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Results from a population-based study suggest sex-specific patterns of self-reported child maltreatment, more frequently reported in former West than East Germany. Aim of the current study was to examine these patterns in two regional samples of the former East- (SHIP, 2008 - 2012) and West German (KORA, 2013 - 2014) population. Child maltreatment was assessed using the Childhood Trauma Screener (CTS). Overall, child maltreatment was less often reported in the East German sample, compared to the West German sample. The most prominent differences were identified in self-rated emotional violence (east 6.1%, west 8.7%), physical violence (east 5.7%, west 10.3%) and physical neglect (east 10.0%, west 19.2%). However, we could not find differences in sex-specific patterns between the East and West German samples. Results were discussed within a historical context, since the events took place before the German reunification in two oppose political systems., Competing Interests: HJG hat Reisekostenunterstützungen und Referentenhonorare von folgenden Firmen erhalten: Fresenius Medical Care, Neuraxpharm, Servier und Janssen Cilag sowie Forschungsunterstützung von Fresenius Medical Care., (Thieme. All rights reserved.)

Aim: The aim of the present study was to determine, if internal German migration was associated with mental distress, somatoform symptoms, depression, and anxiety., Methods: Data from two representative studies from 2020 and 2021 were analysed (N=4922). Mental distress, including the dimensions somatoform symptoms, depression, and anxiety, was assessed with the short version of the Brief Symptom Inventory (BSI-18). Linear regression analyses were performed to examine associations between internal migration and mental distress while controlling for sociodemographic factors (gender, age, partner, household equivalised income, and education)., Results: Internal migrants from East to West Germany reported more mental distress, somatoform symptoms, depression, and anxiety than those who grew up and stayed in the East. This finding remained after controlling for sociodemographic factors. No differences were found between internal migrants from West to East Germany and those who grew up and stayed in West Germany., Discussion: German internal migration should be taken into account when examining differences in mental health in East and West Germany. Our results suggest that particularly the group that had moved from the Eastern to the Western part of Germany reported significantly signs of mental distress., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt vorliegt., (Thieme. All rights reserved.)

Background:  Mental distress is suspected to influence the morbidity of cardiac patients. Evaluating mental distress in cardiac patients is rare and the impact on surgical outcome is still not certified., Methods:  In 94 cardiac surgical patients, mental distress was assessed by the Patient Health Questionnaire-4 (PHQ-4). We defined length of stay in hospital and on intensive care unit as well as time of mechanical ventilation as outcomes on surgery. Age, physical activity, diabetes, overweight, PHQ-4, and an inflammation marker were tested for their predictive value on outcomes., Results:  Reportedly prevalence of generalized anxiety was 16.0% and depression rate was 13.8%. Length of stay in hospital was 13 ± 8 days, time of mechanical ventilation was 10 (0-1,207) hours, and length of stay on intensive care unit was 3 ± 6 days. Length of stay in hospital was significantly predicted by age ( p  = 0.048), low physical activity ( p  = 0.029), and high C-reactive protein (CRP; p  = 0.031). Furthermore, CRP was the only significant predictor of time of mechanical ventilation and length of stay on intensive care unit., Conclusion:  Outcome was not predicted by mental distress. However, inflammation marker CRP was predictive for outcome, potentially caused by higher cardiovascular risk profile. Additionally, depression was referred to be associated with inflammation. Probably, the small sample and the timing of assessment were responsible for the missing relation between mental distress and outcome. We presume a relation with low physical activity and depression. Nevertheless, further randomized studies are needed to pay more attention on patients' distress to intervene preoperatively to improve postoperative outcome., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Aim The aim of the present study was to determine the relevant factors in the mental health of people who experienced internal migration in comparison with people who did not. Methods Data from a longitudinal study in Saxony were used to compare the psychological distress of individuals who migrated internally with that of those who did not in 2010 and 2020. Bootstrapping-based mediation analysis was applied to examine possible mediators between internal migration and mental health.Results Individuals who experienced internal migration reported less mental distress compared to those who did not in 2010, but not in 2020, but these effects disappeared after including covariates and mediators. Important mediators in 2010 were life situation, political solidarity with FRG, winner of German Unification and job security; in 2020, these were threat of old-age poverty and experiences with system.Discussion Internal migration influences mental distress through different factors. Especially the current life circumstances play a crucial role., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Several therapeutic treatments like individual psychotherapy, group therapy, creative therapies and talks with the nursing staff are components in an inpatient psychosomatic (psychotherapeutic) treatment or a psychosomatic day hospital treatment. In Germany, these therapies have to be documented by the administration with so called OPS-Codes. These codes are reported to the Institute for Reimbursement in Hospitals (InEK). With the data of the INDDEP-study it should be investigated how the therapies of 7 hospitals and 8 day-hospitals compare to each other. In addition, it should be studied, if the amount of the documented therapies is connected to the outcome in these hospitals. In the INDDEP-study, data of patients with major depression were assessed at 4 measurement points (admission, discharge, 3 months and 12 months follow up). In addition, the OPS codes of the treatments were documented. The results show that it is possible to get a rough estimation of the psychotherapeutic doses by the OPS-codes. The results show significant differences between the hospitals in terms of the intensity and professional group composition of the treatments. This result is confirmed for in-patient and day hospital treatments. Correlation analyses showed no significant correlation between the total amount of therapy and the improvement in depressive symptoms. It is assumed that there are moderating variables (patient-, therapy and process-related) which moderate the relation between doses and outcome. This should be identified in further studies., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Despite extensive psychosocial consequences, just a small number of pathological gamblers participates in counseling or treatment. Telephone helplines should facilitate pathological gamblers' access to the health care system. There is a lack of research on the use and the effects of such facilities in Germany. The present research focuses on the question whether telephone helplines facilitate pathological gamblers' access to the health care system., Method: All first time calls due to a gambling problem received by the behavioral addiction helpline of the University Medical Center Mainz between 2013 and 2016 were analyzed by SPSS., Results: Of the 773 calls analyzed, 89% were from male gamblers. 79.7% reported gambling in slot machine arcades as the primary problem. 66.6% received a referral for a diagnostic in-person assessment at the outpatient clinic for behavioral addiction of the University Medical Center Mainz. 80.4% made an appointment, of which 81.3% were kept. Men were more likely to keep the appointment. Only a few callers had found out about the behavioral addiction helpline by gambling providers., Conclusions: Telephone helplines facilitate pathological gamblers' access to the health care system.There is a deficit in the propagation of such an offer by gambling providers. Telephone helplines should be communicated more actively to problem gamblers in all gambling venues., Competing Interests: Die Hotline Verhaltenssucht der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Mainz, wird durch Drittmittel von verschiedenen staatlich konzessionierten Glücksspielanbietern bezuschusst. Bei der vorliegenden Untersuchung handelt es sich um eine zusammenfassende Auswertung der Daten, die ohne finanzielle Förderung durchgeführt wurde. Die Autoren waren unabhängig in der Auswahl der Fragestellung, der Auswertung und Interpretation der Daten sowie der Veröffentlichung der Ergebnisse., (© Georg Thieme Verlag KG Stuttgart · New York.)

The proportion of adolescent migrants in Germany aged 15-20 years has risen to about 29.5% in 2014 according to Federal census statistics. The purpose of the current study was to describe and to compare the psychological strains of adolescent 1 st and 2 nd generation migrants with non-migrants in a representative school survey. Acceptance of violence legitimizing masculinity norms was explored and its correlation with psychological strain was analyzed. Self-reported data of psychological strain (internalizing and externalizing problems) and acceptance of violence legitimizing masculinity were gathered among 8 518 pupils aged 12-19 years across different school types. Among the surveyed adolescents, 27.6% reported a migration background (5.8% 1 st generation migrants; 21.8% 2 nd generation migrants). Particularly 1 st generation migrants scored higher in internalizing and externalizing problems than 2 nd generation migrants or non-migrants. The differences, however, were small. Adolescents with migration background suffered from educational disadvantage, especially 1 st generation migrants. Male adolescents reported significantly higher acceptance of violence legitimizing masculinity norms than their female counterparts. Strong agreement with the measured concept of masculinity was found among pupils of lower secondary school and adolescents reported regularly tobacco and cannabis consumption. The acceptance of violence legitimizing masculinity norms was greater among migrants, particularly 1 st generation migrants, than non-migrants. Overall, high acceptance of violence legitimizing masculinity norms was related to externalizing problems, which can be understood as dysfunctional coping mechanisms of social disadvantage and a lack of prospects., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: This study addresses the need for methodologically sound, brief screening procedures (e. g., the PHQ-4) which need to be validated for refugees in their native languages. Method: A cohort of Syrian refugees in the state of Lower Saxony was investigated with the PHQ-4 translated into Standard Arabic language by a professional translation bureau. Based on representative data, the prevalence of anxiety and depressive disorders was estimated among refugees. N=864 persons of mainly male sex (68%) answered with a mean age of M=31.5 (SD=9.3 years, ranging from 16 to 93 years). Results: Internal consistency was good (PHQ-2, respectively GAD-2: α=0.76/0.83; women α=0.76/0.83; men: α=0.76/0.83). Confirmatory factor analyses revealed good to excellent fit: RMSEA=0,068 [95%-KI: 0.028, 0.117], TLI=0.971, CFI=0.995. Measurement invariance was demonstrated for sex. The prevalence of depression was 20%, which corresponds to results reported for the German population; generalized anxiety was moderately higher in the Syrian sample (19.3 vs. 15.2%). Discussion: The Arabic version of the PHQ-4 is an ultra-short and valid screening procedure suitable for refugees from Arabic countries. The finding that the prevalence of depression and anxiety symptoms was moderate may be due to the sample composition, which comprised predominantly young men. Given the often traumatic circumstances of their flight, additional symptoms beyond the scope of this study (esp. PTSD) can be expected., (© Georg Thieme Verlag KG Stuttgart · New York.)

The antiphospholipid syndrome (APS) is characterised by venous and/or arterial thrombosis and pregnancy morbidity in women combined with the persistent presence of antiphospholipid antibodies (aPL). We aimed to identify genetic factors associated with the presence of aPL in a population based cohort. Furthermore, we wanted to clarify if the presence of aPL affects gene expression in circulating monocytes. Titres of IgG and IgM against cardiolipin, β2glycoprotein 1 (anti-β2GPI), and IgG against domain 1 of β2GPI (anti-domain 1) were determined in approx. 5,000 individuals from the Gutenberg Health Study (GHS) a population based cohort of German descent. Genotyping was conducted on Affymetrix Genome-Wide Human SNP 6.0 arrays. Monocyte gene expression was determined in a subgroup of 1,279 individuals by using the Illumina HT-12 v3 BeadChip. Gene expression data were confirmed in vitro and ex vivo by qRT-PCR. Genome wide analysis revealed significant associations of anti-β2GPI IgG and APOH on chromosome 17, which had been previously identified by candidate gene approaches, and of anti-domain1 and MACROD2 on chromosome 20 which has been listed in a previous GWAS as a suggestive locus associated with the occurrence of anti-β2GPI antibodies. Expression analysis confirmed increased expression of TNFα in monocytes and identified and confirmed neuron navigator 3 (NAV3) as a novel gene induced by aPL. In conclusion, MACROD2 represents a novel genetic locus associated with aPL. Furthermore, we show that aPL induce the expression of NAV3 in monocytes and endothelial cells. This will stimulate further research into the role of these genes in the APS.

Current refinements of the dissociation concept have arrived at the distinction between a dimensional, non-pathological type and a discontinuous, pathological class of dissociation, which can be identified by a subset of 8 items of the Dissociative Experiences Scale, the DES-Taxon (DES-T). This study reports on the psychometric evaluation of the German version of the DES-T in a large general population sample (n = 2,359). The distributions of all items and the total score of the DES-T emerged to be non-normal and right-skewed with a sharp peak. The internal consistency proved to be high (Cronbach's α = 0.92), and all items discriminated well with item-total correlations above 0.65. An explorative factor analysis revealed that all items loaded on the first, unrotated factor with loadings of a ≥ 0.7 (explained variance 64%). The DES-T is a one-dimensional measure as indicated by confirmatory factor analysis. There were no relevant associations between the DES-T, sociodemographic characteristics, depression or anxiety. The prevalence of pathological dissociation was 1.6% in the general population. The DES-T proved to be an economic and psychometrically sound self-report measure for the assessment of pathological dissociative phenomena., (© Georg Thieme Verlag KG Stuttgart · New York.)

Research on common and differential factors in the therapeutic process is impeded by the lack of instruments suitable for assessing common change mechanisms. This study presents the psychometric properties of a newly developed time-economic instrument (WIFA-k), which was designed to assess common factors of psychotherapy as designed by Grawe. Within a multi-center study comparing the efficacy of cognitive therapy and psychodynamic therapy in the treatment of social phobia, 6 raters assessed 25 randomly selected, videotaped therapy sessions of each treatment approach, and evaluated common factors using the Wifa-k. Interrater-reliability was found to be high for the items "resource activation", "motivational clarification" and "mastery" and low for the items "therapeutic relationship" and "problem activation". Ways to increase reliability and validity of the scale are discussed., (© Georg Thieme Verlag KG Stuttgart · New York.)

In order to determine if first year medical students of a Medical Psychology and Medical Sociology course have adopted basic physician patient communication skills, we developed an appropriate Objective Structured Clinical Examination (OSCE). The parcours took place in a pretest condition (n=182) and in the following semester under test condition, now relevant for passing the course (n=181). Reliability of the OSCE reached a medium degree (α=0.55/0.50). Results of written examinations and OSCE scores were weakly correlated. The correlation between task competence and patient-centeredness was higher in the pretest than under test condition. Female students mostly achieved higher scores than male students. Nearly all of the students (92%/97%) were in favor of continuing this examination. Physician-patient communication is a process of high complexity, but it can be tested by OSCE. Relevance for passing the course seems to enhance the learning behaviour., (© Georg Thieme Verlag KG Stuttgart · New York.)

Social fears are common, whereas Social Phobia is diagnosed infrequently. Therefore, we compared the clinical diagnoses (ICD-10) in an outpatient and CL service of a psychosomatic university hospital to patients' self ratings in social fears on the Liebowitz Social Anxiety Scale (LSAS). Over the course of one year 688 patients could be characterized regarding their clinical diagnoses, LSAS-scores, symptom severity (SCL-90R) and psychosomatic complaints (GBB-24). Patients were assigned to three groups by their levels of social fears (LSAS). Social Phobia was diagnosed rarely by clinicians (5.5%), but generalized social fears (LSAS>60) were commonly reported by patients (14.6%). Patients with social fears reported higher distress and more psychosomatic complaints. They were more often diagnosed with Depression, Agoraphobia or Panic Disorder and Posttraumatic Stress Disorder. Effective manualized psychotherapeutic short-term approaches are available for patients with Social Phobia. Therefore, a better clinical identification of this group of patients is desirable., (Georg Thieme Verlag KG Stuttgart.New York.)

This paper presents the Social Phobia Psychotherapy Research Network (SOPHO-NET). SOPHO-NET is among the five research networks on psychotherapy funded by "Bundesministerium für Bildung und Forschung". The research program encompasses a coordinated group of studies of social phobia. In the central project (Study A), a multi-center randomized controlled trial, refined models of manualized cognitive-behavioral therapy (CBT) and manualized short-term psychodynamic psychotherapy (STPP) are compared in the treatment of social phobia. A sample of n=512 outpatients will be randomized to either CBT, STPP or wait list. For quality assurance and treatment integrity, a specific project has been established (Project Q). Study A is complemented by four interrelated projects focusing on attachment style (Study B1), cost-effectiveness (Study B2), polymorphisms in the serotonin transporter gene (Study C1) and on structural and functional deviations of hippocampus and amygdala (Study C2). Thus, the SOPHO-NET program allows for a highly interdisciplinary research of psychotherapy in social phobia.

Obesity is associated with an increased somatic morbidity and mortality. This paper focuses on the controversial issue of mental co-morbidity in various populations of overweight and obese persons and the relationship to the utilization of medical care and health behaviour. Therefore, this paper focuses on health care utilization and health behaviour in overweight/obese with mental co-morbidity. In a representative German community sample with n=1281 we administered valid self-rating scales on depression and anxiety. Using established cut-off scores we identified 61 subjects with both overweight/obesity and at least one mental disorder. Compared to the overweight/obese without mental co-morbidity, those subjects showed a more extensive health care utilization of psychiatric and psychotherapeutic services and reported more smoking. Beside the number of somatic problems, age, BMI, female gender and residence in Eastern-Germany a lower subjective health in overweight/obese subjects could be predicted by the occurrence of at least one mental disorder. Our results implicate the need to focus on psychotherapy in weight reduction programmes for participants with mental co-morbidity.

Until now little is known about the role of participation in self-help groups alone or combined with psychotherapy in post-in-patient care. In the present study 2933 patients were questioned about their experience of self-help groups and psychotherapy after discharge from a clinic for psychosomatic medicine and psychotherapy. Nearly 8 % of them utilized self-help groups (mostly combined with out-patient psychotherapy), and altogether 68 % out-patient psychotherapy following in-patient treatment. Patients without out-patient treatment were psychologically less burdened and had better resources than participants of self-help groups or psychotherapy. Self-help group members differed from patients in out-patient psychotherapy by expressing a more positive opinion of groupwork and higher openness to new experiences. Additionly, they had discussed the topic of self-help groups more frequently with their therapists. This may be a starting-point for promoting more self-help activities of patients in the future.