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Concept: German reunification


Narcissism scores are higher in individualistic cultures compared with more collectivistic cultures. However, the impact of sociocultural factors on narcissism and self-esteem has not been well described. Germany was formerly divided into two different social systems, each with distinct economic, political and national cultures, and was reunified in 1989/90. Between 1949 and 1989/90, West Germany had an individualistic culture, whereas East Germany had a more collectivistic culture. The German reunification provides an exceptional opportunity to investigate the impact of sociocultural and generational differences on narcissism and self-esteem. In this study, we used an anonymous online survey to assess grandiose narcissism with the Narcissistic Personality Inventory (NPI) and the Pathological Narcissism Inventory (PNI) to assess grandiose and vulnerable aspects of narcissism, and self-esteem with the Rosenberg Self-Esteem Scale (RSE) in 1,025 German individuals. Data were analyzed according to age and place of birth. Our results showed that grandiose narcissism was higher and self-esteem was lower in individuals who grew up in former West Germany compared with former East Germany. Further analyses indicated no significant differences in grandiose narcissism, vulnerable narcissism or self-esteem in individuals that entered school after the German reunification (≤ 5 years of age in 1989). In the middle age cohort (6-18 years of age in 1989), significant differences in vulnerable narcissism, grandiose narcissism and self-esteem were observed. In the oldest age cohort (> 19 years of age in 1989), significant differences were only found in one of the two scales assessing grandiose narcissism (NPI). Our data provides empirical evidence that sociocultural factors are associated with differences in narcissism and self-esteem.

Concepts: Western Europe, States of Germany, East Berlin, German reunification, Narcissistic personality disorder, West Germany, Narcissism, Germany


Before the fall of the Berlin Wall, mortality was considerably higher in the former East Germany than in West Germany. The gap narrowed rapidly after German reunification. The convergence was particularly strong for women, to the point that Eastern women aged 50-69 now have lower mortality despite lower incomes and worse overall living conditions. Prior research has shown that lower smoking rates among East German female cohorts born in the 1940s and 1950s were a major contributor to this crossover. However, after 1990, smoking behavior changed dramatically, with higher smoking intensity observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differences and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Mortality forecasting methods that do not account for smoking would, perhaps misleadingly, forecast a growing mortality advantage for East German women. Experience from other countries shows that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming an example warning of the consequences of weakening anti-smoking policies and changing behavioral norms.

Concepts: Eastern Bloc, German reunification, East Germany, Berlin Wall, West Berlin, East Berlin, West Germany, Germany


To design effective and commonly accepted public health policies against performance-enhancing drugs (PED), it is important to understand general population attitudes. This article elicits PED attitudes in the Berlin population and compares response rates of former athletes (N= 496) with those of non-athletes (N= 1686). In addition, exploiting the natural experiment of the division of Germany, by comparing East (N= 687) to West Berliners (N= 1315), the article studies the long-term impact of state socialisation on PED attitudes. Former West German amateur athletes are a statistically significant 6ppt more likely to believe that athletes can be successful without doping. Former GDR amateur athletes are 8ppt more likely to believe that doping is inevitable in professional sports.

Concepts: German reunification, Cold War, Socialism, Soviet Union, Communism, East Germany, West Germany, Germany


This article investigates the importance of regional health care availability for old age survival. Using German reunification as a natural experiment, we show that spatial variation in health care in East Germany considerably influenced the convergence of East German life expectancy toward West German levels.

Concepts: German reunification, West Berlin, Willy Brandt, States of Germany, East Germany, East Berlin, West Germany, Germany


 In recent decades, guideline-based therapy of myocardial infarction has led to a considerable reduction in myocardial infarction mortality. However, there are relevant differences in acute care and the extent of infarction mortality. The objective of this survey was to analyze the current care situation of patients with acute myocardial infarction in the region of northeast Germany (Berlin, Brandenburg and Mecklenburg-Vorpommern).

Concepts: Berlin, German reunification, Atherosclerosis, Brandenburg, States of Germany, Germany, East Germany, Myocardial infarction


Before German reunification, old-age mortality was considerably higher in East Germany than West Germany but converged quickly afterward. Previous studies attributed this rapid catch-up to improved living conditions. We add to this discussion by quantifying for the first time the impact of mortality selection.

Concepts: West Berlin, Willy Brandt, East Germany, States of Germany, East Berlin, German reunification, West Germany, Germany


The aim of this study was to analyze the incidence rates of type 1 diabetes in Saxony before and after the German reunification.

Concepts: Mecklenburg-Vorpommern, Thuringia, Saxony-Anhalt, States of Germany, Saxony, West Germany, Germany, German reunification


The invasive Asian bush mosquito Aedes japonicus japonicus was first recognised as established in Germany in 2008. In addition to the first known and quickly expanding population in the southwestern part of the country, three separate populations were discovered in West, North and southeastern Germany in 2012, 2013 and 2015, respectively, by means of the ‘Mueckenatlas’, a German instrument of passive mosquito surveillance. Since the first findings of mosquito specimens in West and North Germany, these regions were checked annually for continuing colonisation and spread of the species. Both affected areas were covered by a virtual 10x10km2 grid pattern in the cells of which cemeteries were screened for immature stages of the mosquito. The cells were considered populated as soon as larvae or pupae were detected, whereas they were classified as negative when no mosquito stages were found in the cemeteries of at least three different towns or villages. Presence was also recorded when Ae. j. japonicus adults were submitted to the ‘Mueckenatlas’ from the respective cell or when there was evidence of local occurrence in localities other than cemeteries. Based on this approach, a significant expansion of the populated area was documented in West Germany since the first detection of Ae. j. japonicus in 2012 (increase in positive grid cells by more than 400%), while the North German population appears not to be expanding so far (reduction of positive grid cells by ca. 30% since 2013). As Ae. j. japonicus finds suitable climatic and ecological conditions in Germany, the differential expansion of the two populations might be attributed to the West German population being older and thus more firmly established than the closely related but younger North German population that might still be in its founder phase. However, geographic spread of all German populations in the future is anticipated. Continuous surveillance is recommended, as Ae. j. japonicus is a competent vector of several pathogens in the laboratory.

Concepts: German reunification, Mosquito, European Union, Netherlands, West Germany, United States Census Bureau, Western Germany, Germany


Little is known about the relationship between family characteristics and survival from childhood acute lymphoblastic leukaemia (ALL), which we studied for the first time in German children.

Concepts: Deutschlandlied, Willy Brandt, East Germany, German reunification, West Germany, European Union, Germany, Acute lymphoblastic leukemia


Aim was to examine the relationship between individually perceived changes in psychosocial stressors associated with German reunification and cardiovascular effects. We hypothesised that higher levels of psychosocial stress related to German reunification were associated with an increase in cardiovascular risk factors and cardiovascular diseases (CVDs).

Concepts: German reunification, Saxony-Anhalt, Treaty on the Final Settlement with Respect to Germany, Brandenburg, Saxony, West Germany, Mecklenburg-Vorpommern, Germany