Biomedical subjects

Michael Höfler

Publications and source records attributed to Michael Höfler.

10 recordsLinked to original sources

PubMed2003

Smoking increases the risk of panic: findings from a prospective community study.

BACKGROUND: We examined prospectively determined bidirectional associations between smoking and panic and other anxiety disorders and their temporal ordering of onset in a representative community sample of adolescents and young adults. METHODS: Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study, a prospective longitudinal study of adolescents and young adults in Munich, Germany. We assessed smoking (occasional and regular), nicotine dependence, panic attacks, panic disorder, other anxiety disorders, and other mental disorders using the Munich-Composite International Diagnostic Interview. RESULTS: At baseline, panic attacks and panic disorder were strongly associated with occasional and regular smoking and nicotine dependence (odds ratio [OR] range, 3.0-28.0). In the prospective analyses, we found increased risk for new onset of panic attacks with prior regular smoking (OR, 2.9; 95% confidence interval [CI], 1.0-8.4) and nicotine dependence (OR, 3.6; 95% CI, 1.2-10.5). Prior nicotine dependence increased also the risk for onset of panic disorder (OR, 3.3; 95% CI, 1.0-10.5), whereas preexisting panic was not associated with subsequent smoking or nicotine dependence. When using Cox regression with time-dependent covariates, prior nicotine dependence was confirmed to be related to subsequent panic attacks (hazard ratio, 2.7; 95% CI, 1.7-4.2), but not panic disorder (hazard ratio, 1.7; 95% CI, 0.7-3.9). Rather, we found indications that prior panic attacks/disorder might also have an effect on secondary development of nicotine dependence. CONCLUSIONS: In young adults, prospective analyses revealed a fairly unique and specific, unidirectional relationship between prior smoking and increased risk for subsequent panic attacks/disorder. However, we could not exclude the existence of a second, less frequent, reverse pathway of prior panic and secondary nicotine dependence.

Adolescent↗

PubMed2003

Association chain graphs: modelling etiological pathways.

Multiple time-dynamic and interrelated risk factors are usually involved in the complex etiology of disorders. This paper presents a strategy to explore and display visually the relative importance of different association pathways for the onset of disorder over time. The approach is based on graphical chain models, a tool that is powerful but still under-utilized in most fields. Usually, the results of these models are displayed using directed acyclic graphs (DAGs). These draw an edge between a pair of variables whenever the assumption of conditional independence given variables on an earlier or equal temporal footing is violated to a statistically significant extent. In the present paper, the graphs are modified in that confidence intervals for the strengths of associations (statistical main effects) are visualized. These new graphs are called association chain graphs (ACGs). Statistical interactions cause 'edges' between the respective variables within the DAG framework (because the assumption of conditional independence is violated). In contrast they are represented as separate graphs within the subsample where the different association chains may work within the ACG framework. With this new type of graph, more specific information can be displayed whenever the data are essentially described only with statistical main- and two-way interaction effects.

Alcoholism↗

PubMed2002

What predicts incident use of cannabis and progression to abuse and dependence? A 4-year prospective examination of risk factors in a community sample of adolescents and young adults.

OBJECTIVES: To determine risk factors of incident onset of use, abuse and dependence of cannabis in a community sample of adolescents and young adults. METHODS: Risk factors were examined in a prospective longitudinal design across 4 years in a representative sample (N = 2,446) aged 14-24 at the outset of the study (EDSP). Patterns of DSM-IV defined cannabis use, abuse and dependence were assessed with the Composite International Diagnostic Interview (M-CIDI). Potential risk factors were assessed at baseline. Incident cannabis use, abuse and dependence at second follow-up (on average 42 months after baseline) were the main outcome measures in this study. Associations were analyzed with logistic and negative binomial regressions. RESULTS: Using 11 of a total of 56 variables examined, the predictive value of the final multiple logistic regression for incident cannabis use was moderately good (area under the ROC curve = 0.78). Cannabis use frequency was predicted in the final model by 18 variables, cannabis abuse by two variables in the younger subsample and nine factors in the older group, and dependence by eight variables (dependence: ROC curve area = 0.97). Incident cannabis use was predicted mainly by availability of drugs, peers' drug use, a more 'positive' attitude towards future drug use, and regular previous use of licit drugs, while cannabis dependence was predicted primarily by parental death before age 15, deprived socio-economic status, and baseline use of other illicit drugs. CONCLUSION: Different factors predict the onset or severity of cannabis use and the progression to abuse and dependence. In addition to well-documented risk factors such as peer group pressure, drug availability, and low self-esteem, findings suggest that family history (e.g. parental mental disorders, early parental death), and prior experiences with legal drugs play a significant role in the initiation of cannabis consumption and the transition to cannabis use disorders in adolescents and young adults. Findings suggest that early intervention and prevention might be improved by better targeted treatment.

Adolescent↗

PubMed2002

Use, abuse and dependence of ecstasy and related drugs in adolescents and young adults-a transient phenomenon? Results from a longitudinal community study.

OBJECTIVE: To determine incidence and patterns of natural course of ecstasy/stimulant/hallucinogen (ESH) use and disorders as well as cohort effects in a community sample of adolescents and young adults. METHOD: Cumulative incidence and patterns of ecstasy use and disorders were examined in a prospective longitudinal design (mean follow-up period=42 months) in a representative sample (N=2446) aged 14-24 years at the outset of the study. Patterns of DSM-IV defined ESH use, abuse and dependence were assessed with the Munich Composite International Diagnostic Interview (M-CIDI). RESULTS: (1) Cumulative lifetime incidence for use of ESH at second follow-up: 9.1%, 1.0% for abuse, 0.6% for dependence; (2) men used and abused ESH more often than women; (3) the younger birth cohort (1977-81) tended to start earlier with substance (ab)use compared to the older birth cohort (1970-77); (4) use of ESH was associated with increasing rates of concomitant use of other licit and illicit drugs; (5) the majority of the lifetime ESH users without disorder had stopped to use these substances and not consumed them during the 12 months preceding the second follow-up; (6) those who had stopped to take ecstasy and related drugs at follow-up also took other illicit drugs less often than those who continued to consume ESH. CONCLUSIONS: Use of designer drugs is widespread in our sample, but the probability of developing use disorders is fairly low (1.6%). The majority of the ESH users stopped their use spontaneously in their twenties (80% of the prior users without disorder, 67% of the prior abusers), but 50% of those that once had fulfilled DSM-IV criteria of dependence continued to use these substances.

Adolescent↗

PubMed2002

Parental major depression and the risk of depression and other mental disorders in offspring: a prospective-longitudinal community study.

BACKGROUND: This article examines associations between DSM-IV depressive disorders, their natural course, other psychopathology, and parental major depression in a community sample of adolescents and young adults. METHODS: Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study, a prospective-longitudinal community study of adolescents and young adults. Results are based on 2427 subjects who completed the follow-up and for whom diagnostic information for both parents was available. DSM-IV mental disorders in respondents were assessed using the Munich-Composite International Diagnostic Interview. Information on depression in parents was collected as family history information from the respondents and from diagnostic interviews with parents of the younger cohort. RESULTS: Offspring with 1 (odds ratio [OR], 2.7; 95% confidence interval [CI], 2.1-3.5) or 2 affected parents (OR, 3.0; 95% CI, 2.2-4.1) had an increased risk for depression. They also had a higher risk for substance use (1 parent affected: OR, 1.4; 95% CI, 1.1-1.7; both parents affected: OR, 1.4; 95% CI, 1.0-1.8) and anxiety disorders (1 parent affected: OR, 1.6; 95% CI, 1.3-1.9; both parents affected: OR, 2.1; 95% CI, 1.6-2.8). There were no differences whether mother or father was affected. Parental depression was associated with an earlier onset and a more malignant course (severity, impairment, recurrence) of depressive disorders in offspring. CONCLUSIONS: Major depression in parents increases the overall risk in offspring for onset of depressive and other mental disorders and influences patterns of the natural course of depression in the early stages of manifestation.

Adolescent↗

PubMed2002

Estimating the prevalence of mental and somatic disorders in the community: aims and methods of the German National Health Interview and Examination Survey.

This paper outlines the principal aims and design of the German National Health Interview and Examination Survey, mental health supplement (GHS-MHS), the first nationwide, epidemiological study of both somatic and mental health in Germany on a representative sample of 4,181 subjects in the community. Both the broader context of the study--in particular its methodological relation to the social and somatic core survey of the German National Health Interview and Examination Survey (GHS-CS)--and the internal methodology of the mental health supplement (GHS-MHS) are presented. The study's strategies and method are derived from a consideration of important theoretical issues arising from epidemiological studies in the field of public health. The main instrument used to assess diagnoses of mental disorders was a standardized diagnostic interview for mental disorders (following DSM-IV (CIDI)) applied by clinically trained interviewers. This diagnostic interview was supplemented by modules on comorbidity, help seeking, treatment and impairment. Somatic health diagnoses were made using an integrated approach including self-report measures, a standardized clinical interview, and laboratory measures. Findings on sampling, response rate, weighting and sample characteristics are presented. Critical issues are discussed, including the scientific objectives that have been achieved by the study. Overall, the GHS core survey and its mental health supplement provide the mental health research community with complex data that allow for high-quality analysis of mental disorders and associations with somatic disorders.

Adolescent↗

PubMed2002

Patterns of incidence and psychiatric risk factors for traumatic events.

Individual differences are thought to influence the propensity for exposure to trauma and the subsequent development of post-traumatic stress disorder (PTSD) symptoms. Prior research has identified pre-existing mood disorders as one such individual risk factor for traumatic events as well as for PTSD. The present study reports the incidence of traumatic events (and PTSD) and examines psychiatric risk factors for trauma exposure in a prospective community sample. Data come from a prospective, longitudinal epidemiological study of adolescents and young adults (age 14-24) in Munich, Germany. Respondent diagnoses (N = 2,548) at baseline and at follow-up 34-50 months later were considered. Psychiatric diagnoses at baseline were examined as predictors of qualifying trauma. Baseline prevalence of persons having experienced trauma meeting DSM-IV A1 and A2 criteria ('qualifying trauma') was 16.7%; during the follow-up period, 20.3% persons had experienced incident (new) qualifying traumata. The prevalence of PTSD, including subthreshold cases, at baseline was 5.6%; by the end of the follow-up period this had increased to 10.3%. Presence of an anxiety disorder at baseline predicted exposure to qualifying traumas during the follow-up period (adjusted ORs ranging from 1.36 for any trauma type to 3.00 for sexual trauma); this association was apparently due to an increased tendency to report events as being particularly horrific (meeting A2 criteria). In contrast, presence of illicit drug use predicted the onset of traumatic events (specifically assaultive and sexual trauma) meeting at least A1 criteria, suggesting an actual exposure to these types of traumatic events for this class of disorders. In this prospective study of urban adolescents and young adults, certain classes of pre-existing psychiatric disorders (most notably anxiety disorders and illicit drug use disorders) were associated with increased risk for qualifying traumatic events. The mechanisms by which premorbid psychiatric disorders promote exposure to traumatic events are unknown. Better understanding of these pathways may lead to novel strategies for primary and secondary prevention of PTSD.

Adolescent↗

PubMed2002

The natural course of DSM-IV somatoform disorders and syndromes among adolescents and young adults: a prospective-longitudinal community study.

OBJECTIVE: Although somatoform disorders are assumed to be chronic clinical conditions, epidemiological knowledge on their natural course based on representative samples is not available. METHOD: Data come from a prospective epidemiologic study of adolescents and young adults in Munich, Germany. Respondents' diagnoses (N = 2548) at baseline and follow-up on average 42 months later are considered. The follow-up incidence, stability as well as selected baseline risk factors (sociodemographics, psychopathology, trauma exposure) for the incidence and stability of somatoform disorders and syndromes are prospectively examined. Diagnostic information was assessed by using the standardized Munich-Composite International Diagnostic Interview (M-CIDI). RESULTS: Over the follow-up period, incidence rate for any of the covered somatoform diagnoses was 25.7%. Stability for the overall group of any somatoform disorder/syndrome was 48%. Female gender, lower social class, the experience of any substance use, anxiety and affective disorder as well as the experience of traumatic sexual and physical threat events predicted new onsets of somatoform conditions, while stability was predicted by being female, prior existing substance use, affective and eating disorders as well as the experience of a serious accident. CONCLUSIONS: At least for a substantial proportion of individuals, the overall picture of somatization seems to be relatively stable, but with fluctuation in the symptom picture over time. Being female, the experience of substance use as well as anxiety disorder seem to constitute risk factors for the onset of new somatoform conditions as well as for a stable course over time.

Adolescent↗

PubMed2002

Generalized anxiety and depression in primary care: prevalence, recognition, and management.

AIMS: Determine attitudes toward patients with generalized anxiety disorder (GAD) and major depressive episodes (MDE) in primary care; determine prevalence of GAD, MDE, and comorbid GAD/MDE among primary care patients; assess physician recognition of GAD and MDE; and describe primary care interventions for these patients. METHOD: 558 primary care physicians participated in a 1-day survey. Over 20,000 patients completed a diagnostic-screening questionnaire for GAD and MDE. Physician questionnaires included a standardized clinical appraisal of somatic and psychosocial symptoms and information on past and current treatments and a prestudy questionnaire assessing experience with and attitudes toward patients with GAD and MDE. RESULTS: 56.9% of physicians viewed GAD as a genuine mental disorder with clinical management problems and considerable patient burden; 27.4% treated GAD patients differently from MDE patients. 5.3% of patients met criteria for GAD, 6.0% for MDE, 3.8% for pure GAD, 4.4% for pure MDE, and 1.6% for comorbid GAD/MDE. Pure GAD and MDE were associated with disability, high utilization of health care resources, and suicidality, which were even higher with comorbid GAD/MDE. Physicians recognized clinically significant emotional problems in 72.5% of patients with pure GAD, 76.5% with pure MDE, and 85.4% with comorbid GAD/MDE. However, correct diagnosis was much lower (64.3% for MDE and 34.4% for GAD). Although the majority of patients with recognized GAD or MDE were treated, only a small minority with GAD were prescribed medications or referred to specialists. CONCLUSION: The high proportion of respondents with pure GAD is inconsistent with previous reports that GAD is usually comorbid with depression. GAD remains poorly recognized and inadequately treated. Improving the recognition and treatment of GAD in primary care patients is discussed relative to new treatments.

Adolescent↗

PubMedDate not supplied

Parental depression and depression in offspring: evidence for familial characteristics and subtypes?

The objectives of this paper were twofold. First, to evaluate in a community sample the age of onset of major depression in adolescents and young adults with and without parental major depression. Second, to examine whether specific clinical characteristics of major depression in adolescents and young adults are associated with elevated rates of major depression among parents. Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study (EDSP), a prospective-longitudinal community study of adolescents and young adults. Results are based on 470 subjects who completed the follow-up, for whom diagnostic information for both parents was available, and who reported at least one episode of major depression according to DSM-IV-criteria through second follow-up. Diagnostic assessment in respondents was accomplished by using the standardized Munich-Composite International Diagnostic Interview (M-CIDI). Information on major depression in parents was collected as family history information from the respondents, and additionally from M-CIDI diagnostic interviews with parents of the younger cohort. Both recurrence and impairment as clinical characteristics of major depression in adolescents and young adults were associated with elevated rates of major depression among parents. Age of onset as well as overall higher impairment as clinical characteristics of major depression in youth were associated with elevated rates of parental major depression in the univariate, but not in the multiple, analyses. Our findings suggest that clinical features of major depression may indicate familial subtypes of the disorder, most evident for recurrence and impairment.

Adolescent↗