Objective: Although associations between testosterone and cardiovascular (CV) morbidity in women have been proposed, no large prospective study has evaluated potential associations between testosterone and mortality in women. The objective was to determine whether baseline testosterone levels in women are associated with future overall or CV morbidity and mortality. Design: Prospective cohort study with a 4.5-year follow-up period. Methods: From a representative sample of German primary care practices, 2914 female patients between 18 and 75 years were analyzed for the main outcome measures: CV risk factors, CV diseases, and all-cause mortality. Results: At baseline, the study population was aged 57.96±14.37 years with a mean body mass index of 26.71±5.17 kg/m2. No predictive value of total testosterone for incident CV risk factors or CV diseases was observed in logistic regressions. Patients with total testosterone levels in the lowest quintile Q1, however, had a higher risk to die of any cause or to develop a CV event within the follow-up period compared to patients in the collapsed quintiles Q2–Q5 in crude and adjusted Cox regression models (all-cause mortality: Q2–Q5 versus Q1: crude hazard ratios (HR) 0.49, 95% confidence interval (CI) 0.33–0.74; adjusted HR 0.62, 95% CI 0.42–0.939; CV events: Q2–Q5 versus Q1: crude HR 0.54, 95% CI 0.38–0.77; adjusted HR 0.68, 95% CI 0.48–0.97). Kaplan–Meier curves revealed similar data. Conclusions: Low baseline testosterone in women is associated with increased all-cause mortality and incident CV events independent of traditional risk factors.

In einer Reihe neuerer epidemiologischer Studien wurde ein Zuwachs in der Prävalenz der Major Depression in jüngeren Geburtskohorten und ein sinkendes Ersterkrankungsalter dieser Störung beobachtet (Cross-National Collaborative Group, 1992; Klerman & Weissman, 1989). Gleichzeitig wurden bei älteren Personen auffallend niedriege Depressionsraten gefunden. Der vorliegende Beitrag gibt einen Überblick über die diesen Beobachtungen zugrundeliegenden Studien. Die Validität der Befunde und ihre Bedeutsamkeit für die Ätiologie der Major Depression sowie mögliche Alternativerklärungen der zeitlichen Effekte werden diskutiert. Während der Befund eines Zuwachses depressiver Störungen in jüngeren Geburtskohorten empirisch gut belegt ist, sind die niedrigen Depressionsraten bei älteren Personen zumindest teilweise auf einen Artefakt der Forschungsmethodologie zurückzuführen. / The findings of a number of recent major epidemiological studies in different countries document an increase in the cumulative lifetime prevalence estimates of major depression with each successively younger birth cohort and a decrease in the age of onset of this disorder (Cross-National Collaborative Group, 1992; Klerman & Weissman, 1989). At the same time comparably low depression estimates are found for the elderly. The paper presents an overview of the major studies conducted in this area in recent years. The validity of the findings, their significance for the aetiology of Major Depression and possible alternative explanations for the temporal trends are discussed. While much valid empirical evidence confirms the increase of Major Depression in recent birth cohorts, the low prevalence estimates in the elderly seen to represent at least in part an artifact of the research methodology.

Objective: Although associations between testosterone and cardiovascular (CV) morbidity in women have been proposed, no large prospective study has evaluated potential associations between testosterone and mortality in women. The objective was to determine whether baseline testosterone levels in women are associated with future overall or CV morbidity and mortality. Design: Prospective cohort study with a 4.5-year follow-up period. Methods: From a representative sample of German primary care practices, 2914 female patients between 18 and 75 years were analyzed for the main outcome measures: CV risk factors, CV diseases, and all-cause mortality. Results: At baseline, the study population was aged 57.96±14.37 years with a mean body mass index of 26.71±5.17 kg/m2. No predictive value of total testosterone for incident CV risk factors or CV diseases was observed in logistic regressions. Patients with total testosterone levels in the lowest quintile Q1, however, had a higher risk to die of any cause or to develop a CV event within the follow-up period compared to patients in the collapsed quintiles Q2–Q5 in crude and adjusted Cox regression models (all-cause mortality: Q2–Q5 versus Q1: crude hazard ratios (HR) 0.49, 95% confidence interval (CI) 0.33–0.74; adjusted HR 0.62, 95% CI 0.42–0.939; CV events: Q2–Q5 versus Q1: crude HR 0.54, 95% CI 0.38–0.77; adjusted HR 0.68, 95% CI 0.48–0.97). Kaplan–Meier curves revealed similar data. Conclusions: Low baseline testosterone in women is associated with increased all-cause mortality and incident CV events independent of traditional risk factors.

Objective: IGF1 is associated with metabolic parameters and involved in glucose metabolism. Low-IGF1 has been implicated in the etiology of glucose intolerance and subjects with pathological causes of either low- or high-IGF1 are at risk of diabetes. We hypothesized that both low- and high-IGF1 levels increase the risk of diabetes and aimed to assess the role of IGF1 in the risk of developing diabetes in a large prospective study. Design: An analysis of two prospective cohort studies, the DETECT study and SHIP. Methods: We measured IGF1 levels in 7777 nondiabetic subjects and assessed incident diabetes mellitus during follow-up. Results: There were 464 cases of incident diabetes during 32 229 person-years (time of follow-up in the DETECT study and SHIP: 4.5 and 5 years respectively). There was no heterogeneity between both studies (P>0.4). The hazard ratios (HRs) of incident diabetes in subjects with IGF1 levels below the 10th or above the 90th age- and sex-specific percentile, compared to subjects with intermediate IGF1 levels, were 1.44 (95% confidence interval (CI) 1.07–1.94) and 1.55 (95% CI 1.06–2.06) respectively, after multiple adjustment. After further adjustment for metabolic parameters, the HR for low-IGF1 became insignificant. Analysis of IGF1 quintiles revealed a U-shaped association of IGF1 with risk of diabetes. Results remained similar after exclusion of patients with onset of new diabetes within 1 year or with borderline glucose or HbA1c levels at baseline. Conclusions: Subjects with low- or high-IGF1 level are at increased risk of developing diabetes.

In einer Reihe neuerer epidemiologischer Studien wurde ein Zuwachs in der Prävalenz der Major Depression in jüngeren Geburtskohorten und ein sinkendes Ersterkrankungsalter dieser Störung beobachtet (Cross-National Collaborative Group, 1992; Klerman & Weissman, 1989). Gleichzeitig wurden bei älteren Personen auffallend niedriege Depressionsraten gefunden. Der vorliegende Beitrag gibt einen Überblick über die diesen Beobachtungen zugrundeliegenden Studien. Die Validität der Befunde und ihre Bedeutsamkeit für die Ätiologie der Major Depression sowie mögliche Alternativerklärungen der zeitlichen Effekte werden diskutiert. Während der Befund eines Zuwachses depressiver Störungen in jüngeren Geburtskohorten empirisch gut belegt ist, sind die niedrigen Depressionsraten bei älteren Personen zumindest teilweise auf einen Artefakt der Forschungsmethodologie zurückzuführen. / The findings of a number of recent major epidemiological studies in different countries document an increase in the cumulative lifetime prevalence estimates of major depression with each successively younger birth cohort and a decrease in the age of onset of this disorder (Cross-National Collaborative Group, 1992; Klerman & Weissman, 1989). At the same time comparably low depression estimates are found for the elderly. The paper presents an overview of the major studies conducted in this area in recent years. The validity of the findings, their significance for the aetiology of Major Depression and possible alternative explanations for the temporal trends are discussed. While much valid empirical evidence confirms the increase of Major Depression in recent birth cohorts, the low prevalence estimates in the elderly seen to represent at least in part an artifact of the research methodology.

Objective: IGF1 is associated with metabolic parameters and involved in glucose metabolism. Low-IGF1 has been implicated in the etiology of glucose intolerance and subjects with pathological causes of either low- or high-IGF1 are at risk of diabetes. We hypothesized that both low- and high-IGF1 levels increase the risk of diabetes and aimed to assess the role of IGF1 in the risk of developing diabetes in a large prospective study. Design: An analysis of two prospective cohort studies, the DETECT study and SHIP. Methods: We measured IGF1 levels in 7777 nondiabetic subjects and assessed incident diabetes mellitus during follow-up. Results: There were 464 cases of incident diabetes during 32 229 person-years (time of follow-up in the DETECT study and SHIP: 4.5 and 5 years respectively). There was no heterogeneity between both studies (P>0.4). The hazard ratios (HRs) of incident diabetes in subjects with IGF1 levels below the 10th or above the 90th age- and sex-specific percentile, compared to subjects with intermediate IGF1 levels, were 1.44 (95% confidence interval (CI) 1.07–1.94) and 1.55 (95% CI 1.06–2.06) respectively, after multiple adjustment. After further adjustment for metabolic parameters, the HR for low-IGF1 became insignificant. Analysis of IGF1 quintiles revealed a U-shaped association of IGF1 with risk of diabetes. Results remained similar after exclusion of patients with onset of new diabetes within 1 year or with borderline glucose or HbA1c levels at baseline. Conclusions: Subjects with low- or high-IGF1 level are at increased risk of developing diabetes.

Diese Dissertation untersucht die Determinanten für Veränderungen in der öffentlichen Meinung zu Zugewanderten und Geflüchteten. Im Mittelpunkt steht die ungeplante Zuwanderung Geflüchteter in den Jahren 2015/16. Die Untersuchung konzentriert sich auf Deutschland, erforscht aber auch den breiteren europäischen Kontext. Erkenntnisse aus Mehrebenenanalysen, Längsschnittdaten und exklusiv erhobenen Geodaten tragen zur bisherigen Forschung bei und helfen, Schlussfolgerungen zu ziehen, wie Zuwanderung in Aufnahmegesellschaften besser gesteuert werden kann. Das erste empirische Kapitel zeigt, dass der Prozess der Generationenablösung in Deutschland nicht zu einem stetig toleranteren und offeneren Meinungsklima gegenüber Zugewanderten führt. Vielmehr ist ein Generationenverlauf zu beobachten, der nicht linear verläuft, sondern schwankend. Außerdem führen die gegenwärtigen Veränderungen der makroökonomischen Bedingungen zu keinen wesentlichen Veränderungen in den Einstellungen einer Generation. Ein Anstieg an Schutzsuchenden in Deutschland führt jedoch zu einer etwas restriktiveren Haltung zu Zugewanderten. Das zweite empirische Kapitel zeigt, dass die Zunahme der Zuwanderung aus verschiedenen Herkunftsländern unterschiedliche Reaktionen in den westlichen EU-Gesellschaften hervorruft. Während der Anstieg der Einwanderungsraten von EU-Bürgern keine signifikante Rolle bei der Veränderung der Einstellung der Einheimischen spielt, erweist sich die zunehmende Einwanderung aus Ländern des globalen Südens und von Geflüchteten als stabiler Prädiktor für eine ablehnendere Haltung der Kohorten. Das dritte empirische Kapitel liefert kaum Belege dafür, dass eine Geflüchtetenunterkunft in unmittelbarer Nähe mit den Einstellungen oder Verhaltensweisen der Einheimischen verbunden ist. Weder aktuelle Bedrohungswahrnehmungen noch erhöhte Kontaktmöglichkeiten durch die Anwesenheit einer Unterkunft in der Nähe haben einen nachhaltigen Effekt auf die Einstellungen der lokalen Bevölkerung. / This dissertation offers comprehensive study on the determinants for changes in public opinion toward immigrants and refugees. Centered around the unplanned immigration of large numbers of refugees in 2015/16, it focuses on Germany but additionally examines the broader context of Europe. Insights from multilevel analysis, longitudinal data and exclusively collected geo-data contribute to previous research and help to find conclusions on how to moderate and manage immigration in host societies. The first empirical chapter concludes that the process of generational replacement in Germany will not lead to a steadily more tolerant and open climate of opinion toward immigrants. Youngest cohorts in east Germany feel equally, and in west Germany increasingly threatened by immigration in comparison to their immediate predecessors. Moreover, current changes in macro-economic conditions do not lead to substantial changes in a generation’s attitudes. An increase in the number of people seeking protection in Germany, however, leads to somewhat more restrictive attitudes toward immigrants. The second empirical chapter shows that increases in immigration from different origin-backgrounds evoke dissimilar reactions within western EU host societies. While increases in immigration rates of EU citizens do not play a significant role in changing natives’ sentiments, rising immigration from countries in the Global South and refugees proves to be a stable predictor of cohorts’ attitudes to become more disapproving. The third empirical chapter finally provides little evidence that the presence of a refugee accommodation in close proximity is associated with locals’ attitudes or behavioral patterns toward refugees in Germany. Neither current threat-perceptions nor increased contact opportunities due to the presence of a refugee accommodation nearby have a lasting effect on locals’ attitudes. Sociotropic concerns at the societal level seem to outweigh actual affectedness at the local level.

Viele Studien zeigen, dass die Beteiligung an politischen Protesten in mittel- und osteuropäischen Ländern geringer ausfällt als in Westeuropa. Das Ausmaß und die Ursachen dieser Ost-West-Partizipationslücke werden jedoch immer noch debattiert. Diese Dissertation untersucht die Ursachen dieses europäischen Protestgefälles. Inspiriert von den Theorien politischer Sozialisation wird untersucht, inwiefern ein frühes Erleben von (1) Repression und (2) Mobilisierung während der Transition zur Demokratie das Protestverhalten verschiedener Generationen in Mittel- und Osteuropa geprägt hat. Hierfür werden mehrebenen Alters-Perioden-Kohorten-Modelle mit wiederholten länderübergreifenden Umfragedaten genutzt. Studie 1 zeigt, dass ein frühes Erleben von Repression einen nachhaltigen Effekt auf die Teilnahme an Demonstrationen hat, nicht aber auf Petitionen und Boykotte. Darüber hinaus beeinflusst die Art der erlebten Repression die Richtung des Effekts: Personen, deren Bürgerrechte während ihrer Jugend eingeschränkt wurden, scheinen in ihrem späteren Leben häufiger an Demonstrationen teilzunehmen. Das Gegenteil ist der Fall für Personen, die Verletzungen persönlicher Integrität erlebt haben. Studie 2 zeigt, dass das Erleben der Mobilisierung während der Transition zur Demokratie diese Ost-West-Protestlücke nicht moderiert. Studie 3, eine Analyse des Protestverhaltens von Ostdeutschen, bestätigt, dass die Erfahrung der bottom-up Transition die mit gewaltsamer Repression verbundene Demobilisierung nicht kompensiert. Durch diese neu gewonnen Erkenntnisse zum Verhältnis von Regimewechsel und Zivilgesellschaft, verbindet und bereichert diese Dissertation die Forschungsfelder zu politischem Verhalten, sozialen Bewegungen und Demokratisierung. / Many studies have shown that protest participation is lower in Central and Eastern Europe than in Western Europe. Yet, the extent of and causes underlying the East-West participation gap are still debated in the literature. This thesis sheds new light on the sources of the European protest divide. Inspired by political socialization theories, it examines how early exposure to (1) repression and (2) mobilization during the transition to democracy has shaped the protest behavior of different generations in postcommunist democracies. This projects applies multilevel age-period-cohort models on data from repeated cross-national surveys to measure the effects of these types of exposure. Study 1 reveals that early exposure to repression has a lasting effect on demonstration attendance but not on participation in petitions and boycotts. Furthermore, the direction of this effect depends on the type of repression experienced by citizens: early exposure to civil liberties restrictions increases citizens’ participation in demonstrations while exposure to personal integrity violations depresses their participation. Study 2 demonstrates that exposure to mobilization during the transition to democracy does not moderate the East-West protest gap. Study 3, an analysis of East Germans’ protest behavior, confirms that the experience of a bottom-up transition does not compensate for the demobilization associated with violent repression. By generating new insights into the relation between regime change and civil society, this project bridges and contributes to the fields of political behavior, social movements, and democratization.