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      Why do we climb mountains? An exploration of features of behavioural addiction in mountaineering and the association with stress-related psychiatric disorders

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          Abstract

          Common knowledge implies that individuals engaging in outdoor sports and especially in regular and extreme mountaineering are exceptionally healthy and hardened. Physical activity in outdoor environments has a positive effect on physical and mental health. However, regular and/or extreme mountaineering might share similarities with behavioural addictions and could thus also have a negative impact on health. In this cross-sectional web-based questionnaire study, we collected data on exercise and mountaineering addiction (Exercise Addiction Inventory; original and adapted version for mountaineering; Exercise Dependence Scale adapted version for mountaineering). Further surveyed parameters included mountaineering habits, Risk-Taking Inventory, Sensation-Seeking/Emotion Regulation/Agency Scale (SEAS), resilience, self-perceived stress, physical activity in metabolic units and mental health. Comparisons were performed between individuals with symptoms of addiction to mountaineering (MA) and individuals without symptoms of addiction to mountaineering or sports in general (CO) using non-parametric analyses. We analysed data from 335 participants, n = 88 thereof with addiction to mountaineering (MA) and n = 247 control participants (CO). The MA group scored significantly higher with regards to self-perceived stress ( p < 0.001) and included a significantly higher number of individuals affected by symptoms of depression ( p < 0.001), symptoms of anxiety ( p < 0.001), symptoms of eating disorders ( p < 0.001), alcohol abuse or dependence ( p < 0.001), illicit drug abuse ( p = 0.050), or current and history of psychiatric disorders ( p < 0.001). Individuals with MA showed higher values in all SEAS subscales as well as increased risk-taking ( p < 0.001). Regular and extreme mountaineering can display features of a behavioural addiction and is associated with psychiatric disorders. Behavioural addiction in mountaineering is associated with higher levels of sensation-seeking, emotion regulation, and agency, as well as increased risk-taking.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00406-022-01476-8.

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          A Global Measure of Perceived Stress

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            A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population.

            The 4-item Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report questionnaire that consists of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). Given that PHQ-4, PHQ-2, and GAD-2 have not been validated in the general population, this study aimed to investigate their reliability and validity in a large general population sample and to generate normative data. A nationally representative face-to-face household survey was conducted in Germany in 2006. The survey questionnaire consisted of the PHQ-4, other self-report instruments, and demographic characteristics. Of the 5030 participants (response rate=72.9%), 53.6% were female and mean (SD) age was 48.4 (18.0) years. The sociodemographic characteristics of the study sample closely match those of the total populations in Germany as well as those in the United States. Confirmatory factor analyses showed very good fit indices for a two-factor solution (RMSEA .027; 90% CI .023-.032). All models tested were structurally invariant between different age and gender groups. Construct validity of the PHQ-4, PHQ-2, and GAD-2 was supported by intercorrelations with other self-report scales and with demographic risk factors for depression and anxiety. PHQ-2 and GAD-2 scores of 3 corresponded to percentile ranks of 93.4% and 95.2%, respectively, whereas PHQ-2 and GAD-2 scores of 5 corresponded to percentile ranks of 99.0% and 99.2%, respectively. A criterion standard diagnostic interview for depression and anxiety was not included. Results from this study support the reliability and validity of the PHQ-4, PHQ-2, and GAD-2 as ultra-brief measures of depression and anxiety in the general population. The normative data provided in this study can be used to compare a subject's scale score with those determined from a general population reference group. Copyright 2009 Elsevier B.V. All rights reserved.
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              Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis

              Abstract Objective To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression. Design Individual participant data meta-analysis. Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015). Inclusion criteria Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model. Results Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age.. Conclusions PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups. Registration PROSPERO CRD42014010673.
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                Author and article information

                Contributors
                katharina.huefner@tirol-kliniken.at
                Journal
                Eur Arch Psychiatry Clin Neurosci
                Eur Arch Psychiatry Clin Neurosci
                European Archives of Psychiatry and Clinical Neuroscience
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0940-1334
                1433-8491
                18 August 2022
                18 August 2022
                2023
                : 273
                : 3
                : 639-647
                Affiliations
                [1 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Hospital of Psychiatry II, , Medical University of Innsbruck, ; Anichstrasse 35, Innsbruck, Austria
                [2 ]GRID grid.6936.a, ISNI 0000000123222966, Department of Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, School of Medicine, , Technical University of Munich, ; Munich, Germany
                [3 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Hospital of Psychiatry I, , Medical University of Innsbruck, ; Innsbruck, Austria
                [4 ]GRID grid.6936.a, ISNI 0000000123222966, Department of Psychosomatics, Klinikum Rechts der Isar, School of Medicine, , Technical University of Munich, ; Munich, Germany
                [5 ]GRID grid.452396.f, ISNI 0000 0004 5937 5237, DZHK (German Centre for Cardiovascular Research), , Partner Site Munich Heart Alliance, ; Munich, Germany
                Author information
                http://orcid.org/0000-0002-5453-8792
                Article
                1476
                10.1007/s00406-022-01476-8
                10085896
                35980451
                6e107b4f-38b0-480e-9636-2296d8c59d51
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 1 March 2022
                : 2 August 2022
                Funding
                Funded by: University of Innsbruck and Medical University of Innsbruck
                Categories
                Original Paper
                Custom metadata
                © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023

                Neurosciences
                exercise addiction,mental health,alpine sports,mountaineering,behavioral addiction
                Neurosciences
                exercise addiction, mental health, alpine sports, mountaineering, behavioral addiction

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