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279-THE VIEW OF PSYCHOTHERAPISTS?
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Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673
when traditional risk factors and marital stress are taken into consideration. Methods: Data were obtained from the Hungarostudy 2002, a national representative study: 12668 persons were interviewed, representing the Hungarian population over the age of 18, according to age, sex and county. Questions referring to marital status, age, education, BMI, smoking habits, alcohol use, physical training, coffee intake and history of hypertension (treated with hypertension formerly, last year as an outpatient and last year in hospital, medication and number of disability days due to hypertension) were included in the survey. Marital stress was measured by the shortened version of the Marital Stress Scale (Orth-Gomer K, 2000). Results: In relation with marital status, married people with high marital stress had the highest mean of disability days due to hypertension (3,29), when the effects of age, sex, education, BMI, coffee intake, smoking habits, alcohol use and frequency of physical training are taken into consideration. They differ significantly from those who are living alone (1,14, p = .03) and from those who have a good marriage (with low marital stress) (1,36, p = .01) who had the lowest mean of disability days due to hypertension. The mean of disability days due to hypertension for those who are living in stressed marriage (although not significantly) is even worse than for those who are divorced or who loosed their spouses. Conclusion: Marital stress has a powerful effect on hypertension, independently from traditional risk factors.
241 THE ROLE OF SPIRITUAL HISTORY AFTER ACUTE MYOCARDIAL INFARCTION IN THE HUNGARIAN POPULATION Baranyai R, Bakos G, Balog P, Kopp MS. Institute of Behavioural Sciences, Semmelweis University Budapest, Hungary. Background: Rehabilitation of patients with coronary artery disease in Hungary is still a major public health problem. Psychological and spiritual assessment might improve their prognosis and quality of life. Aim: Examining correlations between religiosity ( practice and importance) and psychological, social factors among patients after myocardial infarction. Methods: We analysed the data of the Hungarostudy 2002: 12668 subjects representing the Hungarian population according to age, sex and county were interviewed. 276 post-infarct patients were identified. Spirituality was assessed by the importance of religion (no-little-very important-influencing all activities) and according to belief and church-attendance (non believer/non practising/ practising on their own way/goes to church rarely/goes to church regularly). Linear regression models were built. After controlling for age, sex, level of education and annual income (1. model) belief and church attendance was added (2. model). Dependent variables showing significant correlations with importance of religion were regressed on this additional variable, too (3. model). Results: Taking non-believers as a reference group regular church attendants showed a tendency for higher sense of coherence ( p = .07) and significantly higher social support scores. Sense of coherence was found higher in the group practising religion on its own way ( p = .04) and in those going to church rarely ( p = .05). Those going seldom to church had higher value on the positive affect scale ( p = .009), with a tendency of less sensation seeking
( p = .06). The group practising religion on its own way showed a significantly higher value in BDI ( p = .008), vital exhaustion ( p = .02), hopelessness ( p = .05) and sleep disturbances ( p = .02). Problem oriented coping was more dominant in the group attaching little importance to religion ( p = .05), than among those finding it of no importance. Conclusions: Spiritual history about beliefs and practices might shed light on essential factors that play a vital role in the rehabilitation of patients after myocardial infarct. We would stress the significance of identifying patients practising religion on their own way. They may constitute a high-risk subgroup possibly having poorer quality of life and outcome.
135 COMPARING COMPUTER-ASSISTED INTERVIEW DIAGNOSES TO CLINICAL JUDGEMENT Becker J. Department of Psychosomatic Medicine, Charite´ Berlin, Germany. The purpose of the study was evaluating the application of a computer-assisted standardized interview (CIDI) to psychosomatic patients and exploring the prevalence and comorbidity of mental disorders as diagnosed by this interview and by clinical judgment. The standardized Composite International Diagnostic Interview (CIDI) is applied to n = 230 inpatients being routinely diagnosed by experienced clinicians and treated at the Department of Psychosomatic Medicine, Charite´ Berlin, between 11/02 and 11/ 03. The CIDI is a fully standardized computerized diagnostic interview designed for assessing mental disorders according to the definitions of the ICD-10 and DSM-III-R. Prevalence and comorbidity of mental disorders are investigated by descriptive statistics, diagnostic concordance between both diagnostic strategies (CIDI and clinical diagnoses) is explored by diagnostic sensitivity, diagnostic specifity and by kappa statistics. Most frequent disorders as assessed by clinicians and by the CIDI are depressive and somatoform disorders. Whereas the CIDI diagnoses more frequently anxiety disorders and proves well in diagnosing posttraumatic stress disorders, it shows difficulties in differentiating between different types of somatoform disorders, dissociative and adjustment disorders. Clinicians tend to diagnose more often adjustment disorders and different types of somatoform, eating and psychoactive dependence disorders. Both strategies reveal high comorbidity concerning depressive, anxiety and somatoform disorders. Because overall concordance between CIDI diagnoses and clinical judgment is only moderate, we hope for discussions on the appropriateness of the application of fully standardized computer-assisted interviews in the psychosomatic context and/or possible improvements in this field.
279 THE VIEW OF PSYCHOTHERAPISTS? Bell K. Cologne, Germany. Disease Management programs for chronic illnesses have become an integral part of German health care systems. The participants of the symposium are representatives from the political area and from the self administration of physicians and the statuatory health insurances (SHI). They will discuss the importance of integrating psychosomatic perspectives and contents into the programs and how this can be done.
Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673
when traditional risk factors and marital stress are taken into consideration. Methods: Data were obtained from the Hungarostudy 2002, a national representative study: 12668 persons were interviewed, representing the Hungarian population over the age of 18, according to age, sex and county. Questions referring to marital status, age, education, BMI, smoking habits, alcohol use, physical training, coffee intake and history of hypertension (treated with hypertension formerly, last year as an outpatient and last year in hospital, medication and number of disability days due to hypertension) were included in the survey. Marital stress was measured by the shortened version of the Marital Stress Scale (Orth-Gomer K, 2000). Results: In relation with marital status, married people with high marital stress had the highest mean of disability days due to hypertension (3,29), when the effects of age, sex, education, BMI, coffee intake, smoking habits, alcohol use and frequency of physical training are taken into consideration. They differ significantly from those who are living alone (1,14, p = .03) and from those who have a good marriage (with low marital stress) (1,36, p = .01) who had the lowest mean of disability days due to hypertension. The mean of disability days due to hypertension for those who are living in stressed marriage (although not significantly) is even worse than for those who are divorced or who loosed their spouses. Conclusion: Marital stress has a powerful effect on hypertension, independently from traditional risk factors.
241 THE ROLE OF SPIRITUAL HISTORY AFTER ACUTE MYOCARDIAL INFARCTION IN THE HUNGARIAN POPULATION Baranyai R, Bakos G, Balog P, Kopp MS. Institute of Behavioural Sciences, Semmelweis University Budapest, Hungary. Background: Rehabilitation of patients with coronary artery disease in Hungary is still a major public health problem. Psychological and spiritual assessment might improve their prognosis and quality of life. Aim: Examining correlations between religiosity ( practice and importance) and psychological, social factors among patients after myocardial infarction. Methods: We analysed the data of the Hungarostudy 2002: 12668 subjects representing the Hungarian population according to age, sex and county were interviewed. 276 post-infarct patients were identified. Spirituality was assessed by the importance of religion (no-little-very important-influencing all activities) and according to belief and church-attendance (non believer/non practising/ practising on their own way/goes to church rarely/goes to church regularly). Linear regression models were built. After controlling for age, sex, level of education and annual income (1. model) belief and church attendance was added (2. model). Dependent variables showing significant correlations with importance of religion were regressed on this additional variable, too (3. model). Results: Taking non-believers as a reference group regular church attendants showed a tendency for higher sense of coherence ( p = .07) and significantly higher social support scores. Sense of coherence was found higher in the group practising religion on its own way ( p = .04) and in those going to church rarely ( p = .05). Those going seldom to church had higher value on the positive affect scale ( p = .009), with a tendency of less sensation seeking
( p = .06). The group practising religion on its own way showed a significantly higher value in BDI ( p = .008), vital exhaustion ( p = .02), hopelessness ( p = .05) and sleep disturbances ( p = .02). Problem oriented coping was more dominant in the group attaching little importance to religion ( p = .05), than among those finding it of no importance. Conclusions: Spiritual history about beliefs and practices might shed light on essential factors that play a vital role in the rehabilitation of patients after myocardial infarct. We would stress the significance of identifying patients practising religion on their own way. They may constitute a high-risk subgroup possibly having poorer quality of life and outcome.
135 COMPARING COMPUTER-ASSISTED INTERVIEW DIAGNOSES TO CLINICAL JUDGEMENT Becker J. Department of Psychosomatic Medicine, Charite´ Berlin, Germany. The purpose of the study was evaluating the application of a computer-assisted standardized interview (CIDI) to psychosomatic patients and exploring the prevalence and comorbidity of mental disorders as diagnosed by this interview and by clinical judgment. The standardized Composite International Diagnostic Interview (CIDI) is applied to n = 230 inpatients being routinely diagnosed by experienced clinicians and treated at the Department of Psychosomatic Medicine, Charite´ Berlin, between 11/02 and 11/ 03. The CIDI is a fully standardized computerized diagnostic interview designed for assessing mental disorders according to the definitions of the ICD-10 and DSM-III-R. Prevalence and comorbidity of mental disorders are investigated by descriptive statistics, diagnostic concordance between both diagnostic strategies (CIDI and clinical diagnoses) is explored by diagnostic sensitivity, diagnostic specifity and by kappa statistics. Most frequent disorders as assessed by clinicians and by the CIDI are depressive and somatoform disorders. Whereas the CIDI diagnoses more frequently anxiety disorders and proves well in diagnosing posttraumatic stress disorders, it shows difficulties in differentiating between different types of somatoform disorders, dissociative and adjustment disorders. Clinicians tend to diagnose more often adjustment disorders and different types of somatoform, eating and psychoactive dependence disorders. Both strategies reveal high comorbidity concerning depressive, anxiety and somatoform disorders. Because overall concordance between CIDI diagnoses and clinical judgment is only moderate, we hope for discussions on the appropriateness of the application of fully standardized computer-assisted interviews in the psychosomatic context and/or possible improvements in this field.
279 THE VIEW OF PSYCHOTHERAPISTS? Bell K. Cologne, Germany. Disease Management programs for chronic illnesses have become an integral part of German health care systems. The participants of the symposium are representatives from the political area and from the self administration of physicians and the statuatory health insurances (SHI). They will discuss the importance of integrating psychosomatic perspectives and contents into the programs and how this can be done.