[Parental strain, inattention/hyperactivity symptoms and parent-reported ADHD in children and adolescents: results of the KiGGS study]. / Elterliches Belastungserleben, Unaufmerksamkeits­/Hyperaktivitätssymptome und elternberichtete ADHS bei Kindern und Jugendlichen: Ergebnisse aus der KiGGS-Studie.

BACKGROUND: A child's attention deficit hyperactivity disorder (ADHD) is associated with strain for the parents. In turn, psychosocial parental strain is associated with higher probabilities for the occurrence of inattention/hyperactivity symptoms (IHS) in their children. The aim of this paper is to assess the association between parental strain, IHS, and a parent-reported ADHD diagnosis of the children. METHODOLOGY: Based on data from n = 4596 participants of the KiGGS cohort (wave 2: 2014-2017), the type and extent of parental strain was set in relation to IHS and an ADHD diagnosis of the child in cross-sectional analysis. Frequencies, means, beta coefficients, and odds ratios adjusted for sex, age, socioeconomic status, and migration background are reported. RESULTS: In individual consideration, a greater number of parental strains were associated with IHS than with an ADHD diagnosis. In a multivariate analysis, financial worries and parenting problems/conflicts with the children were significant predictors of IHS and an ADHD diagnosis, respectively. In addition, four or more types of parental strain were associated with a higher likelihood of both IHS and an ADHD diagnosis. DISCUSSION: Financial and child-rearing strain are relevant to parents of children with IHS and an ADHD diagnosis. Interrelationships between parental stress and a child's IHS or an ADHD diagnosis can be assumed. To relieve their burden, prevention can either aim at improving the situation of ADHD-affected families or at improving the family's handling of the child's ADHD.

Changes in mental health in the German child and adolescent population during the COVID-19 pandemic - Results of a rapid review.

Background: This rapid review examines changes in the mental health of the German child and adolescent population during the COVID-19 pandemic. Methods: The basis are 39 publications, which were identified by means of systematic literature search (until 19.11.2021) and manual search. The databases of the included publications were systematized with regard to their representativeness for the general population, and the indicators used were categorized with regard to the depicted constructs and their reliability. Results: The large majority of the studies took place at the beginning of the pandemic until the summer plateau 2020. Representative studies mainly reported high levels of pandemic-related stress, increases in mental health problems, and negative impacts on the quality of life. Non-representative studies showed mixed results. Vulnerable groups could only be identified to a limited extent. Both routine and care-related data showed declines in the outpatient and inpatient service utilisation during the various waves of the pandemic followed by catch-up effects. Children and adolescents turned out to be more vulnerable during the pandemic compared to adults, but their stress levels varied with the waves of the pandemic and the related containment measures. Conclusions: A future forward-looking crisis and pandemic management requires a close-knit and continuous surveillance of the mental health of children as well as an improved identification of risk groups.

Health situation in Germany during the COVID-19 pandemic. Developments over time for selected indicators of GEDA 2019/2020 - An update.

The spread of the coronavirus SARS-CoV-2 in 2020 and the containment measures associated therewith have changed many aspects of daily life. An impact on health even beyond infections itself is assumed as well. The health situation of the population in the first phase of the pandemic was thus analysed using data from the German Health Update (GEDA 2019/2020-EHIS). By continuing the survey, the analyses for 2020 are completed (n=26,507 participants), whereby the focus is now on the third phase of the pandemic (second wave of infection, gradual reintroduction of containment measures). The health indicators are presented on a monthly basis. As in the first phase of the pandemic, no pandemic-related changes were observed for tobacco smoking/ second-hand smoke exposure and for received/lack of/provided support. In contrast to the first phase of the pandemic, declines in utilisation of medical services and depressive symptoms are not observed in the third phase. The increase in body weight/body mass index after the first phase of the pandemic did not continue. The survey period allows for a comparison of the periods before and as of the pandemic situation. A decrease in the medical services utilisation and depressive symptoms as well as an increase in the body weight/body mass index is observed in the period from March 2020 to January 2021 compared to the pre-pandemic period from April 2019 to March 2020.

Care for the chronically ill in Germany - The challenges during the COVID-19 pandemic.

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.

Health situation of adults in Germany - Results for selected indicators from GEDA 2019/2020-EHIS.

In this article, we examine selected health indicators for the adult population aged 18 years and older in Germany (n=22,708) from the German Health Update (GEDA 2019/2020-EHIS) conducted between April 2019 and September 2020. These indicators include those of self-assessed health and depressive symptoms as well as chronic physical diseases and conditions. In young adulthood (18 to 44 years), over 80% of participants report good or very good subjective health. During this phase of life, most chronic diseases and conditions are rare, although allergies are frequent, and bronchial asthma and depressive symptoms are not uncommon. From mid adulthood (45 years and older), there is a gradual increase in the prevalence of chronic diseases such as cardiovascular disease, diabetes, chronic obstructive pulmonary disease and osteoarthritis. Over 60% of older adults (65 years and older) report a chronic disease or long-term health problem, while only half continue to report good or very good subjective health. During this stage of life, allergies and depressive symptoms become less prevalent. For some diseases, there are also differences according to gender and level of education. This article demonstrates the high public health relevance of age-associated chronic physical diseases and health related limitations in everyday life in an ageing society as well as the need to provide care for certain health conditions already in young adulthood.

The effects of mental health problems in childhood and adolescence in young adults: Results of the KiGGS cohort.

Mental health problems in childhood and adolescence may have effects into adulthood. With the KiGGS cohort, data are available for the first time that can be used to track the effects of internalising and externalising problems in childhood or adolescence into young adulthood on a national database. From the KiGGS baseline survey (2003-2006) to KiGGS Wave 2 (2014-2017), a total of 3,546 children and adolescents aged 11 to 17 years were tracked over a period of eleven years into young adulthood. Mental health problems in childhood or adolescence were variously associated with impaired mental health, lower life satisfaction and poorer quality of life and indicators of sexual and reproductive health in young adulthood. When psychosocial protective factors at the time of the KiGGS baseline survey were considered, the longitudinal correlations of internalising and externalising problems with indicators of mental health, life satisfaction and physical and psychological quality of life decreased, as did, to a lesser extent, the correlations with indicators of sexual and reproductive health and, for externalising disorders, also with low educational status (reference: medium). Implications for prevention and intervention are discussed.

Changes in views on aging in later adulthood: the role of cardiovascular events.

A number of longitudinal studies have pointed to the long-term impact of different views on aging (VoA) on health in later life, whereas the reverse relationship has rarely been examined. Serious cardiovascular events such as myocardial infarction or stroke are life-threatening events which might in turn lead to changes in VoA. The present longitudinal study examined the effect of a cardiovascular event (CVE) on VoA over a three-year period using pooled data from three waves of the German Ageing Survey (2008, 2011, 2014, age range: 40-95 years). In order to account for alternative explanations for changes in VoA, individuals without CVE (n = 200) were matched to individuals who experienced a CVE (n = 202) using a propensity score matching procedure. Compared to individuals without CVE, individuals who experienced a CVE showed adverse changes in three VoA indicators (self-perceptions of aging as associated with physical losses/with ongoing development; subjective age). These results suggest that CVE can in fact change how individuals view their own aging. According to previous studies, this can lead to future health changes and thus become a health-related downward spiral. Health promotion programs could, therefore, profit by adding specific VoA interventions for individuals who experienced a CVE.

The assessment of views on ageing: a review of self-report measures and innovative extensions.

This is a review of existing self-report measures for assessing views on ageing. It provides an overview of instruments, for which basic psychometric properties are available and describes them according to the purposes for which they are suitable. Literature search resulted in the inclusion of 89 instruments which were categorised along eight dimensions. The majority of measures focus on explicit cognitions about people's own age and ageing or other (older) people. A substantial amount of tools account for the multidimensionality and multidirectionality of views on ageing, i.e. the idea that ageing is accompanied by both gains and losses in several different domains. To some extent, measures reflect that ageing is a long-term process and that views on ageing are malleable, rather than just stable traits. Cluster analysis revealed heterogeneity in instruments regarding the dimensions of Ecosystem, Balance, Stability, Dynamics, and Complexity. It becomes apparent, however, that approaches to measure views on ageing should be extended to more specifically target the implicit level as well as affective, physiological, and behavioural manifestations. Additionally, means for capturing views on ageing on the societal level and tools with a distinct time reference are needed. This is particularly important when one wants to account for the lifelong dynamics of views on ageing.

Current state of research on psychotherapy for home-living vulnerable older adults with depression.

Older home-living vulnerable adults often suffer from chronic conditions accompanied by restrictions in mobility, social participation and reduced independence. Among this rapidly growing population depression is a common and serious health problem; however, there are shortcomings in the diagnosis of depression and provision of psychotherapy. Despite growing evidence in treating depression among the group of nursing home residents or the "young-old", there is a research gap regarding needs-oriented healthcare strategies for very old, frail or care-dependent older adults living at home. The present article provides an overview of different outpatient psychotherapeutic treatment approaches for vulnerable older adults with depression, in particular adaptations tailored to those who are homebound or in need of care. Based on the current state of research, this article derives recommendations for psychotherapy in this special setting to consider the physical and psychosocial resources of this patient group. Furthermore, healthcare strategies for embedding psychotherapy in collaborative, telehealth or home-delivered healthcare services are described and their applicability as psychosocial support for older adults during the coronavirus disease 2019 (COVID-19) pandemic is discussed. Psychotherapy is an efficacious treatment for depression in home-living vulnerable older adults. Further implementing telehealth or home delivered settings, individually tailored psychotherapeutic approaches as well as collaborative and stepped care approaches can increase utilization and medical supply of this patient group. More research and innovative programs are needed to improve access to and provision of psychotherapeutic care as well as their social inclusion.

Outpatient psychotherapy for home-living vulnerable older adults with depression: study protocol of the PSY-CARE trial.

BACKGROUND: There is a need to improve psychotherapeutic approaches to treatment for vulnerable older adults with depression in terms of both clinical practice and health care supply. Against this background, PSY-CARE is testing the feasibility and effectiveness of outpatient psychotherapy for home-living older adults in need of care with depression in Berlin, Germany, and neighboring suburban areas. METHODS: In a two-arm single-center pragmatic randomized controlled trial (RCT), manual-guided outpatient psychotherapy will be compared to brief psychosocial counseling. The study population will be compromised of older adults with clinically significant depressive symptoms who have a long-term care grade, as assessed by the German compulsory state nursing care insurance. In the intervention group, individual cognitive-behavioral psychotherapy tailored to the specific needs of this population will be offered by residential psychotherapists as part of the regular healthcare service. In the active control group, participants will receive individual psychosocial telephone counselling and a self-help guide. The planned sample size is N = 130 (n = 65 participants per group). The reduction of depressive symptoms (primary outcome) as well as the maintaining of activities of daily living, quality of life, and functioning will be assessed with questionnaires provided at baseline, after the end of the intervention and after three months. Feasibility and process evaluation will be conducted qualitatively based on documentation and interviews with psychotherapists, gatekeepers and the participants. DISCUSSION: PSY-CARE investigates the potentials and limitations of providing outpatient psychotherapeutic treatment meeting the demands of vulnerable home-living older adults with depression under the real conditions of the health care system. The study will provide practical implications to improve access to and quality of outpatient psychotherapy for this poorly supplied population. TRIAL REGISTRATION: The trial is registered at ISRCTN55646265 ; February 15, 2019.

Developments in the health situation in Germany during the initial stage of the COVID-19 pandemic for selected indicators of GEDA 2019/2020-EHIS.

SARS-CoV-2, the novel coronavirus, has posed major challenges in Germany in 2020. It is unclear whether the pandemic and containment measures will have an impact on the health of the population beyond the point of infection. The German Health Update (GEDA 2019/2020-EHIS) is a nationwide survey of the population aged 15 years and older (n=23,001) that was conducted between April 2019 and September 2020. The focus of the analysis was on indicators for which pandemic-related changes could be expected. Based on regression models, adjusted proportions and mean values were estimated as trends over time. Any differences in the values found for the time period of containment measures in spring 2020 and the reference period 2019 were statistically tested. Since the implementation of containment measures, both body weight and body mass index (BMI) have increased. The utilisation of general and specialist medical services decreased temporarily. The number of tobacco smokers during the observation period also decreased, yet without revealing a clear link to the pandemic situation. No differences were found in the general population for depressive symptoms and household assistance received and provided. During the period of containment measures, changes to the health situation beyond the occurrence of infections can be observed. However, a more differentiated explanation of these findings will require further analyses.

Corrigendum: Developments in the health situation in Germany during the initial stage of the COVID-19 pandemic for selected indicators of GEDA 2019/2020-EHIS.

[This corrects the article on p. 3-20 in vol. 5.].

Impact of the COVID-19 pandemic and the related containment measures on the mental health of children and adolescents.

Children and adolescents are particularly affected by the COVID-19 pandemic and the official containment measures. However, the effects on their mental health have been little studied. The aim of this narrative review is to summarize existing evidence on the mental health of children and adolescents in the first weeks of the COVID-19 pandemic and during the measures taken to contain it in Germany. First international and national studies draw a differential picture. Children and adolescents showed symptoms of anxiety and depression as well as a reduced quality of life. The closure of childcare and educational facilities and the associated loss of the familiar daytime structure as well as loss of contact and independent learning at home posed considerable challenges for affected children and their families. Spatial confinement at home and the lack of alternative options of stay during the containment measures could also have lead to increased family stress, heightened family aggression, and domestic violence. However, the findings of several studies also show that many families coped with the time during the containment measures mostly well. In the event of possible future pandemics or further waves of the COVID-19 pandemic, the needs of adolescents and their families during the containment measures should be given greater consideration.

There Is Still Time to Be Active: Self-Perceptions of Aging, Physical Activity, and the Role of Perceived Residual Lifetime Among Older Adults.

Self-perceptions of aging (SPA) are a resource in later life. As aging is accompanied with perceptions of the finitude of life, it is assumed that perceived residual lifetime may play a role in the relationship between SPA and health behavior. Among older adults aged 65 years and older, the present study tested whether the relationships between gain- and loss-related SPA and two kinds of physical activity are moderated by perceived residual lifetime. Data were based on 2.367 participants over a 3-year period. Participants with less gain-related SPA were less likely to walk on a regular basis; however, a longer residual lifetime compensated for this negative effect. In addition, participants did sports more often if they not only held less loss-related SPA but also perceived a longer residual lifetime. These results emphasize the importance of perceived residual lifetime in health promotion interventions targeting physical activity in older adults.

Are self-perceptions of ageing modifiable? Examination of an exercise programme with vs. without a self-perceptions of ageing-intervention for older adults.

OBJECTIVE: Longitudinal studies have consistently shown beneficial effects of positive self-perceptions of ageing (SPA) on health. However, SPA are more often negative than positive, particularly in older adults. For this reason, the present study tested the effectiveness of an intervention to promote more positive SPA in the context of an exercise programme for older adults. DESIGN: Eighty-four community-dwelling older adults (66-88 years; M(SD)=76.8(5.29)) were randomly assigned to a group-based exercise programme over 12 weeks with (n = 46) or without (n = 38) a psychological intervention to change SPA, consisting of four intervention units over the programme period. MAIN OUTCOME MEASURES: A gain- and a loss-related domain of SPA were assessed at baseline, after the first half of the programme, directly after the programme and in a follow-up four weeks later. RESULTS: Latent change score models showed an improvement of participants' SPA in the intervention group in both SPA domains after the programme, whereas SPA did not change in the control group. Both groups showed an improvement in physical performance, however, only the IG showed additional improvements in mental health. CONCLUSION: The implementation of an SPA intervention is a promising approach in regular health promotion programmes for older adults.

Regional Impact of Population Aging on Changes in Individual Self-perceptions of Aging: Findings From the German Ageing Survey.

Background and Objectives: The importance of self-perceptions of aging (SPA) for health and longevity is well documented. Comparably little is known about factors that contribute to SPA. Besides individual factors, the context a person lives in may shape SPA. Research has so far focused on country-level differences in age stereotypes, indicating that rapid population aging accompanies more negative age stereotypes. The present study expands previous research by investigating the impact of district-specific population aging within one country on different facets of SPA. Research Design and Methods: Based on a large representative survey in Germany, the study investigates changes in SPA as ongoing development as well as the SPA of physical loss over a 12-year period in adults aged 40+. The study uses several indicators of population aging (e.g., population development, average age, greying index), to identify four clusters differing in their pace of population aging. Based on three-level latent change models, these clusters were compared in their impact on changes in SPA. Results: Compared to districts with an average rate of population aging, the study shows that persons living in regions with a fast population aging rate (C1) hold more negative SPA in both facets (ps = .01). Districts with slow population aging (C2) have significantly higher SPA ongoing development (p = .03). Discussion and Implications: The study underlines the importance for regional differences in population aging on the development of SPA. In particular, societies should be aware that fast population aging may result in more negative SPA.

The role of physical activity in the relationship between self-perceptions of ageing and self-rated health in older adults.

OBJECTIVE: Positive self-perceptions of ageing are associated with better health; however, little is known about the potentially underlying mechanisms. The present longitudinal study examines whether the relationship between self-perceptions of ageing and self-rated health is mediated by physical activity in older adults with multiple chronic conditions. DESIGN: A sample of 309 German community-dwelling older adults aged 65-85 years with two or more chronic conditions was assessed at three measurement occasions over 2.5 years. Participants provided information on self-perceptions of ageing, physical activity, self-rated health, number of chronic conditions and demographics (T1). Physical activity was reassessed six months later (T2) and self-rated health after 2.5 years (T3). Data were analysed using multiple regression and path analyses. MAIN OUTCOME MEASURES: Self-rated health and physical activity. RESULTS: More positive self-perceptions of ageing were related to better self-rated health over a 2.5-year period controlling for confounding variables. Physical activity six months after T1 partially mediated this relationship. CONCLUSION: Having more positive self-perceptions of ageing is associated with higher levels of physical activity, which in turn predict better self-rated health over time. This supports the hypothesis of a behavioural pathway in the self-perceptions of ageing--health link.

Reduction of influence of task difficulty on perceptual decision making by STN deep brain stimulation.

Neurocomputational models of optimal decision making ascribe a crucial role-the computation of conflict between choice alternatives-to the subthalamic nucleus (STN). Specifically, these models predict that deep brain stimulation (DBS) of the STN will diminish the influence of decision conflict on decision making. In this work, patients with Parkinson's disease judged the direction of motion in random dot stimuli while ON and OFF DBS. To induce decision conflict, we varied the task difficulty (motion coherence), leading to increased reaction time (RT) in trials with greater task difficulty in healthy subjects. Results indicate that DBS significantly influences performance for perceptual decisions under high decision conflict. RT increased substantially OFF DBS as the task became more difficult, and a diffusion model best accounted for behavioral data. In contrast, ON DBS, the influence of task difficulty on RT was significantly reduced and a race model best accounted for the observed data. Individual data fits of evidence accumulation models demonstrate different information processing under distinct DBS states. Furthermore, ON DBS, speed-accuracy tradeoffs affected the magnitude of decision criterion adjustment significantly less compared to OFF DBS. Together, these findings suggest a crucial role for the STN in adjusting decision making during high-conflict trials in perceptual decision making.