Acculturation and severity of depression among first-generation Vietnamese outpatients in Germany.

BACKGROUND: Challenges of migration, particularly concerning the process of acculturation are associated with an increased risk of mental illness. Vietnamese migrants constitute the largest Southeast Asian migrant group in Germany, yet there is no data on the relationship between the mental health status and acculturation among this population. AIMS: Therefore, the present study examines the relationship between two well-established dimensions of acculturation, that is, dominant society immersion (DSI) and ethnic society immersion (ESI), the four resulting acculturation strategies (integration, assimilation, separation and marginalization), and severity of depression. METHODS: A sample of N = 113 first-generation Vietnamese outpatients from a psychiatric outpatient clinic for Vietnamese migrants in Germany was studied regarding their self-reported depressive symptoms (Beck Depression Inventory-II (BDI-II)) and acculturation (Stephenson Multigroup Acculturation Scale (SMAS)). RESULTS: Consistent with the hypotheses, patients reported less severe depressive symptoms, when they reported higher orientation toward the German and the Vietnamese society. Moreover, the results showed that integrated patients reported a lower severity of depression compared to marginalized patients, who reported the highest severity of depression. CONCLUSIONS: The findings indicate that among a sample of first-generation Vietnamese patients with depression, an orientation to both, the mainstream society and one's heritage society might serve as a potential resource. The rejection of any orientation to any society is associated with an increased risk for depression.

Substance use to regulate intense posttraumatic shame in individuals with childhood abuse and neglect.

Childhood abuse and neglect (CAN) is considered as a risk factor for substance use disorder (SUD). Based on the drinking to cope model, this study investigated the association of two trauma-relevant emotions (shame and sadness) and substance use. Using ecological momentary assessment we compared real-time emotion regulation in situations with high and low intensity of shame and sadness in currently abstinent patients with CAN and lifetime SUD (traumaSUD group), healthy controls with CAN (traumaHC group), and without CAN (nontraumaHC group). Multilevel analysis showed a positive linear relationship between high intensity of both emotions and substance use for all groups. The traumaSUD group showed heightened substance use in low, as well as in high, intensity of shame and sadness. In addition, we found an interaction between type of emotion, intensity, and group: the traumaHC group exhibited a fourfold increased risk for substance use in high intense shame situations relative to the traumaSUD group. Our findings provide evidence for the drinking to cope model. The traumaSUD group showed a reduced distress tolerance for variable intensity of negative emotions. The differential effect of intense shame for the traumaHC group emphazises its potential role in the development of SUD following CAN. In addition, shame can be considered a relevant focus for therapeutic preinterventions and interventions for SUD after CAN.

Adolescent harm avoidance as a longitudinal predictor of maladaptive cognitive emotion regulation in adulthood: The mediating role of inhibitory control.

The current study investigates the effect of adolescent harm avoidance (HA) on maladaptive cognitive emotion regulation strategies (mCER) in early adulthood. The mediating role of inhibitory control and the moderating effect of gender on this link were also examined. Longitudinal data from 261 adolescents (147 female) were collected in three phases (T0, T1 and T2) over approximately 10 years. Results revealed that, after controlling for HA in adulthood (T2), female adolescents' HA (T0) significantly predicted mCER strategies after 10 years (T2), whereas male adolescents' HA only predicted catastrophizing. In addition, attentional impulsivity (T1) significantly mediated the relation between HA and mCER, though only among women. There was no significant indirect effect for emotional interference and stop-signal reaction time. Results revealed gender and measure specific associations between HA and inhibitory control and suggest that HA could induce inhibitory deficits leading to mCER.

Does Emotion Dysregulation Mediate the Relationship between Early Maltreatment and Later Substance Dependence? Findings of the CANSAS Study.

BACKGROUND/AIMS: Maltreatment in childhood and adolescence is a risk factor for substance use disorders (SUDs) in adulthood. This association has rarely been investigated in the light of emotion dysregulation. To fill this gap, this study examines emotion dysregulation and SUDs among adults with a history of early maltreatment. METHODS: Comparison of emotion dysregulation in adults with a history of early abuse and neglect who developed either an SUD (n = 105) or no mental disorder (n = 54). Further, a mediation model for the association between the severity of early maltreatment and SUDs was tested. Participants completed research diagnostic interviews for psychopathology, the Difficulties in Emotion Regulation Scale, and the Childhood Trauma Questionnaire. RESULTS: By using hierarchical regression techniques and mediational analyses controlling for age and gender, it was possible to provide evidence for the mediating role of emotion dysregulation between early emotional and physical maltreatment and later SUDs. CONCLUSIONS: Emotion dysregulation is a potential mechanism underlying the relationship between early emotional and physical maltreatment and the development of SUDs. In light of these findings, focusing on the early training of adaptive emotion regulation strategies after childhood maltreatment might be of considerable relevance to prevent the development of SUDs.

Examining cognitive emotion regulation in frontal lobe patients: The mediating role of response inhibition.

BACKGROUND: Previous investigations have demonstrated the relationship between inhibitory deficits and maladaptive emotion regulation. Although several neuropsychological studies show that frontal lobe damage can lead to extreme inhibition impairments, there have been no investigations regarding the influence of frontal lobe damage and related inhibition impairments on the use of maladaptive strategies. OBJECTIVE: The goal of the current study was to examine the impact of executive functions impairments due to frontal lobe damage on cognitive emotion regulation. METHODS: Fifteen patients with frontal lobe damage were compared to twenty-two healthy controls on their reported use of maladaptive strategies. The effect of behavioral inhibition deficits among the frontal lobe damage group was examined. RESULTS: Patients reflected a heightened use of maladaptive strategies compared to healthy controls, significantly mediated by Go/NoGo task errors, which are an indicator for response inhibition deficits. CONCLUSIONS: Results suggest that a heightened use of maladaptive strategies by patients relies to a strong extent on their impaired impulse control, highlighting the complex interplay between executive functions and emotional regulation.

Social support and the serotonin transporter genotype (5-HTTLPR) moderate levels of resilience, sense of coherence, and depression.

Gene x environment interactions have mainly been investigated in models of psychopathology. However, the putative interplay between genes and beneficial environmental conditions on positive outcomes has rarely been addressed. We therefore examined the interaction between the serotonin transporter linked polymorphic region (5-HTTLPR) and social support on the sense of coherence (SOC), resilience, and depressive symptoms. Furthermore, we scrutinized our examinations by differentiating between individuals with and without childhood abuse. The sample included 1,811 participants from the general population (Study of Health in Pomerania, Germany). The triallelic genotype of 5-HTTLPR was determined and longitudinal data of social support were used. Among individuals with high social support no significant differences between 5-HTTLPR genotypes regarding all outcome variables were found. However, among those with low social support, carriers of at least one short allele reported significantly increased levels of SOC and resilience, as well as less depressive symptoms than carriers of the l/l genotype. This result was not modified by differentiating between those with childhood abuse and those without. In less supportive social environments the impact of distinct genotypes on behavioral outcomes might be more relevant than in supportive environments where social compensation might take place. Our findings indicate that both alleles of 5-HTTLPR contribute to the adaptability to different environmental conditions.

Neuroticism developmental courses--implications for depression, anxiety and everyday emotional experience; a prospective study from adolescence to young adulthood.

BACKGROUND: Neuroticism is frequently discussed as a risk factor for psychopathology. According to the maturity principle, neuroticism decreases over the course of life, but not uniformly across individuals. However, the implications of differences in personality maturation on mental health have not been well studied so far. Hence, we hypothesized that different forms of neuroticism development from adolescence to young adulthood are associated with differences in depression, anxiety and everyday emotional experience at the age of 25. METHODS: A sample of 266 adolescents from the general population was examined three times over ten years (age at T0: 15, T1: 20 and T2: 25) using questionnaires, interviews and ecological momentary assessment (EMA). At all measurement points, neuroticism was assessed with the NEO inventory. At T2, diagnoses of major depression and anxiety disorders were captured with a structured clinical interview (M-CIDI). Phone-based EMA was used to assess emotional experience and affective instability over a two-week period at T2. RESULTS: The best fitting model was a latent class growth analysis with two groups of neuroticism development. Most individuals (n = 205) showed moderate values whereas 61 participants were clustered into a group with elevated neuroticism levels. In both groups neuroticism significantly changed during the ten year period with a peak at the age of 20. Individuals with a higher absolute level were at 14-fold increased risk for depression and 7-fold risk for anxiety disorders at the age of 25. In EMA, increased negative affect and arousal as well as decreased positive emotions were found in this high group. CONCLUSIONS: Other than expected, personality did not mature in our sample. However, there was a significant change of neuroticism values from adolescence to young adulthood. Further, over 20% of our participants showed a neuroticism development which was associated with adverse outcomes such as negatively toned emotional experience and a heightened risk to suffer from depressive and anxiety disorders in young adulthood. These high-risk persons need to be identified early to provide interventions supporting continuous personality maturation.

Emotional hyper-reactivity in borderline personality disorder is related to trauma and interpersonal themes.

Heightened emotional reactivity is one of the core features of borderline personality disorder (BPD). However, recent findings could not provide evidence for a general emotional hyper-reactivity in BPD. The present study examines the emotional responding to self-relevant pictures in dependency of the thematic category (e.g., trauma, interpersonal interaction) in patients with BPD. Therefore, women with BPD (n=31), women with major depression disorder (n=29) and female healthy controls (n=33) rated pictures allocated to thematically different categories (violence, sexual abuse, interaction, non-suicidal self-injury, and suicide) regarding self-relevance, arousal, valence and the urge of non-suicidal self-injury. Compared to both control groups, patients with BPD reported higher self-relevance regarding all categories, but significantly higher emotional ratings only for pictures showing sexual abuse and interpersonal themes. In addition, patients with BPD and comorbid posttraumatic stress disorder showed higher emotional reactivity in violence pictures. Our data provide clear evidence that patients with BPD show a specific emotional hyper-reactivity with respect to schema-related triggers like trauma and interpersonal situations. Future studies are needed to investigate physiological responses to these self-relevant themes in patients with BPD.

Acculturation, self-construal, mental and physical health: an explorative study of East Asian students in Germany.

The present study explores acculturation and its associated aspects of two East Asian student groups with different levels of exposure to German culture (100 international students from East Asian countries [IS]; 61 second generation students of East Asian descent [SGS]). First, we investigated the relationships between acculturation, self-construal, depressive and somatic symptoms, and differences between the student groups in these variables. Second, the four acculturation types (integration, assimilation, separation and marginalization) were examined regarding their relationship to self-construal and health outcomes. The results showed that the acculturation dimensions (mainstream, heritage) were relevant to the level of depressive symptoms for IS which was not the case for SGS. Furthermore, IS reported more somatic symptoms whereas there was no difference between the two groups in the level of depressive symptoms. In the analysis of acculturation types, assimilated and integrated students were characterized by high independent self-construal, while separated and integrated students showed high interdependent self-construal. Assimilated students displayed the least depressive symptoms of all acculturation groups. This study highlights different characteristics of East Asian students in acculturation, self-construal and health outcomes, and discusses the complexity of the relationships between acculturation types and health.

High social support buffers the effects of 5-HTTLPR genotypes within social anxiety disorder.

An interaction between genetic aspects and environmental stressors has been suggested with regard to the etiology of social anxiety disorder (SAD). However, potential protective interplays which might decrease the risk of SAD have not been considered so far. Thus, we analyzed the interaction between 5-HTTLPR and differing levels of social support regarding SAD. The sample was based on participants of the Study of Health in Pomerania, Germany. We used the triallelic genotype of 5-HTTLPR and longitudinal data of social support. Final analyses were conducted in 79 individuals with SAD and 1,708 without. The diagnosis of SAD was derived from diagnostic interviews in accordance with DSM-IV. Considering the risk of SAD, a general protective effect of high social support was shown independent of variation in 5-HTTLPR genotype. In contrast, the risk of SAD was increased for both genotypes within those individuals with low social support. Additionally, the odds ratio for suffering from SAD was about two times higher for carriers of the l/l genotype compared to those with at least one short allele in those perceiving less-supportive social environments. The findings suggest that SAD is influenced by a protective and a contributing gene × environment interaction. High social support might act in a protective and low social support in an increasing manner on the risk of SAD especially within carriers of the l/l genotype. Therefore, effects of 5-HTTLPR might be buffered by high social support with respect to the risk of SAD.

[Managing emotions--emotions under control]. / Gefühle im Griff--Emotionen intelligent regulieren.

Emotion regulation processes are of central importance to mental and physical health. Based on this relationship we developed the group intervention "Managing Emotions: Emotions under control" (German: "Gefühle im Griff"), which systematically teaches participants specific emotion regulation strategies. Structure and content of the intervention program as well as preliminary results of efficacy are presented (n=18). Using the H-FERST, large effect sizes resulted for the increase of reappraisal and acceptance and for the reduction of rumination, a medium effect size could be shown for the reduction of avoidance, and a small effect size resulted for the increase of activity and social support. Overall psychopathology by means of the BSI was reduced with an effect size of d=0.63 in participants with more severe mental strain (GSI ≥ 0.6).

Longitudinal transmission pathways of borderline personality disorder symptoms: from mother to child?

BACKGROUND: There is evidence that the borderline symptomatology of the mother longitudinally predicts the number of borderline criteria met by the children. However, possible underlying mechanisms have rarely been examined. In line with transactional models of borderline personality disorder (BPD), we analyzed a broad concept of maladaptive mother-child interactions of mothers with BPD symptoms towards their children, including insensitive parenting and mother-child discrepancies, in reporting the child's psychopathological behavior. SAMPLING/METHODS: The sample was drawn from the population-based Greifswald Family Study and consisted of 295 children and their biological mothers. Both were examined at two points in time, first when the children were about 15 years old (T0) and again 5 years later (T1), using path analyses. RESULTS: Maladaptive mother-child interactions (especially an overprotective and rejecting parenting style and high discrepancies regarding internalizing problems) mediate the longitudinal transmission of borderline symptoms from mother to child. Furthermore, our data revealed that this result is consistent for various youth symptoms which are associated with BPD such as impulsivity or dissociation. CONCLUSION: The data of the current study imply that the transmission of borderline symptoms from mother to child is mediated by maladaptive mother-child interactions. For this reason early and professional support may be useful to prevent these children from developing severe psychopathology.

Testing the diathesis-stress model: 5-HTTLPR, childhood emotional maltreatment, and vulnerability to social anxiety disorder.

Regarding the development of social anxiety disorder (SAD), a diathesis-stress paradigm including biological vulnerabilities and environmental stressors can be assumed. However, studies dealing with the etiology of SAD did not integrate both aspects so far. We examined a particular diathesis-stress model for SAD in which we included a functional polymorphism of the serotonin transporter (5-HTTLPR) as a genetic vulnerability factor and childhood emotional maltreatment (CEM) as an environmental stressor. Current analyses were based on individuals who participated in the Study of Health in Pomerania. Psychiatric disorders were assessed with diagnostic interviews according to DSM-IV criteria. The triallelic genotype of 5-HTTLPR was determined. Statistical analyses were performed in 78 individuals with SAD and 1,035 without an axis I disorder. Logistic regression analysis revealed that the experience of CEM (odds ratio [OR] 4.56; 95% confidence interval [CI] 2.65-7.84), the l/l genotype of 5-HTTLPR (OR 2.13; 95% CI 1.31-3.48), female gender (OR 3.03; 95% CI 1.80-5.08) and younger age (OR 1.04; 95% CI 1.02-1.06) increased the odds for SAD. The data suggest that CEM, the l/l genotype of 5-HTTLPR, female gender and younger age are risk factors for SAD. This is in favor of the tested diathesis-stress model.

Borderline personality disorder in four different age groups: a cross-sectional study of community residents in Germany.

Studies examining the natural course of borderline personality disorder (BPD) over the life span have yielded declining prevalence rates in older age groups. However, there is evidence that different BPD symptoms have different longitudinal patterns, with impulsivity decreasing with advancing age and negative affect remaining stable into late adulthood. However, since all studies dealt with treated, clinical samples of BPD patients, it is not yet known whether this represents the natural course of BPD symptoms or just mirrors difference in treatability of these symptoms. The authors addressed this issue by investigating a nonclinical population and compared prevalence of BPD, impulsivity, and depressivity in various age groups from adolescence to late adulthood (N = 2,488); all individuals were assessed by standardized clinical interviews. Syndromal and subsyndromal BPD rates sharply decreased between adolescents and young adults and remained stable thereafter. Whereas the same course was found for impulsivity, depressivity increased between young, middle-aged, and older adults. The present results support the hypothesis that age-related decreases in BPD diagnosis might be attributable to declining levels of impulsivity, whereas the persistence of a subsyndromal BPD might be attributable to an enduring negative affect.

The association between depressive symptoms and emotion recognition is moderated by emotion regulation.

In this study, we examined the associations between depression and aspects of emotional functioning, namely emotion recognition, affectivity and interpersonal problems. Particularly, the moderating role of emotion regulation in these interrelations was tested in a sample of 85 women, who exhibited a wide range of depressive symptoms (Composite International Diagnostic Interview (CIDI), Beck Depression Inventory (BDI)). Emotion recognition was assessed with a paradigm displaying a widely used set of photographs of the six basic emotions in graded intensities. Further, participants were examined regarding emotion regulation (Emotion Regulation Questionnaire (ERQ)), interpersonal problems (Inventory of Interpersonal Problems-Circumplex (IIP-C)) and affectivity (Affect Intensity Measure (AIM), Positive and Negative Affect Schedule (PANAS)). Besides correlation analyses, Johnson-Neyman technique for probing interactions in linear regression models was applied to test for possible moderating effects. Depressive symptoms were positively correlated with error rates in anger recognition, but not with the other basic emotions. This association was moderated by suppression in that regard that more severely depressed women who more frequently used suppression showed superior recognition of angry faces than those with lower suppression values. Further, suppression was associated with an affective imbalance and interpersonal problems in women with current depressive disorder. In sum, our results emphasize the importance of differentiating subtypes of depression depending on emotion regulation capabilities for research on or treatment of emotional functioning in depression.

Maternal transmission of borderline personality disorder symptoms in the community-based Greifswald Family Study.

The authors longitudinally investigated the familial transmission of mothers' BPD symptoms to their offspring, taking maternal depression into consideration. The sample consisted of 323 offspring and their mothers from the community-based Greifswald Family Study. These families were examined for the first time when the children were about 15 years old (T(0)), and again 5 years later (T(1)), using self-ratings and interviews. Regression analyses revealed that maternal BPD symptoms and depression at T(0) were significant predictors of a number of BPD criteria that offspring met at T(1). Furthermore, the analyses also predicted offspring's general psychopathology. In sum, the authors' findings provide evidence for familial aggregation of BPD symptoms and heightened levels of general psychopathology in offspring of mothers with high levels of BPD features, pointing to the need for providing early intervention for this high-risk group.

Cortical inhibition in alexithymic patients with borderline personality disorder.

High levels of alexithymia, a personality trait closely associated with emotion dysregulation, have been found in several psychiatric disorders including borderline personality disorder (BPD). Both BPD and alexithymia have been related to impaired cortical inhibition; however, this relationship has not been tested directly. The aim of the present study was, therefore, to investigate whether cortical inhibition is modulated by alexithymia in BPD. Fifteen BPD patients with Toronto-Alexithymia Scale (TAS-20) scores ≥61, 14 BPD patients with TAS-20 <61, and 16 healthy controls were examined using different TMS paradigms. High-alexithymia patients showed a shortened cortical silent period (CSP) compared to low-alexithymia patients and controls. Additionally, a significant inverse correlation was found between the TAS-20, the left CSP and the left transcallosal conduction time. These findings indicate that alexithymia is associated with changes in GABAergic neurotransmission and facilitated transcallosal inhibition. The results highlight the importance of considering alexithymia in BPD.

[Prevalence and familiarity of personality disorders in Germany: results of the Greifswald family study]. / Prävalenz und Familiarität von Persönlichkeitsstörungen in Deutschland: Ergebnisse der Greifswalder Familienstudie.

BACKGROUND: There are only few data about the prevalence and familiarity of personality disorders (PD) in population based samples in Germany. Moreover, nearly no information exists for the prevalence of PDs among young adults. Thus, in the current study we examined the prevalence, familiarity and psychopathology of PDs, whereby middle-aged adults (about 45 years old) as well as the adult children of these persons (about 20 years old) were examined. METHODS: Participants were interviewed with the Structured Clinical Interview for Personality Disorders (SCID-II) which is based on the DSM-IV criteria for PDs and with the SCL-90. The sample consisted of 411 parents and their adolescent children (n=334). RESULTS: The prevalence for PDs was 11.2% in the parent sample and 14.7% in the adolescent sample. Cluster-B personality disorders (Cluster-B-PDs) were more often diagnosed in the adolescent sample, in particular. Moreover, we did find an elevated risk for children of parents with a PD than for children of parents without a PD to develop a PD where the former group also displayed elevated values with regard to their psychopathology. CONCLUSIONS: This study underlines the importance of PDs in community-based samples. The implications of our findings for treatment and classification of PDs are discussed.

Interpersonal evaluation bias in borderline personality disorder.

BACKGROUND: The cognitive theory of personality disorders hypothesizes that the emotional dysregulation and interpersonal problems in individuals with borderline personality disorder (BPD) are, at least partially, caused by dysfunctional cognitive schemas. These schemas lead to biased evaluation of environmental and interpersonal stimuli. METHOD: This study examined the interpersonal evaluations of individuals with BPD, depressive and healthy control participants with the thin-slice judgments paradigm. Participants were asked to evaluate six persons in six film clips, which showed these persons for 10s, during which these persons entered a room and took a seat. Interpersonal style of the BPD group was investigated with the Inventory of Interpersonal Problems (IIP-C) questionnaire. RESULTS: Individuals with BPD judged the persons as being more negative and aggressive and less positive than the healthy participants, and more aggressive than the depressive individuals. In addition, individuals with BPD reported more extreme interpersonal behavior relative to the controls. CONCLUSIONS: The findings indicate an aggressivistic evaluation bias and elevated levels of interpersonal problems in individuals with BPD as suggested in the cognitive theory.

Temperament and character in patients with borderline personality disorder taking gender and comorbidity into account.

This study examined correlations of borderline personality disorder (BPD) symptoms with scales from Cloninger's psychobiological model taking gender and psychiatric comorbidity into consideration. Inpatients with BPD (n = 202) were compared to several control groups including psychiatrically healthy persons (n = 327), subjects with affective disorders (n = 46), alcohol use disorders (n = 47), cluster C personality disorders (n = 23) and antisocial personality disorder (n = 25). The results indicate that only males with BPD presented an 'explosive' temperament suggested by Cloninger, with simultaneously high levels of novelty seeking and harm avoidance. In contrast, women with BPD were characterized by high levels of harm avoidance, but not novelty seeking. Regarding temperament and character dimensions our analyses suggest that patients with BPD could be characterized, in particular, by a combination of high harm avoidance and very low self-directedness. The specific temperament configuration of BPD postulated by Cloninger's psychobiological model could only partially be supported. The results provide support for the importance of controlling for gender effects when investigating the applicability of dimensional models with respect to personality disorders.