Involvement, depressive symptoms, and their associations with problems and unmet needs in caregivers of adult eating disorder patients.

PURPOSE: This study aimed to examine the most important problems and needs caregivers of adult inpatients with eating disorders (EDs) are confronted with in their everyday lives. A further aim was to investigate the associations between problems, needs, involvement, and depression in carers. METHODS: Fifty-five caregivers of inpatients with EDs (26 anorexia nervosa, 29 bulimia nervosa) completed the Carers' Needs Assessment, Beck Depression Inventory, and the Involvement Evaluation Questionnaire. The relationships between variables were tested via multiple linear regressions and mediation analyses. RESULTS: The most frequent problem reported by caregivers was a lack of information about the course and treatment of the illness and consequent disappointment, whereas their most frequently reported needs were different forms of information and counselling. Problems, unmet needs, and worrying were especially high in parents compared to other caregivers. Involvement mediated significantly between problems (b = 0.26, BCa CI [0.03, 0.49]) as well as unmet needs (b = 0.32, BCa CI [0.03, 0.59]) of caregivers and their depressive symptoms. CONCLUSION: Our findings underline the importance of including the problems and needs of caregivers of adult eating disorder patients in the planning of family and community interventions, to support their mental health. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.

Adverse childhood experiences as risk factors for recurrent admissions in young psychiatric inpatients.

Background: Patients who require psychiatric inpatient treatment early in life are a particularly at-risk population. Factors such as adverse childhood experiences (ACEs) are, however, not well studied in those requiring psychiatric inpatient treatment during both childhood or adolescence and adulthood. Thus, the aim of the current study was to investigate, in young adult inpatients, the risk factors for prior admissions in Child and Adolescent Psychiatry, with a focus on ACEs. Materials and methods: An explorative population-based systematic chart investigation of psychiatric inpatients aged 18-25 was conducted at the University Hospital Tulln, Austria. Data analysis was done with descriptive methods and Pearson's chi- squared-, Fisher's exact-, Mann-Whitney-U-tests and predictive logistic regression models. Results: The sample comprised 390 inpatients (51.8% female), with an average age of 20 years at first psychiatric hospital admission. Those with a former child and adolescent psychiatry inpatient treatment (10.3%) were predominantly female (77.5%). Their number of documented ACEs was increased compared to those without former child and adolescent psychiatry admissions (2 vs 1.1), with up to twice as many experiences of family dysfunction, neglect or abuse. Sexual abuse (OR: 3.0), having been an adopted or fostered child (OR: 4.5), and female sex (OR: 3.0) were identified as main risk factors. Furthermore, former child and adolescent psychiatry inpatients suffered from higher rates of psychosomatic or personality disorders, comorbidities and functional impairment, and were readmitted twice as often in young adulthood. Conclusion: Young adult inpatients with reoccurring psychiatric inpatient treatments have increased rates of severe ACEs. Thus, special attention should be given to identifying ACEs, evaluating needs for psychosocial support and therapy, and meeting these needs after discharge.

A comparison of the three year course between chronic depression and depression with multiple vs. few prior episodes.

This study tested the hypothesis that chronic depression (CD) is more similar to depression with multiple prior episodes (ME) than to depression with few prior episodes (FE). Data from participants (n = 1013) with mild to moderate depressive symptoms (Patient Health Questionnaire [PHQ-9] score 5 - 14) who took part in a randomized control trial of an internet intervention for depression (EVIDENT trial) were re-analyzed. The MINI-interview was conducted to diagnose CD (n = 376). If CD was not diagnosed, the self-reported number of depressive episodes was used to categorize participants as having episodic depression with up to five (FE, n = 422) or more than five (ME, n = 215) prior episodes. Over a three-year period, participants were assessed repeatedly regarding the course of depression (PHQ-9, QIDS), quality of life (SF-12) and therapeutic progress (FEP-2). At baseline, most scores were different between CD and FE but comparable between CD and ME. Time to remission did not differ between CD and ME but was longer in CD compared to FE. Results suggest that ME closely resembles CD and that CD differs from FE.

Indirect (implicit) and direct (explicit) self-esteem measures are virtually unrelated: A meta-analysis of the initial preference task.

BACKGROUND: The initial preference task (IPT) is an implicit measure that has featured prominently in the literature and enjoys high popularity because it offers to provide an unobtrusive and objective assessment of self-esteem that is easy to administer. However, its use for self-esteem assessment may be limited because of weak associations with direct personality measures. Moreover, moderator effects of sample- and study-related variables need investigation to determine the value of IPT-based assessments of self-esteem. METHODS: Conventional and grey-literature database searches, as well as screening of reference lists of obtained articles, yielded a total of 105 independent healthy adult samples (N = 17,777) originating from 60 studies. Summary effect estimates and subgroup analyses for potential effect moderators (e.g., administration order, algorithm, rating type) were calculated by means of meta-analytic random- and mixed-effects models. Moreover, we accounted for potential influences of publication year, publication status (published vs. not), and participant sex in a weighted stepwise hierarchical multiple meta-regression. We tested for dissemination bias through six methods. RESULTS: There was no noteworthy correlation between IPT-based implicit and explicit self-esteem (r = .102), indicating conceptual independence of these two constructs. Effects were stronger when the B-algorithm was used for calculation of IPT-scores and the IPT was administered only once, whilst all other moderators did not show significant influences. Regression analyses revealed a somewhat stronger (albeit non-significant) effect for men. Moreover, there was no evidence for dissemination bias or a decline effect, although effects from published studies were numerically somewhat stronger than unpublished effects. DISCUSSION: We show that there is no noteworthy association between IPT-based implicit and explicit self-esteem, which is broadly consistent with dual-process models of implicit and explicit evaluations on the one hand, but also casts doubt on the suitability of the IPT for the assessment of implicit self-esteem on the other hand.

Gender differences in the relationship of childhood trauma and the course of illness in schizophrenia.

INTRODUCTION: Different types of childhood trauma have been repeatedly shown to contribute to psychotic symptoms. Gender differences in schizophrenia are well known. Some studies argue that trauma history means a significantly higher risk of psychosis for women than men. However, there is evidence of early adverse life events to be associated with higher stress-sensitivity in men. Little is known about the connection of specific type of trauma and specific psychotic symptoms as well as the course of illness with explicit regard to gender differences. METHODS: 102 men and women with schizophrenia spectrum disorder were tested using Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Scale for Assessing Positive Symptoms, Early Trauma Inventory-SR. RESULTS: Although, women had a later age at onset without regarding trauma history (d = 0.74), this difference became non-significant when introducing trauma variables. Patients reporting physical abuse had a significantly earlier age at onset, regardless of their sex (V = 0.13, F = 3.11, p = 0.03. Physical abuse predicted an earlier age at onset only in women (R2 = 0.23). History of general trauma predicted more frequent hospitalizations only in men (R2 = 0.55). CONCLUSIONS: Although women generally tend to have a more favorable course of illness including a later age at onset men, women with CPA seem to lose this "advantage". It is necessary to investigate the contribution of gender interacting with adverse life events in contribution to the phenomenology and etiology of schizophrenia.

Cognitive Correlates of Different Mentalizing Abilities in Individuals with High and Low Trait Schizotypy: Findings from an Extreme-Group Design.

Mentalizing or Theory of Mind (ToM) deficits in schizophrenia have been studied to great extent, but studies involving samples of trait schizotypy yield ambiguous results. Executive functions like cognitive inhibition, cognitive flexibility, and agency are all prerequisites of mentalizing, and it is assumed that the impairment of these functions contributes to ToM deficits in schizophrenia. Whether these impairments influence the ToM performance of people with high trait schizotypy remains unclear. Although impaired self-agency has repeatedly been identified in people with schizotypy, its role in mentalizing is yet to be investigated. The main aim of this study was to explore whether deficits in cognitive and affective ToM can be found in high trait schizotypy, and to identify in what way these deficits are related to the positive and negative dimensions of schizotypy. The secondary aim was to examine whether these deficits correlate with executive functions. Based on the dimensional view of the schizophrenia spectrum, an extreme-group design was applied to non-clinical volunteers demonstrating high (N = 39) and low (N = 47) trait schizotypy. Affective and cognitive ToM were investigated using the Movie for Assessment of Social Cognition, a sensitive and video-based measurement. Cognitive inhibition was assessed using the Stroop Test, and cognitive flexibility was analyzed using the Trail-Making Test. Agency was measured using a computerized self-agency paradigm. Participants in the high-schizotypy group performed significantly worse in the affective ToM task (d = 0.79), and their overall ToM performance was significantly impaired (d = 0.60). No between-group differences were found with regards to cognitive ToM, executive functions, and self-agency. Cognitive flexibility correlated negatively with positive schizotypy, and contributed to a worse overall and affective ToM. Impaired cognitive inhibition contributed to undermentalizing-type errors. It was found that non-clinical participants with high trait (positive) schizotypy - especially those with slight executive-function deficits - may have difficulties in understanding the emotional state of others and consequently in functioning in social situations.

The relevance of traumatic life events in schizophrenia spectrum disorders.

The central goal of this manuscript was to review literature about the interconnections of traumatic life events and symptoms of schizophrenia spectrum of the last 15 years. First of all, the stress-diathesis model and the traumagenic neurodevelopmental model are shortly presented. Psychological effects of traumas and specific psychotic symptoms in connection with traumatic events are discussed. The course of the disease in patients affected by previous traumas and possible mediating factors are also addressed. Studies of both clinical and community samples are cited. It was also our aim to review literature about the neurobiological and neurocognitive processes in people affected by schizophrenia and/or traumatic life events. The role of prefrontal and medial temporal regions are explored with a special emphasis on contextual memory and hippocampal functioning. Finally, the possible effects of exploring traumatic life events on the treatment of schizophrenia are discussed.

Impact of adverse life events on individuals with low and high schizotypy in a nonpatient sample.

The aims of this study were to gain a better understanding of adverse life events connected with the development of schizotypal personality traits and, also, to examine whether subclinical schizotypy has a relationship with vulnerability to traumatic intrusions and avoidance. In a cross-sectional design, 198 undergraduate students completed the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), the Impact of Event Scale (IES), and Paykel's Life Events Scale, together with other relevant scales. The number of adverse life events was significantly related to overall schizotypy measured by O-LIFE scores and positive schizotypy measured by the Unusual Experiences (UnEx) subscale. The subjective severity of life events was significantly related to Cognitive Disorganization (CogDis). Measures of positive schizotypy (UnEx and CogDis) were significantly related to the scores on the IES and on the intrusion and avoidance subscales, too. Adverse life events are associated with schizotypal personality traits, which contribute to a tendency for traumatic intrusions, even in a nonpatient sample.

[Hungarian version of the Impact of Event Scale. Psychometric evaluation]. / Az Események Hatása Kérdoív magyar változatának pszichometriai vizsgálata.

BACKGROUND: The Impact of Event Scale (IES, Horowitz, 1979) has been widely used to evaluate subjective stress following traumatic life events. Based on the theoretical reflections of the authors, it consists of two subscales: intrusion and avoidance. Although the empirical data of the past 30 years have supported the original two-factor model to a large extent, alternative models have also been published. Our aim was to evaluate the psychometric properties of the Impact of Event Scale Hungarian version. METHODS: Data from 244 undergraduate students on the Hungarian version of Impact of Event Scale (Annus, Perczel Forintos, Kiss, 2005) were analyzed. Subjects were asked to fill in Beck Depression Inventory shortened version (Beck & Beck, 1972, Kopp & Forizs, 1993) and STAI-T (Spielberger, 1970, Sipos & Sipos, 1978) too. RESULTS: Internal consistency of the whole IES (Cronbach's a=0,891) as well as of intrusion (Cronbach's a=0,874) and avoidance (Cronbach's a=0,818) was found to be very good. Test-retest reliability of the whole scale (r=0,491, p<0,001) as well as of subscales (for intrusion r=0,543 p<0,001, for avoidance r=0,523 p<0,001) was satisfactory. No association was found between gender and IES scores. Confirmatory and explanatory factor analysis supported the two factor model in our sample. IES had a moderate positive correlation with depression (r=0,273, p<0,001) and anxiety (r=0,381, p<0,001), indicating that it reflects a somewhat related but still independent construct. CONCLUSIONS: The Hungarian version of the Impact of Event Scale has been proved a valid and reliable measure of post-traumatic stress symptoms.

[Psychometric properties of the Hungarian version of the Cognitive Emotion Regulation Questionnaire]. / A kognitiv Erzelem-Regulació Kérdoiv magyar változatának pszichometrial jellemzoi.

OBJECTIVE: The Cognitive Emotion Regulation Questionnaire (CERQ) measures conscious attentional and thinking processes that people often use to regulate their emotions. The English version of the CERQ - consisting of nine subscales: self-blame, rumination, catastrophizing, other blame, acceptance, positive refocusing, planning, positive reappraisal and putting into perspective - showed excellent psychometric properties in previous investigations and is widely used in current research and clinical practice. The present study describes the psychometric properties of the Hungarian version of the CERQ. METHOD: The forward and back-translation method was used for the adaptation. 261 undergraduate and graduate students completed the Hungarian version of the CERQ, the Shortened Beck Depression Inventory (BDI-S), the 5-item version of the WHO Well-being Index (WBS-5) and a short demographical form. RESULTS: CERQ subscales showed acceptable to very good internal consistency (Cronbach's alphas ranging from 0.68 to 0.88) and strong test-retest reliability (Pearson's correlations ranging from 0.58 to 0.85, p<0.001 ). No associations were found between the emotion regulation strategies and gender and socioeconomic status. Confirmatory and exploratory factor analysis supported the theoretical model with nine independent factors. Multiple linear regression analyses revealed significant relationships between BDI-S and self-blame, acceptance, planning, positive reappraisal and catastrophizing (F=14,28 p<0,001, adjusted R2=0,320), and WBI-5 and self-blame, rumination, positive refocusing and positive reappraisal (F=5,89 p<0,001; adjusted R2=0,26). CONCLUSION: Results indicate that the Hungarian version of the CERQ is a reliable and useful instrument for assessment of cognitive emotion regulation strategies.