An integrative theoretical framework of acculturation and salutogenesis.

During the last two decades, the number of international migrants worldwide has constantly risen. In this context, cross-cultural dimensions of psychological disorders receive increased attention, especially depression, anxiety and post-traumatic stress disorders among the migrant population. In this paper we propose a theoretical framework for the understanding of migrant mental health. This framework combines elements from Berry's acculturation model and Antonovsky's salutogenic theory. The former illustrates the main factors that affect an individual's adaptation in a new cultural context. The term acculturative stress denotes unresolved problems resulting from intercultural contact that cannot be overcome easily by simply adjusting or assimilating. The latter specifies the relationship between culturally associated stress and mental health more distinctive, introducing the concepts of generalized resistance resources and sense of coherence that determine mental health outcomes of migrants during acculturative stress periods. Specifically, we provide an integrative framework of acculturation and salutogenesis that helps to integrate inconsistent findings in the migrant mental health literature. The current paper focuses on the effect of resource factors for positive mental health outcomes in the migrant population and summarises some implications for future research activities.

Reported beverage consumed and alcohol-related diseases among male hospital inpatients with problem drinking.

AIMS: The aim of this study was to examine if problem drinkers have varying risks of having alcohol-related diseases according to their reported beverage consumed. METHODS: In a cross-sectional study all consecutive inpatients aged 18- 64 years from four general hospitals of one catchment area were systematically screened for alcohol use. A total of 1011 men with problem drinking were used for this study. Routine treatment diagnoses for all participants were provided by hospital physicians and were classified into three categories according to their alcohol-attributable fractions (AAF; AAF = 0; AAF < 1; AAF = 1). RESULTS: According to their reported beverage consumed, 53.0% of the participants were identified as exclusively beer drinkers, 14.1% exclusively spirits drinkers, 26.0% mixed beer and spirits drinkers and 6.9% individuals drinking wine exclusively or in combination with one or two other beverages (mixed wine drinkers). Compared to spirits drinkers and controlling for possible confounders (i.e. alcohol-associated characteristics, demographic variables), multinomial regressions revealed that beer drinkers, mixed beer and spirits drinkers, and mixed wine drinkers had lower odds of having diseases with AAF = 1 than spirits drinkers (e.g. for AAF = 1: beer versus spirits drinkers: OR = 0.42, CI: 0.25-0.72). Beer drinkers and mixed wine drinkers also had lower odds of having diseases with AAF < 1 than spirits drinkers (e.g. mixed wine versus spirits drinkers: OR = 0.36, CI: 0.18-0.72). CONCLUSIONS: These data suggest an association between the reported beverage consumed and alcohol-related diseases. Among hospitalized problem drinkers, spirits drinkers had the greatest risk of having diseases with AAF < 1 and with AAF = 1.

Dose-response relation between volume of drinking and alcohol-related diseases in male general hospital inpatients.

AIMS: Previous studies investigating dose-response relations between volume of drinking and diseases have focused on single diseases only. Until now, the relation between the drinking volume and the risk of having any alcohol-attributable disease is largely unknown. The aim of the present study is to investigate to what extent is the risk of diseases with different alcohol-attributable fractions (AAFs) predicted by daily alcohol consumption (> 120 g, 61-120 g vs 31-60 g). METHODS: The sample consisted of 805 inpatients classified as at-risk drinking, aged 18-64 years hailing from four general hospitals in North-eastern Germany. Inpatients were classified into three groups (AAF = 1, AAF < 1, AAF = 0). Group differences regarding alcohol-related variables, smoking, and demographics were analysed. A multinomial logistic regression analysis was conducted to predict the risk of diseases with AAF = 1 and AAF < 1. RESULTS: In our sample, 26.6% of the inpatients showed a disease with AAF = 1, while 20.2% had a disease with AAF < 1. Inpatients consuming > 120 g, and inpatients consuming 61-120 g revealed significantly higher odds for diseases with AAF = 1 compared to inpatients consuming 31-60 g (OR = 6.30, CI = 3.55-11.26; OR = 2.91, CI = 1.64-5.13). Regarding diseases with AAF < 1, inpatients consuming > 120 g revealed significantly higher odds compared to the inpatients consuming 31-60 g (OR = 1.97, CI = 1.15-3.37). CONCLUSION: A dose-response relation between the level of the drinking volume and the risk of diseases with AAF = 1 was found in this sample of inpatients from the general hospitals.

Brief alcohol intervention for general hospital inpatients: a randomized controlled trial.

AIM: To test the effectiveness of a brief alcohol intervention among non-dependent general hospital inpatients with alcohol problems, delivered by either a specialized liaison service or hospital physicians. METHOD: All inpatients of 29 wards from four general hospitals of one region in Germany were screened for alcohol problems (n=14,332). Of those screening positive, 595 patients were included in a randomized controlled group design using a time-frame. Patients with alcohol dependence were not considered in this study. Patients received Motivational Interviewing based counselling either by a specialized liaison service, by hospital physicians trained under routine conditions or received hospital treatment as usual without additional counselling. One year later, alcohol consumption, motivation and well-being were assessed. Sample survey analyses and generalized estimating equations were conducted. RESULTS: At baseline, the three groups differed regarding motivation, with higher motivation among the controls. At follow-up, the groups did not differ regarding alcohol consumption, alcohol-related problems and well-being. All groups decreased their alcohol consumption significantly. Regarding motivation, longitudinal analyses revealed significant interaction effects of time and intervention (p<0.05), indicating a stronger increase of readiness to change drinking and a less profound drop of readiness to seek help among those who received intervention compared to the controls. CONCLUSION: The intervention was not effective in reducing alcohol consumption or in increasing well-being 12 months after hospitalization. It had a positive effect on readiness to change drinking and on readiness to seek formal help for alcohol problems. The intervention groups compensated their lag of motivation.

Male at-risk drinkers with heavy episodic drinking: a subclinical diagnosis?

OBJECTIVE: The aim of this study was to examine to what extent general hospital inpatients with risky drinking patterns differ regarding alcohol-associated characteristics. In particular, we tested whether persons with at-risk and heavy episodic drinking (ARHE) differ from those persons with at-risk drinking only (AR) and heavy episodic drinking only (HE). METHOD: The participants were recruited using a two-stage sampling process: (1) screening and (2) diagnostic. All in-patients from four general hospitals, ages 18-64 years (N = 14,332), were systematically screened for alcohol use. For this study, men with AR, HE, or ARHE (n = 425) were used, and men with current alcohol dependence or alcohol abuse were excluded. The severity of the alcohol problem was assessed by the number of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria met. Among the participants' diseases, those that were 100% attributable to alcohol (assigned an alcohol-attributable fraction of 1 [AAF = 1]) were analyzed. RESULTS: Of the sample, 35.3% of the persons were identified with AR, 22.6% with HE, and 42.1% with ARHE. Multinomial logistic regression revealed that, when controlling for age, ARHE was associated with increased odds of having a more severe alcohol problem (odds ratio [OR] = 2.06, confidence interval [CI]: 1.23-3.45), using formal help (OR = 2.21, CI: 1.02-4.79), and having diseases with AAF = 1 (OR = 3.43, CI: 1.58-7.43), compared with AR. CONCLUSIONS: Among at-risk drinkers, persons with ARHE are a special subgroup because there appears to be an indication of a subclinical diagnosis. To provide adequate intervention, future research and clinical practice should distinguish between different risky drinking patterns.

Psychometric properties of the 'Processes of Change' scale for alcohol misuse and its short form (POC-20).

UNLABELLED: Regarding the processes of change, one of the core constructs of the transtheoretical model of intentional behavior change (TTM), extensive research has been done in the field of smoking. However, little is known about the processes of change for alcohol misuse and their measurement. This study's goals were to investigate the psychometric properties of the German Processes of Change (POC) scale and to refine a short version. METHOD: A sample of 653 non-treatment seeking general hospital patients with alcohol problems was used. Construct validity of the POC was analyzed using confirmatory factor analysis. As another validity aspect the use of processes of change across the stages of change was investigated. RESULTS: Internal consistency of the POC-20 ranged between r=.57 and .94. Construct validity was also good (CFI=.94). In line with TTM postulates subjects in later stages reported more behavioral processes compared to individuals in earlier stages. CONCLUSION: Findings indicated superiority of the POC-20 over the long version and good validity of the measure in a high per capita consumption nation.