Vetter, S., Rossegger, A., Elbert, T., Gerth, J., Urbaniok, F., Laubacher, A., Rossler, W., & Endrass, J. (2011). Internet-based Self-Assesment after the Tsunami: lessons learned. BMC Public Health, 11(18). doi:10.1186/1471-2458-11-18
In the aftermath of the Tsunami disaster in 2004, an online psychological self-assessment (ONSET) was developed and made available by the University of Zurich in order to provide an online screening instrument for Tsunami victims to test if they were traumatized and in need of mental health care. The objective of the study was to report the lessons learnt that were made using an Internet-based, self-screening instrument after a large-scale disaster and to discuss its outreach and usefulness. Methods: Users of the online self-assessment decided after finishing the procedure whether their dataset could be used for quality control and scientific evaluation Their answers were stored anonymously only if they consented (which was the case in 88% of the sample), stratified analyses according to level of exposure were conducted. Results: A total of 2,914 adult users gave their consent for analysis of the screenings. Almost three quarter of the sample filled out the ONSET questionnaire within the first four weeks. Forty-one percent of the users reported direct exposure to the Tsunami disaster. Users who were injured by the Tsunami and users who reported dead or injured family members showed the highest degree of PTSD symptoms. Conclusion: ONSET was used by a large number of subjects who thought to be affected by the catastrophe in order to help them decide if they needed to see a mental health professional. Furthermore, men more frequently accessed the instrument than women, indicating that Internet-based testing facilitates reaching out to a different group of people than “ordinary” public mental health strategies.
Spiesshofer, M., Keller, A., Endrass, J., Meyer, T., Moskvitin, K., & Rossegger, A. (2011). Indikatoren für den Behandlungsverlauf einer stationären Entwöhnungsbehandlung Alkoholkranker. Schweizer Archiv für Neurologie und Psychiatrie, 162(2), 66-71.
In den vergangenen Jahren wurden insbesondere im deutschsprachigen Raum Studien über Indikatoren für eine erfolgreiche stationäre Alkoholentwöhnung publiziert. Ziel der vorliegenden Arbeit war es, Prädiktoren für den Behandlungsverlauf einer stationären Alkoholentwöhnung in der Schweiz zu identifizieren. Methode: Gegenstand der Evaluation waren alle Patienten (N=1065), die zwischen 2004 und 2007 in der Forel Klinik, einer für stationäre Entwöhnungsbehandlungen spezialisierten Alkoholfachklinik, behandelt worden sind. Drei Patientengruppen wurden auf Unterschiede hin untersucht: Therapie-Abbrecher, Patienten, die die Behandlung regulär beendet haben, aber nicht von der Behandlung profitierten und erfolgreich behandelte Patienten. Ergebnisse: Die multinomialen logistischen Regressionen zeigten, dass sich Therapieabbrecher im multivariablen Modell hinsichtlich des Alters, der Schulbildung und des Anstellungsverhältnisses von den Therapieabsolventen unterschieden. Anhand der multivariablen Modellen konnte zudem gezeigt werden, dass die erfolgreich Behandelten eher über ein Anstellungsverhältnis verfügten und weniger häufig eine komorbide Persönlichkeitsstörung aufwiesen. Diskussion: Es konnten Indikatoren für einen regulären Behandlungsverlauf sowie für ein günstiges Behandlungsergebnis identifiziert werden. Beim Behandlungsverlauf spielen psychiatrische Kriterien eine eher geringe Rolle und er scheint eher von sozialen Faktoren geprägt zu sein. Das günstige Behandlungsergebnis ist hingegen insofern von psychiatrischen Faktoren beeinflusst, als dass Patienten mit einer komorbiden Persönlichkeitsstörung insgesamt aber weniger vom Klinikaufenthalt profitieren.
Rossegger, A., Keller, A., Odenwald, M., & Endrass, J. (2009). The appropriateness of the treatment setting for the inpatient post-acute treatment of alcohol dependence disorders in Switzerland. International Journal of Mental Health Systems, 3(16). doi:10.1186/1752-4458-3-16
In Switzerland, a total of 1’000 patients a year are treated for alcohol-dependence in specialized institutions. Though the current literature suggests favoring outpatient treatment, whether outpatient or inpatient treatment is more efficient cannot be answered generally. For Germany, “AWMF”-treatment guidelines were formulated in order to treat patients with substance use disorders in the appropriate treatment settings. The aim of the present study was to test the hypothesis that the majority of patients treated in the largest specialized institution for alcohol abuse treatment in Switzerland were treated in the appropriate setting. Methods: All completed treatments conducted in the Forel-Hospital – the largest clinic of its kind in Switzerland - between the 4th of March 2003 and the 20th of December 2006 were included in the investigation (n=915). Patient and treatment characteristics were gathered using the information from the PSYREC and act-info questionnaire. The AWMF criteria were operationalized on the basis of the questionnaire. Results: Applying the AWMF criteria resulted in the emergence of three groups: 73.7% of the study sample could clearly be assigned to the inpatient treatment group, and for 7.5% there was evidence supporting the allocation to an outpatient treatment setting. In 18.8% of the cases, however, the AWMF criteria did not allow an assignment to either of the treatment settings. Of the total sample, 18.5% of all patients apparently did not profit from the inpatient treatment setting, whereas for the vast majority (81.5%), a therapeutic progress was documented. In those patients who, according to the AWMF guidelines, did not need an inpatient setting, a larger proportion improved than in the group of the patients who needed an inpatient treatment in a specialized hospital. Furthermore, the logistic regression analyses revealed that the less severe the clinical state of a patient upon admittance, the higher the odds of improvement during the hospital stay. Conclusions: The results serve as evidence that for at least three out of four patients treated in the investigated specialized institution, an inpatient treatment was appropriate. The principal reason for the necessity of an inpatient treatment setting was that this hospital population showed severe psychiatric, somatic or social irregularities. Only a very limited number of patients hospitalized in a specialized institution for the treatment of alcohol-related disorders can be treated in an outpatient setting.
Vetter, S., Rossegger, A., Rossler, W., Bisson, J. I., & Endrass, J. (2008). Exposure to the tsunami disaster, PTSD symptoms and increased substance use: An internet based survey of male and female residents of Switzerland. BMC Public Health, 8(1), 92. doi:10.1186/1471-2458-8-92
After the tsunami disaster in the Indian Ocean basin an Internet based self-screening test was made available in order to facilitate contact with mental health services. Although primarily designed for surviving Swiss tourists as well as relatives and acquaintances of the victims, the screening instrument was open to anyone who felt psychologically affected by this disaster. The aim of this study was to evaluate the influences between self-declared increased substance use in the aftermath of the tsunami disaster, trauma exposure and current PTSD symptoms. Method: One section of the screening covered addiction related behavior. We analyzed the relationship between increased substance use, the level of PTSD symptoms and trauma exposure using multivariable logistic regression with substance use as the dependent variable. Included in the study were only subjects who reported being residents of Switzerland and the analyses were stratified by gender in order to control for possible socio-cultural or gender differences in the use of psychotropic substances. Results: In women PTSD symptoms and degree of exposure, enlarged the odds of increased alcohol, pharmaceuticals and cannabis use significantly. In men the relationship was more specific: PTSD symptoms and degree of exposure only enlarged the odds of increased pharmaceutical consumption significantly. Increases in alcohol, cannabis and tobacco use were only significantly associated with the degree of PTSD symptoms. Conclusion: The tsunami was associated with increased substance use. This study not only replicates earlier findings but also suggests for a gender specificity of post-traumatic substance use increase.
De Gara, F., Gallo, W.-T., Bisson, J.-I., Endrass, J., & Vetter, S. (2008). Investment in online self-evaluation tests: A theoretical approach. Journal of Trauma Management and Outcomes, 2(1), 1-6. doi:10.1186/1752-2897-2-3
Large-scale traumatic events may burden any affected public health system with consequential charges. One major post-disaster, expense factor emerges form early psychological interventions and subsequent, posttraumatic mental health care. Due to the constant increase in mental health care costs, also post-disaster public mental health requires best possible, cost-effective care systems. Screening and monitoring the affected population might be one such area to optimize the charges. Method: This paper analyzes the potential cost-effectiveness of monitoring a psychologically traumatized population and to motivate individuals at risk to seek early treatment. As basis for our model served Grossman's health production function, which was modified according to fundamental concepts of cost-benefit analyzes, to match the basic conditions of online monitoring strategies. We then introduce some fundamental concepts of cost-benefit analysis. Results: When performing cost-benefit analyses, policy makers have to consider both direct costs (caused by treatment) and indirect costs (due to non-productivity). Considering both costs sources we find that the use of Internet-based psychometric screening instruments may reduce the duration of future treatment, psychological burden and treatment costs. Conclusion: The identification of individuals at risk for PTSD following a disaster may help organizations prevent both the human and the economic costs of this disease. Consequently future research on mental health issues should put more emphasis on the importance of monitoring to detect early PTSD and focus the most effective resources within early treatment and morbidity prevention.
Böker, H., Himmighoffen, H., Straub, M., Schopper, C., Endrass, J., Küchenhoff, B., Weber, S., & Hell, D. (2008). Deliberate self-harm in female patients with affective disorders: Investigation of personality structure and affect regulation by means of Operationalized Psychodynamic Diagnostics. Journal of Nervous and Mental Disease, 196(10), 743-751.
This study investigated psychodynamically relevant dimensions in female depressive patients with and without deliberate self-harm (DSH). DSH is often observed in depressive patients and frequently shows a correlation with personality disorders. Forty female depressive patients with and without DSH were investigated after recovery from acute depressive pathology by means of operationalized psychodynamic diagnostics (OPD). Patients with DSH had a significantly lower level of integration in the OPD dimension structure, and their interpersonal relationships showed dysfunctional interaction patterns. They also had a significantly higher rate of personality disorders. These results underline the significance of aspects of personality structure in female depressive patients with DSH, and enable a deeper understanding of their dysfunctional defense strategies, the connections with underlying disturbed affect regulation, and vicious circles in the therapeutic transference-countertransference relationship. OPD has been shown to be a useful tool for empirical research into therapeutically relevant dimensions of personality.
Walke, L.-M., Byers, A.-L., Gallo, W.-T., Endrass, J., & Fried, T.-R. (2007). The association of symptoms with health outcomes in chronically ill adults. Journal of Pain and Symptom Management, 33(1), 58-66.
Persons with chronic disease experience multiple symptoms. Understanding the association between these symptoms and health outcomes would facilitate a targeted approach to symptom assessment and treatment. Our objectives were to determine the association of a range of symptoms with quality of life, self-rated health, and functional status among chronically ill adults, and to assess methods for evaluating the independent associations of symptoms that may be interrelated. We consecutively enrolled 226 cognitively intact, community-dwelling adults, aged 60 years or older with chronic obstructive pulmonary disease, heart failure, or cancer. Seven symptoms (physical discomfort, pain, fatigue, problems with appetite, feelings of depression, anxiety, and shortness of breath) assessed using the Edmonton Symptom Assessment Scale were examined for their association with self-rated quality of life, self-rated health, and functional status. Principal component analysis and logistic regression revealed similar results. The latter demonstrated that physical discomfort was associated with lower self-rated health (adjusted odds ratio [OR] 1.9; 95% confidence interval 1.2-2.9) and functional disability (adjusted OR 1.8; 95% confidence interval 1.2-2.7). Feelings of depression were associated with poorer quality of life (adjusted OR 1.7; 95% confidence interval 1.1-2.6), and shortness of breath was associated with lower self-rated health (adjusted OR 1.5; 95% confidence interval 1.1-2.0). The association between a range of symptoms and quality of life, self-rated health, and functional status differed across outcomes, but only three symptoms-physical discomfort, feelings of depression, and shortness of breath-maintained their associations when multiple symptoms were examined concurrently. These findings suggest that interventions targeting these symptoms could improve several health-related outcomes.
Modestin, J., Hermann, S., Endrass, J. (2007). Schizoidia in schizophrenia spectrum and personality disorders: role of dissociation. Psychiatry Research, 153(2), 111-118.
Dissociation was one of the roots of the nosopoetic construct “schizophrenia”, and a link seems to exist between psychotic and dissociative phenomena.We explored the relationship between dissociation and schizoidia as defined by the Dissociative Experiences Scale (DES) total score and the schizoidia subscale of the Munich Personality Test (MPT), respectively. The study comprised 43 outpatients diagnosed with schizophrenia spectrum disorders in remission, 47 outpatients with personality disorders and 42 nonpatients. Besides the DES and the MPT, all participants also completed parts of the Symptom Checklist (SCL-90-R) and theTrauma Questionnaire (TQ). In the final multivariable logistic model, a set of five variables was identified as the strongest contributors to the occurrence of schizoida. The model included TQ broken home, MPT neuroticism, schizophrenia spectrum and personality disorder diagnoses, and SCL aggressivity; it did not include any dissociation variable. The purported relationship between dissociation and schizoidia could not be confirmed; the existence of schizophrenia-inherent dissociation appears questionable.
Künig, G., Kaldune, A., Stief, V., Jager, M., Hell, D., Endrass, J., & Schreiter Gasser, U. (2007). CERAD und NOSGER. Der prädiktive Wert dieser Verfahren in der Demenzdiagnostik einer Schweizer gerontopsychiatrischen Patientenpopulation. Nervenarzt, 78, 314-321.
Die CERAD-Batterie (Consortium to Establish a Registry for Alzheimer’s Disease) ist ein gängiges Screeninginstrument in der Diagnostik der Alzheimer-Demenz. Dem NOSGER (Nurses Observation’ Scale for Geriatric Patients), eigentlich entwickelt, um Verhaltensauffälligkeiten im Alltag zu erfassen, scheint bei der Alzheimer-Demenz auch eine diagnostische Bedeutung zuzukommen. Methode: In einer retrospektiven Studie mit 400 Patienten unserer Klinik, die bei unterschiedlichen psychiatrischen Erkrankungen kognitive Störungen aufwiesen, haben wir CERAD und NOSGER mittels logistischer Berechnung in uni- und multivariaten Modellen auf ihren prädiktiven Wert für die Diagnose Demenz untersucht. Ergebnisse: Im univariaten Modell waren alle CERAD-Subtests signifikante Prädiktoren für Demenz. Das beste multivariate Modell umfasste die Subtests „Verbale Flüssigkeit“, „Wortliste Abrufen“, „Konstruktive Praxie Abrufen“ und MMS (Mini-Mental Status). Der NOSGER zeigte keinen prädiktiven diagnostischen Wert. Schlussfolgerungen: Innerhalb einer gerontopsychiatrischen Population grenzt der CERAD Demenzpatienten von nicht dementen mit hoher Vorhersagewahrscheinlichkeit ab, während der NOSGER keinen prädiktiven Wert für die Diagnose Demenz aufweist.
Künig, G., Endrass, J., Bader, J.-P., Hess, K., Keller, A., & Hell, D. (2007). Das Interaktionsverhalten in der Depression nach Parkinsoner Krankheit: Eine Studie mit sequentieller Verhaltensanalyse. Schweizer Archiv für Neurologie und Psychiatrie, 158(3), 123-128.
Berichtet wird über eine vergleichende sequentielle Verhaltensanalyse des Interaktionsverhaltens von zehn Patienten mit Depressionen, zehn Patienten mit idiopathischem Parkinson-Syndrom und zehn gesunden Probanden in Interviews mit trainierten, gesunden Gesprächspartnern. Im Zentrum der Studie stand die Frage nach moeglichen Unterschieden in der Reagibilität und Frequenz der untersuchten Gruppen in Bezug auf Sprechen und Lächeln in der Interaktion mit den Interviewern. Die videographierten Interaktionen wurden von zwei trainierten Auswertern analysiert, zur Kodierung des Lächelns wurde dabei das "Facial Action Coding System" eingesetzt. Folgende Ergebnisse wurden ermittelt: (1) Die Lächelreagibilität in den Interviews mit depressiven Patienten unterschied sich nicht von der in Interviews mit gesunden Personen oder Parkinson-Patienten. Dagegen war in Interviews mit depressiven und Parkinson-Patienten die Lächelfrequenz bei beiden Interaktionspartnern niedriger als in Interviews mit gesunden Personen. (2) Die Sprechreagibilität der depressiven unterschied sich nicht von der gesunder Personen, während Parkinson-Patienten (aber auch ihre gesunden Gesprächspartner) eine verzögerte Reagibilität aufwiesen. Hinsichtlich der Sprechfrequenz gab es zwischen den Gruppen keine Unterschiede. In allen Gruppen sprachen die Interviewer mehr als die Probanden.
Endrass, J., Vetter, S., Gamma, A., Gallo, W.-T., Rossegger, A., Urbaniok, F., & Angst, J. (2007). Are behavioral problems in childhood and adolescence associated with bipolar disorder in early adulthood? European Archives of Psychiatry and Clinical Neuroscience, 257(4), 217-221.
Several recent studies have found an association between conduct problems and bipolar disorder in adolescents. However, prospective studies are rare and most do not apply multivariable analysis strategies to control for important variables (e.g. socio-demographics). The aim of this study was to test the association between certain conduct problems and bipolar disorders. Methods: The sample consisted of 591 adolescents (male and female) representative for 2,600 persons from the Canton of Zurich in Switzerland. Data were prospectively collected through an interviewing procedure, with the first screening taking place at the age of 19–20. The incidence rate was computed using sampling weights, and risk factors of bipolar II disorder were estimated using a multivariable logistic regression model. Results: The 9-year incidence rate of bipolar II disorder in the canton of Zurich was 8.4% (n = 65). Adolescents and children showing behaviour such as repeated running away from home and physical fighting were 2.6–3.5 times more likely to experience a bipolar II disorder than those with no indication of conduct problems. Sensitivity analysis showed that the conduct problems were not the result of low socio-economic status.
Böker, H., Schopper, C., Straub, M., Himmighoffen, H., Endrass, J., Küchenhoff, B., Weber, S., & Hell, D. (2007). Automutilistisches Verhalten bei Patientinnen mit affektiven Störungen: Untersuchung der Persönlichkeitsstruktur und Affektregulation mittels Operationalisierter Psychodynamischer Diagnostik (OPD). Psychotherapie, Psychosomatik, Medizinische Psychologie, 57(8), 319-327.
Automutilistisches Verhalten ist vielfach korreliert mit Persönlichkeitsstörungen und muss unterschieden werden von Suizidalität im Rahmen akuter Episoden affektiver Störungen. Das Ziel der Studie bestand darin, psychotherapeutisch und psychodynamisch bedeutsame Dimensionen der Persönlichkeit (traits) und Affektregulation zu untersuchen. Die Dimensionen „Beziehung“, „Konflikt“ und „Struktur“ wurden mittels der Operationalisierten Psychodynamischen Diagnostik (OPD) erfasst. Methode: 20 depressiv erkrankte Patientinnen mit automutilistischem Verhalten (AMV) und 20 alters- und bildungsgematchte depressiv erkrankte Frauen ohne automutilistisches Verhalten. Ergebnisse: Depressiv erkrankte Frauen mit AMVunterschieden sich in sämtlichen Kategorien der OPD−Dimension „Struktur“ von depressiv erkrankten Frauen ohne AMV. Das Selbsterleben der Patientinnen mit AMV in Beziehungen zu anderen war „isoliert“ und „abgeschottet“. Der negativen Selbstwahrnehmung der AMV−Gruppe entsprach die negative Gegenübertragung (Erleben der Untersucher gegenüber den Patientinnen). Auf der Ebene der OPD−Dimension „Konflikt“ unterschieden sich die AMV−Patientinnen nicht von der Kontrollgruppe. Bei geringem und mäßigem strukturellem Integrationsniveau war der Autonomie-Abhängigkeitskonflikt am häufigsten. Schlussfolgerungen: Die Ergebnisse unterstreichen die Bedeutung persönlichkeitsstruktureller Aspekte automutilistischen Verhaltens bei depressiv erkrankten Patientinnen. Die Operationalisierte Psychodynamische Diagnostik macht therapeutisch relevante Dimensionen der Persönlichkeit der empirischen Forschung zugänglich.
Vetter, S., Endrass, J., Schweizer, I., Teng, H.-M., Rossler, W., & Gallo, W.-T. (2006). The effects of economic deprivation on psychological well-being among the working population of Switzerland. BMC Public Health, 6, 223. doi:10.1186/1471-2458-6-223
The association between poverty and mental health has been widely investigated. There is, however, limited evidence of mental health implications of working poverty, despite ist representing a rapidly expanding segment of impoverished populations in many developed nations. In this study, we examined whether working poverty in Switzerland, a country with substantial recent growth among the working poor, was correlated with two dependent variables of interest: psychological health and unmet mental health need. Method: This cross-sectional study used data drawn from the first 3 waves (1999–2001) of the Swiss Household Panel, a nationally representative sample of the permanent resident population of Switzerland. The study sample comprised 5453 subjects aged 20–59 years. We used Generalized Estimating Equation models to investigate the association between working poverty and psychological well-being; we applied logistic regression models to analyze the link between working poverty and unmet mental health need. Working poverty was represented by dummy variables indicating financial deficiency, restricted standard of living, or both conditions. Results: After controlling other factors, restricted standard of living was significantly (p < .001) negatively correlated with psychological well-being; it was also associated with approximately 50% increased risk of unmet mental health need (OR = 1.55; 95% CI 1.17 – 2.06). Conclusion: The findings of this study contribute to our understanding of the potential psychological impact of material deprivation on working Swiss citizens. Such knowledge may aid in the design of community intervention programs to help reduce the individual and societal burdens of poverty in Switzerland.
Puder, J.-J., Endrass, J., Moriconi, N., Keller, U. (2006). How patients with insulin-treated type 1 and type 2 diabetes view their own and their physician’s treatment goals. Swiss Medical Weekly, 136(35-36), 574-580.
To investigate the subjective treatment goals of insulin-treated diabetic patients. Method: 297 type 1 and 205 type 2 diabetic patients, representative of the North-western Swiss population, filled out a self report questionnaire focusing on their own treatment goals using standardized measures wherever available. Factor analysis of the 16 items reflecting their treatment goals revealed four subscales (Crohnbach’s alpha): High actual quality of life (0.73), weight reduction/ maintenance and daily hassles (0.68), good medical care and knowledge (0.64) and good long term glucose control (0.71). Results: Good long term glucose control was the single most important main treatment goal for most patients (type 1: 60.2%, type 2: 49.7%, p = 0.025). However, both type 1 and type 2 diabetic patients believed that this goal – especially the value of HbA1c – was overestimated (both p <0.0001), while high actual quality of life was underestimated (p = 0.003 and p = 0.05, respectively) by their physicians compared to their own assessment. Good long term glucose control (OR 1.63, p = 0.003) and high actual quality of life (OR 2.17, p <0.0001) were more important and weight reduction/ maintenance and coping with daily hassles (OR 0.75, p = 0.07) were slightly less important treatment goals for type 1 than for type 2 diabetic patients. These differences in goals were best associated with the mode of insulin therapy, self monitoring, and with the extent of diabetes education. Conclusion: Patients believe that physicians overestimate the importance of long term glucose control and underestimate the importance of actual quality of life. Diabetes education and self management have the largest impact on patients’ own treatment goals.
Künig, G., Jäger, M., Stief, V., Kaldune, A., Urbaniok, F., & Endrass, J. (2006). The impact of the CERAD-NP on diagnosis of cognitive deficiencies in late onset depression and Alzheimer`s disease. International Journal of Geriatric Psychiatry, 21(10), 911-916.
To identify the most appropriate test combination for distinguishing between late onset depression (LOD) and Alzheimer’s disease (AD). To achieve this objective, the Consortium to Establish a Register for Alzheimer’s Disease- Neuropsychological Battery (CERAD-NP) data of patients diagnosed with these two conditions were analyzed using multiple regression analysis. Method: In the first regression analysis, the following CERAD-NP subtests were included: verbal fluency, Boston naming test, word list learning, constructional praxis, word list recall, and constructional praxis recall. In a second regression analysis, only CERAD-NP memory parameters were included: word list learning, word list recall, word list intrusions, word list savings, word list recognition, word list false positive errors, constructional praxis recall, and constructional praxis savings. Results: The combination of word list recall and constructional praxis recall best distinguished between LOD and AD, with a ROC of 0.91. In the stepwise regression of memory measures, word list recall, word list savings, and constructional praxis recall was the best combination, resulting in a ROC of 0.92. Conclusion: The most efficacious combination of the CERAD-NP battery for discriminating between LOD and AD consisted of word list recall and constructional praxis recall. Of the CERAD-NP memory measures, word list recall, word list savings, and constructional praxis recall represented the best diagnostic combination.
Angst, J., Gamma, A., Endrass, J., Rössler, W., Ajdacic-Gross, V., Eich, D., Herrell, R., & Merikangas, K.-R. (2006). Is the association of alcohol use disorders with major depressive disorder a consequence of undiagnosed bipolar-II disorder? European Archives of Psychiatry and Clinical Neuroscience, 256(7), 452-457.
There is emerging evidence that there is a spectrum of expression of bipolar disorder. This paper uses the well-established patterns of comorbidity of mood and alcohol use disorder to test the hypothesis that application of an expanded concept of bipolar-II (BP-II) disorder might largely explain the association of alcohol use disorders (AUD) with major depressive disorder (MDD). Method: Data from the Zurich study, a community cohort assessed over 6 waves from ages 20/21 to 40/ 41, were used to investigate the comorbidity between mood disorders and AUD. Systematic diagnostic criteria were used for alcohol abuse, alcohol dependence, MDD, and BP-II. In addition to DSM criteria, two increasingly broad definitions of BP-II were employed. Results: There was substantially greater comorbidity for the BP-II compared to major depression and for alcohol dependence compared to alcohol abuse. The broadest concept of BP-II explained two thirds of all cases of comorbidity of AUD with major depressive episodes (MDE). In fact, the broader the definition of BP-II applied, the smaller was the association of AUD with MDD, up to non-significance. In the majority of cases, the onset of bipolar manifestations preceded that of drinking problems by at least 5 years. Conclusion: The findings that the comorbidity of mood disorders with AUD was primarily attributable to BP-II rather than MDD and that bipolar symptoms usually preceded alcohol problems may encourage new approaches to prevention and treatment of AUD.
Puder, J.-J., Lächelt, S., Endrass, J., Müller, B., & Keller, U. (2005). What are disease perceptions and subjective treatment goals of insulin treated diabetic patients? Swiss Medical Weekly, 135(25-26), 365-371.
Despite increasing importance of patient self-management, little is known about their own perceptions and treatment goals. Objectives: The aim of this explorative study was to examine what diabetic patients perceive as most concerning and what their own treatment goals are. Method: A 23-item anonymous questionnaire was distributed among type 1 diabetic patients treated with and without an insulin pump and insulin treated type 2 diabetic patients in the outpatient clinic of a University Hospital. 86% of the questionnaires were returned (n = 124). Results: In open-ended questions, patients in all three groups together felt mostly restricted by their loss of freedom (24%), the dietary restrictions (17%) and the need to measure blood glucose (17%). Patients treated with an insulin pump worried more about hypoglycaemia and less about dietary restrictions. In closed-ended questions, patients were mostly concerned about hypoglycaemia and developing complications. However, the main treatment goal of both groups together was long-term good blood glucose control (63%). Further patient goals were the prevention of complications (27%) and the preservation of a good quality of life. Quality of life was a more important goal for type 1 diabetic patients (29%) than for type 2 diabetic patients (0%). Patients thought that blood glucose control was more important for their physicians (main treatment goal for 86%) than for themselves. Conclusion: Insulin treated patients with diabetes spontaneously express concerns about their actual quality of life and daily hassles and mention long-term worries after explicit questioning. For their main treatment goals they choose mainly long-term goals. According to the patients, physicians tend to overestimate blood glucose control.
Vetter, S., Endrass, J., Schweizer, I., & Rössler, W. (2005). Specific use of online trauma self-test after Tsunami disaster. European Trauma Bulletin, 12(1), 10-13.
The tsunami in Asia of December 2004 demonstrated that, as a result of the high mobility in western civilisations, disasters may affect populations far away from the centre of destruction. After early interventions, an online trauma self-test trial was established to facilitate ascertainment of therapeutic necessity. Used by more than 3,000 users in the first month after its launch, our trauma self test indicated high rates of PTSD pathology in the analysed sample, thus maintaining the internet’s value as a platform for reaching afflicted individuals. Our evidence supports the assumption that such an internet-test is availed very specifically by users in need. As a consequence, the screening and follow-up of affected populations in the aftermath of a mass disaster may become key elements in public mental health.
Angst, J., Gamma, A., Endrass, J., Hantouche, E., Goodwin, R., Ajdacic, V., Eich, D., & Rössler, W. (2005). Obsessive-compulsive syndromes and disorders: Significance of comorbidity with bipolar and anxiety syndromes. European Archives of Psychiatry and Clinical Neuroscience, 255(1), 65-71.
To determine the prevalence and clinical characteristics of comorbid obsessive compulsive disorders and syndromes (OCD/OCS), compared with pure OCD/OCS among adults in the community. Method: Data were drawn from the Zurich Study, a longitudinal cohort study of 591 adults in the canton of Zurich. Comorbid OCD/OCS was compared with pure OCD/OCS groups in terms of distress, impairment, family history, suicide behavior and treatment using multivariable logistic regression analyses. Results: OCD was significantly comorbid with bipolar I/II and minor bipolar disorders, anxiety states (GAD, repeated panic attacks) and social phobia, whereas there was no clear association between OCD and major depressive disorder or phobias other than social phobia. Results suggest that comorbid OCD/OCS is common among adults in the community, with the majority of those with OCD/OCS having at least one comorbid mood or anxiety disorder with a prevalence of 7.4% compared to 4.8% of remaining OCD/OCS. Comorbidity of OCD/OCS and anxiety states was more common among women (85.6 %) and comorbidity with bipolar spectrum was more common among men (69.6%). Comorbid OCD/OCS was associated with significantly higher levels of treatment seeking,impairment,distress and suicidality compared with pure OCD/OCS. Comorbidity with bipolar disorders significantly increased the risk for alcohol abuse/dependence. Conclusions: Comorbidity of OCD/OCS with bipolar disorder and bipolar spectrum disorders is common and very probably explains the association between OCD and depression found in other studies. The early recognition of bipolar/cyclothymic OCD/OCS may help to prevent the abuse of/dependence on alcohol.
Angst, J., Gamma, A., Endrass, J., Goodwin, R., Ajdacic, V., Eich, D., & Rössler, W. (2004). Obsessive-compulsive severity spectrum in the community: Prevalence, comorbidity, and course. European Archives of Psychiatry and Clinical Neuroscience, 254(3), 156-164.
To describe lifetime prevalence rates, course and comorbidity of obsessive-compulsive disorder (OCD), obsessive-compulsive syndromes (OCS) and OC-symptoms (OC-sx) up to age 41. Method: In the Zurich community cohort study 591 subjects were selected after screening at the age of 19 and studied prospectively by 6 interviews from 20 to 40; they represent 1599 subjects of the normal population. The diagnoses of OCD met DSM-IV criteria. Course was assessed by graphic illustrations and prospective data. Results: The lifetime prevalence rate was 3.5 % for OCD (males 1.7%, females 5.4 %) and 8.7 % for OCS (males 9.9%, females 7.5 %). The onset of OC-sx was 18 years (median); and in 70% before age 20.OCD was treated in one third of cases, OCS in 6.1%. The course of symptoms was chronic in 60%, but OCD and OCS showed in most cases considerable improvements over time. OCD reduced quality of life mostly in the subject’s psychological wellbeing and at work but to a considerable extent also in other social roles. Comorbidity was prominent with bipolar disorder, panic disorder and social phobia and also significant with bulimia, binge eating, generalized anxiety disorder and suicide attempts; there was no association with substance abuse/dependence. Conclusion: OCD and OCD are manifestations of a wide spectrum of severity with high prevalence and strong clinical validity. The long-term course is better than generally assumed.
Keller, A., Endrass, J., & Meyer, T. (2003). Medikamentenabhängigkeiten bei Patienten in der stationären Alkoholismusbehandlung der Forel Klinik. Abhängigkeiten, 9, 46-55.
Retrospektiv wurde die Abhängigkeit von Benzodiazepinen und verwandten Substanzen in der Population einer Alkohol- und Medikamentenentwöhnungsklinik (15 Frauen, 49 Männer) untersucht. Psychiatrische Komorbidität und soziale Faktoren wurden erfasst, um Risikofaktoren für die Entwicklung einer Benzodiazepinabhängigkeit bei Alkoholkranken zu identifizieren. Es zeigte sich dabei, dass Frauen fünfmal häufiger betroffen waren als Männer. Neben dem Geschlecht konnten keine weiteren Risikofaktoren identifiziert werden. Mögliche Erklärungen hierfür werden diskutiert. Zudem wird eine Übersicht über Wirkungsweise, Anwendungsbereiche und Gefahren der Benzodiazepine gegeben.
Gallo, W., Endrass, J., Bradley, E.-H., Hell, D., & Kasl, S.-V. (2003). The influence of internal control on the employment status of German workers. Schmollers Jahrbuch: Zeitschrift für Wirtschafts- und Sozialwissenschaften, 123(1), 71-82.
Using data from the 1994-1996 waves of the German Socio-Economic Panel, this study investigates whether perceived control influences reemployment among displaced German workers. The sample includes 349 workers who lost their jobs between 1994 and 1996. Our results indicate that higher perceived control is associated with increased probability of reemployment following job loss. The findings highlight an important, potentially modifiable determinant of reemployment.
Endrass, J., Angst, J., Gamma, A., Gallo, W., Ajdacic-Gross, V., Eich, D., & Rössler, W. (2003). Premorbid personality in bipolar-II disorders, with reference to family genetics: Results of a prospective epidemiological study. Neurology, Psychiatry and Brain Research, 10.
There are only few studies that focused on the personality risk factors for bipolar II disorder. The aim of this study was to find personality risk factors with reference to family history, social circumstances and comorbid symptoms for bipolar II disorder. Method: The most important methodological limitation of studies that investigate risk factors for mood disorders is their limited longitudinal design. In order to address this issue, the data of the Zurich study was used. The Zurich cohort study - a longitudinal study - is composed of a cohort of 4,547 subjects (m=2201; f=2346) representative of the canton Zurich in Switzerland. Results: Frequent ups and downs of mood and family history of neutrasthenia und mania are the most important predictors for experiencing a bipolar II disorder. Conclusion: The probability of developing a bipolar II disorder can be estimated by genetic and personality variable or early prodromal symptoms. There is some evidence suggesting that there are unspecific genetic factors that contribute to the risk for a bipolar II disorder.
Angst, J., Gamma, A., & Endrass, J. (2003). Risk factors for the bipolar and depression spectra. Acta Psychiatrica Scandinavica, Supplement(418), 15-19.
To identify risk factors for mood disorders in a community sample studied from the ages of 20 to 35 years. Method: Social characteristics, a family history of mood disorders and some personality features were analysed as risk factors for bipolar and depressive disorders by means of logistic regression. Results: Frequent ups and downs of mood were the strongest risk factor for both bipolar and depressive disorders; a weaker risk factor for both was emotional ⁄ vegetative lability (neuroticism). An additional risk factor for bipolar disorders was a positive family history of mania, whereas for depression it was a positive family history of depression ⁄ fatigue. As a risk factor for bipolar disorders, Ups and downs were much stronger than a positive family history of mania. Frequent ups and downs were independent of the family history of mood disorders. Conclusion: The results suggest that mood regulation should be investigated as a new, very important independent risk factor for mood disorders.
Weinmann, M., Bader, J.-P., Endrass, J., & Hell, D. (2001). Sind Kompetenz- und Kontrollüberzeugungen depressionsabhängig? Eine Verlaufsuntersuchung. Zeitschrift für Klinische Psychologie und Psychotherapie, 30(3), 153-158.
Persönlichkeitsressourcen spielen für die Krankheitsbewältigung eine wichtige Rolle. Zur Veränderung selbstreferentieller kognitiver Persönlichkeitsvariablen während depressiven Episoden liegen bislang wenig Untersuchungen vor. Welchen Veränderungen unterliegen Selbstkonzept eigener Fähigkeiten und Kontrollüberzeugungen während einer depressiven Episode. Methode: Verlaufsuntersuchung mittels Selbstbeurteilung 30 stationärer Patienten. Fragebogen: Beck-Depressions-Inventar, Fragebogen zu Kompetenz- und Kontrollüberzeugungen. Ergebnisse: Bei depressiven Patienten zeigte sich eine starke Verminderung des Selbstkonzepts eigener Fähigkeiten (Kompetenzüberzeugung) und der Internalität (Kontrollüberzeugung). Mit der Aufhellung der Depression normalisierten sich diese Werte. Schlußfolgerung: Während einer depressiven Störung findet sich eine Beeinträchtigung kognitiver Persönlichkeitsvariablen, welche Einfluß auf die Krankheitsbewältigung haben.