Research Group "Mental Health Epidemiology"

1. Psychocardiology

  • Therapeutic concepts in psychocardiology
    SPIRR-CAD (A Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease) – a randomised controlled trial. BBF/DFG sponsored randomized Clinical Trial.


  • MEDEA: Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction
    • MEDEA goes East: Magdeburg Examination of Delay in Patients Experiencing Acute Myocardial Infarction
    • MEDEA goes Far East: An international collaboration with Prof. Wendlin Ma, Tonji University, Shanghai.
  • Reframing risk concepts and behavioural clusters in psychocardiology; interaction with classical risk factors with a special focus on type 2 diabetes mellitus
    Over a long time span, the prevailing view of psycho¬pathology in cardiac patients focused on the Type-A-Behaviour Pattern concept which encompasses a hyperactive, mostly hostile personality style with a tendency of over-expression of sympathetic stimulation. A better understanding ...
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  • Mal-adaptation of the autonomic, endocrine and inflammatory parameters may bridge the gap between somatic disease and affective conditions
    There is little doubt that depression and related concepts of negative affectivity impact somatic health substantially. However, the pathways explaining the interaction between mental health features and somatic health have not been fully elucidated so far. Autonomic, endocrine and inflammatory pathways ...
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  • Patient derived sources of prehospital delay after suffering an acute myocardial infarction
    Early access to invasive cardiac treatment is essential for survival after acute myocardial infarction (AMI). The time-frame between symptom onset and reperfusion is a crucial determinant for the clinical course. Patient caused latency is the most important component of pre-hospital delay - though its determinants remain obscure.
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  • Psychosocial issues in patients living with an implanted cardioverter defibrillator
    Stimulated by emerging conceptualization and research in posttraumatic stress disorders (PTSD) in the 90ies, we designed the CASA (Cardiac Arrest Survival Analysis) Study which achieved considerable attention in the emergency medicine field but was also one of the first studies prove the applicability of the PTSD concept in a cardiac population.
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  • Quality of life in patients with atrial fibrillation
    A new and emerging field in psycho-cardiology is research in atrial fibrillation (AF). Currently, we (together with Tobias Limburg from the Herzinfarkt-Institut in Mannheim and in cooperation with Michael Näbauer and Andrea Gerth from the LMU Cardiology Department) are performing analyses on registry data of more than 6,000 participants of the German Competence Network on AF and assess quality of life levels in different subpopulations.
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  • Gender aspects, somatisation and pain sensitivity
    Gender differences in symptom reporting with more women than men suffering from somatic complaints have been widely confirmed in many health surveys. Some time ago, we analyzed data from a representative health examination survey in Germany with 7,466 participants in the age range of 25 to 69 years. The study confirmed a female excess of symptom reporting and utilization of medical services. Nevertheless, symptom reporting and utilization were not closely related. The gender gap in symptom reporting may be largely explained by low social class status, high levels of chronic distress and poor self perceived health.
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2. Psycho-diabetology, obesity and metabolic disorders

  • Psychosocial risk factors and T2DM Risk

    Increasing awareness exists for distressing life conditions and aversive affect mood to unfold an impact on the development of T2DM, contribute to complications and poor treatment adherence and are independently predictive of adverse outcomes. Currently, best evidence exists for depression and for the posttraumatic stress disorder (PTSD). Knowledge gaps include research on the interaction of subthreshold adverse life conditions which may unfold their detrimental influence on T2DM incidence in synergism with other stressful conditions and thus promote a breakdown of human coping conditions. Recent findings from longitudinal population based studies in apparently healthy community dwelling subjects suggest that also sustained sub-threshold stress conditions contribute to the onset of T2DM (e.g. work stress, hostility, anxiety, loneliness, and sleeping disorders). Furthermore, ongoing animal research raises the suspicion that – in addition to known adverse psychological conditions (e.g. depression) – personality traits like anger-out behavior and irritability may contribute to a high risk psychological phenotype.

    • Depression, anxiety, PTSD in synergism with other stressful conditions (e.g. poor sleep) 

    • Synergistic effects of psychosocial risk factors with somatic risks

    •  Exposure to life stress (work stress, marital stress, time urgency etc.)

    • Personality traits (anger behavior, irritability) 

    • Early childhood adversities

    • Long acting and short acting effects

    • Contribution of psycho-social stress factors to a rapid transition from prediabetes states to the complete clinical picture of T2DM
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  • Potentially protective psychosocial factors

    A growing number of investigations suggest that psychological well-being has a protective effect against premature mortality and health adversities. However, only limited evidence has linked these concepts to incident T2DM. One recent inquiry from the Whitehall II Study showed that emotional vitality was associated with decreased odds of physician-diagnosed diabetes, even after a rigorous adjustment for sociodemographic, somatic risk factors and depressive symptoms. The persistence of psychological well-being effect after adjustment for depressed mood supports the idea that well-being stands independently from psychological distress.
    • Stress buffering effects of resilience

    • High Life satisfaction as mediator of diminished T2DM onset risks
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  • Psycho-neuro-endocrine pathways underpinning psychosocial risks
    The pathophysiological pathways explaining the link between adverse distressing cognitive conditions and onset of T2DM still wait for being elucidated. The allostatic load model is a promising first approach to this concept which requires further in depth analysis. Previous studies have suggested potential mediations of this link by specific psychobiological mechanisms which act direct or indirect on the metabolic regulation. Particularly, a pathway via distinct psycho-neuroendocrine-immune parameters (inflammatory cytokines and BDNF) has been suggested in mental stressed individuals and awaits confirmation in epidemiological study approaches.
    Dealing with KORA data, we would like to investigate mental stress induced neuro-endocrine-immune alterations may lead in the long run to derangement in glucose metabolism followed by pre-diabetic and diabetic states. Particularly, the progression from pre-diabetic to full T2DM conditions and endocrine hormones which may promote or inhibit the acceleration awaits future research. In this context, we investigate the stress-buffering effects of stress resilience on these progressions.
    • Endocrine impact on diabetes onset: stress hormones (e.g. cortisol) and pleiotropic hormones (e.g. leptin, melatonin, oxytocin) 

    • Crosstalk of stress induced inflammation with impaired functioning of the HPA axis (glucocorticoid resistance)

    • Allostatic load
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  • Alterations of functional brain networks in T2DM 

    T2DM is associated with cognitive decrements, increased rates of cognitive decline, increased risk of neurodegenerative diseases and depression. First promising evidence comes from studies which evaluated functional networks in prediabetes and diabetes. This project is a cooperation with the Institute of Clinical Radiology at the Klinikum Großhadern in Munich. The KORA-MRT sub-study is a population based cross-sectional study using a MRT system at 3 Tesla (Magnetom Skyra, Siemens AG, Healthcare Sector, Erlangen Germany) equipped with a whole-body radiofrequency coil-matrix system with a total of 400 subjects included (57.8% men and 42.2% women, aged 38 - 72 years).

3. Mental health and aging

  • Advancing the concept of successful mental aging and determining factors that promote or compromise maintenance of positive mental health
    Our general aim in these studies is to identify long acting (chronic) risk factors, mid-term (episodic) and short term (acute) predictors of psychocognitive functioning in older age.
    Related publications
    • Lacruz ME, Emeny RT, Bickel H, Cramer B, Kurz A, Bidlingmaier M, Huber D, Klug G, Peters A, Ladwig KH. Mental health in the aged: prevalence, covariates and related neuroendocrine, cardiovascular and inflammatory factors of successful aging. BMC Med Res Methodol. 2010 Apr 30;10:36
    • Lacruz ME, Emeny RT, Haefner S, Zimmermann AK, Linkohr B, Holle R, Ladwig KH. Relation between depressed mood, somatic comorbidities and health service utilisation in older adults: results from the KORA-Age study.Age Ageing. 2012 Mar;41(2):183-90. Epub 2011 Dec 11.
  • Stress buffering, psychosocial factors variables such as resilience, social support, and coping strategies protect individuals from perceived life stress.
    We will investigate whether stress buffering variables are associated with a more favourable cardiovascular and psycho-endocrine pattern.

  • Endocrine variables and determinants of positive psychocognitive health in age
    Generally, changes in the endocrine system and neuroendocrine pathways are known to influence mental health, cognition and well-being at old age. However, data on mechanisms are scarce, and the impact of mid-term and short-term changes in several endocrine systems at old age is not described yet. Levels of the stress hormone cortisol as well as the growth promoting, anabolic hormones dehydroepiandrosterone-sulfate (DHEA-s), insulin-like growth factor 1 (IGF-1), oxytocin and melatonin were analysed in participants of the medical examination of KORA Age 1 (n=1,079, age 64-94) and associations with cognitive and mental health status are being examined.

4. Posttraumatic stress disorder (PTSD) and severe psychopathology

  • Suicide epidemiology and suicide prevention
    Suicide is the leading cause of unnatural death in Germany, with almost three times as many cases than traffic accident deaths.  However, suicide and suicide prevention do not receive the same attention by interests groups, politicians and the media as the other causes of unnatural death, traffic accident deaths or homicides. Our unit undertakes research in suicide mortality in the general population, looking for age and sex specific patterns as well as risk factors for suicide. Furthermore, we are focussing on railway suicides, collaborating with international partners to reduce railway suicides and to define preventive measures.
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  • Posttraumatic stress disorder (PTSD)
    Posttraumatic stress disorder (PTSD) is a prolonged stress response syndrome whose symptoms develop in the aftermath of extremely stressful life events of exceptionally threatening or catastrophic nature. PTSD is not a static, unidimensional entity, but a multidimensional episodic stress response pattern. The multilevel impact of PTSD on organismic functioning produces syndrome constellations that are built on the triad of core PTSD symptoms: (1) re-experiencing, reliving or re-enacting traumatic memories, (2) avoidance tendencies and psychic numbing, (3) psychobiological changes and physiological reactivity (hyperarousal). Many subjects encounter traumatic psychological stressors at some point in their lifespan. Such exposures to extreme situations impact both the brain and peripheral bodily systems and increase risk for impaired mental health as well as for the development and accelerated progression of chronic physical diseases including T2D.
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  • Depression and Anxiety
    • Depression in the general population
    • Genetic determinants of depression

5. Research grants

  • GESA: GEnder-Sensitive Analyses of mental health trajectories and implications for prevention: A multi-cohort consortium, in collaboration with M. Beutel, Mainz; H. Kruse, Marburg und H. Grabe (Greifswald)
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  • Psychosocial risk factors in the etiology of T2DM and its prognostic impact in the elderly (DiaPro): Establishing a joint German-Malaysian research platform (in planning).