Sven Speerforck

Background: Cannabis users have been stigmatized in the course of the long-standing prohibition. A recent law change in Germany made cannabis possession and cultivation legal for recreational use, potentially impacting stigmatization. This article aims to quantify the experience of perceived and self-stigma related to cannabis use before the law change and to explore associations with sociodemographic-, cannabis use pattern- and psychological distress-related items. Methods: Participants were recruited in 2023 from ISO-certified online access panels. A subsample of n = 684 regular (at least monthly) cannabis users was selected through quota-sampling based on age, gender, education, and federal state to reflect the demographic composition of the German population aged 18–64. A standardized online-questionnaire covering sociodemographics, health-related variables, cannabis use (frequency, purpose) as well as experiences of external and self-stigmatization was employed. Descriptive data analyses were performed utilizing the stigma-related items as outcome variables. Results: External Stigmatization was perceived by 30.6%, while 22.1% reported self-stigma concerning their cannabis use. Higher education, high psychological distress, medical use, and cannabis use disorder (CUD) were significantly associated with both external stigmatization and self-stigma. Respondents speaking publicly about their cannabis use show higher shares of external and self-stigma. Having been in trouble with the police regarding cannabis was positively associated with both types of stigmatization. Conclusion: German residents who use cannabis at least monthly perceived external stigmatization and self-stigma related to cannabis consumption at a relevant level. As medical users and those with CUD are particularly affected, healthcare providers should be sensitized to the issue of stigmatization.

Metachromatic leukodystrophy (MLD) is a rare, autosomal recessive disorder of lipid metabolism characterized by deficiency of arylsulfatase A (ARSA), which leads to an accumulation of sulfatides in central and peripheral nerve system and eventually to progressive demyelination. The adult form of MLD may be misinterpreted as a psychiatric disease, since behavioral signs may precede intellectual decline. Here we report the case of a 53‐year‐old woman initially admitted to a psychiatric ward with symptoms of depression. The behavioral changes were initially attributed to psychosocial stressors within the family, particularly long‐term emotional abuse by the patient’s former partner. However, detailed anamnesis with the patient’s mother revealed progressive behavioral and cognitive decline, urinary and fecal incontinence, that is, features suggestive of an underlying neurological disorder. Notably, laboratory investigations recommended 6 years earlier had not been performed. Neurological examination revealed signs of a frontal syndrome, bilateral pyramidal tract involvement, and mild polyneuropathy. Magnetic resonance imaging (MRI) demonstrated abnormal white matter signal alterations. Further diagnostic investigations showed reduced serum ARSA activity, elevated urinary sulfatides, and a homozygous pathogenic variant in the ARSA gene, confirming the diagnosis of adult‐onset MLD. The homozygous mutation indicated parental consanguinity, suggesting early trauma embedded within the family. This case underscores the complexity of diagnosing MLD and emphasizes the importance of integrating psychiatric, neurological, and systemic family perspectives in the diagnostic process of rare and slowly progressing illnesses.

Gewalterfahrungen in der Kindheit erhöhen das Risiko für psychische Probleme im Erwachsenenalter. Wie die frühe institutionelle Betreuung in der DDR mit Gewalterfahrungen assoziiert ist und Angst und Depression im Erwachsenenalter beeinflussen, ist wenig erforscht. Die Stichprobe umfasst N=1743 Personen, geboren in der DDR (1949–1983). Mit Multigruppen-Pfadanalysen (stratifiziert Männer/Frauen) untersuchen wir den Einfluss vorschulischer Betreuung über den Mediator Kindheitstrauma (CTS) auf Ängstlichkeit (GAD-7) und Depressivität (PHQ-9) im Erwachsenenalter. Es zeigen sich keine direkten Effekte der vorschulischen Betreuung auf Ängstlichkeit und Depressivität. Kindheitstrauma wirkt sich signifikant auf die aktuelle psychische Gesundheit aus (Frauen β=0,253–0,610; Männer β=0,092–0,439). Die Analysen legen nahe, dass es keinen Zusammenhang zwischen institutioneller Betreuung und Gewalterfahrungen in der Kindheit gibt. Weiterer Kontextfaktoren in Betreuung sind für die Entwicklung bevölkerungsweiter Präventionsstrategien, für die Sicherheit von Kindern von Bedeutung. Child abuse increases the risk of adult mental health problems. Limited research explores the association of early institutional childhood care in the GDR with experienced childhood abuse and mediates anxiety and depression in adulthood. The sample includes N=1743 individuals born in the GDR (1949–1983). In multi-group path analyses (stratified men/women), we analysed the influence of pre-school care as a predictor and experienced child abuse (CTS) as a mediator variable for anxiety (GAD-7) and depression (PHQ-9) in adulthood. There are no direct effects of pre-school care on anxiety and depression. Childhood trauma significantly affected current mental health (women β=0.253–0.610; men β=0.092–0.439). Analyses suggest no link between early institutional care and childhood abuse. Considering other contextual factors in childcare is crucial for establishing population-wide prevention strategies for child safety. ^# Geteilte Erstautor*innenschaft: C. Helmert, T. McLaren Received: 25 April 2024 Accepted: 22 August 2024 Article published online: 06 November 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Das Bewusstsein für psychische Erkrankungen in der Allgemeinbevölkerung hat in den letzten Jahren deutlich zugenommen. Vor dem Hintergrund der hohen Prävalenz psychischer Erkrankungen und des häufig großen Leids Betroffener und ihrer Familien und der einhergehenden Isolation ist diese Entwicklung positiv zu bewerten. Eine Entsprechung findet diese Entwicklung in einer deutlichen Zunahme der medialen Berichterstattung besonders für Depressionen [1]. Unter Pandemiebedingungen beschleunigte sich diese Entwicklung in breiteren gesellschaftlichen und politischen Debatten um Einsamkeit und psychische Gesundheit. Folglich wird die Behandlung von Depressionen in der deutschen Allgemeinbevölkerung inzwischen deutlich höher priorisiert als noch 2001 bzw. 2011 [2]. Auch psychotherapeutische und psychopharmakologische Behandlungen sind populärer geworden und werden international deutlich häufiger empfohlen als vor 25 Jahren [3]. Diese Entwicklungen werden in Deutschland flankiert von regelmäßigen Präventionsprogrammen in Bildungseinrichtungen (z. B. Irrsinnig Menschlich e.V.), nationalen Kampagnen für psychische Gesundheit (z. B. Aktionswoche Seelische Gesundheit) und politischen Förderinstrumenten (z. B. Förderbekanntmachung des Bundesministeriums für Gesundheit zur Entstigmatisierung psychischer Erkrankungen). Die Petition „Depression muss in die Lehrpläne!“ des Jugendbeirates der Stiftung Deutsche Depressionshilfe hatte im Juli 2024 innerhalb eines Monats bereits knapp 45.000 Unterschriften gesammelt. Article published online: 12 September 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany