Despite increasing evidence that PDs are not as stable as previously assumed, the long-term stability of PDs remains under major debate. The aim of the current paper was to investigate the categorical and dimensional mean-level and rank-order stability of PDs from adolescence into young adulthood in a high-risk sample. Methods In total, 115 young adults with a history of residential child welfare and juvenile-justice placements in Switzerland were included in the current study. PDs were assessed at baseline and at a 10-year follow-up. On a categorical level, mean-level stability was assessed through the proportion of enduring cases from baseline to follow-up. Rank-order stability was assessed through Cohen's κ and tetrachoric correlation coefficients. On a dimensional level, the magnitude of change between the PD trait scores at baseline and at follow-up was measured by Cohen's d. Rank-order stability was assessed through Spearman's ρ. Results The prevalence rate for any PD was 20.0% at baseline and 30.4% at follow-up. The most frequently diagnosed disorders were antisocial, borderline, and obsessive-compulsive PDs, both at baseline and at follow-up. On a categorical level, the mean-level stability of any PD was only moderate, and the mean-level stability of specific PDs was low, except of schizoid PD. Likewise, the rank-order stability of any PD category was moderate, while ranging from low to high for individual PD diagnoses. On a dimensional level, scores increased significantly for most PDs, except for histrionic traits, which decreased significantly from baseline to follow-up. Effect sizes were generally low. The rank-order stability for dimensional scores ranged from low to moderate. Conclusion The findings indicate low to moderate stability of Pds and Pd traits from adolescence to adulthood, which supports the growing evidence that categorical diagnoses of Pds are quite unstable. This in turn, emphasizes the use of the upcoming ICD-11 that Acknowledgments Pds to be only "relatively" stable.
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Affiliation(s)
- Delfine d’Huart
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Martin Steppan
- Division of Developmental and Personality Psychology, University of Basel, Basel, Switzerland
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marc Birkhölzer
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Nils Jenkel
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
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Barra S, Aebi M, d’Huart D, Schmeck K, Schmid M, Boonmann C. Adverse Childhood Experiences, Personality, and Crime: Distinct Associations among a High-Risk Sample of Institutionalized Youth. Int J Environ Res Public Health 2022; 19:1227. [PMID: 35162246 PMCID: PMC8835310 DOI: 10.3390/ijerph19031227] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/20/2022]
Abstract
Despite high rates of adverse childhood experiences (ACEs) and personality-related disturbances among delinquent juveniles, associations among ACEs, youth personality, and juvenile crime involvement are still unclear. High-risk samples of institutionalized youth are in specific need of a comprehensive assessment of ACEs and personality features in order to broaden the current knowledge on the occurrence and persistence of juvenile crime and to derive implications for prevention and intervention. We examined a heterogeneous high-risk sample of 342 adolescents (35.1% females, 64.9% males) aged between 12 and 18 years (M = 15.74, SD = 1.61 years) living in child-welfare or juvenile justice institutions regarding cumulative ACEs, psychopathic traits, temperament, and clinical personality disorder ratings, and criminal involvement before and up to 10 years after assessment. We found considerable rates of ACEs, although cumulative ACEs did not predict future crime. Latent Profile Analysis based on dimensional measures of psychopathy, temperament, and personality disorders derived six distinct personality profiles, which were differently related to ACEs, personality disturbances, clinical psychopathology, and future delinquency. A socially difficult personality profile was associated with increased risk of future crime, whereas avoidant personality traits appeared protective. Findings indicate that the role of ACEs in the prediction of juvenile delinquency is still not sufficiently clear and that relying on single personality traits alone is insufficient in the explanation of juvenile crime.
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Affiliation(s)
- Steffen Barra
- Institute for Forensic Psychology and Psychiatry, Saarland University Hospital, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Marcel Aebi
- Research & Development, Corrections and Rehabilitation, Department of Justice and Home Affairs, Hohlstrasse 552, 8090 Zurich, Switzerland;
- Child and Adolescent Psychiatry, Medical Faculty, University of Zurich, Neumuensterallee 3, 8032 Zurich, Switzerland
| | - Delfine d’Huart
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Delfine.d' (D.d.); (K.S.); (M.S.); (C.B.)
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Delfine.d' (D.d.); (K.S.); (M.S.); (C.B.)
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Delfine.d' (D.d.); (K.S.); (M.S.); (C.B.)
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Delfine.d' (D.d.); (K.S.); (M.S.); (C.B.)
- Department of Forensic Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
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Urben S, Habersaat S, Palix J, Fegert JM, Schmeck K, Bürgin D, Seker S, Boonmann C, Schmid M. Examination of the importance of anger/irritability and limited prosocial emotion/callous-unemotional traits to understand externalizing symptoms and adjustment problems in adolescence: A 10-year longitudinal study. Front Psychiatry 2022; 13:939603. [PMID: 36245864 PMCID: PMC9556640 DOI: 10.3389/fpsyt.2022.939603] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Within a longitudinal study (10-year follow-up), we aim to examine the role of anger/irritability and limited prosocial emotion/callous-unemotional traits in predicting externalizing symptoms and adjustment problems in individuals formerly in youth residential care institutions. Method These dimensions were assessed in 203 young adults, with baseline assessments during youth residential care and a follow-up 10 years later. Results In general, emotional problems and psychopathological symptoms did not reduce over time. Analyses of regression revealed that a younger age at baseline, anger/irritability both at baseline assessment, and regarding their aggravation over time refer to significant predictors of the level of externalizing symptoms at 10-year follow-up (R 2 = 0.431) and the worsening of externalizing symptoms over time (R 2 = 0.638). Anger/irritability has been observed to be a significant predictors of both the level of adjustment problems at 10-year follow-up (R 2 = 0.471) and its worsening over time (R 2 = 0.656). Discussion Our results suggest that dysregulation of anger/irritability is a key factor in the prediction of long-term externalizing symptoms and adjustment problems as well as its worsening over time. Possible implications for intervention and prevention are discussed.
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Affiliation(s)
- Sébastien Urben
- Division of Child and Adolescent Psychiatry, University Hospital of Lausanne (CHUV) and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Sébastien Urben,
| | - Stéphanie Habersaat
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
| | - Julie Palix
- Institute of Forensic Psychiatry, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
- Department of Forensic Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
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Seker S, Boonmann C, Gerger H, Jäggi L, d'Huart D, Schmeck K, Schmid M. Mental disorders among adults formerly in out-of-home care: a systematic review and meta-analysis of longitudinal studies. Eur Child Adolesc Psychiatry 2022; 31:1963-1982. [PMID: 34169369 PMCID: PMC9663399 DOI: 10.1007/s00787-021-01828-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/13/2021] [Indexed: 01/26/2023]
Abstract
While children and adolescents placed in child welfare or juvenile justice out-of-home care show higher prevalence rates of mental disorders compared to the general population, it remains unclear whether this pattern persists into adulthood. A quantitative synthesis of existing studies is lacking. The aim of this meta-analysis was to estimate the prevalence rates for mental disorders among adults with a foster or residential child welfare or juvenile justice care history, comparing them where possible to rates among the general population. PubMed, PsycInfo, EMBASE, and Web of Science were systematically searched for epidemiological studies published up to 28 October 2020. Nineteen studies, totaling 604,257 participants, met our inclusion criteria. Random-effects models were used for prevalence rates and odds ratios (OR) of mental disorders, and study quality was rated. A prevalence rate of 30% [95% CI (23.36, 37.36)] for any mental disorder in adults with a child welfare care history was found (3-17% for specific disorders). A prevalence rate of 45% [95% CI (42.38, 47.38)] for any mental disorder was found in adults with a juvenile justice care history (6-66% for specific disorders). For out-of-home placement history, adult mental disorders were significantly higher than in the general population (OR = 1.33-2.76). Studies differed in terms of methodology and the disorder groups considered, so heterogeneity between effect sizes ranged from low to high. Our findings suggest that the high risk that mental health issues will persist in adults with an out-of-home placement history needs to be taken seriously in the transition from adolescence to adulthood. The care systems involved need to collaborate and to be aware of these risks.
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Affiliation(s)
- Süheyla Seker
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Heike Gerger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lena Jäggi
- Division of Personality and Developmental Psychology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Delfine d'Huart
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Marc Schmid
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
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Schmeck K, Kumperscak HG, Birkhölzer M, Goth K. Editorial: Dimensional assessment of personality disorders in young people: A closer look on personality functioning in younger ages, different cultures, and various clinical settings. Front Psychiatry 2022; 13:1082189. [PMID: 36483139 PMCID: PMC9724150 DOI: 10.3389/fpsyt.2022.1082189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Klaus Schmeck
- Department of Clinical Research, Medical Faculty, University of Basel, Basel, Switzerland
| | | | - Marc Birkhölzer
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
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d’Huart D, Bürgin D, Seker S, Birkhölzer M, Jenkel N, Boonmann C, Fegert JM, Schmid M, Schmeck K. Risikofaktoren für und Stabilität einer Persönlichkeitsstörung vom Jugendalter bis ins junge Erwachsenenalter in einer Hochrisikopopulation. Kindheit und Entwicklung 2022. [DOI: 10.1026/0942-5403/a000367] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Studien zeigen, dass Persönlichkeitsstörungen (PS) weniger stabil und bei einer frühzeitigen Erkennung gut behandelbar sind. Fragestellung: Ziel dieser Studie ist, 1) die Prävalenz von PS bei ehemalig fremdplatzierten jungen Erwachsenen zu beschreiben, 2) die kategoriale Stabilität von PS vom Jugendalter bis ins junge Erwachsenenalter zu bestimmen und 3) prospektive Risikofaktoren für eine PS im Erwachsenenalter zu identifizieren. Methoden: 180 ehemalig fremdplatzierte junge Erwachsene ( M = 26.3 Jahre) aus einer schweizweiten Längsschnittstudie wurden untersucht. Ergebnisse: 35 % der Teilnehmenden wiesen eine PS auf. Die kategoriale Stabilität belief sich auf 47 %. Folgende Risikofaktoren für eine PS im Erwachsenenalter wurden identifiziert: vorangehende PS, psychopathische Persönlichkeitszüge, Substanzmissbrauch, emotionale Vernachlässigung, kumulierte Misshandlungserfahrungen und Deliktschwere. Diskussion und Schlussfolgerung: Die kategoriale Stabilität irgendeiner PS in dieser Stichprobe gilt als mittelgradig. Dies unterstreicht die Notwendigkeit, PS nicht mehr mit einem lebenslangen, unveränderbaren Schicksal gleichzusetzen. Das Erkennen möglicher Risikofaktoren ist eine wichtige Voraussetzung, um individuelle Behandlungsmöglichkeiten zu gewährleisten und einer Chronifizierung entgegenzuwirken.
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Affiliation(s)
- Delfine d’Huart
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - David Bürgin
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Süheyla Seker
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Marc Birkhölzer
- Jugendforensische Ambulanz (JAM), Klinik für Forensik, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Nils Jenkel
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Cyril Boonmann
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Marc Schmid
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Klaus Schmeck
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
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Seker S, Bürgin D, d’Huart D, Schmid M, Schmeck K, Jenkel N, Fegert JM, Steppan M, Boonmann C. Der Verlauf von psychischen Problemen bei fremdplatzierten Kindern und Jugendlichen bis in deren Erwachsenenalter. Kindheit und Entwicklung 2022. [DOI: 10.1026/0942-5403/a000365] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Fremdplatzierte Kinder und Jugendliche sind psychisch hoch belastet, jedoch ist der Verlauf von psychischen Problemen bis in deren Erwachsenenalter weitgehend unbekannt. Fragestellung: Die Prävalenz und der Verlauf von psychischen Problemen bei fremdplatzierten Kindern und Jugendlichen bis ins Erwachsenenalter wurden in dieser Studie untersucht und mögliche Prädiktoren identifiziert. Methode: 164 Kinder und Jugendliche wurden während der Fremdplatzierung und im Erwachsenenalter längsschnittlich mittels Selbstbeurteilungsfragebogen auf psychische Gesamtauffälligkeit, internalisierende und externalisierende Probleme untersucht. Ergebnisse: 62.2 % der Kinder und Jugendlichen zeigten auffällige Werte für die Gesamtauffälligkeit wohingegen es im Erwachsenenalter noch 35.7 % waren. Die stärksten Prädiktoren für die jeweiligen Skalen im Erwachsenenalter waren die psychischen Probleme im Kindes- und Jugendalter. Mädchen zeigten eine erhöhte Wahrscheinlichkeit für internalisierende Probleme im Erwachsenenalter im Vergleich zu Jungen. Diskussion und Schlussfolgerung: Die psychischen Probleme bei fremdplatzierten Kindern und Jugendlichen verringerten sich bis ins junge Erwachsenenalter, dennoch blieb ein beachtlicher Teil chronisch auffällig. Implikationen für die Forschung und Praxis werden diskutiert.
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Affiliation(s)
- Süheyla Seker
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - David Bürgin
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Ulm
| | - Delfine d’Huart
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - Marc Schmid
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - Klaus Schmeck
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - Nils Jenkel
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - Jörg M. Fegert
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Ulm
| | - Martin Steppan
- Abteilung für Persönlichkeits- und Entwicklungspsychologie, Fakultät für Psychologie, Universität Basel, Schweiz
| | - Cyril Boonmann
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
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Schmid M, Fegert JM, Clemens V, Seker S, d’Huart D, Binder M, Schröder M, Friden L, Boonmann C, Jenkel N, Schmeck K, Bürgin D. Misshandlungs- und Vernachlässigungserfahrungen in der Kindheit: Ein Risikofaktor für die soziale Teilhabe ehemals außerfamiliär platzierter junger Erwachsener. Kindheit und Entwicklung 2022. [DOI: 10.1026/0942-5403/a000366] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Eine Reihe von Studien zeigen soziale Folgen von Misshandlung und Vernachlässigung in der Kindheit im weiteren Lebenslauf. Fragestellung: Diese Studie zielt darauf ab, die langfristigen Auswirkungen von Misshandlungs- und Vernachlässigungserfahrungen auf die soziale Teilhabe in einer Stichprobe von ehemals fremdplatzierten jungen Erwachsenen in der Schweiz zu untersuchen. Methode: Im Rahmen der Studie wurden 218 ehemals fremdplatzierte junge Erwachsene ( MAlter=26.1, 32.6 % weiblich) mit einer psychometrischen Testbatterie befragt. Dabei wurden Misshandlungserfahrungen in der Kindheit erfasst sowie die soziale Teilhabe bezüglich psychischer Gesundheit, Legalbewährung, sozio-ökonomische Lage und Beziehungen untersucht. Ergebnisse: Die Ergebnisse zeigen die hohe Prävalenz und negativen Folgen von kumulierten Misshandlungserfahrungen bei ehemals fremdplatzierten jungen Menschen. Eine höhere Anzahl von Misshandlungserfahrungen ging mit signifikant mehr Problemen in gesundheitlichen, finanziellen und sozialen Lebensbereichen einher. Diskussion und Schlussfolgerung: Die gravierenden Folgen von Misshandlungserfahrungen in der Kindheit unterstreichen die Bedeutung der Prävention und frühzeitigen Intervention. Sie zeigen aber auch, dass viele schwer betroffene junge Menschen neben therapeutischen auch konkrete und lebensweltorientierte Hilfen benötigen, um ihre Entwicklungsaufgaben adäquat zu bewältigen und erfolgreich an der Gesellschaft teilzuhaben.
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Affiliation(s)
- Marc Schmid
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitäre Kliniken Ulm, Universität Ulm
| | - Vera Clemens
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitäre Kliniken Ulm, Universität Ulm
| | - Süheyla Seker
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
| | - Delfine d’Huart
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
| | - Melanie Binder
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
| | - Martin Schröder
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
| | - Liz Friden
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
| | - Cyril Boonmann
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
| | - Nils Jenkel
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
| | - Klaus Schmeck
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
| | - David Bürgin
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel
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Abstract
Zusammenfassung. Theoretischer Hintergrund: Verschiedene Studien zeigen auf, dass ehemals ausserfamiliär platzierte Jugendliche, die viele biologische und psychosoziale Risikofaktoren akkumulieren, im weiteren Lebenslauf häufig eine geringere soziale Teilhabe aufweisen. Fragestellung: Dieser Themenschwerpunkt berichtet von einer Längsschnittstudie (JAEL – Jugendhilfe aus Erfahrung lernen) mit ehemals fremdplatzierten jungen Erwachsenen, die einer Hochrisikostichprobe zugeordnet werden können. Methode: Die Studie kombiniert für ihre Forschungsfragen prospektive und retrospektive Aspekte sowie qualitativ und quantitativ erhobene Daten. Ergebnisse: Der Themenschwerpunkt gibt sowohl eine kurze Einführung in die Methoden und die Rekrutierung der Stichprobe als auch einen Einblick in drei ausgewählte Themen, die in den drei Beiträgen dieses Themenschwerpunktes behandelt werden. Der erste Beitrag berichtet über die Ergebnisse zum Verlauf der psychischen Probleme vom Jugend- bis ins junge Erwachsenenalter. Der zweite Beitrag befasst sich mit Misshandlung und Vernachlässigung in der Kindheit als Risikofaktor für die soziale Teilhabe im jungen Erwachsenenalter, wie z. B. Arbeitslosigkeit, Legalbewährung, sozioökonomische Lage, psychische Gesundheit oder auch Beziehungsfähigkeit. Diese negativen Auswirkungen können durch Selbstwirksamkeitserfahrungen abgemildert werden. Der dritte Beitrag beinhaltet einen der bisher weniger beachteter Längsschnittstudienaspekte, nämlich die Risikofaktoren für eine Persönlichkeitsstörung in einer Hochrisikostichprobe sowie deren Stabilität. Diskussion und Schlussfolgerung: Auf die Bedeutung und Implikationen für Interventionen und Jugendhilfepolitik einerseits und die Forschung in diesem Feld andererseits wird eingegangen.
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Affiliation(s)
- Marc Schmid
- Klinik für Kinder- und Jugendliche der Universitären Psychiatrischen Kliniken Basel (UPK Basel), Universität Basel
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie des Universitätsklinikums Ulm, Universität Ulm
| | - Klaus Schmeck
- Klinik für Kinder- und Jugendliche der Universitären Psychiatrischen Kliniken Basel (UPK Basel), Universität Basel
| | - Cyril Boonmann
- Klinik für Kinder- und Jugendliche der Universitären Psychiatrischen Kliniken Basel (UPK Basel), Universität Basel
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Bühlmann V, Schlüter-Müller S, Fürer L, Steppan M, Birkhölzer M, Schmeck K, Koenig J, Kaess M, Zimmermann R. Therapists' emotional state after sessions in which suicidality is addressed: need for improved management of suicidal tendencies in patients with borderline personality pathology. BMC Psychiatry 2021; 21:590. [PMID: 34814860 PMCID: PMC8609732 DOI: 10.1186/s12888-021-03549-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 10/07/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patient suicidality is a frequently experienced topic for psychotherapists. Especially adolescents with borderline personality pathology (BPP) often exhibit suicidal tendencies. Previous research which examined therapists' countertransference towards suicidal patients suggested that therapists are negatively affected and distressed by them. We hypothesize that this emotional response of the therapists is related to specific sessions in which suicidality came up as a topic. Accordingly, the objective of this study consists in examining therapists' emotional state on a session level of analysis. METHODS The sample consisted of N = 21 adolescents (age 13-19 years) with BPD or subthreshold BPD. Therapists' emotional states were measured in n = 418 sessions using the Session Evaluation Questionnaire. Principal component analysis was used to reduce dimensionality of the therapist response. The emotional states were compared depending on whether suicidality has been addressed in the session (SS) or not (NSS). RESULTS Two components could be identified. Firstly, therapists were more aroused, excited, afraid, angry and uncertain after SS than after NSS. Secondly, therapists were more aroused, excited, definite and pleased after SS than after NSS. DISCUSSION Suicidality does not always have to be a burden for therapists: Both a "distress" and an "eustress" component occur in this context from which the latter is supposed to help clinicians master a difficult situation. Since countertransference feelings are often not fully conscious, it is necessary to do research on therapists' emotional states after sessions in which suicidality is addressed. This is crucial to both prevent the therapeutic process from being endangered and preserve clinicians' mental health. Clinical implications and limitations are discussed.
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Affiliation(s)
- Vera Bühlmann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Susanne Schlüter-Müller
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Martin Steppan
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Marc Birkhölzer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
- Juvenile Forensic Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland.
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
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Weise S, Parzer P, Fürer L, Zimmermann R, Schmeck K, Resch F, Kaess M, Koenig J. Autonomic nervous system activity and dialectical behavioral therapy outcome in adolescent borderline personality pathology. World J Biol Psychiatry 2021; 22:535-545. [PMID: 33522370 DOI: 10.1080/15622975.2020.1858155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We aimed to investigate whether pre-treatment cardiac autonomic nervous system (ANS) activity, indexed by heart rate (HR) and heart rate variability (HRV) predicts clinical outcome and therapy drop-outs in adolescents with borderline personality (BPD) pathology receiving dialectical behavioural therapy (DBT-A). We further tested for an association between changes in ANS function and clinical outcome over time. Traumatic experiences were considered as potential confounding factor. METHODS N = 43 (95.4% female, Mage = 15.5 years) adolescents fulfilling at least sub-threshold criteria for BPD (≥3) were investigated before and after outpatient DBT-A as well as at follow-up. N = 10 patients dropped out of treatment (<50% of treatment sessions). Latent growth curve models were used for analyses. RESULTS Greater pre-treatment resting HRV significantly predicted clinical improvement (decrease in BPD pathology/increase of global functioning) over time. Pre-treatment ANS activity was unrelated to treatment drop-out. Further, changes in ANS activity over treatment were associated with changes in clinical outcome. CONCLUSION This study is the first providing evidence that pre-treatment HRV predicts and is related to treatment response in adolescent borderline personality pathology. Implications for the use of ANS measures in clinical practice and directions for future research are discussed.
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Affiliation(s)
- Sindy Weise
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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Zimmermann R, Fürer L, Kleinbub JR, Ramseyer FT, Hütten R, Steppan M, Schmeck K. Movement Synchrony in the Psychotherapy of Adolescents With Borderline Personality Pathology - A Dyadic Trait Marker for Resilience? Front Psychol 2021; 12:660516. [PMID: 34276484 PMCID: PMC8277930 DOI: 10.3389/fpsyg.2021.660516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Movement synchrony describes the coordination of body movements. In psychotherapy, higher movement synchrony between therapist and patient has been associated with higher levels of empathy, therapeutic alliance, better therapy outcome, and fewer drop-outs. The current study investigated movement synchrony during the psychotherapeutic treatment of female adolescents with borderline personality disorder. It was hypothesized that there are higher levels of movement synchrony in the analyzed therapy sessions compared to pseudo-interactions. Further, we tested whether higher levels of movement synchrony correlate with stronger patients' symptom reduction and whether higher movement synchrony predicts higher post-session ratings. A total of 356 sessions from 16 completed psychotherapies of adolescent patients with BPD were analyzed. Movement synchrony was assessed with motion energy analysis and an index of synchrony was calculated by lagged cross-correlation analysis. As hypothesized, the findings support higher levels of movement synchrony in therapy sessions compared to pseudo-interactions (Cohen's d = 0.85). Additionally, a correlation of movement synchrony with better therapy outcome was found (standardized beta = -0.43 indicating stronger personality functioning impairment reduction). The post-session ratings were negatively associated with higher levels of movement synchrony (standardized beta = -0.1). The relevance of movement synchrony and potential implications for clinical practice are discussed.
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Affiliation(s)
- Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Johann R Kleinbub
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Fabian T Ramseyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Rahel Hütten
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Martin Steppan
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
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Schürmann J, Mühleck M, Perler C, Schmeck K, Reiter-Theil S. Ethische Herausforderungen in der forensischen Kinder- und Jugendpsychiatrie. Eine qualitative Beobachtungsstudie und ein Instrument zur Früherkennung und Frühintervention. Ethik Med 2021. [DOI: 10.1007/s00481-021-00605-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ZusammenfassungDie forensische Kinder- und Jugendpsychiatrie steht in einem komplexen Spannungsfeld medizinischer, rechtlicher und sozialer Anforderungen. Die ethischen Herausforderungen, die sich daraus für den stationären Maßnahmenvollzug ergeben, sind bisher kaum untersucht, spezifische Hilfestellungen für Behandelnde fehlen. Diese Studie hat zum Ziel, ethische Themenfelder und Probleme in diesem Bereich zu identifizieren und ein Instrument zur Früherkennung und -intervention ethischer Probleme im Klinikalltag zu entwickeln. Methode: Eine systematische Literaturrecherche sowie eine Beobachtungstudie in der Jugendforensik der Universitären Psychiatrischen Kliniken Basel werden durchgeführt. Die Beobachtungsdaten werden mittels qualitativer Inhaltsanalyse ausgewertet. Das Instrument wird auf der Basis der Resultate nach einer neuen Methode entwickelt. In der Literaturrecherche wurden 14 valide Publikationen identifiziert, die hauptsächlich ethische Probleme der Gerichtspsychiatrie thematisieren wie professionelle Rollenkonflikte, ethische Probleme der Diagnostik und Begutachtung oder der Umgang mit vertraulichen Informationen. Empirische oder empirisch-normative Studien fehlen. In der Beobachtungsstudie wurden 24 ethische Themen und spezifische Probleme identifiziert, besonders häufig sind ethische Fragen zu Moralkompetenzen der Jugendlichen, zur Behandlungsqualität, zum Umgang mit Regeln und Sanktionen und zur Freiheits- und Privatsphäre. Das Instrument zur Früherkennung und -intervention ethischer Probleme (FIEP) enthält die vier Kernelemente Risikofaktoren, Indikatoren, Interventionsplanung und Entscheidungsfindung. Der Maßnahmenvollzug der forensischen Kinder- und Jugendpsychiatrie offenbart ein breites Spektrum ethischer Themen mit spezifischen ethischen Problemen, welche in der Literatur bisher nur unzureichend untersucht sind. Das hier entwickelte Instrument FIEP unterstützt Behandelnde dabei, ethische Probleme frühzeitig zu erkennen und effizient zu bearbeiten.
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Bürgin D, Boonmann C, Schmeck K, Schmid M, Tripp P, Nishimi K, O’Donovan A. Compounding Stress: Childhood Adversity as a Risk Factor for Adulthood Trauma Exposure in the Health and Retirement Study. J Trauma Stress 2021; 34:124-136. [PMID: 33200440 PMCID: PMC7887022 DOI: 10.1002/jts.22617] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
Childhood adversity (CA) and adulthood traumatic experiences (ATEs) are common and unequally distributed in the general population. Early stressors may beget later stressors and alter life-course trajectories of stressor exposure. Gender differences exist regarding the risk of specific stressors. However, few studies have examined the associations between specific types of CA and ATEs. Using a large-scale sample of older adults, we aimed to (a) determine if specific or cumulative CA increased the risk for specific or cumulative ATEs and (b) examine whether these associations were moderated by gender. In a sample from the U.S. Health and Retirement Study (N = 15,717; Mage = 67.57 years, SD = 10.54), cross-sectional Poisson and logistic regression models were fitted to assess the specific and cumulative associations between CA and ATEs. Overall, cumulative CA was associated with a larger risk ratio of ATEs, adjusted for covariates: aRRRs = 1.28, 1.63, and 1.97 for 1, 2, and 3-4 adverse events in childhood, respectively. Cumulative CA was particularly strongly associated with adulthood physical attacks, aOR = 5.66, and having a substance-abusing spouse or child, aOR = 4.00. Childhood physical abuse was the strongest independent risk factor for cumulative ATEs, aRRR = 1.49, and most strongly associated with adulthood physical attacks, aOR = 3.41. Gender moderated the association between cumulative CA and cumulative ATEs, with slightly stronger associations between cumulative CA and ATEs for women than men. Given that CA and ATEs perpetuate health disparities worldwide, reducing their incidence and effects should be major priorities for public health.
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Affiliation(s)
- David Bürgin
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Paige Tripp
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Kristen Nishimi
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Aoife O’Donovan
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Sharp C, Vanwoerden S, Schmeck K, Birkhölzer M, Goth K. An Evaluation of Age-Group Latent Mean Differences in Maladaptive Identity in Adolescence. Front Psychiatry 2021; 12:730415. [PMID: 34603108 PMCID: PMC8484521 DOI: 10.3389/fpsyt.2021.730415] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Little is known about the differences between age groups in maladaptive personality function as denoted in Criterion A of the Alternative Model for Personality Disorder (AMPD) in the DSM-5, which is the entry criterion for diagnosing personality disorder in the upcoming ICD-11. The current study aimed to address this gap by evaluating latent mean age group differences in maladaptive identity, which is one aspect that has been identified as an important feature of maladaptive, general personality function as represented in the DSM-5 and ICD-11. We were also interested whether mean differences would track with mean differences in borderline personality disorder (BPD) features given prior data suggesting that general personality function overlap with the construct of BPD. A community sample of N = 2,381 adolescents, representing a mix of different socio-economic and educational backgrounds, ages 12-18 (M = 14.92, SD = 1.94; 46% male) completed a measure of maladaptive identity. A subset (n = 1,165) completed a measure of borderline personality features. Latent variable modeling was used to evaluate latent mean differences across seven age bands. Results suggested a normative increase in maladaptive identity after age 12, which remained consistent until age 17 when it dropped back to levels observed in 12-year-olds. Maladaptive identity was significantly associated with mean-level increases in borderline personality features, with these constructs becoming more closely associated with increasing age.
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Affiliation(s)
- Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Salome Vanwoerden
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry, University Clinics of Basel, Basel, Switzerland
| | - Marc Birkhölzer
- Department of Child and Adolescent Psychiatry, University Clinics of Basel, Basel, Switzerland
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatry, University Clinics of Basel, Basel, Switzerland
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Abstract
PURPOSE OF REVIEW This review provides an overview of the state of research on alliance ruptures and resolutions in the treatment of personality disorders (PDs). We discuss frequently used instruments to measure alliance ruptures and resolutions. We discuss the effectiveness of rupture resolution processes and highlight possible avenues for research to explore. Innovative assessments with the potential to reveal the link of ruptures and resolutions and mechanisms of psychotherapeutic change are discussed. RECENT FINDINGS The assessment of alliance rupture and resolutions is heterogeneous. Instruments vary largely with respect to a direct or indirect assessment, the time resolution of assessment (integral therapy, phase, session, event), session sampling strategy and perspectives (patient, therapist, observer). The heterogeneity in the instruments and study designs impedes comparability and interpretation of the findings. Results support the hypothesis that ruptures are more frequent in PD. Results also point towards beneficial effects of rupture resolution patterns, early alliance quality, and resolution complexity. Few studies control findings for pretreatment factors. Evidence points to the direction that rupture resolution processes can be considered a general principle of change in the treatment of PD. The concept of alliance ruptures and resolutions provides a useful tool for the management of the therapeutic alliance and its moments of deteriorations throughout the treatment course. Dimensional pretreatment personality functioning is considered a key variable in future studies to highlight what works for whom.
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Affiliation(s)
- Nathalie Schenk
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Martin Steppan
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland.
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Emery S, Häberling I, Berger G, Baumgartner N, Strumberger M, Albermann M, Nalani K, Schmeck K, Erb S, Bachmann S, Wöckel L, Müller-Knapp U, Contin-Waldvogel B, Rhiner B, Walitza S, Hersberger M, Drechsler R. Verbal Memory Performance in Depressed Children and Adolescents: Associations with EPA but Not DHA and Depression Severity. Nutrients 2020; 12:nu12123630. [PMID: 33255819 PMCID: PMC7761519 DOI: 10.3390/nu12123630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 02/08/2023] Open
Abstract
Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been described as positively associated with cognitive functioning. Current meta-analyses have identified eicosapentaenoic acid (EPA) as potentially more effective than docosahexaenoic acid (DHA). An especially vulnerable subgroup that might benefit from these beneficial effects are depressed youths. In this study, we examined associations between red blood cell (RBC) DHA and EPA levels and depression severity and verbal memory performance in a sample of 107 moderately (n = 63) and severely (n = 44) depressed youths. The findings showed that youths with high RBC EPA levels had steeper learning curves compared to those with moderate or low RBC EPA levels (Pillai's Trace = 0.195, p = 0.027, ηp2 = 0.097). No associations between RBC DHA levels or depression severity and verbal memory performance were observed. Our results further confirm previous findings indicating a more important role of EPA compared to DHA in relation to cognitive functioning. Future research should further investigate the differential role of EPA and DHA concerning cognitive functioning in depressed youths. Evidence supporting beneficial supplementation effects could potentially establish a recommendation for a natural and easily accessible intervention for cognitive improvement or remission.
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Affiliation(s)
- Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
- Correspondence:
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
| | - Noemi Baumgartner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
| | - Michael Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, 4002 Basel, Switzerland; (M.S.); (K.S.); (L.W.)
| | - Mona Albermann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
| | - Kristin Nalani
- Clinic for Psychosomatic Medicine and Psychiatry, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Klaus Schmeck
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, 4002 Basel, Switzerland; (M.S.); (K.S.); (L.W.)
| | - Suzanne Erb
- Child and Adolescent Psychiatric Services St. Gallen, 9004 St. Gallen, Switzerland;
| | - Silke Bachmann
- Department of Psychiatry, University Hospitals of Geneva, 1226 Thônex, Switzerland;
- Department of Psychiatry Psychotherapy, Psychosomatic Medicine, Medical Faculty of Martin Luther University, 06112 Halle, Germany
| | - Lars Wöckel
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, 4002 Basel, Switzerland; (M.S.); (K.S.); (L.W.)
- Clienia Littenheid AG, 9573 Littenheid, Switzerland
| | - Ulrich Müller-Knapp
- Child and Adolescent Psychiatry Klinik Sonnenhof, 9608 Ganterschwil, Switzerland;
| | | | - Bruno Rhiner
- Child and Adolescent Psychiatric Services Thurgau, 8570 Weinfelden, Switzerland;
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
- Center for Integrative Human Physiology Zurich, University of Zurich, 8057 Zurich, Switzerland;
| | - Martin Hersberger
- Center for Integrative Human Physiology Zurich, University of Zurich, 8057 Zurich, Switzerland;
- Division of Clinical Chemistry and Biochemistry, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
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Boonmann C, Pérez T, Schmid M, Fegert JM, Jauk E, Schmeck K. Psychometric properties of the German version of the Youth Psychopathic traits Inventory - short version. BMC Psychiatry 2020; 20:548. [PMID: 33228596 PMCID: PMC7685536 DOI: 10.1186/s12888-020-02943-z] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/07/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of the current study is to examine the psychometric properties of the German Version of the Youth Psychopathic traits Inventory-Short Version (YPI-S). METHODS A sample of 856 adolescents (age: 15-19) from the German-speaking part of Switzerland was included. All participants completed the 50-item YPI, of which we derived the 18 items of the YPI-S. Furthermore, participants completed the Massachusetts Youth Screening Instrument-Version-2 (MAYSI-2), as well a self-report delinquency questionnaire. RESULTS We were able to replicate a three-factor structure and found moderate to good internal consistency for the total score as well as for the three dimensions of the YPI-S. Measurement invariance across gender was established. Furthermore, we found positive small to medium correlations with both internalizing and externalizing mental health problems, substance abuse problems, and offending behavior. CONCLUSIONS Our results suggest that the German version of the YPI-S is a reliable and valid screening instrument for psychopathic traits in both boys and girls from the general population in the German-speaking part of Switzerland.
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Affiliation(s)
- Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland. .,Department of Forensic Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.
| | - Tania Pérez
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Marc Schmid
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Jörg M. Fegert
- grid.6582.90000 0004 1936 9748Child and Adolescent Psychiatric University Hospital, University of Ulm, Ulm, Germany
| | - Emanuel Jauk
- grid.4488.00000 0001 2111 7257Clinical Psychology and Behavioral Neuroscience, Dresden University of Technology, Dresden, Germany
| | - Klaus Schmeck
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
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Schmeck K. Long-Term Consequences of Early Neglect and Abuse. Psychiatr Danub 2020; 32:343-345. [PMID: 33030449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Early neglect and abuse are a major societal problem, with negative consequences for the victim. There is clear evidence that early neglect and abuse are related to an increased prevalence of mental health problems. On the other hand there are children that show resilience towards negative influences in early childhood. In this paper I will describe results of empirical studies that reveal the negative consequences of adverse childhood experiences (ACE) as well as studies on resilience. METHODS Studies relevant for the topic are reviewed. RESULTS In many individuals adverse childhood experiences lead to impaired functioning of neural structures that increase the risk for later psychopathology and maldaptive functioning. However, according to one of the major principles of developmental psychopathology we see multifinality of outcome as some individuals show signs of resilience. CONCLUSION Efforts to prevent adverse influences on children early in life are urgently needed to prevent long-lasting negative consequences that go along with subjective suffering and enormous societal costs. More research is needed to understand the mechanisms of vulnerability and resilience.
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Affiliation(s)
- Klaus Schmeck
- Universitäre Psychiatrische Kliniken (UPK) Basel, Wilhelm Klein-Str. 27, CH-4002 Basel, Switzerland,
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Abstract
The diagnostic concept of Personality Disorder (PD) is changing. A dimensional PD concept that focuses on severity of impairment of personality functioning was introduced in the DSM 5 Section III in 2013 and is adopted by the upcoming ICD-11 in a similar manner. Several reliable, valid and useful instruments to assess personality functioning (Criterion A) either as self-report, expert rating or clinical interview were developed in the past years. This article gives a latest state-of-the-art overview of these measures. It underlines the importance of multi-informant multi-method assessment of, and a longitudinal perspective on PD pathology and the importance of standardized inclusion of PD individuals in studies to increase the significance of research findings.
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Affiliation(s)
- Marc Birkhölzer
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinic (UPK-KJ), Research Department, Wilhelm-Klein-Str. 27, 4002 Basel, Switzerland.
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinic (UPK-KJ), Research Department, Wilhelm-Klein-Str. 27, 4002 Basel, Switzerland
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinic (UPK-KJ), Research Department, Wilhelm-Klein-Str. 27, 4002 Basel, Switzerland
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Fürer L, Schenk N, Roth V, Steppan M, Schmeck K, Zimmermann R. Supervised Speaker Diarization Using Random Forests: A Tool for Psychotherapy Process Research. Front Psychol 2020; 11:1726. [PMID: 32849033 PMCID: PMC7399377 DOI: 10.3389/fpsyg.2020.01726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
Speaker diarization is the practice of determining who speaks when in audio recordings. Psychotherapy research often relies on labor intensive manual diarization. Unsupervised methods are available but yield higher error rates. We present a method for supervised speaker diarization based on random forests. It can be considered a compromise between commonly used labor-intensive manual coding and fully automated procedures. The method is validated using the EMRAI synthetic speech corpus and is made publicly available. It yields low diarization error rates (M: 5.61%, STD: 2.19). Supervised speaker diarization is a promising method for psychotherapy research and similar fields.
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Affiliation(s)
- Lukas Fürer
- Clinic for Children and Adolescents, University Psychiatric Clinic, Basel, Switzerland
| | - Nathalie Schenk
- Clinic for Children and Adolescents, University Psychiatric Clinic, Basel, Switzerland
| | - Volker Roth
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Martin Steppan
- Clinic for Children and Adolescents, University Psychiatric Clinic, Basel, Switzerland
| | - Klaus Schmeck
- Clinic for Children and Adolescents, University Psychiatric Clinic, Basel, Switzerland
| | - Ronan Zimmermann
- Clinic for Children and Adolescents, University Psychiatric Clinic, Basel, Switzerland.,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
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Abstract
The classification of personality disorders in ICD-11 Abstract. In ICD-11, the classification of personality disorders (PD) is no longer categorical but dimensional, along a spectrum defined by the severity of the disorder. The definition of PD is based on the level of impairment of self-directed and interpersonal personality functioning. Only one general diagnostic category "Personality Disorder" remains (ICD-11 Code 6D10). All distinct PD diagnoses from ICD-10 are missing, with the exception of Borderline PD, which can be classified with a "trait qualifier." The type of PD is characterized by specific patterns of five maladaptive personality traits. From the perspective of child and adolescent psychiatry, the most important change from ICD-10 to ICD-11 is the removal of an age limit, meaning PDs can be diagnosed across the lifespan.
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Affiliation(s)
- Klaus Schmeck
- Kinder- und Jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken (UPK) der Universität Basel
| | - Marc Birkhölzer
- Kinder- und Jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken (UPK) der Universität Basel
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Baumgartner N, Häberling I, Emery S, Strumberger M, Nalani K, Erb S, Bachmann S, Wöckel L, Müller-Knapp U, Rhiner B, Contin-Waldvogel B, Schmeck K, Walitza S, Berger G. When parents and children disagree: Informant discrepancies in reports of depressive symptoms in clinical interviews. J Affect Disord 2020; 272:223-230. [PMID: 32553362 DOI: 10.1016/j.jad.2020.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/07/2019] [Revised: 02/06/2020] [Accepted: 04/15/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Parents and their children often disagree on the existence and severity of psychopathological symptoms, especially in major depressive disorder (MDD). Discrepant estimations pose a problem for the validity of diagnoses and illness severity with major implications for treatment evaluation. METHODS 118 adolescents aged 13-18 years and their parents were interviewed and their reports were compared regarding the presence of a MDD diagnosis. In addition, severity ratings of depression symptoms reported in the Children's Depression Rating Scale-Revised (CDRS-R) were compared between parents and their offspring using multivariate analyses and polynomial regressions. The association between borderline features, functional impairment, and treatment history variables with parent-child agreement was assessed. RESULTS In 38% of the cases, parents and adolescents agreed on DSM-IV diagnostic MDD criteria, while in 53%, only the adolescent endorsed criteria for a MDD. A MDD that was endorsed by parents and adolescents was characterized by higher depression severity, higher number of previous treatments, and higher functional impairment. Using a polynomial approach, neither age nor borderline tendencies were associated with agreement. LIMITATIONS We did not differentiate between mother's versus father's reports and borderline features were assessed by self-report only. CONCLUSIONS Adolescents and their parents gave differing reports of the existence and severity of depressive symptoms. The high discrepancy levels combined with the uncertainty of previously published findings due to methodological challenges are concerning. Clinicians and researchers need to consider discrepancies in agreement in relation to diagnosis and illness severity in the context of their clinical and research decisions.
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Affiliation(s)
- Noemi Baumgartner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Switzerland.
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Switzerland
| | - Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Switzerland
| | - Michael Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Switzerland
| | - Kristin Nalani
- Clinic for Psychosomatic Medicine and Psychiatry, Zurich, Switzerland
| | - Suzanne Erb
- Child and Adolescent Psychiatric Services St. Gallen, St. Gallen, Switzerland
| | - Silke Bachmann
- Clienia Littenheid AG, Littenheid, Switzerland; University Clinic of the Martin-Luther University Halle - Wittenberg's Medical Faculty, Switzerland
| | - Lars Wöckel
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Switzerland; Clienia Littenheid AG, Littenheid, Switzerland
| | | | - Bruno Rhiner
- Child and Adolescent Psychiatry Thurgau, Weinfelden, Switzerland
| | | | - Klaus Schmeck
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland; Center for Integrative Human Physiology Zurich, University of Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Switzerland
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Affiliation(s)
- Marc Birkhlzer
- Universitäre Psychiatrische Kliniken Basel
Jugendforensische Ambulanz (JAM)
| | | | - Klaus Schmeck
- Psychiatric University Hospitals Basel
- Child and Adolescent Psychiatric Hospital
- Schaffhauserrheinweg 55
- Basel
- CH-4058
- SWITZERLAND
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Zimmermann R, Fürer L, Schenk N, Koenig J, Roth V, Schlüter-Müller S, Kaess M, Schmeck K. Silence in the psychotherapy of adolescents with borderline personality pathology. Personal Disord 2020; 12:160-170. [PMID: 32324008 DOI: 10.1037/per0000402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/08/2022]
Abstract
Silence in psychotherapy has been associated with different, sometimes opposing meanings. This study investigated silence during adolescent identity treatment in adolescent patients with borderline personality pathology. A more active therapeutic approach with less silence is advised in adolescent identity treatment. It was hypothesized that a session with more silence might be negatively perceived by adolescent patients. A total of 382 sessions that involved 21 female patients were analyzed. Silence was automatically detected from audio recordings. Diarization (segmenting an audio according to speaker identity) was performed. The patient's perception of the sessions was measured with the Session Evaluation Questionnaire. The amount of silence in the different speaker-switching patterns was not independent of one other. This finding supports the hypothesis of mutual attunement of patient and therapist concerning the amount of silence in a given session. Sessions with less silence were rated as being both smoother and better. The potential implications for clinical practice are discussed. The investigation of turn-taking and interpersonal temporal dynamics is relevant for psychotherapy research. The topic can be addressed efficiently using automated procedures. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department
| | | | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy
| | - Volker Roth
- Department of Mathematics and Computer Science
| | | | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department
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