With the onset of the coronavirus pandemic in 2020 in Germany, the population faced a mentally challenging time. Governmental measures like social distancing measures, lockdowns and quarantines were implemented to reduce the spread of the coronavirus and save as many lives as possible. People of old age were soon identified as high risk group for a lethal course of disease and as in particular need of protection. Mental health professionals feared an aggravation of mental distress and mental pathology. Against this background, this dissertation aimed to investigate mental coping and the progression of mental health outcomes in old and oldest-old risk groups over the course of the COVID-19 pandemic, as well as associated sociodemographic and psychosocial factors associated with it. In our first study, we investigated the perceived stress coping competence (self-efficient coping vs. helplessness-associated coping) as well as perceived worries about and perceived threat by the COVID-10 pandemic and associated sociodemographic and psychosocial factors in the oldest-old population in Germany in the early phase of the pandemic. Linear multivariate regression models revealed that in our sample of n=197 people aged 78 to 100 years old higher levels of resilience were linked to higher perceived self-efficient coping. Male gender compared to the female gender, and a medium educational level in reference to a low educational level, was associated with less helplessness-associated coping. Loneliness showed associations with both, self-efficient and helplessness-associated coping. Higher levels of anxiety and depressive symptoms were linked to higher scores of helplessness-associated coping. Regarding perceived worries about the pandemic, binary logistic regression models showed that male gender and higher perceived social support were linked to more worries about the pandemic. Despite the higher risk for a severe course of disease for people of old age, older age was associated with less perceived personal threat by the coronavirus. Furthermore, more reported depressive symptoms were linked to less perceived threat, and higher reported somatization symptoms were associated with higher personal threat by the virus. Therefore, mental health factors seem to shape the way oldest-old individuals perceive the COVID-19 pandemic in partly unexpected ways, and resilience may illustrate an important factor when targeting more functional ways of coping with stress. Moreover, people of oldest-old age experiencing greater loneliness, high depressive and anxiety symptoms could be supported by adapting their coping skill repertoire to foster the feeling of self-efficiency when coping with stress. In our second and third study, we analyzed the development and progression of mental health factors like depressive, anxiety and somatization symptoms. First, in study 2 with n=156 people of oldest-old age (range= 78 to 97 years) Wilcoxon t-tests showed an increase of anxiety, depressive and somatization symptoms from 2021 to 2021 with generalized regression models revealing that higher levels of symptomatology in 2020 were associated with higher symptom burden in 2021. Higher perceived social support in 2020 was linked to less depressive symptoms in 2021. Building on this findings, we then conducted multilevel mixed-effects generalized linear models to analyzed data over three points of measurement from 2020, 2021 and end of 2021/beginning of 2022 with n=135 participants (age range= 78 to 97 years). Results showed that after a first increase of depressive and anxiety symptoms from 2020 to 2021, symptomatology levels stayed relatively stable from 2021 to 2021/2022. Moreover, older age and higher reported worries were associated with higher levels of anxiety symptoms. Greater perceived social support was linked to less anxiety and depressive symptoms over time. Resilience was associated with less depressive symptoms. Since pre-existing heart conditions illustrated an additional risk factor, next to an older age (60+ years), for a serious and lethal course of coronavirus disease, the fourth study additionally focused on an old age sample with cardiovascular risk profiles. The aim was a comparison of this cardiovascular risk group with the general old age population in terms of symptomatology levels and psychosocial factors associated with it. We analyzed data of n=1236 participants with n=618 showing a cardiovascular risk profile, drawn from the AgeWell.de study, and n=618 from a representative survey of the old age general population with an age range of 64 to 81 years in the beginning of the COVID-19 pandemic. Results showed that the cardiovascular risk group showed higher depressive symptom levels compared to the general population. Multivariate regression models revealed that in the cardiovascular risk group higher perceived social support was linked to less depressive and anxiety symptoms. In the general old age population perceived social support was associated with depressive symptoms, social support and anxiety symptoms showed no such association. Higher perceived worries were associated with higher reported anxiety symptoms in the general population only. Perceived resilience was linked to less depressive and anxiety symptoms in both groups. In conclusion, the oldest-old individuals showed an overall good mental health in the long term despite a first increase in anxiety and depressive symptomatology within the first year. Fostering perceived social support and perceived resilience may play an important role in preventing and reducing depressive symptomatology in times of crises like the pandemic.:Table of Contents I 1. Introduction 1.1. The Severe Acute Respiratory Syndrome Coronavirus 2: the Disease and the Pandemic 1.2. Mental Health during the Pandemic in the General Adult Population 1.3. Mental Health in Old Age – with a Focus on Depression and Anxiety 1.3.1. Epidemiology 1.3.2. Etiology 1.4. Social Support as a Protective Factor? The Role of Social Goals over the Lifespan 1.5. Aims of the Dissertation 2. Empirical Investigations in the Old Age Population during the COVID-19 Pandemic 2.1. The Perception of Coping with Stress in the Oldest-old Population 2.2. The Development of Mental Health Factors and the Role of Social Support in the Oldest-old Population 2.3. The Development of Depressive and Anxiety Symptoms during the COVID-19 Pandemic and the Role of Psychosocial Factors in the Oldest-old Population 2.4. Depressive and Anxiety Symptoms in an Old Age Cardiovascular Risk Group Compared to the Old Age General Population 3. General Discussion 3.1. Implications for Prospective Research and Impulses for Public Mental Health Strategies 4. Conclusion Summary References Appendix List of Tables and Figures II

La suicidalité (idéations suicidaires avec ou sans plan, tentatives de suicide) est une problématique très importante à l’adolescence. Les adolescents ayant des traits liés au trouble de la personnalité limite (TPL) constituent un sous-groupe à risque suicidaire. Il est aussi largement reconnu que le désespoir, les symptômes dépressifs, anxieux et extériorisés augmentent la vulnérabilité aux idéations et aux comportements suicidaires. Cependant, le rôle médiateur de ces problèmes de santé mentale, dans la relation entre les traits du TPL et la suicidalité n’a pas été vérifié dans les études antérieures. En s’inspirant des modèles théoriques sur l’émergence de la suicidalité, cette thèse propose un nouveau paradigme conceptuel concernant le rôle médiateur des problèmes intériorisés et extériorisés dans cette relation, chez les adolescents de 12 à 15 ans. L’objectif du premier article de la thèse était d’examiner le rôle de quatre médiateurs (désespoir, symptômes dépressifs, anxieux et extériorisés) dans l’association entre les traits du TPL et la suicidalité. Le deuxième article avait pour but d’approfondir cette question en explorant le rôle médiateur de sept problèmes spécifiques, chez les filles et les garçons : désespoir, symptômes dépressifs, de phobie sociale, d’anxiété généralisée, du déficit d’attention avec ou sans hyperactivité, symptômes oppositionnels et des conduites. L’intégration de certaines hypothèses provenant des modèles théoriques a permis de suggérer des trajectoires hypothétiques de médiation. Concernant la méthodologie, les problèmes de santé mentale ont été évalués par le Dominique Interactif pour Adolescents-Révisé (DIA-R) et l’Échelle de désespoir de Beck. La base de données utilisée pour effectuer l’analyse de cheminement incluait un échantillon de 446 adolescents francophones et anglophones âgés de 12 à 15 ans recrutés dans les écoles et les établissements cliniques de Montréal. Les modèles obtenus à partir des analyses de cheminement ont mis en évidence un bon ajustement des données suggérant la plausibilité des trajectoires hypothétiques proposées. Une association directe a été observée entre les traits du TPL et l’échelle de suicidalité du DIA-R. Tel que prévu, plusieurs problèmes de santé mentale interviennent comme variables médiatrices dans cette relation. Les symptômes dépressifs expliquent l’effet médiateur du désespoir, des symptômes anxieux et extériorisés. Cet effet était observé chez les filles et les garçons. De plus, les résultats mettent en évidence que le lien indirect entre les traits du TPL, le désespoir et la suicidalité était plus important chez les filles. Le lien indirect entre les traits du TPL, les symptômes de phobie sociale, le désespoir et la suicidalité était aussi plus important chez les filles. En conclusion, cette recherche doctorale contribue à enrichir les connaissances au sujet de l’association entre les traits du TPL et la suicidalité, chez les filles et les garçons de 12 à 15 ans. Le cadre conceptuel intégratif suggéré, dans chacun des articles de la thèse, pourrait aider les cliniciens à identifier précocement les problèmes de santé mentale afin de diminuer le risque suicidaire. / Suicidality (suicidal ideations with or without a plan, suicide attempts) is a very important issue in adolescence. Adolescents with borderline traits (BT) represent a high-risk group for suicidality. It is also widely recognized that hopelessness, depressive, anxiety and externalizing symptoms increase the risk of suicidal ideations and suicide attempts. Theoretical models suggested a mediating effect of mental disorders/symptoms between personality characteristics similar to BT and suicidality in adolescence. However, previous studies did not examine this research question. In this present thesis, the integration of theoretical considerations provides a new conceptual framework regarding the mediating role of internalizing and externalizing problems in the relation between BT and suicidality in adolescents aged 12 to 15 years. The objective of the first article of the thesis was to examine the role of four mediators (hopelessness, depressive, anxiety and externalizing symptoms) in the association between BT and suicidality. The aim of the second article was to extend this question by analyzing the role of seven specific problems in boys and girls: hopelessness, depression, social phobia, generalized anxiety, attention deficit/hyperactivity, opposition and conduct symptoms. The integration of certain hypotheses from theoretical models allowed to suggest hypothetical mediational pathways. With regard to the methodology, mental health problems were assessed by the Dominic Interactive for Adolescents-Revised and the Beck Hopelessness Scale. A path analysis was conducted using a sample of 446 adolescents aged 12 to 15 years recruited from school and clinical settings from Montreal. The model obtained from path analysis showed a good fit to the data suggesting the plausibility of pathways. A direct association was observed between BT and the DIA-R Sucidality Scale. As hypothesized, several mental health problems intervened as mediating variables in this relation. Depressive symptoms explained the mediating effect of hopelessness, anxiety and externalizing symptoms. This effect was observed in girls and boys. In addition, the results highlighted that the indirect association between BT, hopelessness and suicidality was more important in girls. The indirect relation between BT, social phobia symptoms, hopelessness and suicidality was also more important in girls. In conclusion, this doctoral thesis contributed to extend our knowledge about the association between BT and suicidality, in girls and boys aged 12 to 15 years. The suggested integrative conceptual framework could help clinicians to early identify mental health problems to prevent the suicidal risk.

La détresse psychologique est plus fréquente et sévère chez les patients atteints de maladies coronariennes (MC) que chez les individus sains. Nous en savons peu sur l’évolution dans le temps de ces différences et si ces différences s'étendent aux personnes atteintes de maladies non cardiovasculaires (CV). Objectifs: Examiner la présence, la sévérité et l'évolution de la détresse psychologique chez les hommes et les femmes atteintes de MC et celles du même âge souffrant de maladies non CV. Méthodes: 1294 personnes (61% d'hommes; moyenne = 60,4 ± 7,0 ans) atteintes de MC ou de maladies non CV ont été questionnées sur leur support social, leur degré d'hostilité, de stress, d'anxiété et de dépression au départ de l’étude (T1) ainsi que 4,8 ± 0,8 ans plus tard (T2). Des analyses à mesures répétées mixtes (sexe*statut MC*temps), de Chi carré et de McNemar ont été effectuées. Résultats: Les femmes atteintes de MC ont rapporté davantage de symptômes dépressifs que les autres participants aux deux évaluations (p’s<0,01), et davantage de symptômes d’anxiété et de stress que les autres participants au T1 (p’s <0,05). Au T2, le stress perçu demeurait significativement plus élevé chez les femmes atteintes de MC que chez les hommes (p’s<0,01), bien que les différences d’anxiété n’étaient plus significatives. Les hommes ont rapporté plus d'hostilité que les femmes (p=0,001). Les femmes souffrant de MC se situaient davantage dans la plage clinique de dépression (p<0,001), d'anxiété (p=0,001) et de stress (p=0,030) au T1, et de dépression (p=0,009) et de stress (p=0,002) au T2. Conclusion: L'intensité, la prévalence, et l’évolution de la détresse des patients diffère en fonction de la mesure examinée, de leur sexe et/ou de leur statut CV. Alors que la détresse psychologique était prédominante chez ces patients atteints de diverses maladies, les femmes atteintes de MC étaient particulièrement et chroniquement vulnérables. / Psychological distress is more prevalent and severe among patients with coronary artery disease (CAD) compared to healthy individuals. Little is known regarding its time course, and whether these differences extend to individuals with non-cardiovascular (CV) illnesses. Objective: This study examined the presence, severity, and time course of psychological distress in men and women with CAD and those of similarly aged individuals suffering from non-CV conditions. Methods: 1294 individuals (61% men; meanage = 60.4 ± 7.0 years) with stable CAD or non-CV illnesses reported on social support, hostility, stress, anxiety and depression at baseline as well as 4.8 ± 0.8 years later. Analyses involved mixed (Sex*CAD status*Time) repeated measures analyses (controlling for relevant covariates), as well as Chisquare and McNemar analyses. Results: Women with CAD reported more symptoms of depression compared to other participants at both evaluations (p’s<0.01), and reported more symptoms of anxiety and stress compared to others at T1 (p’s <0.05). At T2, perceived stress remained significantly greater among women with CAD compared to men (p’s<0.01), though differences in anxiety were no longer significant. Men reported more hostility than women (p=0.001). CAD women fell within the clinical range for depression (p<0.001), anxiety (p=0.001), and stress (p=0.030) more frequently compared to others at T1, and for depression (p=0.009) and stress (p=0.002) at T2. Conclusions: The evolution of patient distress differed as a function of the measure examined, their sex, and/or CV status. While psychological distress was prevalent among these patients with diverse health conditions, women with CAD were particularly and chronically vulnerable.

More individuals gets symptoms which relates to the indoor climate or the building at the workplace. Indoor climate investigations are often multifactorial, symptoms can come to existence from building-related problems as well from psychic- and social problems. To deal with the problem a working method called the Previa-model was manufactured. The Previa-model builds on working with both building-related symptoms (BRS) and nonspecific building-related symptoms (NBRS) side by side as far as it goes. Furthermore, chart the individuals symptoms, demands on management and a cooperation between psychologists, work environment engineers, company doctors and nurses. The focus is on helping individuals decrease their anxiety and stress as much as possible. The purpose of this study was to examine how the Previa-model have facilitated indoor climate investigations. Which components in the Previa-model could decrease anxiety and stress. Also, how psychologists could help individuals who have NBRS. The study builds on interviews with one work environment engineer and three psychologists. Data was collected from assignments based on the Previa-model, one ongoing and three finished and result from a survey. The result showed that the application of the Previa-model led to good results in the investigations and customers were in general very pleased with the outcome. Sixteen components that could decrease anxiety and stress were found. Furthermore, could psychologists support individuals by dealing with stress, anxiety and emotional impingement. Indoor climate problems are often very complex and difficult to solve, but working with several investigations and actions at the same time makes it possible to succeed.

Background: This study examined the bidirectional nature of mother-infant positive and negative emotional displays during social interactions across multiple tasks among postpartum women accounting for childhood maltreatment severity. Additionally, effects of maternal postpartum psychopathology on maternal affect and effects of task and emotional valence on dyadic emotional displays were evaluated. Sampling and Methods: A total of 192 mother-infant dyads (51% male infants) were videotaped during free play and the Still-Face paradigm at 6 months postpartum. Mothers reported on trauma history and postpartum depression and posttraumatic stress disorder (PTSD) symptoms. Reliable, masked coders scored maternal and infant positive and negative affect from the videotaped interactions. Results: Three path models evaluated whether dyadic affective displays were primarily mother driven, infant driven, or bidirectional in nature, adjusting for mothers' maltreatment severity and postpartum psychopathology. The bidirectional model had the best fit. Child maltreatment severity predicted depression and PTSD symptoms, and maternal symptoms predicted affective displays (both positive and negative), but the pattern differed for depressive symptoms compared to PTSD symptoms. Emotional valence and task altered the nature of bidirectional affective displays. Conclusions: The results add to our understanding of dyadic affective exchanges in the context of maternal risk (childhood maltreatment history, postpartum symptoms of depression and PTSD). Findings highlight postpartum depression symptoms as one mechanism of risk transmission from maternal maltreatment history to impacted parent-child interactions. Limitations include reliance on self-reported psychological symptoms and that the sample size prohibited testing of moderation analyses. Developmental and clinical implications are discussed.

Mindfulness-based interventions reduce depressive symptoms and rumination, and enhance mindfulness in adults; this non-randomised controlled feasibility study aimed to determine whether these conclusions apply to young people, and whether mindfulness and rumination mediate the effect on depressive symptoms. Participants aged 12-16 received a nine-week universal mindfulness intervention in schools delivered by trained teachers (intervention group, N = 256) or their regular school curriculum (control group, N = 266). Intervention schools were matched to control schools on key variables (publicly-funded versus private, mainstream versus special needs). Young people who received the intervention reported fewer depressive symptoms post-intervention relative to controls, which was maintained at three-month follow-up. Mindfulness and rumination were unchanged immediately after the intervention, however by follow-up, intervention participants were significantly more mindful and less likely to ruminate than controls. The extent to which young people practiced mindfulness was negatively correlated with depressive symptoms at post-intervention and follow-up, positively correlated with mindfulness at post-intervention and follow-up, and positively correlated with rumination at follow-up. This universal mindfulness intervention shows promise for reducing depressive symptoms, reducing rumination and increasing mindfulness in young people, however further research is warranted, particularly regarding the mechanisms of change.

People all over the world do experience some kind of trauma during their lives. Some may experience more than one trauma, and some may experience more intense trauma, but sooner or later we all experience trauma. Sadly, our children are not excluded. The first aim of this study, was to investigate the influence of trauma on the lives of children in their mid childhood years. The following questions were asked: · What are the specific developmental tasks for middle childhood, regarding their physical, cognitive, affective, social, religious, moral and esthetical development? · What about trauma is so traumatic? · Are there any recognisable and predicted effects, present in children who experienced trauma? · And last, but not least, how do children understand and experience a traumatic death? The second aim of this study was to develop a trauma counselling program for children who experienced a trauma. The program had to focus on the specific needs of children in their mid childhood years. In order to do this, the following points were looked at: · What is the current understanding of trauma? Are there any counselling programs for children available, and how do they work? · There are a vast majority of intervention techniques available, the most popular techniques – playtherapy, bibliotherapy, grouptherapy, arttherapy and narrative therapy, were briefly discussed. · Finally a graphic presentation of a new trauma counselling program was included. To see whether this trauma counselling program could help children to overcome posttraumatic symptoms and prevent posttraumatic stress-disorder, it was implemented during two case studies. · The first case study was a girl that had been bitten by dogs twice. As a result of this trauma, she developed an unnatural fear of dogs. The trauma counselling program was implemented, and after a few weeks the girl was able to conquer and control her fear of dogs. · The second case study was a boy who needed to accept his father’s suicide. The trauma counselling program was adapted to suit his specific needs, and once again the program helped the boy to understand and accept his father’s suicide. The success of these two case studies, lead to the acceptance of this study’s hypothesis, namely, that if one developed a trauma counselling program that are compatible with the needs of children in their mid childhood years, it will help children to accept and overcome trauma. Therefore posttraumatic stress symptoms will be reduced and post-traumatic disorder will be prevented. / Dissertation (MEd (Learning Support, Guidance and Counselling))--University of Pretoria, 2006. / Educational Psychology / unrestricted

The aim of this study was to investigate the relationship between noncognitive symptoms and premorbid temperament in a group with Alzheimer’s disease. The relationship between premorbid temperament and noncognitive symptoms can be used to understand symptom susceptibility and risk, caregiver burdens, as well as providing insights into the neuroanatomical substrates of temperament and noncognitive behaviour. Sixty-three primary caregivers of Alzheimer’s patients fulfilled the eligibility criteria for this study. Information regarding the noncognitive symptoms and premorbid temperament was procured from the primary caregivers. In fifty-one cases, a secondary caregiver also provided information about the premorbid temperament of the Alzheimer’s patient. The latter was obtained to enhance the reliability of retrospective data. The Behaviour Rating Scale for Dementia, the Formal Characteristics of Behaviour-Temperament Inventory, and the Blessed Dementia scale were used to elicit data on noncognitive symptomatology, premorbid temperament, and current cognitive status, respectively. ii Noncognitive symptoms were grouped into two clusters namely neuropsychiatric and neurobehavioural disturbances. The neuropsychiatric cluster included mood and psychotic symptoms and the neurobehavioural cluster included vegetative and overall behavioural dysregulatory symptoms. Results showed that there is a wide spectrum of noncognitive symptom manifestation in patients’ profiles and that the neurobehavioural dysregulatory symptoms are more common than the neuropsychiatric symptoms in this Alzheimer’s cohort. With regard to symptom manifestation and cognitive status, a Pearson product moment correlational analysis showed that a lower level of cognitive functioning is significantly associated with aggressive episodes and a higher level of cognitive functioning with manifestations of depressive symptoms. In terms of interrater concordance on premorbid temperament ratings, intraclass correlations were significant for five of the six temperament domains, thus indicating a reliable estimate of premorbid disposition. Canonical correlational analysis yielded two significant variates. The first variate indicated that Alzheimer’s disease patients with a proclivity for aggressive behaviours and general behavioural deregulation but lower depressive profiles, were premorbidly more emotionally reactive, had low sensory thresholds (high sensitivity), and greater cognitive deficit. The second variate showed that patients with Alzheimer’s disease who tended to manifest with depressive and dysregulatory behaviour appear to have been premorbidly perseverative in temperament with a low sensory threshold (high sensitivity) and the tendency to maintain and attain a low level of activity (stimulation). Taken together, the significant variates revealed a dimensional relationship between depressive symptoms, aggressive symptoms, and behavioural dysregulation; and sensory sensitivity, emotional reactivity, perseverance, and activity, with cognitive status serving as a moderating variable. In conclusion, the study indicated a dimensional relationship between specific premorbid temperament traits and noncognitive symptoms, thereby highlighting the possible predictive influence of premorbid temperament on noncognitive manifestations in Alzheimer’s disease patients. / Thesis (PhD (Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

(in English): The aim of this diploma thesis is to analyse an availability of care for people mostly in productive age suffering from Parkinson's disease. In the first part, the author describes in a detail symptoms and medical treatment of the disease with an emphasis on the effects of these symptoms on life of patient and his/her surroundings. Following part pay attention to a specific group of so-called Young Onset, or younger patients. Finally, the thesis analyses the current state of the care in the Czech Republic with a comparison to a Dutch model. After exposing problematic spots in the Czech model, the author offers recommendations for viable changes in the institutional care system. The technique of analysing secondary literature was used in order to achieve the aim of this thesis.

Background: Anxiety and depression disorders among adolescents are increasing globally and seriously endanger their health and quality of life. Having anxiety or depressive symptoms in adolescence can have serious consequences and even increase the risk of later adult disorder. Physical activity could be a good way to prevent this. However, an updated review on how and why physical activity interventions may be relevant for reducing and preventing symptoms of depression and anxiety among adolescents is needed. This study aims to study physical activity interventions that focus on the symptoms of depression and anxiety among adolescents. Methods: To bring together previous scientific research, a scoping literature review has been applied. A search was performed in PubMed database to identify studies and meta-analyses meeting the inclusion criteria. Finally references from recent published systematic reviews and meta-analysis were checked. Results: The search yielded a total of 5,091 records with additional 56 records identified through other meta-analyses and reviews. A total of fifteen articles were included for the final review. Most of the included studies showed that there was a significant difference in depressive score after the physical activity intervention. An improvement in anxiety symptoms was identified as well. Overall, 15-60 minutes of aerobics exercise 2-3 times/week, for a minimum of 8 weeks, led to feeling less anxious and depressive. In conclusion, physical activity interventions may be very beneficial for decreasing both depressive and anxiety levels among adolescents.