R. Eberle-Sejari, Agnes Nocon, J. Unterhitzenberger, R. Rosner
The effectiveness of psychosocial interventions in young war-traumatized refugees – systematic review and meta-analysis
European Journal of Psychotraumatology, vol. 8, no. Sup2
Background: The United Nations reported that in 2016 over 65 million people worldwide have forcibly left home. Over 50% are children and adolescents; a substantial number has been traumatized and displaced by war. Objective: To provide an overview of the effectiveness of psychosocial interventions in this group we conducted a narrative review and a meta-analysis of intervention studies providing data on posttraumatic stress symptoms (PTSS), depression, anxiety, grief, and general distress. Method: We searched PILOTS, MEDLINE, WoS, Embase, CENTRAL, LILACS, PsycINFO, ASSIA, CSA, and SA for studies on treatment outcomes for war-traumatized displaced children and adolescents. Between-group effect sizes (ES) and pre-post ES were reconstructed for each trial. Overall pre-post ES were calculated using a random effects model. Results: The narrative review covers 23 studies with a variety of treatments. Out of the 35 calculated between-group ES, only six were significant, all compared to untreated controls. Two of them indicated significant adverse effects on symptoms of general distress or depression. When calculating pre-post effect sizes, the positive between-group results of cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) were reproduced and singular other treatments showed significant positive effects. However, the mean pre-post effects for PTSS and depression could not be interpreted due to the high heterogeneity of the included studies (PTSS: ES = 0.78; I2 = 88.6%; depression: ES = 0.35; I2 = 93.1%). Only the mean pre-post effect for seven active CBT treatment groups for depression (ES = 0.30, 95% CI [0.18, 0.43]) was interpretable (Q = 3.3, df = 6, p = .77). Conclusion: Given the large number of children and adolescents displaced by war there were regrettably few treatment studies available, and many of them were of low methodological quality. The effect sizes lagged behind the effects observed in traumatized minors in general, and often were small or non-significant. However, CBT and IPT showed promising results that need further replication.
R. Eberle-Sejari, Agnes Nocon, R. Rosner
Zur Wirksamkeit psychotherapeutischer Interventionen bei jungen Flüchtlingen und Binnenvertriebenen mit posttraumatischen Symptomen – ein systematischer Review
Kindheit und Entwicklung, vol. 24, no. 3, pp. 156-169
Trotz hoher Zahlen junger Flüchtlinge und der häufig hohen Belastung mit Symptomen einer Posttraumatischen Belastungsstörung (PTBS) gibt es Unsicherheiten über Therapiemöglichkeiten und deren Effektivität in dieser Patientengruppe. Zur Untersuchung der Wirksamkeit unterschiedlicher Interventionen wurde ein systematischer Review durchgeführt. Nach einer Literaturrecherche mit 798 Treffern erfüllten zehn Studien die Einschlusskriterien. Acht Studien konnten signifikante Reduktionen der PTBS-Symptomatik feststellen. Vielversprechend erscheinen dabei folgende Therapien: Narrative Expositionstherapie für Kinder, „Meditation-Relaxation”, Eye Movement Desensitization and Reprocessing und „Rapid-Ed-Therapie”. Aufgrund der dürftigen Studienlage und methodischer Mängel ist eine genauere Empfehlung allerdings schwierig.
D. Kartal, K. Fodor, S. Yoo, E. Alisic, L. Soler, Agnes Nocon, J. Unterhitzenberger, S. Leistner, M. Milosavljevic, J. White, C.-Y. Chou
Is traumatic stress research global? A bibliometric analysis
European Journal of Psychotraumatology, vol. 5
Agnes Nocon, R. Rosner, S. Jan
Psychotherapeutic interventions from the western world in war-traumatized children - a metaanalysis
[Congress Abstract; 13th European Conference on Traumatic Stress: Trauma and its clinical pathways; PTSD and beyond; June 6-9, 2013, Bologna, Italy]
European Journal of Psychotraumatology, vol. 55, no. 4
S. Knappe, Agnes Nocon, K. Beesdo-Baum, H.-U. Wittchen
Re-examining the differential familial liability of agoraphobia and panic disorder
Depression and Anxiety, vol. 29, no. 11, pp. 931-938
Controversy surrounds the question of whether agoraphobia (AG) exists as an independent diagnostic entity apart from panic. In favor of this position, AG without panic disorder (PD) in parents was found being unrelated to offsprings' risk for AG or PD, albeit it may enhance the familial transmission of PD (Nocon et al., Depress Anxiety 2008;25:422-434). However, a recent behavioral genetic analysis (Mosing et al., Depress Anxiety 2009;26:1004-1011) found an increased risk for both PD and AG in siblings of those with AG without PD, casting doubt on whether AG exists independently of PD. Convincing evidence for either position notably requires considering also other anxiety disorders to establish the position of AG relative to the panic/anxiety spectrum.
Familial transmission of panic attacks (PAs), PD, and AG was examined in a 10-year prospective-longitudinal community study of 3,021 adolescents and young adults including completed direct and indirect information on parental psychopathology. Standardized diagnostic assessments using the Munich-Composite International Diagnostic Interview allowed generating exclusive diagnostic groups independent from diagnostic hierarchy rules.
Parental PD without AG was associated with an increased risk for PA and PD+AG, but not for PD without AG or AG without PD in offspring. Parental AG without PD was unrelated to the offsprings' risk for PA, exclusive PD or AG, or PD+AG. Findings were largely unaffected by adjustment for other offspring or parental anxiety disorders.
Findings provide further evidence for the independence of AG apart from the PD spectrum.
R. Lieb, A. Heck, M. Uhr, Agnes Nocon, T. Brückl, M. Ising, E. Binder, P. Zimmermann, H. Pfister, F. Holsboer
Interaction of FKBP5 gene variants and adverse life events in predicting depression onset: Results from a 10-year prospective community study
American Journal of Psychiatry, vol. 168, no. 10, pp. 1107-1116
The binding protein FKBP5 is an important modulator of the function of the glucocorticoid receptor, the main receptor of the stress hormone system. This turns the FKBP5 gene into a key candidate for gene-environment interactions, which are considered critical for pathogenesis of stress-related disorders. The authors explored gene-environment interactions between FKBP5 gene variants and adverse life events in predicting the first occurrence of a major depressive episode.
The analyses were based on 884 Caucasians in a 10-year prospective community study. At baseline, they were 14–24 years old and did not fulfill criteria for a major depressive episode. The DSM-IV-based Munich Composite International Diagnostic Interview was used to assess adverse life events preceding baseline and major depressive episodes during follow-up. On the basis of previous findings, five single-nucleotide polymorphisms (SNPs) within the FKBP5 gene were selected for genotyping.
While the authors did not observe genetic main effects, they found interactions between the five SNPs and traumatic (but not separation) events, with the strongest effect for severe trauma. The effect of trauma on incident major depressive episodes was evident among subjects homozygous for the minor alleles but not subjects with other genotypes. The findings were replicated in the U.K. Environmental Risk Longitudinal Twin Study.
These hypothesis-driven results suggest that an interaction between FKBP5 genotype and trauma is involved in the onset of depression. Subjects homozygous for the minor alleles of the investigated FKBP5 SNPs seem to be particularly sensitive to effects of trauma exposure in terms of triggering depression onset.
R. Lieb, M. Uhr, Agnes Nocon, T. Brückl, M. Ising, P. Zimmermann, H.-U. Wittchen, E. Binder, H. Pfister, F. Holsboer
The interplay of variations in the FKBP5 gene and adverse life events in predicting the first onset of depression during a ten-year follow-up
[Congress Abstract; 26th Symposium of the AGNP; Munich; October, 7-10, 2009]
Pharmacopsychiatry, vol. 42, no. 5
R. Lieb, Agnes Nocon, T. Brückl, P. Zimmermann, Angst, H.-U. Wittchen, H. Pfister, F. Holsboer
Heterogeneity of DSM-IV Major Depressive Disorder as a Consequence of Subthreshold Bipolarity
Archives of General Psychiatry, vol. 66, no. 12, pp. 1341-1352
J. Rehm, R. Lieb, Agnes Nocon, T. Brückl, P. Zimmermann, H.-U. Wittchen, H. Pfister, M. Höfler, H. Irving
Pathways into panic and phobias
The International Journal of Neuropsychopharmacology, vol. 11, no. Suppl. 1
R. Lieb, Agnes Nocon, K. Beesdo, D. Pine, H.-U. Wittchen, A. Gloster, M. Hoefler
Agoraphobia and Panic: Prospective-longitudinal Relations Suggest a Rethinking of Diagnostic Concepts
Psychotherapy and Psychosomatics, vol. 77, no. 3, pp. 147-157
Background: The relationship of panic attacks (PA), panic disorder (PD) and agoraphobia (AG) is controversial. The aim of the current study is to prospectively examine the 10-year natural course of PA, PD and AG in the first three decades of life, their stability and their reciprocal transitions. Methods: DSM-IV syndromes were assessed via Composite International Diagnostic Interview – Munich version in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14–24 years at baseline. Results: (1) Incidence patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed differences in age of onset, incidence risk and gender differentiation. (2) Temporally primary PA and PD revealed only a moderately increased risk for subsequent onset of AG, and primary AG had an even lower risk for subsequent PA and PD. (3) In strictly prospective analyses, all baseline groups (PA, PD, AG) had low remission rates (0–23%). Baseline PD with AG or AG with PA were more likely to have follow-up AG, PA and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to PD without AG and AG without PA. Conclusions: Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that AG exists as a clinically significant phobic condition independent of PD. The majority of agoraphobic subjects in this community sample never experienced PA, calling into question the current pathogenic assumptions underlying the classification of AG as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.
R. Lieb, Agnes Nocon, T. Brückl, K. Beesdo, M. Ising, P. Zimmermann, H.-U. Wittchen
The interplay of familial depression liability and adverse events in predicting the first onset of depression during a 10-year follow-up
Biological Psychiatry, vol. 63, no. 4, pp. 406-414
The aim of the present article is to explore interaction and correlation effects between familial depression liability and selected adverse (separation and traumatic) events in predicting the first onset of a major depressive episode (MDE) in a 10-year prospective longitudinal community survey.
Analyses are based on 1982 subjects (14 to 24 years at baseline) without baseline MDE who participated during the whole study period and for whom diagnostic information about psychopathology in both parents was available. The offspring's familial depression liability was determined by aggregating information on parental depressive symptoms obtained from family history data and direct interviews with parents. Data were assessed with the Munich-Composite International Diagnostic Interview according to its DSM-IV algorithms.
Adverse events predicted a substantially increased incidence of MDE among respondents with familial liability but not in those without familial liability. There was a significant interaction between familial liability and traumatic events with the strongest effect for the number of severe traumatic events (risk difference = 11.3%; 95% confidence interval = 3.55-19.15). Associations with familial liability were most pronounced for separation events.
Adverse events are particularly pathogenic in individuals with familial liability. The involvement of interactions and correlations between familial liability and adversity might depend on type, severity, and number of events. Both processes are suggested to be concomitant rather than exclusive.