Drinking, Family Relations and Authority in Early Modern Germany

The ideal of orderly family life in early modern Germany did not exclude drinking. In fact, drinks shared at the family table were closely tied to early modern notions of the marital bond and were also a necessary component of normal work relations. Drinking became a problem only when it threatened the stability of the household. The amount of alcohol involved in such cases might be as little as one drink if the circumstances were unsuitable. On the other hand, drinking that would by our standards be viewed as excessive or chronic could be considered acceptable . Even during and immediately after the period of Reformation, when polemical and prescriptive literature addressing the household was dominated by the problem of sin, drunkenness was rarely treated as a spiritual issues. The primary concern of both authorities and populace was not to protect the health or the rights of individuals but to protect the sanctity of the household and the stability of the community.

Trust and Social Networks in a Changing Europe.

This project set out to investigate the effects of the recent massive social transitions in Eastern Europe on the everyday social lives of the inhabitants of three very different nations: Georgia, Russia and Hungary. It focused in particular on the availability and nature of the support networks available to three different segments of each of the societies (manual workers, students and entrepreneurs) and the impact of network participation on psychological and physical well-being. The group set four specific questions to investigate: the part played by individual psychological beliefs in the formation and maintenance of social networks and the consequent formation of trusting relations; the implication of the size and quality of these networks for mental health; the nature of the social groups inhabited by the respondents and the implication of their work schedule and daily routines on the maintenance of a social and family life; and an analysis of how cultures vary in their social networks and intimacy. Three different methods were used to examine social support and its implications: structured questionnaires, semi-structured short interviews and a media analysis of newspaper materials. The questionnaires were administered to 150 participants in each country, equally divided between students studying full time, manual workers employed in factories, and business people (small kiosk owners, whose work and life style differs considerably from that of the manual workers). The questionnaires investigated various predictors of social support including the locus of control, relationship beliefs, individualism-collectivism and egalitarianism, demographic variables (age, gender and occupation), social support, both in general and in relation to significant events that have occurred since the transition from communism. Those with an internal locus of control were more likely to report a higher level of social support, as were collectivists, while age too was a significant predictor, with younger respondents enjoying higher levels of support, regardless of the measures of support employed. Respondents across the cultures referred to a decline of social support and the group also found a direct correlation between social support and mental health outcomes. All 450 respondents were interviewed on their general responses to changes in their lives since the fall of communism and the effects of their work lives on their social lives and the home environment. The interviews revealed considerable variations in the way in which work-life offered opportunities for a broader social life and also provided a hindrance to the development of fulfilling relationships. Many of the work experiences discussed were culture specific, with work having a particularly negative impact on the social life of Russian entrepreneurs but being seen much more positively in Georgia. This may reflect the nature of support offered in a society as overall support levels were lowest in Russia, meaning that social support may be of particular importance there. The way in cultural values and norms about personal relationships are transmitted in a culture is a critical issue for social psychologists and the group examined newspaper articles in those newspapers read by the respondents in each of the three countries. These revealed a number of different themes. The concept of a divided society and its implications for personal relationships was clearest in Russian and Hungary, where widely-read newspapers dwelt on the contrast between "new Russians/Hungarians" and the older, poorer ones and extended considerable sympathy to those suffering from neglect in institutions. Magyar Nemzet, a paper widely read by Hungarian students reflects the generally more pessimistic tone about personal relationships in Russia and Hungary and gave a particularly detailed analysis of the implications this holds for human relations in a modern society. In Georgia, however, the tone of the newspapers is more positive, stressing greater social cohesion. Part of this cohesion is framed in the context of religion, with the church appealing to a broader egalitarianism, whereas in less egalitarian Hungary appeals by the Church are centred more on the nuclear family and its need for expansion in both size and influence. The division between the sexes was another prominent issue in Hungary and Russia, while the theme of generational conflict also emerged in Hungarian and Georgian papers, although with some understanding of "young people today". The team's original expectation that the different newspapers read by the different groups of respondents would present differing images of personal relationships was not fulfilled, as despite variations in style, they found little clear "ideological targeting" of any particular readership. They conclude that the vast majority of respondents recognised that the social transition from communism has had a significant impact on the well-being of social relationships and that this is a pertinent issue for all segments of society. While the group see the data collected as a source to be worked on for some time in the future, their initial impressions include the following. Social support is clearly an important concern across all three countries. All respondents (including the students) lament the time taken up by their heavy work schedules and value their social networks and family ties in particular. The level of social support differs across the countries investigated, with Georgian apparently enjoying significantly higher levels of social support. The analysis produced an image of a relatively cohesive and egalitarian society in which even the group most often seen as distant from the general population, business people, is supported by a strong social network. In contrast, the support networks available to the Russian respondents seem particularly weak and reflect a general sense of division and alienation within the culture as a whole. The implications of low levels of social support may vary across countries. While Russians reported the lowest level of mental health problems, the link between social support and mental health may be strongest in that country. In contrast, in Hungary it is the link between fatalism and mental health problems which is particularly strong, while in Georgia the strongest correlation was between mental health and marital quality, emphasising the significance of the marital relationship in that country.

Self-conscious emotions and depression: Rumination explains why shame, but not guilt, is maladaptive

Feelings of shame and guilt are factors associated with depression. However, studies simultaneously investigating shame and guilt suggest that only shame has a strong unique effect, although it is not yet clear which psychological processes cause shame and not shame-free guilt to be related to depression. The authors hypothesized that shame, in contrast to guilt, elicits rumination, which then leads to depression. Therefore, in this study we investigated event-related shame and guilt, event-related rumination, and depression among 149 mothers and fathers following family breakup due to marital separation. Data were analyzed using latent variable modeling. The results confirm that shame but not guilt has a strong unique effect on depression. Moreover, the results show that the effect of shame is substantially mediated by rumination. The results are discussed against the background of self-discrepancies and self-esteem.

Substance use disorder treatment programs in Switzerland and the USA: Program characteristics and 1-year outcomes

AIM: This study compared matched samples of substance use disorder (SUD) patients in Swiss and United States (US) residential treatment programs and examined the relationship of program characteristics to patients' substance use and psychosocial functioning at a 1-year follow-up. DESIGN AND SETTING: The study used a prospective, naturalistic design and a sample of 10 public programs in the German-speaking part of Switzerland and 15 US public treatment programs. PARTICIPANTS: A total of 358 male patients in Swiss programs were matched on age, marital status and education with 358 male patients in US programs. A total of 160 Swiss and 329 US patient care staff members also participated. MEASUREMENT: Patients completed comparable inventories at admission, discharge and 1-year follow-up to assess their substance use and psychological functioning and receipt of continuing care. Staff members reported on program characteristics and their beliefs about substance use. FINDINGS: Compared to Swiss patients, US patients had more severe substance use and psychological problems at intake and although they did not differ on abstinence and remission at follow-up, had somewhat poorer outcomes in other areas of functioning. Swiss programs were longer and included more individual treatment sessions; US programs included more group sessions and were more oriented toward a disease model of treatment. Overall, length of program, treatment intensity and 12-step orientation were associated with better 1-year outcomes for patients in both Swiss and US programs. CONCLUSIONS: The sample of Swiss and US programs studied here differed in patient and treatment characteristics; however, in general, there were comparable associations between program characteristics and patients' 1-year outcomes. These findings suggest that associations between treatment processes and patients' outcomes may generalize from one cultural context to another.

Checking Assumptions in Latent Class Regression Models via a Markov Chain Monte Carlo Estimation Approach: An Application to Depression and Socio-Economic Status

Latent class regression models are useful tools for assessing associations between covariates and latent variables. However, evaluation of key model assumptions cannot be performed using methods from standard regression models due to the unobserved nature of latent outcome variables. This paper presents graphical diagnostic tools to evaluate whether or not latent class regression models adhere to standard assumptions of the model: conditional independence and non-differential measurement. An integral part of these methods is the use of a Markov Chain Monte Carlo estimation procedure. Unlike standard maximum likelihood implementations for latent class regression model estimation, the MCMC approach allows us to calculate posterior distributions and point estimates of any functions of parameters. It is this convenience that allows us to provide the diagnostic methods that we introduce. As a motivating example we present an analysis focusing on the association between depression and socioeconomic status, using data from the Epidemiologic Catchment Area study. We consider a latent class regression analysis investigating the association between depression and socioeconomic status measures, where the latent variable depression is regressed on education and income indicators, in addition to age, gender, and marital status variables. While the fitted latent class regression model yields interesting results, the model parameters are found to be invalid due to the violation of model assumptions. The violation of these assumptions is clearly identified by the presented diagnostic plots. These methods can be applied to standard latent class and latent class regression models, and the general principle can be extended to evaluate model assumptions in other types of models.

[Changes in partner relationship after organ transplantation: comparison between heart, liver, and kidney transplantation]

AIM: This study was conducted to delineate partnership-relation functioning over time and specifically matched to various organs such as heart, liver, and kidney. METHOD: Prospective, paralleled case-control-study including patients and their respective partners before and one year after organ transplantation in 23 heart-transplant recipients, 19 liver-transplant patients, and 16 kidney-transplant recipients. To assess partnership functioning, the FB-Z (family assessment measure) of Cierpka and Frevert was used. Statistics included descriptive methods, correlations, and analysis of variance including the items "organ" and "time". RESULTS: Heart-transplant recipients and their partners show significant better overall measures in their partnership ratings (sum-value) in comparison to liver or kidney patients and their partners. In all patient and partner groups, except in kidney-transplant recipients a significant deterioration over time is discernible in the subscales role performance and emotionality. In respect to the item "organ" significant differences were found in overall functioning and the subscale communication where heart-transplant recipients and their partners have significant better functioning compared to kidney or liver transplant patients. In kidney patients and their partners only communication changes to the better in the time course. CONCLUSION: In any organ transplantation the two sides of the coin are important to bear in mind, the one is the live-saving act of transplantation as such, the other is the important distress in the phase before but equally after the operation, mainly in the first year where patients and their respective partners have to be followed and treated even in respect to psychosocial and marital functioning.

Solid organ transplantation: are there predictors for posttransplant noncompliance? A literature overview

BACKGROUND: Many studies confirm that noncompliance or poor compliance is one of the great problems in health care as it results in waste of resources and funds. METHODS: This overview includes literature on heart, liver, and kidney transplants with emphasis on heart transplantation in adult and pediatric transplant patients and addresses the following variables as potential predictors of postoperative compliance problems: demographic variables (age, marital status, gender) psychological variables (anxiety, denial) psychiatric disorders (major depression, anxiety, and personality disorders), poor social support, pretransplant noncompliance, obesity, substance abuse, and health-related variables (distance from transplant center, indication for transplantation, required pretransplant assist device). Relevant studies on these topics that were conducted up to 1999 are included and discussed in this overview. The most important results are presented in tables. RESULTS: Unfortunately, there has not been any systematic and comprehensive review of the literature on predictors of noncompliance in organ transplant patients so far. With organ transplantation noncompliance impairs both life quality and life span as it is a major risk factor for graft rejection episodes and is responsible for up to 25% of deaths after the initial recovery period. Therefore, it might be assumed that well-informed transplant patients are a highly motivated group whose compliance is just as high. This is not the case. However, even when graft loss means loss of life as in heart or liver transplantation, noncompliance occurs. To best select potential organ recipients, it would be ideal if patients who are very likely to show noncompliant behavior could be identified already before being transplanted. CONCLUSION: The literature overview shows the necessity of preoperative psychosocial screening regarding predictors for posttransplant noncompliance.

Suicide Bombers in Israel: Their Motivations, Characteristics, and Prior Activity in Terrorist Organizations

This paper examines the characteristics of suicide bombers as reflected in the Israeli press during the Second Intifada in Israel. The analysis aims to determine whether there were significant differences in the characteristics of suicide bombers with religious motives versus those with nationalist motives. The findings reveal that gender, education level, and organizational affiliation correlated significantly with motives for carrying out suicide attacks. Most of the suicide bombers with religious motives were men with elementary education. In addition, the results show that most of the suicide bombers who were affiliated with the Hamas organization acted out of religious motives. No significant differences were found between suicide bombers with religious and those with nationalist motives with regard to age, marital status, and prior activity in terrorist organizations.

Domestic Violence

Since the 1960s, there has been growing awareness regarding the issue of domestic violence as a form of violence against women, which has been largely influenced by the work of feminist activist and scholars in North America and Europe (Dobash and Dobash 1992). Other terms have been used to describe the same phenomenon, including domestic abuse, spousal abuse, wife battering, marital violence, intimate partner violence. Though there is no doubt that this problem has existed for much more than five decades, the tendency to label it as ‘private matters’ or ‘marital disagreements’ has obscured the reality of women living with abuse in their home. At a general level, domestic violence can be defined as the means used by a man in order to assert his control and domination over his intimate partner, whether they are married or not (Mullender 1996). It can involve incidents of physical and sexual violence, as well as verbal, psychological and financial abuse. Though some of its manifestations may be associated with particular cultural or religious groups – e.g. forced marriage and honour killing in South-Asian communities – domestic violence affects women from all classes and backgrounds.

Impact of unlinked deaths and coding changes on mortality trends in the Swiss National Cohort

BACKGROUND Results of epidemiological studies linking census with mortality records may be affected by unlinked deaths and changes in cause of death classification. We examined these issues in the Swiss National Cohort (SNC). METHODS The SNC is a longitudinal study of the entire Swiss population, based on the 1990 (6.8 million persons) and 2000 (7.3 million persons) censuses. Among 1,053,393 deaths recorded 1991-2007 5.4% could not be linked using stringent probabilistic linkage. We included the unlinked deaths using pragmatic linkages and compared mortality rates for selected causes with official mortality rates. We also examined the impact of the 1995 change in cause of death coding from version 8 (with some additional rules) to version 10 of the International Classification of Diseases (ICD), using Poisson regression models with restricted cubic splines. Finally, we compared results from Cox models including and excluding unlinked deaths of the association of education, marital status, and nationality with selected causes of death. RESULTS SNC mortality rates underestimated all cause mortality by 9.6% (range 2.4%-17.9%) in the 85+ population. Underestimation was less pronounced in years nearer the censuses and in the 75-84 age group. After including 99.7% of unlinked deaths, annual all cause SNC mortality rates were reflecting official rates (relative difference between -1.4% and +1.8%). In the 85+ population the rates for prostate and breast cancer dropped, by 16% and 21% respectively, between 1994 and 1995 coincident with the change in cause of death coding policy. For suicide in males almost no change was observed. Hazard ratios were only negligibly affected by including the unlinked deaths. A sudden decrease in breast (21% less, 95% confidence interval: 12%-28%) and prostate (16% less, 95% confidence interval: 7%-23%) cancer mortality rates in the 85+ population coincided with the 1995 change in cause of death coding policy. CONCLUSIONS Unlinked deaths bias analyses of absolute mortality rates downwards but have little effect on relative mortality. To describe time trends of cause-specific mortality in the SNC, accounting for the unlinked deaths and for the possible effect of change in death certificate coding was necessary.

Alcohol-selling outlets and mortality in Switzerland--the Swiss National Cohort

AIM To examine the association of alcohol-related mortality and other causes of death with neighbourhood density of alcohol-selling outlets for on-site consumption. DESIGN, SETTING AND PARTICIPANTS Longitudinal study of the adult Swiss population (n = 4 376 873) based on census records linked to mortality data from 2001 to 2008. MEASUREMENTS Sex-specific hazard ratios (HR) for death and 95% confidence intervals (95%CI) were calculated using Cox models adjusting for age, educational level, occupational attainment, marital status and other potential confounders. The density of alcohol-selling outlets within 1000 m of the residence was calculated using geocodes of outlets and residences. FINDINGS Compared with >17 outlets within 1000 m the HR for alcohol-related mortality in men was 0.95 (95%CI: 0.89-1.02) for 8-17 outlets, 0.84 (95%CI: 0.77-0.90) for 3-7 outlets, 0.76 (95%CI: 0.68-0.83) for 1-2 outlets and 0.60 (95%CI: 0.51-0.72) for 0 outlets. The gradient in women was somewhat steeper, with a HR comparing 0 with >17 outlets of 0.39 (95%CI: 0.26-0.60). Mortality from mental and behavioural causes and lung cancer were also associated with density of alcohol-selling outlets: HRs comparing 0 outlets with >17 outlets were 0.64 (95%CI: 0.52-0.79) and 0.79 (95%CI: 0.72-0.88), respectively, in men and 0.46 (95%CI: 0.27-0.78) and 0.63 (95%CI: 0.52-0.77), respectively, in women. There were weak associations in the same direction with all-cause mortality in men but not in women. CONCLUSIONS In Switzerland, alcohol-related mortality is associated with the density of outlets around the place of residence. Community-level interventions to reduce alcohol outlet density may usefully complement existing interventions.

Suicide assisted by right-to-die associations: a population based cohort study

Background: In Switzerland, assisted suicide is legal but there is concern that vulnerable or disadvantaged groups are more likely to die in this way than other people. We examined socio-economic factors associated with assisted suicide. Methods: We linked the suicides assisted by right-to-die associations during 2003–08 to a census-based longitudinal study of the Swiss population. We used Cox and logistic regression models to examine associations with gender, age, marital status, education, religion, type of household, urbanization, neighbourhood socio-economic position and other variables. Separate analyses were done for younger (25 to 64 years) and older (65 to 94 years) people. Results: Analyses were based on 5 004 403 Swiss residents and 1301 assisted suicides (439 in the younger and 862 in the older group). In 1093 (84.0%) assisted suicides, an underlying cause was recorded; cancer was the most common cause (508, 46.5%). In both age groups, assisted suicide was more likely in women than in men, those living alone compared with those living with others and in those with no religious affiliation compared with Protestants or Catholics. The rate was also higher in more educated people, in urban compared with rural areas and in neighbourhoods of higher socio-economic position. In older people, assisted suicide was more likely in the divorced compared with the married; in younger people, having children was associated with a lower rate. Conclusions: Assisted suicide in Switzerland was associated with female gender and situations that may indicate greater vulnerability such as living alone or being divorced, but also with higher education and higher socio-economic position.

Inflammation and symptoms of depression and anxiety in patients with acute coronary heart disease

Depression following an acute coronary syndrome (ACS, including myocardial infarction or unstable angina) is associated with recurrent cardiovascular events, but the depressive symptoms that are cardiotoxic appear to have particular characteristics: they are 'incident' rather than being a continuation of prior depression, and they are somatic rather than cognitive in nature. We tested the hypothesis that the magnitude of inflammatory responses during the ACS would predict somatic symptoms of depression 3 weeks and 6 months later, specifically in patients without a history of depressive illness. White cell count and C-reactive protein were measured on the day after admission in 216 ACS patients. ACS was associated with very high levels of inflammation, averaging 13.23×10(9)/l and 17.06 mg/l for white cell count and C-reactive protein respectively. White cell count during ACS predicted somatic symptom intensity on the Beck Depression Inventory 3 weeks later (β=0.122, 95% C.I. 0.015-0.230, p=0.025) independently of age, sex, ethnicity, socioeconomic status, marital status, smoking, cardiac arrest during admission and clinical cardiac risk, but only in patients without a history of depression. At 6 months, white cell count during ACS was associated with elevated anxiety on the Hospital Anxiety and Depression Scale independently of covariates including anxiety measured at 3 weeks (adjusted odds ratio 1.08, 95% C.I. 1.01-1.15, p=0.022). An unpredicted relationship between white cell count during ACS and cognitive symptoms of depression at 6 months was also observed. The study provides some support for the hypothesis that the marked inflammation during ACS contributes to later depression in a subset of patients, but the evidence is not conclusive.

Cortisol levels and history of depression in acute coronary syndrome patients

BACKGROUND: Depressed mood following an acute coronary syndrome (ACS) is a risk factor for future cardiac morbidity. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is associated with depression, and may be a process through which depressive symptoms influence later cardiac health. Additionally, a history of depression predicts depressive symptoms in the weeks following ACS. The purpose of this study was to determine whether a history of depression and/or current depression are associated with the HPA axis dysregulation following ACS. METHOD: A total of 152 cardiac patients completed a structured diagnostic interview, a standardized depression questionnaire and a cortisol profile over the day, 3 weeks after an ACS. Cortisol was analysed using: the cortisol awakening response (CAR), total cortisol output estimated using the area under the curve method, and the slope of cortisol decline over the day. RESULTS: Total cortisol output was positively associated with history of depression, after adjustment for age, gender, marital status, ethnicity, smoking status, body mass index (BMI), Global Registry of Acute Cardiac Events (GRACE) risk score, days in hospital, medication with statins and antiplatelet compounds, and current depression score. Men with clinically diagnosed depression after ACS showed a blunted CAR, but the CAR was not related to a history of depression. CONCLUSIONS: Patients with a history of depression showed increased total cortisol output, but this is unlikely to be responsible for associations between depression after ACS and later cardiac morbidity. However, the blunted CAR in patients with severe depression following ACS indicates that HPA dysregulation is present.

Social relationship correlates of major depressive disorder and depressive symptoms in Switzerland: nationally representative cross sectional study

BACKGROUND The quality and quantity of social relationships are associated with depression but there is less evidence regarding which aspects of social relationship are most predictive. We evaluated the relative magnitude and independence of the association of four social relationship domains with major depressive disorder and depressive symptoms. METHODS We analyzed a cross-sectional telephone interview and postal survey of a probability sample of adults living in Switzerland (N = 12,286). Twelve-month major depressive disorder was assessed via structured interview over the telephone using the Composite International Diagnostic Interview (CIDI). The postal survey assessed depressive symptoms as well as variables representing emotional support, tangible support, social integration, and loneliness. RESULTS Each individual social relationship domain was associated with both outcome measures, but in multivariate models being lonely and perceiving unmet emotional support had the largest and most consistent associations across depression outcomes (incidence rate ratios ranging from 1.55-9.97 for loneliness and from 1.23-1.40 for unmet support, p's < 0.05). All social relationship domains except marital status were independently associated with depressive symptoms whereas only loneliness and unmet support were associated with depressive disorder. CONCLUSIONS Perceived quality and frequency of social relationships are associated with clinical depression and depressive symptoms across a wide adult age spectrum. This study extends prior work linking loneliness to depression by showing that a broad range of social relationship domains are associated with psychological well-being.