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Published in: BioPsychoSocial Medicine 1/2015

Open Access 01-12-2015 | Research

Associations of physical activity with depressiveness and coping in subjects with high-grade obesity aiming at bariatric surgery: a cross-sectional study

Authors: Ulf Elbelt, Anne Ahnis, Andrea Riedl, Silke Burkert, Tatjana Schuetz, Juergen Ordemann, Christian J. Strasburger, Burghard F. Klapp

Published in: BioPsychoSocial Medicine | Issue 1/2015

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Abstract

Background

Reduced physical activity is supposed to be associated with depressiveness and more passive coping patterns. For further evaluation of this assumed relation we studied energy expenditure due to physical activity - usually referred to as activity thermogenesis (AT) - together with depressiveness (clinical diagnosis, depression module of the Patient Health Questionnaire), and coping behaviours (Brief COPE Inventory) in 50 patients with high-grade obesity (42 ± 12 years; 9 with II° and 41 with III° obesity) aiming at bariatric surgery.

Methods

AT was assessed with a portable armband device (SenseWear™ armband). Depressiveness and coping were assessed using validated questionnaires.

Results

Weight-adjusted non-exercise AT and intensity of physical activity (metabolic equivalent) correlated inversely with body mass index (non-exercise AT: r = −0.32, P < 0.05; mean metabolic equivalent: r = −0.37, P < 0.01) but not with depressiveness. The coping strategies “support coping” and “active coping” showed significant inverse correlations to a) weight-adjusted non-exercise AT (“support coping”: r = −0.34, P < 0.05; “active coping”: r = −0.36, P < 0.05), b) weight-adjusted exercise-related AT (“support coping”: r = −0.36, P < 0.05; “active coping”: r = −0.38, P < 0.01) and c) intensity of physical activity (for mean metabolic equivalent: “support coping”: r = −0.38, P < 0.01; “active coping”: r = −0.40, P < 0.01; for duration of exercise-related AT: “support coping”: r = −0.36, P < 0.05; “active coping”: r = −0.38, P < 0.01).

Conclusions

AT was not associated with depressiveness. Furthermore, supposed adaptive coping strategies of individuals aiming at bariatric surgery were negatively associated with AT.
Literature
1.
go back to reference Thompson D, Karpe F, Lafontan M, Frayn K. Physical activity and exercise in the regulation of human adipose tissue physiology. Physiol Rev. 2012;92(1):157–91.CrossRefPubMed Thompson D, Karpe F, Lafontan M, Frayn K. Physical activity and exercise in the regulation of human adipose tissue physiology. Physiol Rev. 2012;92(1):157–91.CrossRefPubMed
2.
go back to reference Schmidt M, Johannesdottir SA, Lemeshow S, Lash TL, Ulrichsen SP, Bøtker HE, Sørensen HT: Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study. BMJ Open 2013,3e002698. doi: 10.1136/bmjopen-2013-002698. Schmidt M, Johannesdottir SA, Lemeshow S, Lash TL, Ulrichsen SP, Bøtker HE, Sørensen HT: Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study. BMJ Open 2013,3e002698. doi: 10.​1136/​bmjopen-2013-002698.
3.
go back to reference Freedman DM, Ron E, Ballard-Barbash R, Doody MM, Linet MS. Body mass index and all-cause mortality in a nationwide US cohort. Int J Obes (Lond). 2006;30(5):822–9.CrossRef Freedman DM, Ron E, Ballard-Barbash R, Doody MM, Linet MS. Body mass index and all-cause mortality in a nationwide US cohort. Int J Obes (Lond). 2006;30(5):822–9.CrossRef
4.
go back to reference Levine JA. Non-exercise activity thermogenesis (NEAT). Best Pract Res Clin Endocrinol Metab. 2002;16(4):679–702.CrossRefPubMed Levine JA. Non-exercise activity thermogenesis (NEAT). Best Pract Res Clin Endocrinol Metab. 2002;16(4):679–702.CrossRefPubMed
6.
go back to reference Ravussin E, Lillioja S, Anderson TE, Christin L, Bogardus C. Determinants of 24-hour energy expenditure in man. Methods and results using a respiratory chamber. J Clin Invest. 1986;78(6):1568–78.CrossRefPubMedPubMedCentral Ravussin E, Lillioja S, Anderson TE, Christin L, Bogardus C. Determinants of 24-hour energy expenditure in man. Methods and results using a respiratory chamber. J Clin Invest. 1986;78(6):1568–78.CrossRefPubMedPubMedCentral
7.
go back to reference Elbelt U, Schuetz T, Hoffmann I, Pirlich M, Strasburger CJ, Lochs H. Differences of energy expenditure and physical activity patterns in subjects with various degrees of obesity. Clin Nutr. 2010;29(6):766–72.CrossRefPubMed Elbelt U, Schuetz T, Hoffmann I, Pirlich M, Strasburger CJ, Lochs H. Differences of energy expenditure and physical activity patterns in subjects with various degrees of obesity. Clin Nutr. 2010;29(6):766–72.CrossRefPubMed
8.
go back to reference Levine JA, Eberhardt NL, Jensen MD. Role of nonexercise activity thermogenesis in resistance to fat gain in humans. Science. 1999;283(5399):212–4.CrossRefPubMed Levine JA, Eberhardt NL, Jensen MD. Role of nonexercise activity thermogenesis in resistance to fat gain in humans. Science. 1999;283(5399):212–4.CrossRefPubMed
9.
go back to reference Strine TW, Mokdad AH, Dube SR, Balluz LS, Gonzalez O, Berry JT, et al. The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gen Hosp Psychiatry. 2008;30(2):127–37.CrossRefPubMed Strine TW, Mokdad AH, Dube SR, Balluz LS, Gonzalez O, Berry JT, et al. The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gen Hosp Psychiatry. 2008;30(2):127–37.CrossRefPubMed
10.
go back to reference Konttinen H, Silventoinen K, Sarlio-Lähteenkorva S, Männistö S, Haukkala A. Emotional eating and physical activity self-efficacy as pathways in the association between depressive symptoms and adiposity indicators. Am J Clin Nutr. 2010;92(5):1031–9.CrossRefPubMed Konttinen H, Silventoinen K, Sarlio-Lähteenkorva S, Männistö S, Haukkala A. Emotional eating and physical activity self-efficacy as pathways in the association between depressive symptoms and adiposity indicators. Am J Clin Nutr. 2010;92(5):1031–9.CrossRefPubMed
11.
go back to reference de Wit LM, Fokkema M, van Straten A, Lamers F, Cuijpers P, Penninx BW. Depressive and anxiety disorders and the association with obesity, physical, and social activities. Depress Anxiety. 2010;27(11):1057–65.CrossRefPubMed de Wit LM, Fokkema M, van Straten A, Lamers F, Cuijpers P, Penninx BW. Depressive and anxiety disorders and the association with obesity, physical, and social activities. Depress Anxiety. 2010;27(11):1057–65.CrossRefPubMed
12.
13.
go back to reference Everson-Rose SA, Lewis TT, Karavolos K, Dugan SA, Wesley D, Powell LH. Depressive symptoms and increased visceral fat in middle-aged women. Psychosom Med. 2009;71(4):410–6.CrossRefPubMedPubMedCentral Everson-Rose SA, Lewis TT, Karavolos K, Dugan SA, Wesley D, Powell LH. Depressive symptoms and increased visceral fat in middle-aged women. Psychosom Med. 2009;71(4):410–6.CrossRefPubMedPubMedCentral
14.
go back to reference Rivenes AC, Harvey SB, Mykletun A. The relationship between abdominal fat, obesity, and common mental disorders: results from the HUNT study. J Psychosom Res. 2009;66(4):269–75.CrossRefPubMed Rivenes AC, Harvey SB, Mykletun A. The relationship between abdominal fat, obesity, and common mental disorders: results from the HUNT study. J Psychosom Res. 2009;66(4):269–75.CrossRefPubMed
15.
go back to reference Ahlberg AC, Ljung T, Rosmond R, McEwen B, Holm G, Akesson HO, Bjorntorp P. Depression and anxiety symptoms in relation to anthropometry and metabolism in men. Psychiatry Res. 2002;112(2):101–10. Ahlberg AC, Ljung T, Rosmond R, McEwen B, Holm G, Akesson HO, Bjorntorp P. Depression and anxiety symptoms in relation to anthropometry and metabolism in men. Psychiatry Res. 2002;112(2):101–10.
16.
go back to reference Annesi JJ. Relations of mood with body mass index changes in severely obese women enrolled in a supported physical activity treatment. Obes Facts. 2008;1(2):88–92.CrossRefPubMed Annesi JJ. Relations of mood with body mass index changes in severely obese women enrolled in a supported physical activity treatment. Obes Facts. 2008;1(2):88–92.CrossRefPubMed
17.
go back to reference Simon GE, Rohde P, Ludman EJ, Jeffery RW, Linde JA, Operskalski BH, Arterburn D. Association between change in depression and change in weight among women enrolled in weight loss treatment. Gen Hosp Psychiatry. 2010;32(6):583–9. Simon GE, Rohde P, Ludman EJ, Jeffery RW, Linde JA, Operskalski BH, Arterburn D. Association between change in depression and change in weight among women enrolled in weight loss treatment. Gen Hosp Psychiatry. 2010;32(6):583–9.
18.
go back to reference Beydoun MA, Wang Y. Pathways linking socioeconomic status to obesity through depression and lifestyle factors among young US adults. J Affect Disord. 2010;123(1–3):52–63.CrossRefPubMed Beydoun MA, Wang Y. Pathways linking socioeconomic status to obesity through depression and lifestyle factors among young US adults. J Affect Disord. 2010;123(1–3):52–63.CrossRefPubMed
19.
20.
go back to reference Ball K, Burton NW, Brown WJ. A prospective study of overweight, physical activity, and depressive symptoms in young women. Obesity (Silver Spring). 2009;17(1):66–71.CrossRef Ball K, Burton NW, Brown WJ. A prospective study of overweight, physical activity, and depressive symptoms in young women. Obesity (Silver Spring). 2009;17(1):66–71.CrossRef
21.
go back to reference Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA. Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol. 2002;156(4):328–34.CrossRefPubMed Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA. Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol. 2002;156(4):328–34.CrossRefPubMed
22.
go back to reference Fox KR. The influence of physical activity on mental well-being. Public Health Nutr. 1999;2(3A):411–8.CrossRefPubMed Fox KR. The influence of physical activity on mental well-being. Public Health Nutr. 1999;2(3A):411–8.CrossRefPubMed
23.
go back to reference Foreyt JP, Brunner RL, Goodrick GK, St Jeor ST, Miller GD. Psychological correlates of reported physical activity in normal-weight and obese adults: the Reno diet-heart study. Int J Obes Relat Metab Disord. 1995;19 Suppl 4:69–72. Foreyt JP, Brunner RL, Goodrick GK, St Jeor ST, Miller GD. Psychological correlates of reported physical activity in normal-weight and obese adults: the Reno diet-heart study. Int J Obes Relat Metab Disord. 1995;19 Suppl 4:69–72.
24.
go back to reference Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, et al. Effects of exercise training on older patients with major depression. Arch Intern Med. 1999;159(19):2349–56.CrossRefPubMed Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, et al. Effects of exercise training on older patients with major depression. Arch Intern Med. 1999;159(19):2349–56.CrossRefPubMed
25.
go back to reference Tsigos C, Hainer V, Basdevant A, Finer N, Fried M, Mathus-Vliegen E, Micic D, Maislos M, Roman G, Schutz Y, Toplak H, Zahorska-Markiewicz B. Management of obesity in adults: European clinical practice guidelines. Obes Facts. 2008;1(2):106–16. Tsigos C, Hainer V, Basdevant A, Finer N, Fried M, Mathus-Vliegen E, Micic D, Maislos M, Roman G, Schutz Y, Toplak H, Zahorska-Markiewicz B. Management of obesity in adults: European clinical practice guidelines. Obes Facts. 2008;1(2):106–16.
26.
go back to reference Folkman S, Lazarus RS. The relationship between coping and emotion: implications for theory and research. Soc Sci Med. 1988;26(3):309–17.CrossRefPubMed Folkman S, Lazarus RS. The relationship between coping and emotion: implications for theory and research. Soc Sci Med. 1988;26(3):309–17.CrossRefPubMed
27.
go back to reference Li W, Rukavina P. A review on coping mechanisms against obesity bias in physical activity/education settings. Obes Rev. 2009;10(1):87–95.CrossRefPubMed Li W, Rukavina P. A review on coping mechanisms against obesity bias in physical activity/education settings. Obes Rev. 2009;10(1):87–95.CrossRefPubMed
28.
go back to reference Carver CS. You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92–100.CrossRefPubMed Carver CS. You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92–100.CrossRefPubMed
29.
go back to reference Elfhag K, Rossner S. Who succeeds in maintaining weight loss? a conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6(1):67–85.CrossRefPubMed Elfhag K, Rossner S. Who succeeds in maintaining weight loss? a conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6(1):67–85.CrossRefPubMed
30.
go back to reference Byrne SM. Psychological aspects of weight maintenance and relapse in obesity. J Psychosom Res. 2002;53(5):1029–36.CrossRefPubMed Byrne SM. Psychological aspects of weight maintenance and relapse in obesity. J Psychosom Res. 2002;53(5):1029–36.CrossRefPubMed
31.
go back to reference Rydén A, Karlsson J, Persson LO, Sjöström L, Taft C, Sullivan M. Obesity-related coping and distress and relationship to treatment preference. Br J Clin Psychol. 2001;40(2):177–88.CrossRefPubMed Rydén A, Karlsson J, Persson LO, Sjöström L, Taft C, Sullivan M. Obesity-related coping and distress and relationship to treatment preference. Br J Clin Psychol. 2001;40(2):177–88.CrossRefPubMed
32.
go back to reference Mahabir S, Baer DJ, Giffen C, Clevidence BA, Campbell WS, Taylor PR, Hartman TJ. Comparison of energy expenditure estimates from 4 physical activity questionnaires with doubly labeled water estimates in postmenopausal women. Am J Clin Nutr. 2006;84(1):230–6. Mahabir S, Baer DJ, Giffen C, Clevidence BA, Campbell WS, Taylor PR, Hartman TJ. Comparison of energy expenditure estimates from 4 physical activity questionnaires with doubly labeled water estimates in postmenopausal women. Am J Clin Nutr. 2006;84(1):230–6.
33.
go back to reference Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56.CrossRefPubMedPubMedCentral Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56.CrossRefPubMedPubMedCentral
34.
go back to reference Scheers T, Philippaerts R, Lefevre J. Patterns of physical activity and sedentary behavior in normal-weight, overweight and obese adults, as measured with a portable armband device and an electronic diary. Clin Nutr. 2012;31(5):756–64.CrossRefPubMed Scheers T, Philippaerts R, Lefevre J. Patterns of physical activity and sedentary behavior in normal-weight, overweight and obese adults, as measured with a portable armband device and an electronic diary. Clin Nutr. 2012;31(5):756–64.CrossRefPubMed
35.
go back to reference Welk GJ, McClain JJ, Eisenmann JC, Wickel EE. Field validation of the MTI actigraph and body media armband monitor using the IDEEA monitor. Obesity (Silver Spring). 2007;15(4):918–28.CrossRef Welk GJ, McClain JJ, Eisenmann JC, Wickel EE. Field validation of the MTI actigraph and body media armband monitor using the IDEEA monitor. Obesity (Silver Spring). 2007;15(4):918–28.CrossRef
36.
go back to reference Müller MJ, Bosy-Westphal A, Klaus S, Kreymann G, Lührmann PM, Neuhäuser-Berthold M, et al. World health organization equations have shortcomings for predicting resting energy expenditure in persons from a modern, affluent population: generation of a new reference standard from a retrospective analysis of a German database of resting energy expenditure. Am J Clin Nutr. 2004;80(5):1379–90.PubMed Müller MJ, Bosy-Westphal A, Klaus S, Kreymann G, Lührmann PM, Neuhäuser-Berthold M, et al. World health organization equations have shortcomings for predicting resting energy expenditure in persons from a modern, affluent population: generation of a new reference standard from a retrospective analysis of a German database of resting energy expenditure. Am J Clin Nutr. 2004;80(5):1379–90.PubMed
37.
go back to reference Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282(18):1737–44.CrossRefPubMed Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282(18):1737–44.CrossRefPubMed
38.
go back to reference Tritt K, von Heymann F, Zaudig M, Zacharias I, Söllner W, Loew T. [Development of the “ICD-10-Symptom-Rating” (ISR) questionnaire]. Z Psychosom Med Psychother. 2008;54(4):409–18.PubMed Tritt K, von Heymann F, Zaudig M, Zacharias I, Söllner W, Loew T. [Development of the “ICD-10-Symptom-Rating” (ISR) questionnaire]. Z Psychosom Med Psychother. 2008;54(4):409–18.PubMed
39.
go back to reference Fischer HF, Tritt K, Klapp BF, Fliege H. [Factor structure and psychometric properties of the ICD-10-Symptom-Rating (ISR) in samples of psychosomatic patients]. Psychother Psychosom Med Psychol. 2010;60(8):307–15.CrossRefPubMed Fischer HF, Tritt K, Klapp BF, Fliege H. [Factor structure and psychometric properties of the ICD-10-Symptom-Rating (ISR) in samples of psychosomatic patients]. Psychother Psychosom Med Psychol. 2010;60(8):307–15.CrossRefPubMed
40.
go back to reference Goldberg D, Fawcett J. The importance of anxiety in both major depression and bipolar disorder. Depress Anxiety. 2012;29(6):471–8.CrossRefPubMed Goldberg D, Fawcett J. The importance of anxiety in both major depression and bipolar disorder. Depress Anxiety. 2012;29(6):471–8.CrossRefPubMed
41.
go back to reference Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.CrossRefPubMed Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.CrossRefPubMed
42.
go back to reference Greden JF. Physical symptoms of depression: unmet needs. J Clin Psychiatry. 2003;64 Suppl 7:5–11.PubMed Greden JF. Physical symptoms of depression: unmet needs. J Clin Psychiatry. 2003;64 Suppl 7:5–11.PubMed
43.
go back to reference Brähler E, Schumacher J, Brähler C. [First all-Germany standardization of the brief form of the Gissen complaints questionnaire GBB-24]. Psychother Psychosom Med Psychol. 2000;50(1):14–21.CrossRefPubMed Brähler E, Schumacher J, Brähler C. [First all-Germany standardization of the brief form of the Gissen complaints questionnaire GBB-24]. Psychother Psychosom Med Psychol. 2000;50(1):14–21.CrossRefPubMed
44.
go back to reference Turner-Bowker DM, Bayliss MS, Ware Jr JE, Kosinski M. Usefulness of the SF-8 health survey for comparing the impact of migraine and other conditions. Qual Life Res. 2003;12(8):1003–12.CrossRefPubMed Turner-Bowker DM, Bayliss MS, Ware Jr JE, Kosinski M. Usefulness of the SF-8 health survey for comparing the impact of migraine and other conditions. Qual Life Res. 2003;12(8):1003–12.CrossRefPubMed
45.
go back to reference Hörhold M, Bolduan D, Klapp C, Volger H, Scholler G, Klapp B. [Testing a screening strategy for identifying psychosomatic patients in gynecologic practice]. Psychother Psychosom Med Psychol. 1997;47(5):156–62.PubMed Hörhold M, Bolduan D, Klapp C, Volger H, Scholler G, Klapp B. [Testing a screening strategy for identifying psychosomatic patients in gynecologic practice]. Psychother Psychosom Med Psychol. 1997;47(5):156–62.PubMed
46.
go back to reference Rosemann T, Grol R, Herman K, Wensing M, Szecsenyi J. Association between obesity, quality of life, physical activity and health service utilization in primary care patients with osteoarthritis. Int J Behav Nutr Phys Act. 2008;5:4.CrossRefPubMedPubMedCentral Rosemann T, Grol R, Herman K, Wensing M, Szecsenyi J. Association between obesity, quality of life, physical activity and health service utilization in primary care patients with osteoarthritis. Int J Behav Nutr Phys Act. 2008;5:4.CrossRefPubMedPubMedCentral
47.
go back to reference Tucker LA, Earl AB. Emotional health and weight gain: a prospective study of midlife women. Am J Health Promot. 2010;25(1):30–5.CrossRefPubMed Tucker LA, Earl AB. Emotional health and weight gain: a prospective study of midlife women. Am J Health Promot. 2010;25(1):30–5.CrossRefPubMed
48.
go back to reference Hrabosky JI, White MA, Masheb RM, Grilo CM. Physical activity and its correlates in treatment-seeking obese patients with binge eating disorder. Int J Eat Disord. 2007;40(1):72–6.CrossRefPubMed Hrabosky JI, White MA, Masheb RM, Grilo CM. Physical activity and its correlates in treatment-seeking obese patients with binge eating disorder. Int J Eat Disord. 2007;40(1):72–6.CrossRefPubMed
49.
go back to reference Hörchner R, Tuinebreijer WE, Kelder H, van Urk E. Coping behavior and loneliness among obese patients. Obes Surg. 2002;12(6):864–8.CrossRefPubMed Hörchner R, Tuinebreijer WE, Kelder H, van Urk E. Coping behavior and loneliness among obese patients. Obes Surg. 2002;12(6):864–8.CrossRefPubMed
50.
go back to reference Ahnis A, Figura A, Hofmann T, Stengel A, Elbelt U, Klapp BF. Surgically and conservatively treated obese patients differ in psychological factors, regardless of body mass index or obesity-related co-morbidities: a comparison between groups and an analysis of predictors. PLoS One. 2015;10(2):e0117460.CrossRefPubMedPubMedCentral Ahnis A, Figura A, Hofmann T, Stengel A, Elbelt U, Klapp BF. Surgically and conservatively treated obese patients differ in psychological factors, regardless of body mass index or obesity-related co-morbidities: a comparison between groups and an analysis of predictors. PLoS One. 2015;10(2):e0117460.CrossRefPubMedPubMedCentral
Metadata
Title
Associations of physical activity with depressiveness and coping in subjects with high-grade obesity aiming at bariatric surgery: a cross-sectional study
Authors
Ulf Elbelt
Anne Ahnis
Andrea Riedl
Silke Burkert
Tatjana Schuetz
Juergen Ordemann
Christian J. Strasburger
Burghard F. Klapp
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BioPsychoSocial Medicine / Issue 1/2015
Electronic ISSN: 1751-0759
DOI
https://doi.org/10.1186/s13030-015-0042-4

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Reviewer acknowledgement 2014