Question: Comorbidity, i.e., additional psychological distress in patients already suffering from chronic somatic diseases (e.g., orthopedic conditions) is of growing importance. The quality of analyzing and interpreting the often used Brief Symptom Inventory (BSI) used with orthopedic patients should improve by employing a new “case definition” of four groups (instead of two) of differentially psychologically distressed patients instead of two groups as before.Methods: Four groups with the different psychological distress definitions of “no,” “mild,” “remarkable,” and “severe” were to be analyzed from a group of 639 orthopedic patients in inpatient rehabilitation clinics. The BSI is transformed into T values (M=50, SD=10). There is “no” distress if no T [two scales] is ≥60 and “mild” distress if T [two scales] and/or T [GSI] is ≥60 and <63. If T [two scales] and/or T [GSI] is ≥63 and <70, it is “remarkable,” and if T [two scales] and/or T [GSI] ≥70, it speaks for “severe” psychological distress.Results: The new tool for analyzing psychological distress based on the T-scores of the BSI resulted in the following four groups: No psychological distress (41.9%): unspecific health-related information stands for a useful intervention. About 13.3% demonstrated low psychological distress: shorter diagnostic interviews and a few more diagnostic examinations led to a low-level outpatient group program to improve health and well-being in a preventive sense; one repeated measurement in 4weeks is advised. Remarkable psychological distress (26%): in-depth exploration using interviews, tests, and questionnaires to choose specific interventions in a single and/or group setting, outpatient or inpatient treatment; repeated measurements and process control. About 18.8% reported severe psychological distress: in-depth exploration led to specific interventions in a single and/or group setting, almost an inpatient setting; immediately crisis intervention and high-frequent process control.Conclusion: The new evaluation strategy of the BSI should improve practice and research; further investigation is necessary.

Purpose Medication non-adherence is a huge concern for the medical community. For chronic, especially neurological diseases, taking medication is a central pillar of treatment. To improve adherence to these oftentimes complex medication regimens, the construct needs to be understood in more depth. The aim of this study was to investigate associations between adherence with sociodemographics, clinical variables, and coping in neurological patients. Patients and Methods The sample consisted of 545 patients from a German neurological clinic. Adherence was assessed with the Stendal Adherence to Medication Score (SAMS). Patients were grouped as completely adherent (SAMS = 0), non-adherent (upper 25% of the sample), and moderately adherent. Associations with coping were assessed using the Essen Coping Questionnaire. Results Medication adherence was low compared to other non-neurological patient samples. Differences between adherence groups were found regarding gender and facets of coping, namely “trivialisation, wishful thinking and defence” and “finding of inner stability”. Conclusion Interventions to improve medication adherence should focus on facets of coping with disease, increasing acceptance of disease, willpower, and confidence in treatment.

Purpose Nonadherence is a complex behaviour that contributes to poor health outcomes; therefore, it is necessary to understand its underlying structure. Network analysis is a novel approach to explore the relationship between multiple variables. Patients and Methods Patients from four different studies (N = 1.746) using the self-reported Stendal Adherence to Medication Score (SAMS) were pooled. Network analysis using EBICglasso followed by confirmatory factor analysis were performed to understand how different types of nonadherence covered in the SAMS items are related to each other. Results Network analysis revealed different categories of nonadherence: lack of knowledge about medication, forgetting to take medication, and intentional modification of medication. The intentional modification can further be sub-categorized into two groups, with one group modifying medication based on changes in health (improvement of health or adverse effects), whereas the second group adjusts medication based on overall medication beliefs and concerns. Adverse effects and taking too many medications were further identified as most influential variables in the network. Conclusion The differentiation between modification due to health changes and modification due to overall medication beliefs is crucial for intervention studies. Network analysis is a promising tool for further exploratory studies of adherence.

Hintergrund Geschwister von Kindern mit chronischen Erkrankungen oder Behinderung haben ein erhöhtes Risiko für Entwicklungsschwierigkeiten. Daher wurden Präventionsangebote entwickelt, um Schutzfaktoren bei diesen Kindern zu stärken. Ziel der Arbeit Es soll untersucht werden, inwiefern Teilnehmende von Präventionsangeboten psychische, soziale und ökonomische Belastungen aufgrund der Erkrankung/Behinderung aufweisen. Zudem soll erforscht werden, ob weitere soziodemografische Risikofaktoren bei teilnehmenden Geschwisterkindern bestehen. Methodik Es wurden 79 Familien von teilnehmenden Kindern eingeschlossen. Der Familienbelastungsfragebogen sowie ein demografischer Fragebogen wurden eingesetzt. Der kumulative Risikoansatz diente zur Beschreibung des soziodemografischen Risikos. Ergebnisse Im Vergleich zu Normwerten waren teilnehmende Familien stärker durch die Erkrankung/Behinderung belastet. Bei 56 % der Kinder bestanden weitere soziodemografische Risikofaktoren. Schlussfolgerungen Präventionsangebote erreichen belastete Familien. Geschwisterangebote sollten weiter ausgebaut werden.