[Domestic violence and its psychological consequences during the COVID-19 pandemic-key findings from German-speaking countries]. / Häusliche Gewalt und ihre psychischen Folgen während der COVID-19-Pandemie ­ Zentrale Befunde aus dem deutschsprachigen Raum.

The impact of traumatic experiences on mental health during the COVID-19 pandemic has been insufficiently discussed in the German-speaking countries. Against this background, a working group of scientifically and clinically active colleagues was formed on behalf of the German-Speaking Society for Psychotraumatology (DeGPT). The aim of the working group was to summarize central research findings on the incidence of domestic violence and associated psychological distress during the COVID-19 pandemic in German-speaking countries and to discuss their implications. In addition, associations between pre-existing childhood trauma and psychological distress during the pandemic should be illuminated. The present narrative review was prepared for this purpose.The results of the studies conducted indicate high prevalences of domestic violence during the COVID-19 pandemic, which, however, predominantly correspond to pre-pandemic prevalences. Adults with current or pre-existing interpersonal traumatic experiences during childhood or adolescence reported increased psychological distress during the pandemic compared with adults without such experiences. A number of risk factors (e.g., female gender, lower frequency of social contacts) increased the risk of psychological distress and posttraumatic stress disorder symptoms during the pandemic. According to these findings, people with current or past interpersonal trauma exposure represent a vulnerable group with special support needs during pandemic contexts.

The Effect of the Covid-19 Pandemic on Domestic Violence in Germany: A Comparison of Three Representative Population Surveys.

The COVID-19 pandemic has had profound societal and economic effects. Concerns were raised that domestic violence might increase because of the enacted infection control measures. Previous findings on this issue have been contradictory. Since existing studies mainly rely on official reports, administrative data, helpline calls, or retrospective measures, their findings are likely to prove unreliable. Few population-based surveys include pre-pandemic data, limiting their ability to test for causality regarding increasing violence. Therefore, the aim of this study was to compare findings from population-representative surveys on the prevalence of intimate partner violence (IPV) and violence against children (VAC) before and during the COVID-19 pandemic. Based on the data of N = 3,639 individuals living with a romantic partner and N = 1,313 parents living with at least one of their children from three German representative population surveys, we estimated average marginal effects for the temporal trends (i.e., pre vs. post infection control measures) of domestic violence separately for males and females. To minimize bias across survey waves, inverse probability weighting was used. Results show no statistically significant increase in either physical or psychological forms of IPV or VAC as a result of the implementation of COVID measures. On the contrary, the 1-year prevalence was decreasing for certain forms of violence. Our findings suggest that the assessment of the consequences of infection control measures needs an empirical basis. Further research should be conducted using high-quality data sources. Therefore, the present study should be considered a stepping stone for ongoing research efforts to examine the consequences of pandemic-related infection control measures on the general population.

What contributes to the long-term implementation of an evidence-based early childhood intervention: a qualitative study from Germany.

Background: Rigorous research trials have demonstrated that early childhood interventions can reach socially disadvantaged families and can have a lasting impact on the healthy development of their children. However, little is known about the internal and contextual factors that contribute to the long-term implementation of such interventions. In this study, we investigated the development of the home visiting program Pro Kind. The program was adapted from the evidence-based US-American Nurse-Family Partnership program and was implemented in Germany in 2006. Using an exploratory approach, we examined factors contributing to the long-term implementation of this program. Methods: Qualitative interviews with program implementers (midwives, social workers, program managers) of the Pro Kind program and key stakeholders in two cities in Germany were conducted. Interview guides were developed to assess participants' perceptions and experiences on how the program had developed over time internally and in the interaction with its environment. Data were collected between March and September 2021. Drawing on the Consolidated Framework for Implementation Research (CFIR), data was coded according to the principles of thematic analysis. Results: A total of 25 individuals (11 program implementers, 14 key stakeholders) were interviewed. The identified factors related to three out of five domains of the CFIR model in our analysis. First, regarding the intervention characteristics, the evidence of effectiveness and the relative advantage of the implementation of the program compared to similar interventions were viewed as contributors to long-term implementation. However, the program's adaptability was discussed as a constraining factor for reaching the target group. Second, concerning the inner setting, stakeholders and program implementers perceived the implementation climate, the leadership engagement and the program's size as relevant factors for networking strategies and program visibility. Third, as part of the outer setting, the degree of networking with external stakeholders was highlighted of great importance for the program. Conclusions: We identified several factors of particular importance for the long-term implementation and sustainability of an early childhood intervention at the practice level, particularly in the local context in Germany. These findings should inform the design of impactful, scalable, and sustainable early childhood interventions targeting disadvantaged families.

[Psychometric Properties of a Short Alexithymia Scale (SAS-3) in the German General Population]. / Psychometrische Eigenschaften einer Kurzskala zur Erfassung von Alexithymie (SAS-3) in der deutschen Allgemeinbevölkerung.

OBJECTIVE: The literature on alexithymia has multiplied in recent decades as the construct has important implications for mental health. The so far used inventories are of limited use in epidemiological research, primary care, and other clinical settings where time and effort are important factors in assessment. Based on items of the authorized German version of the Toronto Alexithymia Scale, the aim of this study was to develop an ultra-short questionnaire for a condensed and unidimensional assessment of alexithymia. METHODS: Criteria for the abbreviated scale were: (a) one-dimensionality (necessary to calculate a global score), (b) one item from each of the originally postulated dimensions, and (c) no reverse-coded items (to avoid method artifacts). Data were drawn from two nationwide representative population surveys in Germany: a survey conducted in 1996 to develop the SAS-3 (N=2.047); and a survey conducted in 2013 (N=2.508) for the evaluation and calculation of SAS-3 percentiles. RESULTS: Reasonable correlations between the SAS-3 and the PHQ-2, the GAD-2, and the GBB-8 were observed. Based on a confirmatory factor analysis, the one-dimensionality of the SAS-3 could be confirmed, achieving very good fit indices. An additional invariance analysis regarding gender and different age groups resulted in (partial) strict invariance for the different multi-group analyses. Percentile ranks for SAS-3 sum score are reported stratified by gender and by age groups. CONCLUSIONS: The SAS-3 appears to be suitable in epidemiological research and other instances requiring an economical assessment of alexithymia.

Dimensional Latent Structure of Callous-Unemotional Traits in German Adolescents: Results from Taxometric Analyses.

A large amount of research has addressed the issue of the latent status of psychiatric disorders and related phenomena. We used a new taxometric approach developed by Ruscio to examine the latent status of callous-unemotional (CU) traits in a large representative study of German ninth graders (N = 3,878). Rather than estimating a putative taxon base rate and using that estimate to generate the taxon comparative data, we estimated CCFI profiles with each base rate estimate between 2.5% and 97.5% in increments of 2.5%. Results of different indicator sets clearly suggested a dimensional solution. This finding is consistent with different studies showing the dimensionality of psychopathy in adolescents. In summary, the results of this study point to the need for critical reflection in defining a high-risk-group in the context of CU traits. However, further studies are necessary to substantiate this result in different samples using different measurement approaches.

Who beats their partner, and who beats their schoolmates? A comparison of teen dating and school physical violence perpetration in Lower Saxony, Germany.

Teen dating violence (TDV) and school violence (SV) are two major social problems in adolescence. Until recently, the antecedents of both TDV and SV have been analyzed largely independently of each other. This study analyses and compares the determinants of both TDV and SV, with a focus on physical violence. Based on a comprehensive survey of ninth-grade adolescents at the average age of 15 years (N = 3,800) conducted in the German federal state of Lower Saxony, the findings showed that there is a significant but low correlation between both physical TDV and SV (r = 0.21). Concerning the determinants, we found that males carry out physical SV significantly more often, but physical TDV significantly less often than female respondents. Acquaintance with violent friends shows a stronger correlation with SV but not with TDV. Low self-control and violent media consumption are determinants of both TDV and SV. Empathy as a protective factor and parental violence as another risk factor were found to be only weak and sometimes not significantly correlated with both TDV and SV.

Psychometric properties of the Somatic Symptom Scale 8 (SSS-8) in a representative sample of German adolescents.

OBJECTIVE: The psychometric properties of the Somatic Symptom Scale 8 (SSS-8) have been investigated in different studies. However, there is no study examining its psychometric properties on representative data of adolescents. The study at hand will present results from a large representative sample of German adolescents (13 to 18 years). METHODS: The following analyses draw on cross-sectional data from German ninth-grade students collected in 2015. Altogether, 10,638 individuals were surveyed with a return rate of 68.5% as part of a periodic representative survey in the German federal state of Lower Saxony. RESULTS: For the SSS-8, coefficient omega for the full sample was ω = 0.90, and ω = 0.77 and 0.79 for males and females, respectively. In addition, a convergent validity was determined with the Patient Health Questionnaire 2 (PHQ-2), Generalized Anxiety Disorder 2 (GAD-2), and the brief form of Perceived Social Support Questionnaire (FSozU-K6). Based on a confirmatory factor analysis and measurement invariance analysis (for gender and migration background), the initially determined factor structure by Gierk et al. of the SSS-8 could be confirmed. CONCLUSION: The results support the reliability and validity of the SSS-8 for use with adolescents. The use of the SSS-8 seems to be meaningful within different frameworks, especially when, due to a lack of time or for reasons of cost, no face-to-face interviews can be conducted.

Prenatal and Infancy Home Visiting in Germany: 7-Year Outcomes of a Randomized Trial.

OBJECTIVES: Given the lasting positive effects of prenatal and infancy home visiting in the United States on disadvantaged mothers and children at school age, we analyzed the follow-up effects of a German home visiting program (ProKind). We hypothesized improvements in 3 domains at child age 7 years: (1) child development and life satisfaction, (2) maternal mental health and life satisfaction, and (3) adverse parenting, abusive parenting, and neglectful parenting. METHODS: We conducted a randomized controlled trial of home visiting, enrolling 755 pregnant, low-income women with no previous live births. The intervention comprised 32.7 home visits by family midwives and/or social pedagogues until child age 2 years. Assessments were completed on 533 7-year-old firstborn offspring to evaluate 8 primary hypotheses. RESULTS: We found significant positive effects for 4 of the 8 primary hypotheses. Mothers in the intervention group reported fewer behavioral problems among their children in the Child Behavior Checklist (effect size [ES] = 0.21; 95% confidence interval [CI]: 0.03 to 0.38), less child abusive parenting (ES = 0.19; 95% CI: 0.00 to 0.37), fewer maternal mental health problems (ES = 0.25; 95% CI: 0.07 to 0.43), and higher maternal life satisfaction (ES = 0.25; 95% CI: 0.07 to 0.43). Additional preregistered subgroup analyses regarding child sex revealed larger effects for boys and mothers of boys. CONCLUSIONS: The results suggest that in a western European welfare state, home visiting targeting disadvantaged mothers has lasting effects in important outcome domains. Therefore, home visits also appear to be an effective and efficient public health intervention in European settings.

The effects of home visiting on mother-child interactions: Evidence from a randomized trial using dynamic micro-level data.

BACKGROUND: Home visiting programs constitute an important policy to support vulnerable families with young children. One of their principal aims is to improve infant-parent relationships, so a key measure of their effectiveness is based on observational measures of parent-children interactions. In the present study we provide novel evidence on the effectiveness of home visiting programs in improving mother-child interactions within a randomized controlled trial (RCT) of the Pro Kind program. A major goal of the Pro Kind program is to promote child development by strengthening the intuitive parenting skills of mothers. On this basis, the following research question is addressed in this paper: What is the impact of the Pro Kind home visitation program on the quality of mother-child interaction? METHODS: A randomly chosen subsample of the original sample was selected to participate on video recordings. This subsample of 109 mother-child dyads was videotaped during a 3-min typical play situation at the participants' homes when the child was aged 25 months. We use a novel micro-coding system which allows us to examine how the intervention affected the dynamic feedback responses of both mothers and children in three key measures of behavior: orientation, positive contingency, and negative/lack of contingency. The analysis was conducted using a set of static probit models and dynamic cross-lagged panel probit models for each measure. RESULTS: The intervention significantly improved the interactions between girls and their mothers, by increasing the prevalence of orientation and positive contingency (and reducing that of negative/lack of contingency). This was achieved by increasing both the persistence of positive behaviors and also the probability of switching from negative to positive behaviors in the treatment group. Mixed impacts were detected for boys. CONCLUSIONS: Overall, it can be said that the Pro Kind program has a positive impact on the quality of mother-daughter interaction. However, our findings might also influence the design and delivery of home visiting programs, to the extent that they suggest that more attention has to be devoted to the interactions between boys and their mothers. Furthermore, the results show the importance of careful dynamic modelling of interactions data from videotaped observations to have a more complete understanding of the effectiveness of home visiting programs.

Psychometric Properties of Two Brief Versions of the Hopkins Symptom Checklist: HSCL-5 and HSCL-10.

The Hopkins Symptom Checklist-25 (HSCL-25) is a widely applied measure of depression and anxiety. The present study examines two of its short forms-the HSCL-5 and HSCL-10, which have been proposed by previous research-in a representative sample of the German general population. To this end, we conducted exploratory and confirmatory analysis on two subsamples (n = 1,246 and n = 1,216). Our results suggest that, compared with the HSCL-25, both short forms represent economical ways of assessing depression and anxiety. Model fit was good and correlations with established measures demonstrate convergent validity. Both HSCL short forms are strongly invariant across sex, and we found evidence for partial strong invariance across age groups. Further analyses showed that differences in HSCL can be partially explained by sociodemographic variables. Finally, we report normative values for usage by researchers and clinicians. We recommend the HSCL-5 and HSCL-10 for clinical and research-oriented application.

Associations Between Classroom Normative Climate and the Perpetration of Teen Dating Violence Among Secondary School Students.

The aim of this study was to investigate how classroom normative climate regarding the perpetration of teen dating violence (TDV) was related to adolescents' self-reported perpetration of (verbal/emotional, threatening, relational, physical, and sexual) violence within romantic relationships in the previous 12 months. Based on Theory of Normative Conduct, we hypothesized that higher classroom levels of TDV perpetration were associated with a higher likelihood of individual TDV perpetration. Data were drawn from a large survey of ninth-grade students conducted in the state of Lower Saxony, Germany (n = 10,638). From this sample, an analysis sample of n = 4,351 students at risk was drawn (mean age: 15.0, SD: 0.76; 46.6% male). More than half (54.8%) of the at-risk sample reported engagement in any form of TDV within the previous 12 months, whereby rates varied considerably by the dimension of TDV. Controlling for a range of risk factors on the classroom level (proportion of students dependent on social welfare, proportion of students with migration background) and individual level (exposure to family violence, sociodemographic characteristics, TDV victimization, and peer- and school-related factors), regression analyses showed that higher rates of classroom-level TDV perpetration were positively related to individual verbal/emotional TDV perpetration. This pattern of results was observable across all dimensions of TDV. Furthermore, gender-specific patterns of TDV perpetration were observable: Girls were more affected by classroom levels of verbal/emotional and physical TDV than boys, while boys were more affected by classroom levels of relational and sexual TDV. Results highlight the role of the wider peer context in shaping adolescent dating experiences and specifically point to the relevance of the classroom ecology for the socialization of dating violence in adolescents.

The Influence of Harsh Parenting and Parental Warmth During Childhood on Later Involvement in Prison Misconduct.

Research has shown that childhood victimization is associated with later involvement in delinquency. Prevalence rates of childhood victimization also tend to be higher among prison inmates compared with the general population. However, it has rarely been examined if childhood experiences-both negative and positive-have an effect on prison misconduct. We analyzed self-report data from more than 4,800 male and female adult prisoners in Germany to examine if childhood experiences of harsh parenting and parental warmth are associated with physical inmate-on-inmate violence. We also assessed the inmates' attitude toward violence and examined if violence approval mediates the relationship between childhood experiences and violent misconduct. The results of the structural equation models show that both harsh parenting and positive, caring parental behavior have a small, but significant effect on violent prison misconduct, which is completely mediated by the inmates' attitude toward violence. Furthermore, the results suggest that the same model holds for both male and female inmates, indicating that childhood victimization is not a gender-responsive need. The strength of the direct association between violence approval and violent misconduct underscores the need to assess the inmates' attitude toward violence to identify those most at risk of engaging in violence during incarceration.

Slapping Them Into Heaven? Individual and Social Religiosity, Religious Fundamentalism, and Belief in Heaven and Hell as Predictors of Support for Corporal Punishment.

Support for corporal punishment (CP) has been associated with religiosity. Yet, little is known about which aspects of religiosity predict support for CP. To close this gap in the literature, we investigated how individual and social religiosity, religious fundamentalism, belief in heaven, belief in hell, and demographic variables contribute for the support of CP. We analyzed population-based cross-sectional data, as gathered in the General Social Survey, with a final sample size of n = 671. Using ordinal regression, we found that increased support for CP was best predicted by belief in heaven and religious fundamentalism. These results suggest that support for CP seems to emerge mainly from absolute belief in divine reward and retribution. Religious parents might endorse CP as a means to ensure that their children enter heaven.

Validation of a Three-Item Short Form of the Modified Weight Bias Internalization Scale (WBIS-3) in the German Population.

INTRODUCTION: Individuals suffering from overweight or obesity frequently experience weight-based stigmatization. The widespread belief that weight is a matter of personal will and self-control results in various weight-based stereotypes (e.g., laziness, lack of self-discipline, or neglect). OBJECTIVE: Based on the modified version of the Weight Bias Internalization Scale (WBIS-M), a short form for the economic assessment of weight bias internalization in the general population was compiled and validated. METHODS: A three-item short form (WBIS-3) was derived based on data from a representative sample of the German population (n = 1,092). This new short form was validated in a second representative population sample (n = 2,513). Item characteristics and internal consistency were obtained. Measurement invariance was tested. Construct validity was established via the correlation with theoretically related constructs (depression, anxiety, eating behavior, discrimination, weight status). To establish scale validity, all analyses were performed for the whole sample as well as for the subsample of individuals with overweight. Age- and gender-specific population norms were provided. RESULTS: The WBIS-3 exhibited excellent psychometric properties. Internal consistency was α = 0.92. Strong measurement invariance was confirmed regarding age, gender, discrimination, and weight status in both the whole sample as well as the overweight subsample. CONCLUSIONS: The WBIS-3 constitutes a valid and economical tool for the assessment of weight bias internalization in epidemiological contexts. Measurement invariance allows for an unbiased comparison of means, correlation coefficients, and path coefficients within structural equation modeling across groups.

[Measurement invariance and normative data of the 8-item short form of the Center of Epidemiological Studies-Depression Scale (CES-D-8)]. / Normierung und Evaluation der Messinvarianz der 8-Item-Kurzform der Center of Epidemiological Studies-Depression Scale (CES-D-8).

Measurement invariance and normative data of the 8-item short form of the Center of Epidemiological Studies-Depression Scale (CES-D-8) Objectives: Female gender is a risk factor for depression. It is questionable whether a given psychometric instrument depicts depressive symptom severity in men and women alike. Therefore, we examined measurement invariance of the Center of Epidemiological Studies Depression Scale-8 (CES-D-8) between women, men and different age groups. Additionally, we aimed providing normative data for CES-D-8. Methods: We assessed depressive symptoms in a German population-based sample (N = 2,507) with the CES-D-8. Gender-distorted items were excluded in the short form. Results: Using confirmatory factor analysis (CFA), we found good model fit for men, women and the overall sample. A multi-group CFA confirmed measurement invariance of CES-D-8 regarding the tested factors and their interaction. Gender- and age-group-specific norms were computed. Conclusion: The use of the CES-D-8 can be recommended in epidemiological contexts, for practice and research. Different values between women and men of different age groups can be compared appropriately from a psychometric perspective.

Evaluation of the Universal Prevention Program Klasse2000 in Fourth Grade Primary School Children: Protocol for a Propensity Score-Matching Approach.

BACKGROUND: Klasse2000 is the most widely adopted school-based prevention program in Germany. It addresses health promotion, addiction, and violence prevention in primary schools. As a universal prevention program, it has reached more than 1.4 million German children in the past 25 years. OBJECTIVE: The effectiveness of Klasse2000 will be evaluated with a large representative survey among students. Students who have participated in the prevention program (intervention group) will be compared with students who did not participate (control group). The comparison will cover the following outcome domains: well-being, self-esteem, emotion regulation, food habits, behavioral problems, and school and classroom atmosphere. Furthermore, victimization and perpetration regarding bullying, alcohol consumption, smoking, and media consumption are assessed. METHODS: To control for potential group differences, treatment effects will be estimated using propensity score-matching, which matches students from the intervention and control groups based on an identical propensity score or a propensity score that does not differ by more than a previously defined distance. The treatment effect will then be estimated in the matched sample taking the matching process into account. RESULTS: Enrollment of schools began in March 2017. A total of 6376 students participated in the survey (n=4005 in control group; n=2371 in Klasse2000). The parent survey was returned by 52.13% (3324/6376) of parents. Results are expected in mid-2020. CONCLUSIONS: The results on the effectiveness of the Klasse2000 prevention program will form an empirical basis for legitimizing universal prevention programs and for planning future prevention approaches. TRIAL REGISTRATION: German Clinical Trials Register DRKS00014332; https://tinyurl.com/y2trvq4p. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14371.

A reanalysis of the center for epidemiological studies depression scale (CES-D) using non-parametric item response theory.

The "Center for Epidemiological Studies Depression Scale" (CES-D; Radloff, 1977) is a questionnaire used world-wide to measure depressive symptoms. Although the original four-factor-structure has been widely accepted and replicated, some studies point to other factor-structures like a one- and two-factor-structure. The goal of the current study was to evaluate the factor structure of the CES-D (one-, two- and four-factor-structure), which was found using classical test theory (CTT), with two non-parametric item-response-theory-models (Mokken-Scaling; Monotone-homogeneity-model; MHM and Double-monotonicity-model; DMM). To this end, a representative German sample was analyzed (N = 2,507). Regarding the one-factor-model, neither the MHM nor the DMM were supported; the two-factor-model and the four-factor-model, however, satisfied the assumptions of the MHM but not of the stricter DMM. Sum scores therefore constitute ordinal scales for the two-factor and four-factor-structure. This justifies, for example, the use of percentile ranks or medians and associated statistical techniques. Especially the use of the 16 negative formulated items seems appealing. Further studies should explore, whether the use of these 16 instead of the original 20 items is of advantage regarding the practical validity of the CES-D (e.g. higher sensitivity and specificity in screening applications and better temporal stability).

Factor Structure of the Inventory of Callous-Unemotional Traits in a Representative Sample of German 9th Grade Students.

Callous-unemotional (CU) traits represent the affective components of the psychopathy construct and show a strong relationship to violence and conduct-disorder in children. The Inventory of Callous-Unemotional Traits (ICU) is the current standard to assess CU traits. Despite the ICU having originally been constructed as a four-dimensional instrument, several studies found a three-factorial structure in combination with a general ICU-factor to be the best fitting factor-model. An imbalance in the number of positively and negatively worded items can be observed between the identified ICU dimensions. To investigate the effect of item keying on the factor structure we tested different factor-models in data stemming from a large sample (N = 3878) of German ninth grade students. Our findings suggest that the original four-factorial structure with a method factor shows good model fit. This solution is furthermore in line with the specifiers of the additional coding of Limited Prosocial Emotions for Conduct Disorder in the DSM-V.

Norm values and psychometric properties of the short version of the Trier Inventory for Chronic Stress (TICS) in a representative German sample.

The Trier Inventory for Chronic Stress (TICS), consisting of 57 items, is an instrument for measuring chronic stress in nine areas. There is also a short form (SSCS) of the TICS consisting of 12 items. However, this 12-item short form does not include all nine areas of the theoretical model and the long version. Therefore, a short version including all nine scales/areas was investigated. The TICS was taken by a sample of N = 2,473 respondents from the general population, aged 14 to 99, selected by random-route sampling. Confirmatory factor analyses applying robust maximum likelihood estimations (MLM) tested the model fit. The one-factor-model proposed by the original authors was tested, and the SSCS showed an unacceptable model fit. For the development of an economical short version of the TICS, including items of the nine areas of chronic stress, nine items based on the alphamax algorithm were selected. The one-factor-model of this new short version of the TICS of nine items provided a good fit for the latent construct and showed good reliability (α = .88). A new and reliable short version of the TICS consisting of only 9 items representing the 9 scales/areas for the assessment of chronic stress was identified to possess a good model fit and good reliability.