Supplemental material 1: Sociodemographics and clinical assessments of N = 1011 MindDoc users
André Kerber
2023-11-25
In this document, a subsample of N = 1011 MindDoc users, who were directly recruited over the app and underwent a separate online assessment is investigated. Besides sociodemographic information, several validated questionnaires on psychopathology were assessed.
Measures
PHQ-9
The PHQ-9 (B. Löwe et al. (2002); Bernd Löwe et al. (2004)) corresponds to the depression module of the Patient Health Questionnaire (PHQ-D). It was developed as a screening instrument for the diagnosis of depression for routine use in somatic medical settings and is recommended by the American Psychiatric Association as an instrument for measuring the severity of major depression according to the new DSM-5 criteria. The PHQ-9 measures the frequency of each of the 9 DSM-5 diagnostic criteria from 0 (not at all) to 3 (almost every day). The PHQ-9 also has good sensitivity to change when using the sum score, so it can be used to determine intervention effects.
GAD-7
The GAD-7 (Kroenke et al. (2007); R. L. Spitzer et al. (2006)) corresponds to the anxiety disorder module of the Patient Health Questionnaire (PHQ-D). It was developed to identify potential patients with a generalized anxiety disorder and to record the symptom severity of general anxiety. The one-dimensional instrument measures symptoms of generalized anxiety disorder as defined in the DSM-5. The item scores range from 0 (not at all) to 3 (almost every day). The GAD-7 is a valid and efficient instrument for screening for anxiety disorders and assessing severity in clinical practice and research (Kroenke et al. (2007)).
SSS-8
The Somatic Symptom Scale-8 (SSS-8) is a short version of the PHQ-15. This eight-item questionnaire was developed for use in situations with limited time, e.g. in a busy primary care setting or for conducting epidemiological surveys. The selection criteria for the items criteria were symptom prevalence in primary care, correlation with other measures of somatization, and with other measures of somatization disorders and correlations between the original items (Gierk et al. (2014)).
LPFS-BF
The LPFS-BF (Weekers, Hutsebaut, and Kamphuis (2019); German version: C. Spitzer et al. (2021)) is a brief self-report instrument that measures the degree of impairment in personality functioning as defined in the DSM-5, Section III (APA, 2013), which largely corresponds to the definition of severity of personality disorder in the ICD-11 (Bach and Simonsen (2021)). The 12 items correspond to the 12 subdomains of the LPFS. Respondents are asked to rate these items on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). The LPFS-BF items measure both self-functioning (i.e., sense of identity, impulse and affect regulation, and self-reflection) and interpersonal functioning (i.e., ability to understand the experiences and motivations of others, anticipate the effects of one’s behavior on others, and maintain relationships) to the same degree. Its psychometric properties are good. For example, the internal consistency of the total score (sum) was high in both clinical and general population samples (C. Spitzer et al. (2021)).
PID5BF+
The PID5BF+ is a 34-item self-assessment instrument based on the Personality Inventory for DSM-5 (PID-5) and expanded to include the ICD-11 domain Anankastia. The PID-5 is the official 220-item self-report instrument for assessing maladaptive personality traits according to the DSM-5 AMPD (Krueger et al. (2012)). The PID5BF+ has been extensively tested in clinical and non-clinical samples, has shown adequate psychometric properties (Bach et al. (2020);Kerber et al. (2020)). The PID5BF+ is suitable for dimensional screening of psychopathology profiles according to the HiTOP system (Kotov et al. (2021)). For example, high values in the Negative Affectivity domain indicate problems in the area of internalization, high values in Psychoticism indicate problems in the area of thought disorders and the domains Closedness/Detachment, Antagonism and Disinhibition correspond to the HiTOP spectra with the same names. A population-representative survey of this instrument is available to classify the psychopathology profiles (Rek et al. (2021)).
Table with sociodemographics and clinical assessments
| Overall (N=1011) |
|
|---|---|
| age | |
| Mean (SD) | 35.6 (12.2) |
| Median [Min, Max] | 34.0 [13.0, 79.0] |
| gender | |
| diverse | 32 (3.2%) |
| female | 800 (79.1%) |
| male | 179 (17.7%) |
| relationship_status | |
| partnership | 133 (13.2%) |
| partnership & livingtogether | 313 (31.0%) |
| single | 316 (31.3%) |
| Missing | 249 (24.6%) |
| contactwfriends | |
| monthly | 274 (27.1%) |
| multiplepermonth | 252 (24.9%) |
| weekly | 123 (12.2%) |
| multipleperweek | 91 (9.0%) |
| daily | 13 (1.3%) |
| Missing | 258 (25.5%) |
| education | |
| College degree | 421 (41.6%) |
| High school | 317 (31.4%) |
| Higher secondary school | 234 (23.1%) |
| Lower secondary school | 30 (3.0%) |
| no school grad | 9 (0.9%) |
| jobstatus | |
| full-time_working | 373 (36.9%) |
| homemaker | 17 (1.7%) |
| in_training | 124 (12.3%) |
| jobless | 54 (5.3%) |
| part-time_working | 138 (13.6%) |
| pensioned | 50 (4.9%) |
| Missing | 255 (25.2%) |
| dep_PHQ9 | |
| no | 89 (8.8%) |
| mild (PHQ9 5-9) | 255 (25.2%) |
| moderate (PHQ9 10-14) | 281 (27.8%) |
| severe (PHQ9 15-19) | 221 (21.9%) |
| very severe (PHQ9 > 19) | 165 (16.3%) |
| anx_GAD7 | |
| no | 169 (16.7%) |
| mild (GAD7 5-9) | 369 (36.5%) |
| moderate (GAD7 10-14) | 278 (27.5%) |
| severe (GAD7 > 14) | 195 (19.3%) |
| som_SSS8 | |
| no | 99 (9.8%) |
| low (SSS8 4-7) | 154 (15.2%) |
| medium (SSS8 8-11) | 264 (26.1%) |
| high (SSS8 12-15) | 227 (22.5%) |
| very high (SSS8 > 16) | 267 (26.4%) |
| LPFSBF | |
| none to mild (LPFSBF <24) | 221 (21.9%) |
| moderate (LPFSBF 24 - 33) | 480 (47.5%) |
| severe (LPFSBF > 32) | 310 (30.7%) |
| Outpatient_treatment_last_6m | |
| no | 350 (34.6%) |
| psychiatrist visits | 53 (5.2%) |
| psychiatrist visits + medication | 77 (7.6%) |
| psychotherapy (at least 50 min per visit) | 240 (23.7%) |
| psychotherapy + psychiatrist visits + medication | 248 (24.5%) |
| Missing | 43 (4.3%) |
| Inpatient_treatment_last_6m | |
| no | 514 (50.8%) |
| emergency room | 71 (7.0%) |
| daycare psychiatry/psychosomatics | 125 (12.4%) |
| stationary psychiatry/psychosomatics | 210 (20.8%) |
| Missing | 91 (9.0%) |
It is a clinical sample. 93.9% showed anxiety or depression
symptoms. More than half (N= 661, 65.4 %) are undergoing outpatient
psychiatric/psychotherapeutic treatment, more than a third have been in
hospital at least once in the last year due to mental health problems
(N= 497, 49.2 %). N = 667 (66%) showed moderate to severe depressive
symptoms, N = 473 (46.8%) showed moderate to severe anxiety symptoms, N
= 758 (75%) showed moderate to severe somatization symptoms (cut-off
from validation studies on PHQ-9 (Kroenke,
Spitzer, and Williams (2001)), GAD-7 (Bernd Löwe et al. (2008)) and SSS-8. N= 790
(78.1%) showed moderate to severe impairment of personality function
(LPFS-BF sum scores more than one or two standard deviations away from
the population mean (C. Spitzer et al.
(2021)))
Comparison to German representative sample from Rek et al. (2021)
The figure shows combined density- and boxplots together with the
mean value and one standard deviation (dashed lines) for 5 domains of
the PID5BF+ in comparison to a German representative sample Rek et al. (2021). The yellow area corresponds
to the range between one and two standard deviations (SD), the red area
corresponds to more than two SD.
The sample showed increased values compared to a representative norm sample (N=4727) in the areas of internalization (67% showed values greater than one SD, 20% values greater than two SD above population mean on the Negative Affectivity scale of the PID5BF+), Detachment (51% showed values greater than one SD, 24% showed values greater than two SD on the Detachment scale of the PID5BF+) and Disinhibition (48% showed values greater than one SD, 19% showed values greater than two SD on the Disinhibition scale of the PID5BF+).