The consequences of traumatic brain injury (TBI) for health-related quality of life (HRQoL) are poorly investigated, and a TBI-specific instrument has not previously been available. The cross-cultural development of a new measure to assess HRQoL after TBI is described.An international TBI Task Force derived a conceptual model from previous work, constructed an initial item bank of 148 items, and then reduced the item set through two successive multi-centre validation studies. The first study with eight language versions of the QOLIBRI recruited 1528 participants with TBI and the second with six language versions 921 participants. The data from 795 participants from the second study who had complete GCS and GOS data were used to finalise the instrument.The final version of the QOLIBRI consists of 37 items in six scales. Satisfaction is assessed in the areas of "Cognition", "Self", "Daily life and Autonomy", and "Social Relationships" and feeling bothered by "Emotions "and "Physical Problems". The QOLIBRI scales meet standard psychometric criteria (internal consistency,  = .75 to .89, test-retest reliability, r tt = .78 to .85). Test-retest reliability (r tt = 0.68 to 0.87) as well as internal consistency ( = .81 to .91) was also good in a subgroup of participants with lower cognitive performance. Although there is one strong HRQoL factor, a six scale structure explaining additional variance was validated by exploratory and confirmatory factor analyses and with Rasch modelling.The QOLIBRI is a new cross-culturally developed instrument for assessing HRQoL after TBI that fulfils standard psychometric criteria. It is potentially useful for clinicians and researchers conducting clinical trials, assessing the impact of rehabilitation or other interventions, or carrying out epidemiological surveys.

The QOLIBRI (Quality of Life after Brain Injury) is a novel health-related quality-of-life (HRQoL) instrument specifically developed for traumatic brain injury (TBI). It provides a profile of HRQoL in six domains together with an overall score. Scale validity and factors associated with HRQoL were investigated in a multi-center international study. A total of 795 adults with brain injury were studied from 3 months to 15 years post-injury. The majority of participants (58%) had severe injuries as assessed by 24-h worst Glasgow Coma Scale (GCS) score. Systematic relationships were observed between the QOLIBRI and the Glasgow Outcome Scale-Extended (GOSE), Hospital Anxiety and Depression Scale (HADS), and SF-36. Within each scale patients with disability reported having low HRQoL in two to three times as many areas as those who had made a good recovery. The main correlates of the total QOLIBRI score were emotional state (HADS depression and anxiety), functional status (amount of help needed and outcome on the GOSE), and comorbid health conditions. Together these five variables accounted for 58% of the variance in total QOLIBRI scores. The QOLIBRI is the first tool developed to assess disease-specific HRQoL in brain injury, and it contains novel information not given by other currently available assessments.

Objective: Adult attachment has been suggested to mediate the effect of social support on stress protection. The purpose of this study was to investigate the effects of adult attachment and social support on psychological and endocrine responses to psychosocial stress.Methods: Sixty-three healthy men who were married or cohabiting were randomly assigned to receive either instructed social support from their partner or no social support before being exposed to a standardized psychosocial stressor (Trier Social Stress Test). Attachment was determined using the Experiences in Close Relationships -Revised questionnaire (ECR-R). State anxiety, mood, and salivary cortisol levels were repeatedly assessed before and after stress.Results: Secure attachment was associated with stronger decreases in state anxiety levels following stress exposure. More importantly, the combination of social support and secure attachment exhibited the lowest anxiety levels after stress (interaction effect). Social support alone reduced cortisol responses to stress, whereas secure attachment did not influence cortisol concentrations.Conclusion: This first study on the interaction of adult attachment and social support in terms of psychological and endocrine stress responses concurs with previous studies suggesting an important protective role of attachment for psychological stress responsiveness. However, attachment did not directly moderate cortisol responses to acute stress. ABSTRACT Objective:Adult attachment has been suggested to mediate the effect of social support on stress protection.The purpose of this study was to investigate the effects of adult attachment and social support on psychological and endocrine responses to psychosocial stress. Methods:Sixty-three healthy men who were married or cohabiting were randomly assigned to receive either instructed social support from their partner or no social support before being exposed to a standardized psychosocial stressor (Trier Social Stress Test). Attachment was determined using the Experiences in Close Relationships -Revised questionnaire (ECR-R). State anxiety, mood, and salivary cortisol levels were repeatedly assessed before and after stress. Results:Secure attachment was associated with stronger decreases in state anxiety levels following stress exposure. More importantly, the combination of social support and secure attachment exhibited the lowest anxiety levels after stress (interaction effect). Social support alone reduced cortisol responses to stress, whereas secure attachment did not influence cortisol concentrations. Conclusion:This first study on the interaction of adult attachment and social support in terms of psychological and endocrine stress responses concurs with previous studies suggesting an important protective role of attachment for psychological stress responsiveness. However, attachment did not directly moderate cortisol responses to acute stress.

It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p < 0.001), and need predicted intention (GP: beta 0.45, p < 0.001; MHP: beta 0.38, p < 0.001). Intention predicted service use with a MHP after 6 months (beta 0.31, p < 0.01; GP: beta 0.17, p = 0.093). More knowledge was associated with more self-identification (beta 0.21, p < 0.01), while support for discrimination was associated with lower self-identification (beta - 0.14, p < 0.05). Blaming persons with mental illness for their problem was associated with lower perceived need (beta - 0.16, p < 0.05). Our models explained 37% of the variance of seeking help with a MHP, and 33% of help-seeking with a GP. Recognizing one's own mental illness and perceiving a need for help are impaired by lack of knowledge, prejudice, and discrimination. Self-identification is a relevant first step when seeking help for mental disorders.

Introduction: Following behavioral recommendations is key to successful containment of the COVID-19 pandemic. Therefore, it is important to identify causes and patterns of non-compliance in the population to further optimize risk and health communication. Methods: A total of 157 participants [80% female; mean age = 27.82 years (SD = 11.01)] were surveyed regarding their intention to comply with behavioral recommendations issued by the German government. Latent class analysis examined patterns of compliance, and subsequent multinomial logistic regression models tested sociodemographic (age, gender, country of origin, level of education, region, and number of persons per household) and psychosocial (knowledge about preventive behaviors, risk perception, stigmatizing attitudes) predictors. Results: Three latent classes were identified: high compliance (25%) with all recommendations; public compliance (51%), with high compliance regarding public but not personal behaviors; and low compliance (24%) with most recommendations. Compared to high compliance, low compliance was associated with male gender [relative risk ratio (RRR) = 0.08 (0.01; 0.85)], younger age [RRR = 0.72 (0.57; 0.93)], and lower public stigma [RRR = 0.21 (0.05; 0.88)]. Low compliers were also younger than public compliers [RRR = 0.76 (0.59; 0.98)]. Discussion: With 25% of the sample reporting full compliance, and 51% differing in terms of public and personal compliance, these findings challenge the sustainability of strict regulatory measures. Moreover, young males were most likely to express low compliance, stressing the need for selective health promotion efforts. Finally, the positive association between public stigma and compliance points to potential othering effects of stigma during a pandemic, but further longitudinal research is required to examine its impact on health and social processes throughout the pandemic.

Background Promulgating a continuum model of mental health and mental illness has been proposed as a way to reduce stigma by decreasing notions of differentness. This systematic review and meta-analysis examines whether continuum beliefs are associated with lower stigma, and whether continuum interventions reduce stigma. Methods Following a pre-defined protocol (PROSPERO: CRD42019123606), we searched three electronic databases (PubMed, Web of Science, and PsycINFO) yielding 6726 studies. After screening, we included 33 studies covering continuum beliefs, mental illness, and stigma. Of these, 13 studies were included in meta-analysis. Results Continuum beliefs are consistently associated with lower stigma. Interventions were effective at manipulating continuum beliefs but differ in their effects on stigmatising attitudes. Conclusions We discuss whether and to what extent attitudes towards people with mental illness can be improved by providing information on a mental health-mental illness continuum. It appeared to be relevant whether interventions promoted a feeling of ‘us’ and a process of identification with the person with mental illness. We discuss implications for the design of future interventions.

There is a 24 month embargo from 24 December 2013 to 24 December 2015 in accordance with the journal's author permissions. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for self-archiving.The accepted version may be used on the following terms, which may be amended from time to time: Use by non-commercial users For non-commercial and non-promotional research and private study purposes individual users may view, print, download and copy self-archived articles, as well as text-and data-mine the content subject to the following conditions: ■The authors' moral rights are not compromised. These rights include the right of "paternity" (also known as "attribution" -the right for the author to be identified as such) and "integrity" (the right for the author not to have the work altered in such a way that the author's reputation or integrity may be impugned). All re-use must be fully attributed. ■Where content in the article is identified as belonging to a third party, it is the obligation of the user to ensure that any reuse complies with the copyright policies of the owner of that content. ■Self-archived content may not be re-published verbatim in whole or in part, whether or not for commercial purposes, in print or online. This restriction does not apply to use of quotations with appropriate citation, or text and data mining provided that the mining output is restricted to short excerpts of text and data and excludes images (unless further consent is obtained from Wiley). 2 AbstractUnderstanding public risk perceptions and their underlying processes is important in order to learn more about the way people interpret and respond to hazardous emergency events. Direct experience with an involuntary hazard has been found to heighten the perceived risk of experiencing the same hazard and its consequences in the future but it remains unclear if cross-over effects are possible (i.e. experience with one hazard influencing perceived risk for other hazards also). Furthermore, the impact of objective risk and country of residence on perceived risk is not well understood. As part of the BeSeCu (Behaviour, Security and Culture) project a sample of 1045 survivors of emergencies from seven European countries (i.e. Germany, Czech Republic, Poland, Sweden, Spain, Turkey and Italy) was drawn. Results revealed heightened perceived risk for emergency events (i.e. domestic and public fires, earthquakes, floods and terrorist attacks) when the event had been experienced previously plus some evidence of cross-over effects, although these effects were not so strong. The largest country differences in perceived risk were observed for earthquakes, but this effect was significantly reduced by taking into account the objective earthquake risk. For fires, floods, terrorist attacks and traffic accidents, only small country differences in perceived risk were found. Further studies including a larger number of countries are welcomed.

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