@article{DeekenRapp2022, author = {Deeken, Friederike and Rapp, Michael Armin}, title = {Technology-based interventions as an approach to treating apathy in people with dementia}, series = {International psychogeriatrics : the official journal of the International Psychogeriatric Association}, volume = {34}, journal = {International psychogeriatrics : the official journal of the International Psychogeriatric Association}, number = {2}, publisher = {Cambridge Univ. Press}, address = {Cambridge}, issn = {1741-203X}, doi = {10.1017/S1041610222000035}, pages = {95 -- 96}, year = {2022}, language = {en} } @article{BlockSchulzeDeekenetal.2021, author = {Block, Andrea and Schulze, Susanne and Deeken, Friederike and H{\"a}usler, Andreas and Rezo, Anna and Rapp, Michael Armin and Wippert, Pia-Maria}, title = {Effects of inflammatory markers and biographical stress on treatment response in depression}, series = {Psychoneuroendocrinology : an international journal ; the official journal of the International Society of Psychoneuroendocrinology}, volume = {131}, journal = {Psychoneuroendocrinology : an international journal ; the official journal of the International Society of Psychoneuroendocrinology}, number = {Supplement}, publisher = {Elsevier}, address = {Oxford}, issn = {0306-4530}, doi = {10.1016/j.psyneuen.2021.105535}, pages = {S24 -- S24}, year = {2021}, abstract = {Background Recent research emphasized the role of inflammatory processes in the pathophysiology of depression. Theories hypothesizes that life events (LE) can affect the immune system and trigger depressive symptoms. LE are also considered as one of the best predictors for the onset and course of depressive disorders. Methods Observational study across three treatment settings: n=208 depressive patients (75.5\%f, M 46.6 y) were examined on depression (BDI-II), life events (ILE) and inflammatory markers (IL-6, CRP, fibrinogen, ICAM-1, TNF-alpha, E-selectin) at baseline (t0), 5-week(t1) and 5-month(t2) follow-up. Effects and interactions were analyzed with regression models. Results LE were associated with depressive symptoms at t0 (beta=.209; p=.002) and both follow-ups. Except for CRP, which was linked to depression symptoms at t2 (betai=-.190; p=.032), there were no effects of inflammatory markers on depressive symptoms. At t1, an interaction between CRP and LE in total (beta=-.249; p=.041) was found as well as for LE in the past five years (beta=-.122; p=.027). Similar interactions were found between cumulative LE and ICAM-1 (beta=-.197; p=.003) and IL-6 (beta=-.425; p=.001). Conclusion The cumulative burden of LE effects symptoms and treatment outcome in depressive patients. There is some evidence that inflammatory marker may have long-term effects on treatment outcome as they seem to weaken the determining relation between LE and depression.}, language = {en} } @article{DeekenReichertZechetal.2022, author = {Deeken, Friederike and Reichert, Markus and Zech, Hilmar and Wenzel, Julia and Wedemeyer, Friederike and Aguilera, Alvaro and Aslan, Acelya and Bach, Patrick and Bahr, Nadja Samia and Ebrahimi, Claudia and Fischbach, Pascale Christine and Ganz, Marvin and Garbusow, Maria and Großkopf, Charlotte M. and Heigert, Marie and Hentschel, Angela and Karl, Damian and Pelz, Patricia and Pinger, Mathieu and Riemerschmid, Carlotta and Rosenthal, Annika and Steffen, Johannes and Strehle, Jens and Weiss,, Franziska and Wieder, Gesine and Wieland, Alfred and Zaiser, Judith and Zimmermann, Sina and Walter, Henrik and Lenz, Bernd and Deserno, Lorenz and Smolka, Michael N. and Liu, Shuyan and Ebner-Priemer, Ulrich Walter and Heinz, Andreas and Rapp, Michael Armin}, title = {Patterns of Alcohol Consumption Among Individuals With Alcohol Use Disorder During the COVID-19 Pandemic and Lockdowns in Germany}, series = {JAMA Network Open}, volume = {5}, journal = {JAMA Network Open}, edition = {8}, publisher = {JAMA Network / American Medical Association}, address = {Chicago, Illinois, USA}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2022.24641}, pages = {1 -- 11}, year = {2022}, abstract = {Importance Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence. Objective To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms. Design, Setting, and Participants This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021). Main Outcomes and Measures Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates. Results Of the 1743 screened participants, 189 (119 [63.0\%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (β = 11.39; 95\% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (β = 26.82; 95\% CI, 21.87-31.77; P < .001) and New Year's Eve (β = 66.88; 95\% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (β = 0.12; 95\% CI, 0.06-0.15; P < .001), but AC was significantly lower (β = -5.45; 95\% CI, -8.00 to -2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (β = -11.10; 95\% CI, -13.63 to -8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (β = -6.14; 95\% CI, -9.96 to -2.31; P = .002) and in participants with severe AUD (β = -6.26; 95\% CI, -10.18 to -2.34; P = .002). Conclusions and Relevance This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals.}, language = {en} } @article{DeekenHaeuslerNordheimetal.2017, author = {Deeken, Friederike and H{\"a}usler, Andreas and Nordheim, Johanna and Rapp, Michael Armin and Knoll, Nina and Rieckmann, Nina}, title = {Psychometric properties of the Perceived Stress Scale in a sample of German dementia patients and their caregivers}, series = {International psychogeriatrics}, volume = {30}, journal = {International psychogeriatrics}, number = {1}, publisher = {Cambridge Univ. Press}, address = {New York}, issn = {1041-6102}, doi = {10.1017/S1041610217001387}, pages = {39 -- 47}, year = {2017}, abstract = {Background: The aim of the present study was to investigate the psychometric characteristics of the Perceived Stress Scale (PSS) in a sample of dementia patients and their spousal caregivers. Methods: We investigated the reliability and validity of the 14-item PSS in a sample of 80 couples, each including one spouse who had been diagnosed with mild to moderate dementia (mean age 75.55, SD = 5.85, 38.7\% female) and one spousal caregiver (mean age 73.06, SD = 6.75, 61.3\% female). We also examined the factor structure and sensitivity of the scale with regard to gender differences. Results: Exploratory factor analysis of the PSS revealed a two-factor solution for the scale; the first factor reflected general stress while the second factor consisted of items reflecting the perceived ability to cope with stressors. A confirmatory factor analysis verified that the data were a better fit for the two-factor model than a one-factor model. The two factors of the PSS showed good reliability for patients as well as for caregivers ranging between alpha = 0.73 and alpha = 0.82. Perceived stress was significantly positively correlated with depressive symptomatology in both caregivers and patients. Mean PSS scores did not significantly differ between male and female patients nor did they differ between male and female caregivers. Conclusion: The present data indicate that the PSS provides a reliable and valid measure of perceived stress in dementia patients and their caregivers.}, language = {en} } @article{DeekenRezoHinzetal.2019, author = {Deeken, Friederike and Rezo, Anna and Hinz, Matthias and Discher, Robert and Rapp, Michael Armin}, title = {Evaluation of technology-based interventions for informal caregivers of patients with dementia}, series = {The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry}, volume = {27}, journal = {The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry}, number = {4}, publisher = {Elsevier}, address = {New York}, issn = {1064-7481}, doi = {10.1016/j.jagp.2018.12.003}, pages = {426 -- 445}, year = {2019}, abstract = {Objective: The aim of this study was to estimate the efficacy of technology-based interventions for informal caregivers of people with dementia (PWD). Methods: PubMed, PsycINFO, and Cochrane Library databases were searched in August 2018, with no restrictions in language or publication date. Two independent reviewers identified 33 eligible randomized controlled trials (RCTs) conducting a technology-based intervention for informal carers of PWD. Meta-analyses for the outcome measures caregiver depression and caregiver burden were conducted with subgroup analyses according to mode of delivery (telephone, computer/web-based, combined interventions). To assess methodologic quality, the Cochrane risk-of-bias assessment was rated. Results: Meta-analyses revealed a small but significant postintervention effect of technology-based interventions for caregiver depression and caregiver burden. Combined interventions showed the strongest effects. Conclusion: Technology-based interventions have the potential to support informal caregivers of PWD. Because of advantages such as high flexibility and availability, technology-based interventions provide a promising alternative compared with "traditional services," e.g., those for people living in rural areas. More high-quality RCTs for specific caregiver groups are needed.}, language = {en} } @article{HaeuslerSanchezGellertetal.2016, author = {H{\"a}usler, Andreas and S{\´a}nchez, Alba and Gellert, Paul and Deeken, Friederike and Rapp, Michael Armin and Nordheim, Johanna}, title = {Perceived stress and quality of life in dementia patients and their caregiving spouses: does dyadic coping matter?}, series = {International psychogeriatrics}, volume = {28}, journal = {International psychogeriatrics}, publisher = {Cambridge Univ. Press}, address = {New York}, issn = {1041-6102}, doi = {10.1017/S1041610216001046}, pages = {1857 -- 1866}, year = {2016}, abstract = {Background: Given the well-established association between perceived stress and quality of life (QoL) in dementia patients and their partners, our goal was to identify whether relationship quality and dyadic coping would operate as mediators between perceived stress and QoL. Results: We found negative correlations between stress and QoL in both partners (QoL-AD: r = -0.62; p < 0.001; WHO-QOL Overall: r = -0.27; p = 0.02). Spousal caregivers had a significantly lower DCI total score than dementia patients (p < 0.001). Dyadic coping was a significant mediator of the relationship between stress and QoL in spousal caregivers (z = 0.28; p = 0.02), but not in dementia patients. Likewise, relationship quality significantly mediated the relationship between stress and QoL in caregivers only (z = -2.41; p = 0.02). Conclusions: This study identified dyadic coping as a mediator on the relationship between stress and QoL in (caregiving) partners of dementia patients. In patients, however, we found a direct negative effect of stress on QoL. The findings suggest the importance of stress reducing and dyadic interventions for dementia patients and their partners, respectively.}, language = {en} } @article{SanchezThomasDeekenetal.2019, author = {S{\´a}nchez, Alba and Thomas, Christine and Deeken, Friederike and Wagner, S{\"o}ren and Kl{\"o}ppel, Stefan and Kentischer, Felix and von Arnim, Chrstine A. F. and Denkinger, Michael and Conzelmann, Lars O. and Biermann-Stallwitz, Janine and Joos, Stefanie and Sturm, Heidrun and Metz, Brigitte and Auer, Ramona and Skrobik, Yoanna and Eschweiler, Gerhard W. and Rapp, Michael Armin}, title = {Patient safety, cost-effectiveness, and quality of life}, series = {Trials}, volume = {20}, journal = {Trials}, number = {71}, publisher = {BioMed Central}, address = {London}, issn = {1468-6694}, doi = {10.1186/s13063-018-3148-8}, pages = {15}, year = {2019}, abstract = {Background Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients' age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective. Methods The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures. Discussion Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances. Trial registration German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017.}, language = {en} }