Klaus Schmeck

Zusammenfassung: Theoretischer Hintergrund: Fremdplatzierte Kinder und Jugendliche akkumulieren verschiedene belastende Kindheitserfahrungen und potenziell traumatische Lebensereignisse (PTEs). Fragestellung: In der vorliegenden Studie wurden die Prävalenz, Kumulation und Koinzidenz sowie Geschlechtsunterschiede belastender Kindheitserfahrungen und PTEs bei ehemals fremdplatzierten jungen Erwachsenen untersucht. Methode: 211 junge Erwachsene ( M _Alter =25.9; 31.8 % Frauen) aus einer schweizweiten Kohortenstudie wurden mit Hilfe eines umfassenden psychometrischen Fragebogens zu belastenden Kindheitserfahrungen (KERF) und zu PTEs (LEC-R) befragt. Ergebnisse: Durchschnittlich wurden 3.0 unterschiedliche Arten belastender Kindheitserfahrungen und 4.5 unterschiedliche PTEs berichtet. Häufigste Formen waren das Erleben emotionaler Vernachlässigung (65.8 %) sowie das Erleben oder Bezeugen physischer Übergriffe (63.0 %). Frauen erlebten signifikant mehr belastende Kindheitserfahrungen, hingegen fanden sich keine Unterschiede bezüglich der Anzahl berichteter PTEs. Bestimmte belastende Erfahrungen traten häufig gemeinsam auf, zum Beispiel in Form von systemübergreifender Gewaltexposition in und außerhalb von Familien, als auch das Erleben von Unfällen und das Erleben von physischer Gewalt. Diskussion und Schlussfolgerung: Die Ergebnisse verdeutlichen die hohe Kumulation und Verflechtung von belastenden Erfahrungen und unterstreichen die Notwendigkeit früher und anhaltender Präventions- und Interventionsmaßnahmen.

Zusammenfassung: Fragestellung: Ehemalig fremdplatzierte junge Erwachsene (Care Leaver) waren in ihrer Kindheit einer Vielzahl psychosozialer Belastungsfaktoren ausgesetzt. Im deutschsprachigen Raum ist bisher wenig darüber bekannt, wie hoch die Prävalenz psychischer Störungen in dieser Population ist. Das Hauptziel dieses Beitrages ist es, die Prävalenzen psychischer Störungen bei Care Leavern zu beschreiben und Implikationen für Versorgungssysteme zu diskutieren. Methodik: Die psychischen Störungen, inklusive Persönlichkeitsstörungen, wurden anhand des Strukturierten Klinischen Interviews bei 175 Schweizer Care Leavern (Durchschnittsalter = 26.53 Jahre, 32.00 % Frauen) erfasst. Deskriptive Informationen wurden in absoluten und relativen Häufigkeiten präsentiert und Zusammenhänge wurden anhand t-Tests und χ²-Tests berechnet. Ergebnisse: 58.29 % der Teilnehmenden erfüllten die Diagnosekriterien für mindestens eine psychische Störung, wobei die Substanzkonsumstörungen (37.71 %), Persönlichkeitsstörungen (35.43 %) und die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (19.43 %) die häufigsten Diagnosen waren. Frauen zeigten häufiger Angststörungen sowie Cluster-C-Persönlichkeitsstörungen, während Männer häufiger eine Alkoholkonsumstörung aufwiesen. Schlussfolgerungen: Ungefähr die Hälfte der Schweizer Care Leaver erfüllt die Diagnosekriterien für mindestens eine psychische Störung. Das junge Erwachsenenalter stellt für Care Leaver – ähnlich wie für die Gleichaltrigen aus der Allgemeinbevölkerung – eine sensible Phase für psychische Störungen dar. Dies stellt sozialpädagogische und psychiatrische Versorgungssysteme vor die Herausforderung, das Angebot für psychisch belastete junge Menschen entlang der Transition ins Erwachsenenalter weiter präventiv zu gestalten.

Purpose: Depression is associated with low-grade systemic inflammation and impaired intestinal function, both of which may reduce dietary iron absorption. Low iron status has been associated with depression in adults and adolescents. In Swiss adolescents, we determined the associations between paediatric major depressive disorder (pMDD), inflammation, intestinal permeability and iron status. Methods: This is a matched case–control study in 95 adolescents with diagnosed pMDD and 95 healthy controls aged 13–17 years. We assessed depression severity using the Children’s Depression Rating Scale-Revised. We measured iron status (serum ferritin (SF) and soluble transferrin receptor (sTfR)), inflammation (C-reactive protein (CRP) and alpha-1-acid-glycoprotein (AGP)), and intestinal permeability (intestinal fatty acid binding protein (I-FABP)). We assessed history of ID diagnosis and treatment with a self-reported questionnaire. Results: SF concentrations did not differ between adolescents with pMDD (median (IQR) SF: 31.2 (20.2, 57.0) μg/L) and controls (32.5 (22.6, 48.3) μg/L, p = 0.4). sTfR was lower among cases than controls (4.50 (4.00, 5.50) mg/L vs 5.20 (4.75, 6.10) mg/L, p < 0.001). CRP, AGP and I-FABP were higher among cases than controls (CRP: 0.16 (0.03, 0.43) mg/L vs 0.04 (0.02, 0.30) mg/L, p = 0.003; AGP: 0.57 (0.44, 0.70) g/L vs 0.52 (0.41, 0.67) g/L, p = 0.024); I-FABP: 307 (17, 515) pg/mL vs 232 (163, 357) pg/mL, p = 0.047). Of cases, 44% reported having a history of ID diagnosis compared to 26% among controls (p = 0.020). Finally, 28% of cases had iron treatment at/close to study inclusion compared to 14% among controls. Conclusion: Cases had significantly higher systemic inflammation and intestinal permeability than controls but did not have lower iron status. Whether this is related to the higher rate of ID diagnosis and iron treatment in adolescents with depression is uncertain.

Background: New advances in the field of machine learning make it possible to track facial emotional expression with high resolution, including micro-expressions. These advances have promising applications for psychotherapy research, since manual coding (e.g., the Facial Action Coding System), is time-consuming. Purpose: We tested whether this technology can reliably identify in-session emotional expression in a naturalistic treatment setting, and how these measures relate to the outcome of psychotherapy. Method: We applied a machine learning emotion classifier to video material from 389 psychotherapy sessions of 23 patients with borderline personality pathology. We validated the findings with human ratings according to the Clients Emotional Arousal Scale (CEAS) and explored associations with treatment outcomes. Results: Overall, machine learning ratings showed significant agreement with human ratings. Machine learning emotion classifiers, particularly the display of positive emotions (smiling and happiness), showed medium effect size on median-split treatment outcome (d = 0.3) as well as continuous improvement (r = 0.49, p < 0.05). Patients who dropped out form psychotherapy, showed significantly more neutral expressions, and generally less social smiling, particularly at the beginning of psychotherapeutic sessions. Conclusions: Machine learning classifiers are a highly promising resource for research in psychotherapy. The results highlight differential associations of displayed positive and negative feelings with treatment outcomes. Machine learning emotion recognition may be used for the early identification of drop-out risks and clinically relevant interactions in psychotherapy.

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; M_Age-Baseline = 16.1 years; M_{Age-Follow-Up} = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a “multiproblem”-class (51.8% baseline; 33.7% follow-up), a “low symptom”-class (39.2% baseline; 60.2% follow-up), and an “externalizing”-class (9.0% baseline; 6.0% follow-up). Individuals in the “multiproblem”-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.

To investigate if the Personality Disorder (PD) severity concept (Criterion A) of the ICD-11 and DSM-5 AMPD is applicable to children and adolescents, following the ICD-11 lifespan perspective of mental disorders, age-specific and informant-adapted assessment tools are needed. The LoPF-Q 6-18 PR (Levels of Personality Functioning Questionnaire Parent Rating) was developed to assess Impaired Personality Functioning (IPF) in children aged 6–18 in parent-reported form. It is based on the established self-report questionnaire LoPF-Q 12-18. Psychometric properties were investigated in a German-speaking clinical and school sample containing 599 subjects. The final 36-item version of LoPF-Q 6-18 PR showed good scale reliabilities with 0.96 for the total scale IPF and 0.90-0.87 for the domain scales Identity, Self-direction, Empathy, and Intimacy/Attachment and an acceptable model fit in a hierarchical CFA with CFI = 0.936, RMSEA = 0.078, and SRMR = 0.068. The total score discriminated significantly and with large effect sizes between the school population and (a) adolescent PD patients (d = 2.7 standard deviations) and (b) the younger patients (6–11-year-olds) with internalizing and externalizing disorders (d = 2.2 standard deviations). Informant agreement between parent and self-report was good at 0.47. Good construct validity can be assumed given sound covariation with related measures of psychopathology (CBCL 4-18, STiP-5.1, OPD-CA2-SQ PR) and maladaptive traits (PID5BF+ M CA IRF) in line with theory and matching the result patterns obtained in older samples in self-report. The results suggest that parent-reported assessments of IPF and maladaptive traits are equivalent to self-reported measures for Criterion A and B. Assessing IPF as early as age six might be a valuable step to foster early detection of PD, or maladaptive personality development, respectively individuals at risk.

Background: Borderline personality disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity, and interpersonal relationships, which typically result in significant and negative deterioration of the person’s overall functioning and well-being. Measuring and characterizing the rapidly changing patterns of instability in BPD dysfunction as they occur in a person’s daily life can be challenging. Ecological momentary assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research and, thus, is well suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are characterized by frequent repeated assessments that are delivered to participants in real-life, real-time settings using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant, considering all planned prompts sent. Low compliance with prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated, and estimated. Objective: This systematic meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD. Methods: A systematic review was conducted on November 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features. Results: In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates. Conclusions: Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can be aggregated and interpreted jointly.