[Actual Duration of Postgraduate Training of Medical Residents in Germany: Results of the KarMed Study Ten Years After Physician Licensure]. / Reale Dauer der fachärztlichen Weiterbildung in Deutschland ­ Ergebnisse der KarMed-Studie zehn Jahre nach Approbation.

BACKGROUND: Professional qualification as a doctor of medicine includes completion of medical studies and residency. Data on the real duration of residency are currently not assessed systematically in Germany. OBJECTIVES: Our study aimed to analyze data on the real length of residency under consideration of area of expertise (specialization), part-time working, grades after school and medical studies, gender, and parenthood of the physicians in residency. MATERIAL AND METHODS: The KarMed Study's database consists of annual postal surveys throughout the entire residency of medical students, beginning with their "Practical Year" in 2008/2009 until 2019. The study analyzed data six and ten years within this residency period. RESULTS: The majority of the residents was capable of finishing their residency within the minimal time. One significant effect on actual duration of residency was the subject choice. One-third of the female residents had not yet finished their residency after ten years. Partenhood had a significant effect on female residents, but not on male residents. A regression analysis showed (R²corr=0.03, p<0.001) that the duration of residency was associated with the grade received after studying (ß=0.30). Male residents were more satisfied with the overall residency then female residents. DISCUSSION: Structural improvement in postgraduate training needs to be adjusted in terms of parental status. Prospective studies should take the selection process of universities into account and examine its association with the time required to complete residency.

[Influence of partnership on burnout and gratification crisis in residents considering the distribution of house work and working time]. / Zum Einfluss von Partnerschaft auf Burnout und Gratifikationskrisen bei Ärzten und Ärztinnen in fachärztlicher Weiterbildung unter Berücksichtigung der Aufteilung von beruflicher Tätigkeit und Hausarbeit.

Background: Social support through the partner can have an impact on work related stress perception of physicians. So far, there is no empirical data on the association of gratification crisis and social support through the partner in physician's profession. Objectives: This study evaluates the effects of social support, in terms of distribution of house work and amount of working time within a partnership, on burnout and gratification crisis of residents. Material and Methods: Data acquisition was carried out within the multi-centric and prospective "KarMed" study in Germany at the end of the postgraduate training in 2016 (N = 433). The ERI and MBI scales were used. Results: Results yielded significant effects of distribution of house work and the amount of working time on gratification crisis and burnout. Conclusions: The satisfaction with the distribution of house work as well as working time in a partnership plays an important role for the wellbeing of residents. In terms of decreasing numbers of outpatient practices, the results of the present study underlie the relevance of work-life balance.

Changes in bodily complaints (PHQ-15) over six years in a large general population sample.

OBJECTIVE: The Patient Health Questionnaire-15 (PHQ-15) is a widely used instrument for measuring bodily complaints. The aims of this study were to analyze changes of bodily complaints over a six-year period in a large general population community sample, to test age and sex differences in these changes, and to examine associations between these changes and changes in other health-related variables. METHODS: A total of 4821 adult subjects took part this longitudinal study at baseline (t1) and six years later (t2). The participants completed the PHQ-15 and several other questionnaires. RESULTS: Over the six-year period, the mean score of the complaints increased from 5.18 ± 3.67 to 5.75 ± 3.97. The highest increase in terms of effect sizes was found for sexual pain/problems. While the increase in the PHQ-15 mean score was nearly identical for males and females, there were age differences in these increase rates: Participants of the oldest age group (70 years and above) experienced the greatest increase in complaints. Participants from lower socioeconomic levels also reported high increases in complaints. The correlation between the t1 and the t2 PHQ-15 score was r = 0.66. Changes in complaints from t1 to t2 were associated with changes in multiple other variables such as anxiety, social support, optimism, life satisfaction, and quality of life. CONCLUSION: The data reported here can be used to better interpret changes in patients' health state over several years.

[Persistent fatigue symptoms following COVID-19 infection in healthcare workers: risk factors and impact on quality of life]. / Anhaltende Fatigue als Folge einer COVID-19-Infektion bei Beschäftigten im Gesundheitswesen: Risikofaktoren und Auswirkungen auf die Lebensqualität.

BACKGROUND AND OBJECTIVES: Employees from medical and nursing professions are at increased risk for a SARS-CoV­2 infection and thus more frequently affected by COVID-19 sequelae. Previous studies have identified post-viral fatigue as the most common sequelae. The aim of this study was to investigate risk factors and effects induced by clinically relevant fatigue symptoms following a COVID-19 infection of healthcare workers. METHODS: In the spring of 2021, 4315 insured members of the Statutory Accident Insurance and Prevention in the Health and Welfare Service were contacted for a written survey on their COVID-19 disease in 2020 and its sequelae. Information on Symptoms of acute infection, disease sequelae, and potential risk factors were collected, as well as the physical and mental health status after SARS-CoV­2 infection. The general fatigue scale of the Multidimensional Fatigue Inventory (MFI) was used as fatigue screening. Regression analyses and multivariate analyses of variance were calculated for data analysis. RESULTS: Of the respondents, 10.7% showed severe fatigue symptoms. Identified risk factors for clinical fatigue symptoms included preexisting mental and respiratory conditions and severity of acute infection. Furthermore, severe long-/post-COVID fatigue was associated with higher psychological distress, lower health-related quality of life, and more frequent incapacity to work. CONCLUSIONS: Severe long-/post-COVID fatigue is associated with a high level of distress, which requires specific rehabilitation approaches and poses a challenge to the social insurance agencies and accident insurers to develop appropriate rehabilitation concepts.

[The Impact of Parenthood, Support, and Short-Term Contracts on Work-Family Conflict of Female and Male Residents' Career]. / Der Einfluss von Elternstatus, erlebter Unterstützung und Befristung auf das Belastungserleben und die Karriereentwicklung von Ärztinnen und Ärzten am Ende der Weiterbildung.

BACKGROUND: Work factors and work-family interference play an important role in physicians leaving clinical practice. OBJECTIVES: The purpose of this study was to examine residents' work-family conflict and family-work conflict in association with parental status, perceived support, and short-term contracts. MATERIAL AND METHODS: Data acquisition was carried out within the multi-centric and prospective "KarMed" study in Germany at the end of the postgraduate training in 2016 (N=433). The Work-Family Conflict and Family-Work Conflict scales were used. Further independent variables were gender, parental status, short-term contracts, and perceived support from partner. Results Female physicians with children interrupted postgraduate training five times more often then female physicians without children and 18 times more often than male physicians with children. Female as well as male physicians with children showed greater family-work conflicts, and female physicians without children scored higher on work-family conflict. Male physicians did not show significant results on work-family conflict. Neither short-term contracts nor perceived support from the partner had a significant influence on work-family or family work conflict. CONCLUSIONS: There is a need to reduce work-family conflicts and their associated factors in female resident physicians.

[Analysis of career and life satisfaction of women residents with children during their postgraduate training compared to male colleagues: A longitudinal analysis as part of the KarMed study]. / Berufsverlaufs- und Lebenszufriedenheit von Ärztinnen in fachärztlicher Weiterbildung mit Kindern im Vergleich zu ihren männlichen Kollegen ­ Eine longitudinale Untersuchung im Rahmen der KarMed-Studie.

OBJECTIVE: Former results of the KarMed study revealed a significant decrease in the career satisfaction of female physicians with children in the course of their postgraduate training compared to male physicians with children. Yet, female physicians with children showed the highest scores on satisfaction with life at the fourth year of postgraduate training. The present study evaluates whether the different courses of career satisfaction and life satisfaction of female physicians compared to male physicians are caused by parental status. METHODS: Data were collected in the course of the KarMed study (2008-2016). A cross-lagged panel design was used to analyze data from T2 to T5. RESULTS: The results indicate an inverse association of career satisfaction with life satisfaction. Women physicians with a low level of career satisfaction were more likely to have children than those with a higher career satisfaction. Furthermore, we found a causal effect of parental status on career satisfaction in male physicians. For female physicians, yet not for male physicians, life satisfaction predicts the parental status. CONCLUSIONS: The structural improvement in postgraduate training needs to be adjusted in terms of parental status. Prospective studies should take medical leave during pregnancy as well as parental leave of male medical residents into account.

Associations between self-rated health and the assessments of anchoring vignettes in cardiovascular patients / Asociación entre la autopercepción de la salud y la evaluación de viñetas de caso en pacientes cardiovasculares

BACKGROUND/OBJECTIVE: Assessments of health can be biased by response shift effects. One method for detecting such effects is the use of anchoring vignettes. The aim of this study was to analyze the relationship between participants' self-assessed health state and their assessments of these vignettes. METHOD: A total of 342 cardiovascular patients assessed their own state of health on a 0-100 visual analogue scale. The patients additionally assessed two vignettes featuring fictional persons suffering from specific complaints. A sample of the general population (N = 1,236) served as controls. RESULTS: The participants rated the health state of the vignette character featuring physical problems as being significantly better than the general population did (effect size: d = 0.53). The group difference in the assessment of the vignette featuring primarily mental health problems was lower (d = -0.17). Participants' assessments of the vignettes were positively correlated with their assessments of their own health state (r = .26 and r = .10) and with several quality of life variables. CONCLUSIONS: Anchoring vignettes are a useful tool for detecting response shift effects

ANTECEDENTES/OBJETIVO: Las evaluaciones de la salud pueden estar sesgadas por efectos de cambio en la respuesta. Un método para detectar ese tipo de efectos es el uso de viñetas de caso. El objetivo de este estudio fue analizar la relación entre el estado autoinformado de salud y la evaluación de estas viñetas. MÉTODO: Un total de 342 pacientes cardiovasculares evaluaron su estado de salud personal en una escala analógica-visual de 0-100. Adicionalmente, debían evaluar dos viñetas describiendo personas ficticias que sufrían de algunas condiciones de salud. Una muestra de la población general (N = 1.236) sirvió como grupo control. RESULTADOS: Los participantes evaluaron el estado de salud de los protagonistas de las viñetas como significativamente mejor que la población general (tamaño del efecto d = 0,53). La diferencia entre grupos de la evaluación de la viñeta con problemas primariamente de salud mental fue más baja (d = -0,17). La evaluación de la salud de las viñetas muestra una correlación positiva con la evaluación del propio estado de salud (r = 0,26 y r = 0,10) y con varias variables de calidad de vida. CONCLUSIONES: Las viñetas de caso son una herramienta útil para detectar efectos de cambio en la respuesta

Associations between self-rated health and the assessments of anchoring vignettes in cardiovascular patients.

BACKGROUND/OBJECTIVE: Assessments of health can be biased by response shift effects. One method for detecting such effects is the use of anchoring vignettes. The aim of this study was to analyze the relationship between participants' self-assessed health state and their assessments of these vignettes. METHOD: A total of 342 cardiovascular patients assessed their own state of health on a 0-100 visual analogue scale. The patients additionally assessed two vignettes featuring fictional persons suffering from specific complaints. A sample of the general population (N = 1,236) served as controls. RESULTS: The participants rated the health state of the vignette character featuring physical problems as being significantly better than the general population did (effect size: d = 0.53). The group difference in the assessment of the vignette featuring primarily mental health problems was lower (d = -0.17). Participants' assessments of the vignettes were positively correlated with their assessments of their own health state (r = .26 and r = .10) and with several quality of life variables. CONCLUSIONS: Anchoring vignettes are a useful tool for detecting response shift effects.

ANTECEDENTES/OBJETIVO: Las evaluaciones de la salud pueden estar sesgadas por efectos de cambio en la respuesta. Un método para detectar ese tipo de efectos es el uso de viñetas de caso. El objetivo de este estudio fue analizar la relación entre el estado autoinformado de salud y la evaluación de estas viñetas. MÉTODO: Un total de 342 pacientes cardiovasculares evaluaron su estado de salud personal en una escala analógica-visual de 0-100. Adicionalmente, debían evaluar dos viñetas describiendo personas ficticias que sufrían de algunas condiciones de salud. Una muestra de la población general (N = 1.236) sirvió como grupo control. RESULTADOS: Los participantes evaluaron el estado de salud de los protagonistas de las viñetas como significativamente mejor que la población general (tamaño del efecto d = 0,53). La diferencia entre grupos de la evaluación de la viñeta con problemas primariamente de salud mental fue más baja (d = -0,17). La evaluación de la salud de las viñetas muestra una correlación positiva con la evaluación del propio estado de salud (r = 0,26 y r = 0,10) y con varias variables de calidad de vida. CONCLUSIONES: Las viñetas de caso son una herramienta útil para detectar efectos de cambio en la respuesta.

[Burnout and Gratification Crises in Female and Male Physicians during Postgraduate Medical Education in Germany - A Longitudinal Study]. / Burnout und Gratifikationskrisen im Längsschnitt bei Ärztinnen und Ärzten während der fachärztlichen Weiterbildung in Deutschland.

Several studies have demonstrated high work related stress and burnout symptoms in physicians. The study examined the longitudinal relationships of burnout and gratification crisis during 6 years of postgraduate medical education, controlled for gender and parental status. Data acquisition was carried out within the KarMed-study. Administered were the Maslach Burnout Inventory (MBI-HSS (MP)) (MBI) and the Effort-Reward-Imbalance (ERI). The analyses focused on general linear models and general linear mixed models with repeated measure designs. The amount of burnout perceived at the beginning of the postgraduate medical education is highly associated with the perceived amount of burnout at the end. Gratification crisis were significant for one subscale of the MBI (emotional exhaustion), yet not for personal accomplishment nor depersonalization. Significant time effects were found on all 3 subscales of the MBI, with gender effects on the subscales emotional exaustion and depersonalization. Having kids did not have significant effects, controlled for all measurement points of burnout as well as for gratification crisis. Theoretical implications and practical consequences for doctors, as well as the limitations of the study, are discussed.

[Evaluation of Germany's Sixth National Health Target Entitled "Depressive Illnesses - Prevention, Early Diagnosis, Sustainable Treatment": Developments over the Last 10 Years]. / Evaluation zum Nationalen Gesundheitsziel "Depressive Erkrankungen: verhindern, früh erkennen, nachhaltig behandeln" ­ Die Entwicklung 10 Jahre nach Verabschiedung.

BACKGROUND: Revision of the evaluation concept of Germany's sixth national health target entitled "Depressive illnesses - prevention, early diagnosis, sustainable treatment" developed in 2006. OBJECTIVES: Analysis of available of data since 2006 to determine if the objectives of the health target and its sub-goals (awareness, prevention, diagnosis/indication/therapy, health care structure, patient empowerment, rehabilitation) were achieved. MATERIALS AND METHODS: The 6 sub-goals were screened in terms of indicators of progress towards goal over the last decade, and then examined for accessible data sources. RESULTS: The sub-goal prevention yielded routine data from t0 onwards (start of activities). The other sub-goals awareness, diagnosis, and health care provided selective data sources, generated mostly by scientific studies. An important milestone within the sub-goal of diagnosis/indication/therapy was the development of the National Clinical Practice guideline for depression. Data were sparse in the areas rehabilitation and patient empowerment. CONCLUSIONS: The six sub-goals are still valid. Yet, the validity of the data in terms of the evaluation of the health target is limited mainly because of the cross-sectional designs of studies. Prospective systematic surveys are required to further evaluate the national health target and its implementation for both qualitative and quantitative longitudinal indicators.

[Longitudinal evaluation of female and male medical residents' career satisfaction]. / Longitudinale Untersuchung der Berufsverlaufszufriedenheit von Ärztinnen und Ärzten in der Facharztweiterbildung.

OBJECTIVE: Evaluation of longitudinal data of German medical residents' career satisfaction and its dependency on perceived delays in obtaining the degree as a medical specialist, as well as postgraduate training quality, controlled for gender, parental status, and specialty choice. METHODS: Data was collected within the KarMed study. The first data collection (T0) was conducted in 2008/2009 at the end of the practical year. Hierarchical linear models and path analysis were used to analyse longitudinal associations after three and five years (T3 to T5). RESULTS: A positive residents' career satisfaction had a small causal effect on the training quality. A delay in obtaining the degree as a medical specialist had a small negative effect on residents' career satisfaction. A high residents' career satisfaction was negatively associated with a delay in training. Gender predicted the career satisfaction of physicians with children. The career satisfaction of female physicians with children decreased significantly in the course of their postgraduate training compared to male physicians with children. The speciality choice had no significant impact on residents' career satisfaction. CONCLUSION: Residents who were satisfied with their job subjectively rated the quality of postgraduate training conditions more positively. The anticipated delays in obtaining the degree as a medical specialist and the residents' career satisfaction were reciprocally related. The improvement of career satisfaction in female physicians with children needs special attention in the future.

[What is Known About the Real Length of Postgraduate Medical Education in Germany?] / Was wissen wir über die reale Dauer der ärztlichen Weiterbildung in Deutschland?

OBJECTIVE: This study examines the real length of postgraduate medical education in Germany. The regulations define minimal time periods in months for each discipline. We especially analyze the differences between minimum and real length, as well as the percentages of interrupting or dropping out physicians by gender. METHODS: Within the KarMed study, annual postal surveys were sent to graduates of seven medical faculties in Germany from their last year of undergraduate education until after six years of postgraduate training. The return rate at baseline was 48 % (n = 1012) and the 5 surveys after baseline reached rates of 85 % and more. Descriptive statistics were used for analyses. RESULTS: Half of the residents did not finish within the minimum time period. This proportion was higher among women (65 %) then men (43 %); among women with child/children this proportion reached 91 %. Female residents expecting a prolongation estimated an average time period of 19.6 months (SD = 14.7), male residents of 11.5 months (SD = 8.6).Female residents named problems in relation to children as the most important factor. Half of the reasons given by male residents (and 31 % of those given by females) are related to organizational and curricular problems of postgraduate education. CONCLUSION: Effective measures are needed to reduce the problem of continuation of postgraduate education in the course of getting/having children and/or to promote the return to training in the hospital. For this, curricular and organizational measures, e. g. rotation plans and better possibilities for part-time training, should be offered.

Social support in the general population: standardization of the Oslo social support scale (OSSS-3).

BACKGROUND: The objectives of the study were to generate normative data for the Oslo Social Support Scale (OSSS-3) for different age groups for men and women and to further investigate the factor structure in the general population. METHODS: Nationally representative face-to face household surveys were conducted in Germany in 2008 (n = 2524). RESULTS: Normative data for the Oslo Social Support Scale were generated for men and women (52.3% female) and different age levels (mean age (SD) of 48.9 (18.3) years). Men had mean scores comparable to women (10.1 [SD = 2.3] vs. 10.2 [SD = 2.2]). The EFA resulted in a clear one-factor solution for the OSSS-3. CONCLUSIONS: The normative data provide a framework for the interpretation and comparisons of social support with other populations.

Psychometric properties of the Satisfaction with Life Scale (SWLS), derived from a large German community sample.

PURPOSE: The aim of this study was to test psychometric properties of the Satisfaction with Life Scale (SWLS), to provide normative values, and to analyze associations between life satisfaction and sociodemographic and behavioral data. METHODS: A German community sample (n = 9711) with an age range of 18-80 years was surveyed using the SWLS and several other questionnaires. Confirmatory factor analysis (CFA) was used to test the dimensionality of the SWLS. Invariance across gender and age groups was tested with multiple-group CFA. Associations between SWLS, sociodemographic variables, and behavioral variables were tested with ANOVAs. RESULTS: Confirmatory factorial analysis results confirmed that the SWLS is a one-dimensional scale. Measurement invariance across gender was completely confirmed, while concerning age strict measurement invariance was confirmed. The effects of gender and age on satisfaction with life were weak. Satisfaction with life was associated with fatigue (r = - .49), the mental component of quality of life (r = .45), anxiety (r = - .42), dispositional optimism (r = .41), pessimism (r = - .34), sleep quality (r = - .32), and sociodemographic factors such as marital status, income, and occupational status. Non-smokers reported higher life satisfaction than smokers. CONCLUSIONS: Because of the good psychometric properties, the SWLS can be recommended for use in epidemiological research. Normative values based on a large community sample are provided.

Resilient coping in the general population: standardization of the brief resilient coping scale (BRCS).

BACKGROUND: There has been a marked tendency for researchers, clinicians, and policy makers to shift their focus from risk to resilience. This should be assessed by comparing the outcome to a context specific reference group. The objectives of the study were to generate normative data for the BRCS for different age groups for men and women and to further investigate the construct validity and factor structure in a general population. METHODS: Nationally representative face-to face household surveys were conducted in Germany in 2013 (n = 2508). RESULTS: Normative data for the BRCS were generated for men and women (53.2% female) and different age levels (mean age (SD) of 49.7 (18.0) years). Men had significantly higher mean scores compared with women (14.9 [SD = 3.2] vs. 14.6 [SD = 3.1]). The results of the EFA and CFA clearly indicate a unidimensional solution with one factor. Furthermore, the invariance of the one-factor model was tested for the whole sample across gender and six age groups. CONCLUSIONS: The normative data provide a framework for the interpretation and comparisons of resilience with other populations.

Optimism and pessimism in the general population: Psychometric properties of the Life Orientation Test (LOT-R) / Optimismo y pesimismo en la población general: propiedades psicométricas del Life Orientation Test (LOT-R)

Background/Objective: The Life Orientation Test-Revised (LOT-R) is often used to assess dispositional optimism. The aims of this study were to test psychometric properties of the LOT-R, to provide normative scores, and to test the association between optimism and several psychological, sociodemographic, and behavioral factors. Method: A randomly selected German general population community sample with an age range of 18-80 years (N=9,711) was surveyed. Results: The Confirmatory Factor Analysis (CFA) proved two (correlated) factors: Optimism and Pessimism. Invariance tests across gender and age groups confirmed metric invariance. There were only small gender differences in the LOT-R total score (M=16.4 for females and M=16.1 for males). The correlation between the subscales Optimism and Pessimism was strong for young and well educated people. Low optimism mean scores were observed for unemployed people, people with low income, smokers, and obese people. Normative scores of the LOT-R are provided. Conclusions: The study confirmed the bidimensional structure of the LOT-R and invariance across age and gender. We can recommend using this instrument for measuring dispositional optimism and pessimism in epidemiological research and clinical practice (AU)

Antecedentes/Objetivo: La versión revisada del Life Orientation Test (LOT-R) se emplea a menudo para evaluar el optimismo disposicional. Los objetivos de este estudio fueron establecer las propiedades psicométricas del LOT-R, y probar la asociación entre optimismo y varios factores psicológicos, socio-demográficos y conductuales. Método: Para ello se entrevistó una muestra comunitaria aleatoriamente seleccionada de la población general alemana, con un rango de edad de 19-80 años (N=9.711). Resultados: El Análisis Factorial Confirmatorio (CFA) sugiere dos factores (correlacionados): Optimismo y Pesimismo. Las pruebas de invarianza para género y edad confirmaron la invarianza métrica. Solamente se encontraron pequeñas diferencias de género en el puntaje total (M=16,4 para mujeres y M=16,1 para hombres). Se encontraron bajos puntajes medios en personas desempleadas, personas con bajos ingresos, fumadores y personas con obesidad. Se proveen valores normativos para el LOT-R. Conclusiones: El estudio confirma la estructura bidimensional del LOT-R y la invarianza en género y edad. El instrumento puede recomendarse para medir optimismo disposicional y pesimismo en investigación epidemiológica y en la práctica clínica (AU)

Frequency of somatic symptoms in the general population: Normative values for the Patient Health Questionnaire-15 (PHQ-15).

BACKGROUND: The PHQ-15 is widely used as an open access screening instrument for somatic symptoms in different health care settings. The objectives of the study were to contribute to the construct validity and to generate normative data for the PHQ-15. METHODS: The survey was conducted in the general population in Germany from August 2011 to November 2014 (n=9250). All participants underwent an extensive core assessment including a set of questionnaires. RESULTS: Men reported significantly less (p<0.001) physical symptoms than women (4.6 [SD=3.6] vs. 6.3 [SD=4.1]). The PHQ-15 total score was strongly correlated with the physical component of quality of life (r=-0.58), fatigue (r=0.56), anxiety (r=0.54) and sleep problems (r=0.54). While high socioeconomic status was associated with low prevalences of all complaints, obesity was associated with some of the complaints, especially shortness of breath and pain in arms, legs, and joints. Normative data for the PHQ-15 were generated for men and women. CONCLUSIONS: This investigation confirms the burden caused by somatic symptoms in terms of impaired physical quality of life. In association with psychosocial consequences such as anxiety as well as sleep problems, future studies should also focus on the disease burden of somatic symptoms. In addition, the normative data provide a framework for the interpretation and comparison with other populations.

Childhood adversities and distress - The role of resilience in a representative sample.

While adverse childhood experiences have been shown to contribute to adverse health outcomes in adulthood, specifically distress and somatic symptoms, few studies have examined their joint effects with resilient coping style on adult adjustment. Hence, we aim to determine the association between resilient coping and distress in participants with and without reported childhood adversities. A representative German community sample (N = 2508) between 14-92 years (1334 women; 1174 men) was examined by the short form of the Childhood Trauma Questionnaire, the Brief Resilience Coping Scale, standardized scales of distress and somatoform symptoms. Childhood adversity was associated with reduced adjustment, social support and resilience. It was also strongly associated with increased distress and somatoform complaints. Resilient coping was not only associated with lower distress, it also buffered the effects of childhood adversity on distress. Our study corroborates the buffering effect of resilience in a representative German sample. High trait resilient subjects show less distress and somatoform symptoms despite reported childhood adversities in comparison to those with low resilient coping abilities.

Perceived stress in first year medical students - associations with personal resources and emotional distress.

BACKGROUND: Medical students have been found to report high levels of perceived stress, yet there is a lack of theoretical frameworks examining possible reasons. This cross-sectional study examines correlates of perceived stress in medical students on the basis of a conceptual stress model originally developed for and applied to the general population. The aim was to identify via structural equation modeling the associations between perceived stress and emotional distress (anxiety and depression), taking into account the activation of personal resources (optimism, self-efficacy and resilient coping). METHODS: Within this cross-sectional study, 321 first year medical students (age 22 ± 4 years, 39.3% men) completed the Perceived Stress Questionnaire (PSQ-20), the Self-Efficacy Optimism Scale (SWOP) and the Brief Resilient Coping Scale (BRCS) as well as the Patient Health Questionnaire (PHQ-4). The statistical analyses used t-tests, ANOVA, Spearman Rho correlation and multiple regression analysis as well as structural equation modeling. RESULTS: Medical students reported higher levels of perceived stress and higher levels of anxiety and depression than reference samples. No statistically significant differences in stress levels were found within the sample according to gender, migration background or employment status. Students reported more self-efficacy, optimism, and resilient coping and higher emotional distress compared to validation samples and results in other studies. Structural equation analysis revealed a satisfactory fit between empirical data and the proposed stress model indicating that personal resources modulated perceived stress, which in turn had an impact on emotional distress. CONCLUSIONS: Medical students' perceived stress and emotional distress levels are generally high, with personal resources acting as a buffer, thus supporting the population-based general stress model. Results suggest providing individual interventions for those students, who need support in dealing with the challenges of the medical curriculum as well as addressing structural determinants of student stress such as course load and timing of exams.

Optimism and pessimism in the general population: Psychometric properties of the Life Orientation Test (LOT-R).

Background/Objective: The Life Orientation Test-Revised (LOT-R) is often used to assess dispositional optimism. The aims of this study were to test psychometric properties of the LOT-R, to provide normative scores, and to test the association between optimism and several psychological, sociodemographic, and behavioral factors. Method: A randomly selected German general population community sample with an age range of 18-80 years (N = 9,711) was surveyed. Results: The Confirmatory Factor Analysis (CFA) proved two (correlated) factors: Optimism and Pessimism. Invariance tests across gender and age groups confirmed metric invariance. There were only small gender differences in the LOT-R total score (M = 16.4 for females and M = 16.1 for males). The correlation between the subscales Optimism and Pessimism was strong for young and well educated people. Low optimism mean scores were observed for unemployed people, people with low income, smokers, and obese people. Normative scores of the LOT-R are provided. Conclusions: The study confirmed the bidimensional structure of the LOT-R and invariance across age and gender. We can recommend using this instrument for measuring dispositional optimism and pessimism in epidemiological research and clinical practice.

Antecedentes/Objetivo: La versión revisada del Life Orientation Test (LOT-R) se emplea a menudo para evaluar el optimismo disposicional. Los objetivos de este estudio fueron establecer las propiedades psicométricas del LOT-R, y probar la asociación entre optimismo y varios factores psicológicos, socio-demográficos y conductuales. Método: Para ello se entrevistó una muestra comunitaria aleatoriamente seleccionada de la población general alemana, con un rango de edad de 19-80 años (N = 9.711). Resultados: El Análisis Factorial Confirmatorio (CFA) sugiere dos factores (correlacionados): Optimismo y Pesimismo. Las pruebas de invarianza para género y edad confirmaron la invarianza métrica. Solamente se encontraron pequeñas diferencias de género en el puntaje total (M = 16,4 para mujeres y M = 16,1 para hombres). Se encontraron bajos puntajes medios en personas desempleadas, personas con bajos ingresos, fumadores y personas con obesidad. Se proveen valores normativos para el LOT-R. Conclusiones: El estudio confirma la estructura bidimensional del LOT-R y la invarianza en género y edad. El instrumento puede recomendarse para medir optimismo disposicional y pesimismo en investigación epidemiológica y en la práctica clínica.