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Childhood adversity is associated with psychopathology. First evidence in adults suggests that threat anticipation, i.e., an enhanced anticipation of unpleasant events creating an enduring sense of threat, may be a putative mechanism linking childhood adversity to psychopathology. This study aimed to test the indirect effect of childhood adversity on psychopathology via threat anticipation in a large community sample of adolescents. We measured childhood trauma and bullying victimization (as indicators of childhood adversity), threat anticipation, general psychopathology and prodromal psychotic symptoms in adolescents aged 12–16 years (full sample size N = 1682; minimum sample size in the complete case sample N = 449) in wave I of the SIGMA study. We found strong evidence that childhood adversity (e.g. childhood trauma, adj. β (aβ) = 0.54, p <.001) and threat anticipation (e.g. aβ = 0.36, p <.001) were associated with general psychopathology and prodromal psychotic symptoms. Moreover, there was evidence that the association between childhood adversity, general psychopathology and prodromal psychotic symptoms is mediated via pathways through threat anticipation (e.g. childhood trauma, aβindirect effect = 0.13, p <.001). Threat anticipation may be a potential mechanism linking childhood adversity and psychopathology in adolescents. [ABSTRACT FROM AUTHOR]

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Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hypertension might be a contributing factor of mental illness. The aim of this study was to investigate the association between different levels of hypertension care and mental distress among hypertensive individuals in Malaysia. We constructed a hypertension care cascade using data of 6531 hypertensive individuals aged ≥ 35 years that were collected as part of the community health survey conducted in 2013 in the South East Asia Community Observatory. We examined the association between the status of hypertension care and mental distress using multiple logistic regressions. Respondents who had not been screened for hypertension and those who had uncontrolled blood pressure (BP) had higher odds of depression, anxiety and, stress compared to those who had been screened and those who had controlled BP, respectively. Respondents who were not taking antihypertensive medication had lower odds of depression and anxiety compared to those who were on medication. There was an association between different levels of hypertension care and mental distress. The application of a hypertension care cascade may help improve the provision of mental health support in primary care clinics. Specific mental health interventions could be provided for patients with particular needs along the cascade. [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy (CBT) represents one of the major treatment options for depressive disorders besides pharmacological interventions. While newly developed digital CBT approaches hold important advantages due to higher accessibility, their relative effectiveness compared to traditional CBT remains unclear. We conducted a systematic literature search to identify all studies that conducted a CBT-based intervention (face-to-face or digital) in patients with major depression. Random-effects meta-analytic models of the standardized mean change using raw score standardization (SMCR) were computed. In 106 studies including n = 11854 patients face-to-face CBT shows superior clinical effectiveness compared to digital CBT when investigating depressive symptoms (p < 0.001, face-to-face CBT: SMCR = 1.97, 95%-CI: 1.74–2.13, digital CBT: SMCR = 1.20, 95%-CI: 1.08–1.32) and adherence (p = 0.014, face-to-face CBT: 82.4%, digital CBT: 72.9%). However, after accounting for differences between face-to-face and digital CBT studies, both approaches indicate similar effectiveness. Important variables with significant moderation effects include duration of the intervention, baseline severity, adherence and the level of human guidance in digital CBT interventions. After accounting for potential confounders our analysis indicates comparable effectiveness of face-to-face and digital CBT approaches. These findings underline the importance of moderators of clinical effects and provide a basis for the future personalization of CBT treatment in depression. [ABSTRACT FROM AUTHOR]

Purpose: Negative life events (LEs) are associated with mental health problems in youth. However, little is known about underlying mechanisms. The aim of the study was to investigate whether exposure to LEs modifies stress sensitivity in youth's daily life. Methods: Ecological Momentary Assessment (EMA) was used to assess stress sensitivity (i.e., association of momentary stress with (i) negative affect and (ii) psychotic experiences) in 99 adolescents and young adults (42 service users, 17 siblings, and 40 controls; Mage 15 years). Before EMA, exposure to LEs (e.g., intrusive threats, experience of loss, serious illness) was assessed. Results: Lifetime as well as previous-year exposure to LEs modified stress sensitivity in service users: they experienced more intense negative affect and psychotic experiences in response to stress when high vs. low exposure levels were compared. In contrast, controls showed no differences in stress sensitivity by exposure levels. Looking at specific types of LEs, controls showed less intense negative affect in response to stress when high vs. low exposure levels to threatening events during the last year, but not lifetime exposure, were compared. In siblings, no evidence was found that LEs modified stress sensitivity. Conclusion: Stress sensitivity may constitute a putative risk mechanism linking LEs and mental health in help-seeking youth, while unfavourable effects of LEs on stress sensitivity may attenuate over time or do not occur in controls and siblings. Targeting individuals' sensitivity to stress in daily life using novel digital interventions may be a promising approach towards improving youth mental health. [ABSTRACT FROM AUTHOR]

Mental disorders are widespread and a major public health problem. The risk of developing a mental disorder at some point in life is around 40%. Therefore, mental disorders are among the most common diseases. Despite the introduction of newer psychotropic drugs, disorder-specific psychotherapy and stimulation techniques, many of those affected still show insufficient symptom remission and a chronic course of the disorder. Conceptual and technological progress in recent years has enabled a new, more flexible and personalized form of mental health care. Both the traditional therapeutic concepts and newer decentralized, modularly structured, track units, together with innovative digital technologies, will offer individualized therapeutic options in order to alleviate symptoms and improve quality of life of patients with mental illnesses. The primary goal of closely combining inpatient care concepts with innovative technologies is to provide comprehensive therapy and aftercare concepts for all individual needs of patients with mental disorders. Last but not least, this also ensures that specialist psychiatric treatment is available regardless of location. In twenty-first century psychiatry, modern care structures must be effectively linked to the current dynamics of digital transformation. This narrative review is dedicated to the theoretical and practical aspects of a cross-sectoral treatment system combined with innovative digital technologies in the psychiatric-psychotherapeutic field. The authors aim to illuminate these therapy modalities using the example of the Central Institute of Mental Health in Mannheim. [ABSTRACT FROM AUTHOR]

Copyright of Der Nervenarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bullying victimization confers the risk for developing various mental disorders, but studies investigating candidate mechanisms remain scarce, especially in the realm of youth mental health. Elevated stress sensitivity may constitute a mechanism linking bullying victimization and mental health problems. In the current study, we aimed to investigate whether exposure to bullying victimization amplifies stress sensitivity in youth's daily life. The Experience Sampling Method (ESM) was used to measure stress sensitivity [i.e. the association of momentary stress with (i) negative affect and (ii) psychotic experiences] in 42 help-seeking youths (service users), 17 siblings, and 40 comparison subjects (mean age 15 years). Before ESM assessments, bullying victimization at school as well as various psychopathological domains (i.e. depression, anxiety, psychosis) were assessed. Service users exposed to high levels of overall (primary hypotheses) as well as specific types (secondary hypotheses; physical and indirect, but not verbal) of bullying victimization experienced more intense negative affect and psychotic experiences in response to stress compared to those with low exposure levels (all p < 0.05), whereas, in contrast, controls showed either less intense negative affect or no marked differences in stress sensitivity by exposure levels. In siblings, a less consistent pattern of findings was observed. Findings suggest that stress sensitivity may constitute a potential risk and resilience mechanism linking bullying victimization and youth mental health. Interventions that directly target individuals' reactivity to stress by providing treatment components in real-life using mHealth tools may be a promising novel therapeutic approach. [ABSTRACT FROM AUTHOR]

Background: 22q11.2 deletion syndrome (22q11DS) is a genetic disorder associated with an increased risk of psychiatric disorders. Vulnerability for psychopathology has been related to an increased reactivity to stress. Here, we examined affective states, perceived stress, affective and psychotic reactivity to various sources of environmental stress using the experience sampling method (ESM), a structured diary technique allowing repeated assessments in the context of daily life. Methods: Adults with 22q11DS (n = 31; age, 34.1 years) and matched healthy controls (HCs; n = 24; age, 39.9 years) were included. ESM was used to assess affective states, perceived stress, and stress reactivity. Data were analyzed using multilevel regression models. Results: Adults with 22q11DS displayed overall higher levels of negative affect but comparable levels of positive affect compared to HCs. Higher levels of perceived stress were reported by individuals with 22q11DS. Comparable affective and psychotic reactivity in relation to all types of environmental stress was observed between the two groups. Conclusion: The results point toward higher levels of negative affect and differences in the perception of daily hassles in 22q11DS but no difference in affective or psychotic reactivity to stress. This study contributes to the growing literature regarding the impact of stress on the development of psychopathology in the 22q11DS population. [ABSTRACT FROM AUTHOR]

Adolescents and young adults are highly focused on peer evaluation, but little is known about sources of their differential sensitivity. We examined to what extent sensitivity to peer evaluation is influenced by interacting environmental and genetic factors. A sample of 354 healthy adolescent twin pairs (n = 708) took part in a structured, laboratory task in which they were exposed to peer evaluation. The proportion of the variance in sensitivity to peer evaluation due to genetic and environmental factors was estimated, as was the association with specific a priori environmental risk factors. Differences in sensitivity to peer evaluation between adolescents were explained mainly by non-shared environmental influences. The results on shared environmental influences were not conclusive. No impact of latent genetic factors or gene-environment interactions was found. Adolescents with lower self-rated positions on the social ladder or who reported to have been bullied more severely showed significantly stronger responses to peer evaluation. Not genes, but subjective social status and past experience of being bullied seem to impact sensitivity to peer evaluation. This suggests that altered response to peer evaluation is the outcome of cumulative sensitization to social interactions. [ABSTRACT FROM AUTHOR]

Purpose: Subjective quality of life (SQOL) is an established patient-reported outcome in the evaluation of treatments for psychosis. The use of SQOL measures in the presence of psychiatric symptoms and cognitive deficits has been questioned. However, there is little evidence on whether items function differently as indicators of SQOL in psychotic patients with different levels of symptoms and deficits. Substantial differential item functioning (DIF) would, indeed, challenge the validity of established measures. We aimed to investigate the validity of a widely used measure of subjective quality of life (SQOL), i.e., the Lancashire Quality of Life Profile (LQOLP), in the presence of cognitive deficits and psychiatric symptoms in patients with severe and enduring psychosis. Method: We analysed SQOL ratings of 690 psychotic patients on the LQOLP using item response modelling to detect differential item functioning (DIF) attributable to psychiatric symptoms and cognitive deficits. Results: Patients with more severe general psychopathology were less likely to rate their 'personal safety' positively (OR .96, 95% CI .93-.99). More severely depressed patients were less likely to endorse positive 'life as a whole' (OR .93, 95% CI .89-.98) and 'mental health' (OR .93, 95% CI .91-.97) ratings. There was no DIF attributable to cognitive deficits. Conclusions: The findings suggest that the validity of the LQOLP in psychotic patients may be impaired by DIF due to psychopathology, although the magnitude of effects is unlikely to be of clinical significance. The validity appears not to be compromised by cognitive deficits. [ABSTRACT FROM AUTHOR]

In this study, we aimed to establish: (1) whether social isolation modifies the effect of unemployment on first episode psychosis and duration of untreated psychosis (DUP); and (2) whether the gap between high employment expectations and perceived poor employment achievement is associated with first-episode psychosis; and (3) whether the relationship of this achievement–expectation gap and first-episode psychosis is strongest in the African-Caribbean population. All patients with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study. A random sample of healthy participants living within the same catchment areas was also recruited. Data were collected on socio-demographic and clinical characteristics, DUP, social contacts, and perceived levels of employment achievement and expectation. Analysis was conducted on data of 546 participants (224 cases, 322 controls) from the ÆSOP study. The relationship between unemployment and risk of non-affective psychosis was moderated by social contacts (unemployed/low social contacts, OR 7.52, 95% CI 2.97–19.08; unemployed/medium social contacts, OR 3.27, 95% CI 1.66–6.47; unemployed/high social contacts, OR 1.36, 95% CI 0.47–3.93). Unemployed patients experienced a longer DUP when having reported lower levels of social contacts. Participants whose employment achievement was lower than their expectations were more likely to be cases than those in whom achievement matched or exceeded expectations (adjusted OR 1.84, 95% CI 1.13–3.02). This applied equally to both African-Caribbean and White British participants (the Mantel–Haenszel test for homogeneity of odds ratios, χ 2 = 0.96, P = 0.33). This study suggests that unemployment, social isolation, employment achievement and expectations are important environmental factors associated with risk of psychosis. More attention needs to be focused on interactions between environmental factors as well as subjective experience of those factors in future research on the aetiology of psychosis. [ABSTRACT FROM AUTHOR]

Introduction: In this study, we aimed to establish: (1) whether social isolation modifies the effect of unemployment on first episode psychosis and duration of untreated psychosis (DUP); and (2) whether the gap between high employment expectations and perceived poor employment achievement is associated with first-episode psychosis; and (3) whether the relationship of this achievement-expectation gap and first-episode psychosis is strongest in the African-Caribbean population.Method: All patients with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study. A random sample of healthy participants living within the same catchment areas was also recruited. Data were collected on socio-demographic and clinical characteristics, DUP, social contacts, and perceived levels of employment achievement and expectation. Analysis was conducted on data of 546 participants (224 cases, 322 controls) from the AESOP study.Results: The relationship between unemployment and risk of non-affective psychosis was moderated by social contacts (unemployed/low social contacts, OR 7.52, 95% CI 2.97-19.08; unemployed/medium social contacts, OR 3.27, 95% CI 1.66-6.47; unemployed/high social contacts, OR 1.36, 95% CI 0.47-3.93). Unemployed patients experienced a longer DUP when having reported lower levels of social contacts. Participants whose employment achievement was lower than their expectations were more likely to be cases than those in whom achievement matched or exceeded expectations (adjusted OR 1.84, 95% CI 1.13-3.02). This applied equally to both African-Caribbean and White British participants (the Mantel-Haenszel test for homogeneity of odds ratios, chi (2 )= 0.96, P = 0.33).Conclusions: This study suggests that unemployment, social isolation, employment achievement and expectations are important environmental factors associated with risk of psychosis. More attention needs to be focused on interactions between environmental factors as well as subjective experience of those factors in future research on the aetiology of psychosis. [ABSTRACT FROM AUTHOR]

Background: While there is a need to assess morale in community mental health professionals, it still remains to be determined how to obtain and interpret data in a sound and meaningful way. The aims of the present study were to assess the extent to which levels of morale are sensitive to differences between professional groups and health care systems, and identify factors influencing morale across groups and settings.Methods: A literature search of electronic databases was undertaken to identify studies measuring morale in different groups of community mental health professionals. Data was subjected to a pooled analysis. Differences between groups and sites were tested using factorial ANOVA and respective effect sizes were estimated based on Cohen's [1] work.Results: Data of four studies and a total of 723 professionals (from Austria, Germany, Italy and United Kingdom) were combined in a pooled analysis. Significant differences of morale levels were found between professional groups and study sites, and differences between professional groups varied significantly by study site. Effect sizes estimated for differences between particular groups of different health care systems ranged from small to large. Age was found to be a factor independently associated with morale.Conclusions: Staff in community mental health care show substantial differences in morale levels depending on the professional group and context. These differences can often be identified even if in sample sizes of only 30 participants per group. Levels of morale need to be established specifically for different professional groups and context, and age should be controlled as an influential factor. The findings show a discriminant validity of assessment instruments for staff morale in community mental health care, and underline the rationale for such assessments in research and routine care. [ABSTRACT FROM AUTHOR]

An introduction is presented to an article published in this issue including article on genetic and environmental factors in mental illness.