British Journal of Clinical Psychology, 48(2), June 2009, pp.125-140.
Publisher:
Wiley
Individuals with social phobia are at an increased risk to develop alcohol problems. However, the mechanism responsible for this association is unclear. It has been suggested that alcohol reduces anxiety by impairing initial appraisal of threatening stimuli. Information that is especially threatening, however, may be resistant to such an effect of alcohol. The influence of alcohol preferential processing of threat stimuli. Alcohol significantly reduced this bias. Only in sober participants, this attentional bias correlated with measures of social anxiety. In controls, no biases were observed. Alcohol seems to attenuate the impact of threatening social stimuli on social phobia patients, which may negatively reinforce the consumption of alcohol and at least partially explain
Individuals with social phobia are at an increased risk to develop alcohol problems. However, the mechanism responsible for this association is unclear. It has been suggested that alcohol reduces anxiety by impairing initial appraisal of threatening stimuli. Information that is especially threatening, however, may be resistant to such an effect of alcohol. The influence of alcohol on the appraisal of five emotional facial expressions was tested. Forty social phobia patients and 40 controls performed a dot probe task, after drinking either alcohol or orange juice. Stimuli were faces with happy, angry, neutral and also two ambiguous expressions that were formed by blending angry or happy faces and neutral faces. Sober patients showed an attentional bias towards angry faces, indicating preferential processing of threat stimuli. Alcohol significantly reduced this bias. Only in sober participants, this attentional bias correlated with measures of social anxiety. In controls, no biases were observed. Alcohol seems to attenuate the impact of threatening social stimuli on social phobia patients, which may negatively reinforce the consumption of alcohol and at least partially explain the heightened comorbidity with alcohol related problems known from epidemiological studies.
British Journal of Health Psychology, 12(4), November 2007, pp.511-523.
Publisher:
Wiley
... of hypochondriasis and health anxiety. Results reveal a 0.4% point prevalence rate of DSM-IV hypochondriasis. In contrast to that, 6% of the German population suffers from severe health anxiety. There are small positive effects for female gender, higher age and lower school education on health anxiety. Subjects with high health anxiety report a much lower health-related quality of life and a higher risk for a type of psychotherapeutic or psychiatric treatment. These results support the development of less restrictive criteria for hypochondriasis and place emphasis on the clinical and socio-economic relevance of health anxiety.
Epidemiologic studies on hypochondriasis are very rare and have not been included in large North American community surveys until now. In order to gain information on the prevalence as well as the socio-demographic characteristics of hypochondriasis, the following community study was carried out. Analyses are based on an assessment of 1575 subjects selected by socio-demographic representation criteria for the German community. All subjects completed the Illness Attitude Scales (IAS) and responded to several additional questions on sociodemographics and diagnostic criteria pertaining to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) hypochondriasis. The IAS is internationally one of the best-established self-rating questionnaires for the assessment of hypochondriasis and health anxiety. Results reveal a 0.4% point prevalence rate of DSM-IV hypochondriasis. In contrast to that, 6% of the German population suffers from severe health anxiety. There are small positive effects for female gender, higher age and lower school education on health anxiety. Subjects with high health anxiety report a much lower health-related quality of life and a higher risk for a type of psychotherapeutic or psychiatric treatment. These results support the development of less restrictive criteria for hypochondriasis and place emphasis on the clinical and socio-economic relevance of health anxiety.
British Journal of Psychiatry, 195(4), October 2009, pp.308-317.
Publisher:
Cambridge University Press
Individuals with anxiety disorders often do not receive accurate diagnosis or adequate treatment in primary care, which can result in high medical costs. This study aimed to analyse the cost effectiveness of an optimised care model for people with anxiety disorders in primary care, using a cluster randomised controlled trial involving 46 primary care practices and 389 individuals positively screened with anxiety in Leipzig, Germany. Physicians in the intervention group received specific training and the offer of a psychiatric consultation service in treating anxiety disorders which were aimed at improving GPs’ diagnostic and therapeutic knowledge and skills. The results showed no significant differences between the intervention and control group, and therefore the analysed care model did
Individuals with anxiety disorders often do not receive accurate diagnosis or adequate treatment in primary care, which can result in high medical costs. This study aimed to analyse the cost effectiveness of an optimised care model for people with anxiety disorders in primary care, using a cluster randomised controlled trial involving 46 primary care practices and 389 individuals positively screened with anxiety in Leipzig, Germany. Physicians in the intervention group received specific training and the offer of a psychiatric consultation service in treating anxiety disorders which were aimed at improving GPs’ diagnostic and therapeutic knowledge and skills. The results showed no significant differences between the intervention and control group, and therefore the analysed care model did not prove to be cost effective.
Subject terms:
primary care, training, anxiety, cost effectiveness, doctors;
British Journal of Health Psychology, 11(4), November 2006, pp.607-621.
Publisher:
Wiley
The purpose of the present study was to investigate predictors of perceived vulnerability for breast cancer in women with an average risk for breast cancer. On the basis of empirical findings that suggested which variables might be associated with perceived vulnerability for breast cancer, the authors investigated whether knowledge of breast cancer risk factors, cancer worry, intrusions about breast cancer, optimism about not getting cancer and perceived health status have a predictive value for perceived breast cancer vulnerability. In a 3-step approach, the authors recruited 292 women from the general public in Germany who had neither a family history of breast cancer nor breast cancer themselves. After receiving an initial informational letter about study objectives, the women were interviewed by telephone and then asked to fill in a self-administered questionnaire. The authors used structural equation modelling and hypothesized that each of the included variables has a direct influence on perceived vulnerability for breast cancer.The authors found a valid model with acceptable fit indices. Optimism about not getting cancer, intrusions about breast cancer and women's perceived health status explained 32% of the variance of perceived vulnerability for breast cancer. Cancer worry and knowledge about breast cancer did not influence perceived vulnerability for breast cancer. Perceived vulnerability for breast cancer is associated with health-related variables more than with knowledge about breast cancer risk factors.
The purpose of the present study was to investigate predictors of perceived vulnerability for breast cancer in women with an average risk for breast cancer. On the basis of empirical findings that suggested which variables might be associated with perceived vulnerability for breast cancer, the authors investigated whether knowledge of breast cancer risk factors, cancer worry, intrusions about breast cancer, optimism about not getting cancer and perceived health status have a predictive value for perceived breast cancer vulnerability. In a 3-step approach, the authors recruited 292 women from the general public in Germany who had neither a family history of breast cancer nor breast cancer themselves. After receiving an initial informational letter about study objectives, the women were interviewed by telephone and then asked to fill in a self-administered questionnaire. The authors used structural equation modelling and hypothesized that each of the included variables has a direct influence on perceived vulnerability for breast cancer.The authors found a valid model with acceptable fit indices. Optimism about not getting cancer, intrusions about breast cancer and women's perceived health status explained 32% of the variance of perceived vulnerability for breast cancer. Cancer worry and knowledge about breast cancer did not influence perceived vulnerability for breast cancer. Perceived vulnerability for breast cancer is associated with health-related variables more than with knowledge about breast cancer risk factors.
Molecular Diversity Preservation International and Multidisciplinary Digital Publishing Institute
The COVID-19 pandemic has affected care workers all over the globe, as older and more vulnerable people face a high risk of developing severe symptoms and dying from the virus infection. The aim of this study was to compare staff experiences of stress and anxiety as well as internal and external organizational support in Sweden, Italy, Germany, and the United Kingdom (UK) in order to determine how care staff were affected by the pandemic. A 29-item online questionnaire was used to collect data from care staff respondents: management (n = 136), nurses (n = 132), nursing assistants (n = 195), and other healthcare staff working in these organizations (n = 132). Stress and anxiety levels were highest in the UK and Germany, with Swedish staff showing the least stress. Internal and external
(Edited publisher abstract)
The COVID-19 pandemic has affected care workers all over the globe, as older and more vulnerable people face a high risk of developing severe symptoms and dying from the virus infection. The aim of this study was to compare staff experiences of stress and anxiety as well as internal and external organizational support in Sweden, Italy, Germany, and the United Kingdom (UK) in order to determine how care staff were affected by the pandemic. A 29-item online questionnaire was used to collect data from care staff respondents: management (n = 136), nurses (n = 132), nursing assistants (n = 195), and other healthcare staff working in these organizations (n = 132). Stress and anxiety levels were highest in the UK and Germany, with Swedish staff showing the least stress. Internal and external support only partially explain the outcomes. Striking discrepancies between different staff groups’ assessment of organizational support as well as a lack of staff voice in the UK and Germany could be key factors in understanding staff’s stress levels during the pandemic. Structural, political, cultural, and economic factors play a significant role, not only factors within the care organization or in the immediate context
(Edited publisher abstract)
Subject terms:
care workers, care homes, staff, staff views, stress, anxiety, service provision;
International Journal of Geriatric Psychiatry, 35(9), 2020, pp.1028-1035.
Publisher:
Wiley
The purpose of this study was to identify whether the onset and the end of fear of falling (FOF) are associated with psychosocial consequences (in terms of depressive symptoms, loneliness, social isolation, autonomy, and subjective well‐being). Methods/Design: Longitudinal data for this study were taken from the nationally representative German Ageing Survey which included community‐dwelling individuals ≥40 years (wave 5 and wave 6). Psychosocial outcome measures were assessed using widely established and well‐validated scales. The presence of FOF was used as the main explanatory variable. It was adjusted for age, family status, labor force participation, self‐rated health, physical functioning, as well as the number of chronic conditions. Results: Linear fixed effects regressions revealed that FOF was associated with adverse psychosocial outcomes (increased depressive symptoms, lower life satisfaction, lower positive affect, higher negative affect, and lower perceived autonomy). Asymmetric fixed effects regressions analysis showed that the onset of FOF was associated with reduced life satisfaction as well as reduced autonomy, whereas the end of FOF was associated with reduced depressive symptoms, decreased loneliness scores, as well as decreased negative affect. Conclusions: The study findings suggest that future studies should analyze the consequences of FOF differently (onset and end of FOF) which has practical important implications. More specifically, while strategies to avoid the onset of FOF may help to maintain satisfaction with life and autonomy, strategies to end FOF may contribute to avoid increased loneliness, feelings of negative affect, as well as increased depressive symptoms.
(Publisher abstract)
The purpose of this study was to identify whether the onset and the end of fear of falling (FOF) are associated with psychosocial consequences (in terms of depressive symptoms, loneliness, social isolation, autonomy, and subjective well‐being). Methods/Design: Longitudinal data for this study were taken from the nationally representative German Ageing Survey which included community‐dwelling individuals ≥40 years (wave 5 and wave 6). Psychosocial outcome measures were assessed using widely established and well‐validated scales. The presence of FOF was used as the main explanatory variable. It was adjusted for age, family status, labor force participation, self‐rated health, physical functioning, as well as the number of chronic conditions. Results: Linear fixed effects regressions revealed that FOF was associated with adverse psychosocial outcomes (increased depressive symptoms, lower life satisfaction, lower positive affect, higher negative affect, and lower perceived autonomy). Asymmetric fixed effects regressions analysis showed that the onset of FOF was associated with reduced life satisfaction as well as reduced autonomy, whereas the end of FOF was associated with reduced depressive symptoms, decreased loneliness scores, as well as decreased negative affect. Conclusions: The study findings suggest that future studies should analyze the consequences of FOF differently (onset and end of FOF) which has practical important implications. More specifically, while strategies to avoid the onset of FOF may help to maintain satisfaction with life and autonomy, strategies to end FOF may contribute to avoid increased loneliness, feelings of negative affect, as well as increased depressive symptoms.
(Publisher abstract)
Subject terms:
falls, older people, anxiety, ageing, psychosocial approach, loneliness;
Fear of falling leads to many adverse consequences and may compromise the quality of life of older adults. Psychological factors are potential mediators between the fear of falling and quality of life, but have yet to be explored in detail. This study presents results from examining the mediating effect of the self-concept of health and physical independence. Data from Western and Eastern countries were compared. Concerns about falling, the level of participation in physical activities, the self-concept of health and physical independence, and health-related quality of life were measured using samples from Taiwan (n = 193) and Germany (n = 182). Multiple regression models were used to test the mediating effects. The relationship between fear of falling and quality of life was partially mediated through participation in physical activities and the self-concept of health and physical independence in both the Taiwanese and German samples. In particular, the self-concept of health and physical independence of the Taiwanese sample resulted in the strongest mediating effect. Potential mediating mechanisms through both participation in physical activities and the self-concept of health and physical independence provide useful information for understanding related theories and for explicating interventions. Cultural factors should also be accounted for when conducting research and programs related to the fear of falling.
(Publisher abstract)
Fear of falling leads to many adverse consequences and may compromise the quality of life of older adults. Psychological factors are potential mediators between the fear of falling and quality of life, but have yet to be explored in detail. This study presents results from examining the mediating effect of the self-concept of health and physical independence. Data from Western and Eastern countries were compared. Concerns about falling, the level of participation in physical activities, the self-concept of health and physical independence, and health-related quality of life were measured using samples from Taiwan (n = 193) and Germany (n = 182). Multiple regression models were used to test the mediating effects. The relationship between fear of falling and quality of life was partially mediated through participation in physical activities and the self-concept of health and physical independence in both the Taiwanese and German samples. In particular, the self-concept of health and physical independence of the Taiwanese sample resulted in the strongest mediating effect. Potential mediating mechanisms through both participation in physical activities and the self-concept of health and physical independence provide useful information for understanding related theories and for explicating interventions. Cultural factors should also be accounted for when conducting research and programs related to the fear of falling.
(Publisher abstract)
Subject terms:
health, falls, quality of life, anxiety, independence, self-concept, older people;
Aging and Mental Health, 16(3), April 2012, pp.413-422.
Publisher:
Taylor and Francis
The goal of this study was to compare adult age-related differences in the experience of worry within 2 countries in order to explore how cultural and age differences impact worry. Data were collected from 173 Germans (77 older adults aged 54-91 years, and 96 younger adults aged 18-28 years) and 263 Americans (79 older adults aged 54-89 years, and 184 younger adults aged 18-26 years). The participants completed measures including a general worry scale and two hypothesised correlates of worry (life events and locus of control). The results indicated that, although there were some similarities between the groups, there were differences between the cultures and the age groups in their experiences of worry. Younger adults reporting more worries than did older adults in both countries. The hypothesised correlates of worry differentially contributed to the prediction of worry across the 2 cultures and across the 2 age groups. With one minor exception, the hypothesised correlates did not predict worry within the German sample, but did predict worry within the American sample. Among the younger adult American sample, endorsement of external locus of control and life events predicted worry, but among the older American sample, positive endorsement of internal locus of control predicted worry.
The goal of this study was to compare adult age-related differences in the experience of worry within 2 countries in order to explore how cultural and age differences impact worry. Data were collected from 173 Germans (77 older adults aged 54-91 years, and 96 younger adults aged 18-28 years) and 263 Americans (79 older adults aged 54-89 years, and 184 younger adults aged 18-26 years). The participants completed measures including a general worry scale and two hypothesised correlates of worry (life events and locus of control). The results indicated that, although there were some similarities between the groups, there were differences between the cultures and the age groups in their experiences of worry. Younger adults reporting more worries than did older adults in both countries. The hypothesised correlates of worry differentially contributed to the prediction of worry across the 2 cultures and across the 2 age groups. With one minor exception, the hypothesised correlates did not predict worry within the German sample, but did predict worry within the American sample. Among the younger adult American sample, endorsement of external locus of control and life events predicted worry, but among the older American sample, positive endorsement of internal locus of control predicted worry.
Subject terms:
life events, older people, young adults, adults, anxiety, cultural identity;
British Journal of General Practice, 57(543), October 2007, pp.801-807.
Publisher:
Royal College of General Practitioners
Psychological distress is a common phenomenon in patients with heart failure. Depressive symptoms are often under-diagnosed or inadequately treated in primary care. This German study aimed to analyse anxiety and/or depression in primary care patients with heart failure according to psychosocial factors, and to identify protective factors for the resolution of psychological distress. In 291 primary care patients with heart failure the following factors were measured using validated questionnaires at baseline and 9 months later: anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), quality of life (Minnesota Living with Heart Failure Questionnaire), coping with illness (Freiburg questionnaire for coping with illness), and social support (social support questionnaire). problems, social support, and NYHA classification independently predicted distress at follow up. High social support contributed to a resolution of anxiety or depression, while partnership and low levels of emotional problems protected patients who began the study in a good emotional state from psychological distress.
Psychological distress is a common phenomenon in patients with heart failure. Depressive symptoms are often under-diagnosed or inadequately treated in primary care. This German study aimed to analyse anxiety and/or depression in primary care patients with heart failure according to psychosocial factors, and to identify protective factors for the resolution of psychological distress. In 291 primary care patients with heart failure the following factors were measured using validated questionnaires at baseline and 9 months later: anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), quality of life (Minnesota Living with Heart Failure Questionnaire), coping with illness (Freiburg questionnaire for coping with illness), and social support (social support questionnaire). Severity of heart failure (New York Heart Association [NYHA] classification and Goldman's Specific Activity Scale), and sociodemographic characteristics were documented using self-report instruments. Twenty-six (32.5%) of the 80 patients who were distressed at baseline had normal HADS scores 9 months later, while the remainder stayed distressed. In logistic regression, baseline distress, emotional problems, social support, and NYHA classification independently predicted distress at follow up. High social support contributed to a resolution of anxiety or depression, while partnership and low levels of emotional problems protected patients who began the study in a good emotional state from psychological distress.
Subject terms:
primary care, risk, social networks, anxiety, depression, heart diseases;
British Journal of Clinical Psychology, 45(3), September 2006, pp.279-295.
Publisher:
Wiley
Social phobics are at a higher risk of developing alcohol problems. The mechanism promoting this association is not clear. According to Sayette (1993b), alcohol attenuates anxiety responses by disrupting initial appraisal of threatening stimuli. We used the emotional Stroop test and an implicit memory test to investigate whether alcohol hinders appraisal of social threat words in patients to controls, social phobics showed an implicit memory bias for social threat words. This bias was attenuated by alcohol. Alcohol disrupts appraisal of social anxiety-related stimuli in controls but not in social phobics; in these it hinders the consolidation of memory. This also suggests that social phobics experience similar anxiety with and without alcohol, but remember this experienced anxiety less
Social phobics are at a higher risk of developing alcohol problems. The mechanism promoting this association is not clear. According to Sayette (1993b), alcohol attenuates anxiety responses by disrupting initial appraisal of threatening stimuli. We used the emotional Stroop test and an implicit memory test to investigate whether alcohol hinders appraisal of social threat words in patients diagnosed with social phobia. Thirty-two women with social phobia (DSM-IV) and 32 female controls performed an emotional Stroop test either after drinking alcohol resulting in a blood alcohol levels (BAL) of 0.6‰ or after drinking a non-alcoholic beverage. The emotional Stroop test contained social anxiety-related and neutral stimuli. Implicit memory for the words presented was tested with a word-stem completion test. Without alcohol, both controls and socially-phobic participants took longer to name the colour of socially-threatening stimuli than of neutral stimuli. Alcohol levelled response latencies to the two stimulus categories only in controls. Socially-phobic participants responded more slowly to social anxiety-related stimuli than to neutral stimuli, irrespective of their BAL. In contrast to controls, social phobics showed an implicit memory bias for social threat words. This bias was attenuated by alcohol. Alcohol disrupts appraisal of social anxiety-related stimuli in controls but not in social phobics; in these it hinders the consolidation of memory. This also suggests that social phobics experience similar anxiety with and without alcohol, but remember this experienced anxiety less precisely. This effect might act as a reinforcer for the use of alcohol for the purpose of self-medication in future situations.