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Journal: Psychotherapie, Psychosomatik, medizinische Psychologie


The aim was to translate the Patient-Provider Orientation Scale (PPOS) into German and to assess the degree of medical students' patient-centeredness in 2 student samples in Freiburg (GER) and in Basel (CH). The German translation of PPOS was administered to 259 medical students in Freiburg and to 137 medical students in Basel. Construct validity was tested using factor analysis. Based on factor analysis and tests of internal consistency, a shortened version with 6 items for each of the 2 subscales “sharing” and “caring” was generated (PPOS-D12). PPOS D12 is a reliable instrument to assess patient-centeredness among medical students in German-speaking countries.

Concepts: Psychometrics, Language, Reliability, Italian language, Germany, Switzerland, German language, Alsace


Anxiety, depression and posttraumatic stress disorder are the main psychopathological symptoms shown by refugees. We conducted a systematic review. First, we identified key-words for a systematic search in PUBMED. We included original articles since 2009 with 1) a non-clinical sample of refugees, 2) refugees living at maximum 5 years in the host country, 4) with the outcomes anxiety, depression, and PTSD and 5) a sample with >100 participants. Then we read titles, abstracts and fulltexts. We identified 1 877 studies. Based on this screening procedure, we included in our review 15 studies. 52% of the refugees are from Africa (Somalia, Congo, Rwanda, Liberia, Sierra-Leon and Togo), 33% from Asia (Syria, Bhutan, Vietnam, Cambodia, Iraq) and 16% are from more than one continent. In those studies n=6 769 refugees participated in the studies. The number of participants varied from n=117 to n=1,422 (Median: n=366 refugees). Prevalence rates for PTBS varied from 5-71% (mean prevalence rate: 32%) rates for depression varied from 11-54% (mean prevalence rate: 35%). Sensitivity analyses suggest that refugees, which come from countries with intense human rights violations according to the Political Terror Scale, have an increased rate of psychopathological symptoms. Heterogeneity of prevalence rate is related both 1) to methodological and 2) to difference in the refugee populations according to the human rights violations in the countries of origin of refugees. It is necessary to include further databases in a systematic review. There is an urgent need for representative studies on refugees needs for psychosocial and medical care, especially for those refugees coming from countries with intense human rights violations. Psychosocial and medical services for these refugees are urgently needed to enhance and enable a perspective in the host country Germany.

Concepts: Human rights, Selective serotonin reuptake inhibitor, Abnormal psychology, Posttraumatic stress disorder, Prevalence, United Nations, Vietnam War


Introduction The ICD-10 symptom rating (ISR) is a self-rating instrument that is based on ICD-10 syndromes. Can previous findings concerning its validity be replicated in a non-clinical sample? Material & Methods N=428 study participants - mainly students - completed the ISR and the SCL-90-R in an online survey. Results The assumed factorial structure was replicated with a good model fit. The correlations between the content-related scales of the two instruments ranged from rmin=0.60 to rmax=0.85. Study participants indicated that they did not find completing the ISR stressful. Discussion and Conclusions These results indicate good validity and applicability of the ISR.

Concepts: Metalogic, Logic, Soundness


We conducted an exploratory questionnaire-based study (n=63) to assess the importance of personality organization for therapy success in a day treatment setting. Patients completed self-report measures at the beginning and end of treatment spanning 4-6 week capturing impairments in personality organization (IPO-16), acute symptom severity (SCL-90-R, BDI-2), personality disorders (ADP-IV), and traumatic experiences in childhood and adolescence (CTQ). We observed strong associations between impairments in personality organization, personality pathology, traumatic experiences, and acute symptom severity. Impairments in personality organization did not change during treatment. In contrast to other studies, an influence of personality organization on treatment success could not be demonstrated. The importance of personality organization for therapy planning should be studied further.

Concepts: Longitudinal study, Psychological trauma, Childhood, Cultural studies, Psychiatry, Personality disorder, Personality, Personality pathology


Body image avoidance is conceptualised as a behavioural manifestation of body image disturbance, and describes efforts to avoid confrontation with one’s own body. While studies have provided hints that body image avoidance in adulthood contributes to the development and maintenance of eating disorders, so far, there are no corresponding findings for adolescence. The Body Image Avoidance Questionnaire (BIAQ) is the most widely used international questionnaire for measuring body-related avoidance behaviour. As its German version has only been validated in an adult sample, the aim of the present study is to statistically test the questionnaire in adolescents with eating disorders. In total, N=127 female adolescents, including n=57 with Anorexia Nervosa, n=24 with Bulimia Nervosa, and n=46 healthy controls, answered the BIAQ as well as various other instruments for assessing body image disturbance and eating disorder symptoms. The factor structure assumed for the original English version, comprising the higher-order factor “body-related avoidance behaviour” and the 4 subfactors “clothing”, “social activities”, “eating restraint” and “grooming and weighing”, was confirmed by a confirmatory factor analysis. With the exception of the scale “grooming and weighing”, all scales showed mostly acceptable internal consistencies, test-retest reliability, differential validity and construct validity. Due to their satisfying psychometric properties, the use of the BIAQ scales “clothing”, “social activities” and “eating restraint” can be recommended in research and practice for adolescence.

Concepts: Psychometrics, Factor analysis, Anorexia nervosa, Eating disorders, Reliability, Vomiting, Bulimia nervosa, Maudsley Family Therapy


The present article gives an overview of quality assurance measures in outpatient psychotherapy. Therefore, we review elements considered important to assure quality in general and for psychotherapy in particular. We focus on possibilities to assure the quality of psychotherapy outcomes. Recently, an increased outcome orientation has gained considerable attention and is emphasized by national and international policy makers. Finally, recent developments in feedback research are discussed and practical applications presented.

Concepts: Present, Evaluation, Quality, Quality control, Policy, Outcome, Software quality assurance


Background Prevalence rates for eating disorders remained stable over the years despite the implementation of numerous prevention strategies. This may be due to discrepancies between research and practice and scientific findings are not fully applied to the care of risk groups. The school-based programs PriMa and Torera for primary prevention of eating disorders have been delivered in Thuringian schools since 2004. A current survey provides information on barriers and facilitators for a long-term implementation in the school routine. Objectives and Methods Using the “Consolidated Framework for Implementation Research”, factors which impact the implementation process are discussed. Results Impeding factors for a long-term implementation are missing framework conditions, staff turnover and a lack of financial support from politicians. Possible solutions could be the establishment of extra time in the curriculum, the employment of individuals responsible for prevention and a close network between all people involved. Conclusion According to the Society for Prevention Research, discussing implementation factors builds the last part of comprehensive program evaluations. We illustrate the barriers for the integration of evidence-based prevention programs in daily school life. It is important to implement new structures prior to the implementation of resource-intensive new prevention programs in order to increase the effectiveness of said programs and enable long-term implementation.

Concepts: Debate, Research, Prevention, Implementation, Design, Prevalence, School, The Establishment


Background The evaluation whether a person who died by suicide suffered from a psychiatric disorder poses a diagnostic problem on psychological autopsy studies and is debated controversially. Objective Do patients and relatives or friends agree on DSM-5(®)-diagnoses? Methods A sample of N=20 inpatients and their relatives or friends were interviewed using a structured-clinical interview. In total agreement on 78 patient-based and 72 relatives- or friends-based diagnoses could be assessed. Results Agreement of patients' and relatives' or friend’s diagnoses was low. Moderate concordance was found for the following diagnoses: Posttraumatic Stress Disorder, Somatic Symptom Disorder, Borderline Personality Disorder, and Binge-Eating Disorder. Only for the Persistent Depressive Disorder, the Binge-Eating Disorder, and the Borderline Personality Disorder good positive predictive values (0.75-0.80) were observed. Conclusion On the basis of interviews with relatives or friends, no reliable diagnostic decisions can be made.

Concepts: Mental disorder, Abnormal psychology, Schizophrenia, Borderline personality disorder, Schizotypal personality disorder, Self-harm, Antisocial personality disorder, Suicide


Objectives The Suicide Behaviors Questionnaire-Revised (SBQ-R) was developed by Osman et al. (2001) to economically assess different aspects of suicidality. It consists of 4 items. There are several critical points concerning item construction: (1) temporal frame (e. g. retrospective vs. prospective) and (2) response labels of item 1 and 3 (e. g. 2 alternatives with the same scoring). Information about psychometric properties of the German version of the SBQ-R were not available until now. The SBQ-R is assumed to be a unidimensional measure and is evaluated using a total score, although its dimensionality has never been tested. Methods The SBQ-R and several measures for convergent validity were assessed in a representative sample of the German general population (N=2497). Convergent validity was tested against symptoms of depression and anxiety (PHQ-4), as well as the core constructs of the Interpersonal Theory of Suicidal Behavior (IPTS) (INQ, ACSS-FAD). Unidimensionality of the SBQ-R was tested using confirmatory factor analysis and intercorrelations with the convergent measures were calculated. Results The initial model fit of the unidimensional solution was unsatisfactory. After inclusion of a correlated error term of item 2 and item 4 based on modification indices, the model fit was very good. Moreover the SBQ-R showed satisfactory internal consistency (Cronbach’s α=0.72). With the exception of the ACSS-FAD, all correlations with convergent measures were according to the theoretically proposed expectations. Conclusion In principle the findings on the psychometric properties justify the use of the SBQ-R, although several critical points concerning item scoring remain unresolved. Moreover, sufficient unidimensional model fit was not possible without including correlated errors. Since suicidality is a frequently assessed construct in suicide research and as an exclusion criterion in clinical studies, it would be desirable to develop an economic, psychometrically sound and compelling instrument for the assessment of the different aspects of suicidality in future.

Concepts: Regression analysis, Assessment, Educational psychology, Psychometrics, Factor analysis, Validity, Reliability, Suicide


Background Cancer is often associated with negative psychosocial consequences not only for patients but also for their partners. These consequences are also influenced by the applied coping strategies. Objective The study examines the influence of Dyadic Coping (DC) on social support and psychological distress (symptoms of depression and anxiety) in haemato-oncological patients and their partners. Of particular interest is the significance of dyadic accordance (conformity) of the assessment of DC (“discrepancy indexes”). Methods The study investigates 330 couples (haemato-oncological patients and their partners, average age patient 57.0 years, 63.3 percent male, 25.8 percent acute leukemia). In addition to Dyadic Coping Inventory (DCI), standardized instruments are used. Research data is being analyzed with t-tests, partial correlation and regression. Results Patients and partners use similar dyadic coping strategies, whereby partners assess coping behaviors of patients more accurately than vice versa. Regarding social support, the DC total score plays a more decisive role than discrepancy indexes, in particular with patients (R(2)=20.4%). Conversely, discrepancy indexes explain a large part of the patients' variance (R(2)=10.2%); regarding psychological stress, the DC total score shows no effects in this model. Discussion The results demonstrate the relevance of the DC discrepancy indexes as a measure for interpersonal accordance for psychosocial outcomes, especially for psychological distress. Further application-related research is necessary to generate reliable statements about these associations.

Concepts: Anxiety, Psychology, Stress, Human behavior