The effect of depressive symptomatology on the association of vitamin D and sleep.

BACKGROUND: Sleep disorders and vitamin D deficiency are highly prevalent health problems. Few studies examined the effect of vitamin D concentrations on objectively measured sleep with high methodological quality and temporal proximity. Previous analysis within the LIFE-Adult-Study suggested that a lower concentration of serum vitamin D was associated with both shorter and later night sleep. However, no conclusion about underlying mechanisms could be drawn. We addressed the question whether this relationship is explained by the presence of depressive syndromes, which are linked to both vitamin D deficiency and sleep disturbances. METHODS: It was investigated whether the association of vitamin D concentrations and night sleep parameters is mediated or moderated by depressive symptomatology. We investigated a subset (n = 1252) of the community sample from the LIFE-Adult-Study, in which sleep parameters had been objectively assessed using actigraphy, based on which two sleep parameters were calculated: night sleep duration and midsleep time. Serum 25(OH) D concentrations were measured using an electrochemiluminescence immunoassay. Depressive symptomatology was evaluated with the Centre for Epidemiological Studies Depression Scale. The mediation effect was analyzed by using Hayes' PROCESS macro tool for SPSS for Windows. RESULTS: The depressive symptomatology was neither significantly associated with night sleep duration nor midsleep time. The associations between vitamin D concentrations and night sleep duration/midsleep time through mediation by depressive symptomatology were not significant. Corresponding moderator analyses were also non-significant. CONCLUSION: The associations between vitamin D concentrations and night sleep parameters (sleep duration and midsleep time) seem to be neither mediated nor moderated by depressive symptomatology.

The Depression Screener for Teenagers (DesTeen): a valid instrument for early detection of adolescent depression in mental health care.

OBJECTIVE: Diagnosis of comorbid depressive disorder is challenging, even in mental health care. Screening instruments could be economic tools in indicating depression. For the first time, the current study investigates the validity of the newly developed Depression Screener for Teenagers (DesTeen) and its abbreviated five-item form DesTeen-a in a mental health setting. METHODS: A total of 88 patients aged 13-16 years were recruited in institutions specialized in child and adolescent psychiatry, psychotherapy or psychosomatic medicine. DSM-IV-TR diagnoses of major depression or dysthymia based on a structured diagnostic interview served as the gold standard for validation. For assessing the criterion validity of the DesTeen and the DesTeen-a, areas under the receiver operating characteristic curve (AUC) were calculated. Specificity and sensitivity were computed for optimal cut-off scores according to the Youden Index. RESULTS: Point prevalence of depression was 27.3%. Diagnostic accuracy of the DesTeen was high (AUC=.94). Using a cut-off score of ≥ 18, sensitivity was .96 and specificity was .86. The DesTeen-a showed no loss in validity (AUC=.94). At a cut-off point of ≥ 6, sensitivity remained excellent (.96), while specificity was slightly lower (.80). LIMITATIONS: The limited representativeness and the small sample size restrict the generalizability of the findings. CONCLUSIONS: The DesTeen and its abbreviated version are valid instruments to screen for adolescent depression in mental health care. Since structured interviews to diagnose comorbid mental disorders are rarely applied, the DesTeen and the DesTeen-a can support mental health specialists in making the diagnostic process more efficient, thus facilitating effective treatment planning.

Increasing knowledge about depression in adolescents: effects of an information booklet.

PURPOSE: This study evaluates a newly developed information booklet about depression among adolescents. The aim was to examine the enhancement of knowledge through the booklet with the objective of reducing stigma and facilitating awareness of own treatment needs. METHODS: 628 German ninth graders were enrolled in a pre-post-follow-up study using study-specific questionnaires to investigate knowledge enhancement in seven depression-related topics. Exploratively, knowledge enhancement was calculated with respect to education level and gender. Additionally, the students assessed the booklet's layout, content and utility. Knowledge enhancement was analyzed using repeated measures ANOVA for index values of the booklet's topics. The effect size partial eta square (η²) was computed. RESULTS: The pre-post-follow-up comparison yielded significant knowledge enhancement for all seven index values (p < 0.001). The associated effect sizes were medium to large. The strongest effects were achieved for the categories "Antidepressants" (η² = 0.56), "Symptoms" (η² = 0.45) and "Treatment" (η² = 0.17) of depression as well as for "Suicidality" (η² = 0.36). Although baseline knowledge was high in all students, knowledge enhancement was greater in better educated than in less educated students. Overall assessment of the booklet was good (mean = 2.15 on a rating scale from "very good" (1) to "fail" (6)). CONCLUSIONS: The information booklet as a low-threshold educational approach can significantly enhance depression-specific knowledge in students. Hence, it helps adolescents to acknowledge their own symptoms and treatment needs as well as to recognize these specific mental health problems in their peers. Thus, the booklet can contribute to the reduction of stigma and treatment barriers in adolescents.

Prevalence of depression and depressive symptoms in women with previous miscarriages or stillbirths - A systematic review.

Women who have had miscarriages or stillbirths are known to have an elevated risk for depression. However, the prevalence of depressive disorders and/or symptoms in this group is unclear. Therefore, our aim was to estimate the corresponding prevalence of depression and depressive symptoms. A systematic literature search of the databases MEDLINE, psycINFO and PSYNDEX was conducted to consider all studies published between 2000 and 2022 in English or German on the prevalence of depression or depressive symptoms in women following miscarriages or stillbirths. Studies using valid psychiatric diagnoses or validated assessment methods regarding depression were included in the systematic review. The PRISMA guidelines were followed. Data concerning depressive symptoms were extracted from 14 studies. The range regarding prevalence of depressive symptoms in women with previous miscarriages or stillbirths was very wide (5%-91.2%). All longitudinal studies demonstrate a reduction of depressive symptoms over time. The prevalence of depressive disorders had a range of 5.4 (only for minor depression according to DSM-IV) - 18.6% (for depressive disorders according to ICD-10). The included studies are very heterogeneous considering the investigated groups, the length of pregnancies and time passed since the occurrence of miscarriages or stillbirths. Women with miscarriages or stillbirths have an elevated risk for depressive symptoms and disorders. In most affected women, depressive symptoms are most pronounced in the first months after the pregnancy loss and diminish over time.

Depression after pregnancy loss: the role of the presence of living children, the type of loss, multiple losses, the relationship quality, and coping strategies.

Background: Pregnancy loss (PL) is a common, yet rarely examined public health issue associated with an increased risk of impaired mental health, particularly depression.Objective: Previous research shows childlessness to be a correlate of depression after PL. First studies also indicate associations of the type of loss, multiple losses, relationship quality, and coping strategies with depression after the loss of a pregnancy. However, results are inconsistent and the few existing studies show methodological deficits. Therefore, we expect higher depression scores for women without living children, and we exploratively examine the associations between the type of loss, the number of losses, relationship quality, and coping strategies with depression scores for women who suffered a PL.Method: In an online setting, N = 172 women with miscarriage (n = 137) or stillbirth (n = 35) throughout the last 12 months completed the Patient Health Questionnaire (PHQ-D), Brief-COPE, and Partnerschaftsfragebogen (PFB), a German questionnaire measuring relationship quality.Results: In a multiple hierarchical regression analysis, stillbirth, ß = 0.15, p = .035, presence of living children, ß = -0.17, p = .022, and self-blame/emotional avoidance, ß = 0.34, p < .001, are predictors of depression scores. However, there was no association between depression symptoms and other coping strategies, relationship quality, and multiple losses.Conclusions: Especially with regard to women who have no living children, have suffered a stillbirth, or are affected by self-blame/emotional avoidance, health care providers should monitor the presence of depressive symptoms. Our results indicate the need for specific instruments measuring coping style and relationship quality after PL, since the standard items of the PFB and the Brief-COPE seem inappropriate for this setting.

Stillbirth is associated with higher maternal depression scores than miscarriage.Women with living children show lower depression scores after pregnancy loss than childless women.Self-blame and emotional avoidance are associated with higher maternal depression scores after pregnancy loss.

Cohort profile: BioMD-Y (biopsychosocial factors of major depression in youth) - a biobank study on the molecular genetics and environmental factors of depression in children and adolescents in Munich.

PURPOSE: BioMD-Y is a comprehensive biobank study of children and adolescents with major depression (MD) and their healthy peers in Germany, collecting a host of both biological and psychosocial information from the participants and their parents with the aim of exploring genetic and environmental risk and protective factors for MD in children and adolescents. PARTICIPANTS: Children and adolescents aged 8-18 years are recruited to either the clinical case group (MD, diagnosis of MD disorder) or the typically developing control group (absence of any psychiatric condition). FINDINGS TO DATE: To date, four publications on both genetic and environmental risk and resilience factors (including FKBP5, glucocorticoid receptor activation, polygenic risk scores, psychosocial and sociodemographic risk and resilience factors) have been published based on the BioMD-Y sample. FUTURE PLANS: Data collection is currently scheduled to continue into 2026. Research questions will be further addressed using available measures.

Social support and (complex) posttraumatic stress symptom severity: does gender matter?

Background: Perceived social support is an established predictor of post-traumatic stress disorder (PTSD) after exposure to a traumatic event. Gender is an important factor that could differentiate responses to social support, yet this has been little explored. Symptoms of complex PTSD are also common following trauma but have been under-researched in this context. Large scale studies with culturally diverse samples are particularly lacking.Objectives: In a multi-country sample, we examined: (a) gender differences in perceived social support and both posttraumatic stress symptom severity (PTSS) and complex posttraumatic stress symptom severity (CPTSS); (b) associations between social support and PTSS/CPTSS; and (c) the potential moderating role of gender in the relationship between perceived social support and trauma-related distress.Method: A total of 2483 adults (Mage = 30yrs, 69.9% females) from 39 countries, who had been exposed to mixed trauma types, completed the Multidimensional Scale of Perceived Social Support and the International Trauma Questionnaire (which captures PTSS/CPTSS). Regression analyses examined associations between gender, perceived social support, and PTSS/CPTSS; and tested for gender by social support interactions in predicting PTSS/CPTSS scores. Models were adjusted for age and socioeconomic status.Results: In our cross-country sample, females had greater PTSS/CPTSS than males (B = .23 [95% CI 0.16, 0.30], p < .001; B = .20 [0.12, 0.27], p < .001; respectively), but there was no evidence of gender differences in perceived social support (B = .05 [-0.05, 0.16], p = .33). For both genders, low perceived social support was associated with higher PTSS/CPTSS (females: B = -.16 [-0.20, -0.12], p < .001; B = -.27 [-0.30, -0.24], p < .001; respectively; males: B = -.22 [-0.29, -0.15], p < .001; B = -.31 [-0.36, -0.26], p < .001; respectively), and for PTSS only we found weak evidence that this association was stronger for males vs. females (B = .07 [0.04, 0.14, p = .04).Conclusion: Individuals who feel more socially supported have lower trauma-related distress, and this association is similar in males and females. PTSD/CPTSD interventions may benefit from augmenting perceived social support, regardless of gender.

In our multi-country sample, females show higher levels of (complex) posttraumatic stress symptom severity than males.There is no evidence of gender differences in perceived social support.Greater perceived social support is associated with lower (complex) posttraumatic stress symptom severity across both genders.

Childhood maltreatment is linked to larger preferred interpersonal distances towards friends and strangers across the globe.

Childhood maltreatment (CM) is thought to be associated with altered responses to social stimuli and interpersonal signals. However, limited evidence exists that CM is linked to larger comfortable interpersonal distance (CID) - the physical distance humans prefer towards others during social interactions. However, no previous study has investigated this association in a comprehensive sample, yielding sufficient statistical power. Moreover, preliminary findings are limited to the European region. Finally, it is unclear how CM affects CID towards different interaction partners, and whether CID is linked to social functioning and attachment. To address these outstanding issues, adults (N = 2986) from diverse cultures and socio-economic strata completed a reaction time task measuring CID towards an approaching stranger and friend. Higher CM was linked to a larger CID towards both friends and strangers. Moreover, insecure attachment and less social support were associated with larger CID. These findings demonstrate for the first time that CM affects CID across countries and cultures, highlighting the robustness of this association.

Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes.

OBJECTIVE: The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. METHODS: Data from 92 residents aged 65-97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. RESULTS: Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 (0.92) at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 (0.69) at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression (0.92), whereas the GDS-15 was sensitive only for major depression (0.85), but not for minor depression (0.54). For specificity, there was no significant difference between WHO-5 (0.79) and GDS-15 (0.88), but both instruments outperformed the GDS-4 (0.53). CONCLUSIONS: The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents.

Screening for adolescent depression in paediatric care: validity of a new brief version of the Center for Epidemiological Studies Depression Scale.

BACKGROUND: The study assessed the criterion validity of the 15-item version of the Center for Epidemiological Studies Depression Scale (CES-D-15) as a screening instrument in paediatric care. METHOD: A total of 327 patients (13-16 years) completed the CES-D-15 and a diagnostic interview serving as gold standard diagnosis for validation. RESULTS: Receiver operating characteristics yielded an overall accuracy of area under the curve (AUC) = .90 (95% CI [.85, .95]) for the detection of any depressive disorder. At the optimal cut-off point of 14, sensitivity (.85) and specificity (.84) were good. CONCLUSIONS: The CES-D-15 is a promising tool for paediatricians to enhance the recognition rate of juvenile depression.

Suicide rates during and after the first COVID-19 lockdown in Germany in 2020.

The impact of the COVID-19 pandemic and of measures implemented to curb the spread of the virus on suicidal behavior has been investigated in different regions of the world, but does not yet allow to draw conclusions for Germany. Especially lockdowns might have effects on suicide rates via impact on mental disorders, changes in the choice of suicide method, a decrease in help seeking behavior, or a deterioration in the quality of medical care for people with mental disorders. The following research questions were addressed: i) did suicide rates in Germany in 2020 change during lockdown and non-lockdown periods when compared to a ten-year baseline? ii) was there a change in the proportion of suicide methods during the lockdown compared to baseline? An interrupted time-series analysis based on a linear regression was used. For the comparisons of predicted and observed suicide rates, excess suicide mortality rates (ESMR) were chosen among others. Changes in the choice of method were analyzed by comparing the rates of different methods to those at baseline. Although the mean suicide rate in 2020 was not significantly different from baseline, the weekly analysis of suicide rates revealed a significant difference (χ2 = 64.16; df = 39; p = 0.007), with some weeks showing higher and others lower rates than previous years. The effects for separate weeks were attenuated to non-significance after correction for multiple testing. Suicide mortality during the first lockdown in 2020 was significantly lower than expected (ESMR = 0.933; 95% CI: 0.890; 0.985) whereas, in the post-lockdown period, the registered suicide mortality was not significantly different from the expected one (ESMR = 1.024; 95% CI: 0.997; 1.051). During lockdown, there was a significant increase of the percentage of the suicide method categories jumping and 'other methods' and a decrease of poisoning and lying in front of a moving object. Being able to determine whether the choice of more or less lethal methods during lockdown versus non-lockdown periods partly explains this finding would require a representative assessment of attempted suicides.

Munich Alliance Against Depression.

Background: A four-level community-based intervention aiming simultaneously to improve the care for depression and to prevent suicidal behavior has been implemented in the German city Munich. Aims: Changes in suicide rates in Munich during 2009-2014 were analyzed with respect to a 10-year baseline. The same was true for a control region (Cologne) and Germany minus Munich. Method: The interventions included training of primary care providers, a public awareness campaign, training of community facilitators, and support for patients and relatives. Analyses included repeated-measures, generalized linear models. Results: In Munich, the suicide rate significantly decreased during the intervention period compared to baseline (percentage change = -15.0%; p < .001, 198 compared to 222 suicides per year). Differences in the change for Munich and the change for the control locations (Cologne; -1.7%; p = .71) and Germany minus Munich (-6.2%; p = .09) were not significant. Limitations: Data on suicide attempts were unavailable. Conclusion: In Munich, a clinically and statistically significant decrease in suicide rate was found. This change was numerically but not significantly larger than in the control regions. The results are promising, however. Because of low suicide base rates and limited power, no strong conclusions can be drawn concerning suicide preventive effects of the intervention.

Evaluation of an information booklet for adolescents on depression: evidence from a randomized controlled study.

BACKGROUND: Adolescents with depression often show barriers to seek treatment offers due to various reasons, including limited knowledge about the manifestation of the disorder, its treatment options, or fear of stigmatization. Psychoeducational approaches might reduce these barriers by increasing depression literacy. The aim of the present randomized controlled study was to evaluate whether an innovative and age-appropriate evidence-based information booklet about youth depression increases depression-specific knowledge in adolescents with depression and is also appealing to the target group. METHODS: 50 adolescents with a history of depression (current/remitted) aged 12-18 years participated in the study including a pre-, post- and follow-up assessment. Participants were randomly assigned to one of two groups. The experimental group received a target group-specific information booklet about youth depression including seven subdomains. The active control group received an information booklet about asthma in youth that was highly comparable to the depression booklet in terms of format and length. Before and after reading, and at a four-week follow-up, we assessed knowledge about youth depression based on a questionnaire. Furthermore, participants evaluated the acceptability of the information booklets. RESULTS: Unlike the active control group, the experimental group showed a significant increase in depression-specific knowledge from pre to post and from pre to follow-up across all subdomains. This increase was evident in four subdomains ("symptoms", "treatment", "antidepressants", and "causes"). The overall reception of the information booklet about depression was positive and participants stated that they would recommend the information booklet about depression to their peers. CONCLUSION: This is the first randomized controlled study to demonstrate that an information booklet about youth depression effectively imparts depression-specific knowledge to participants with a history of depression and shows high acceptance. Information booklets that are appealing and increase depression-specific knowledge might be a promising low-threshold and cost-effective approach to reduce barriers to treatment and raise awareness.

Screening for depression in adolescents: validity of the patient health questionnaire in pediatric care.

BACKGROUND: This study examines the criterion validity of the Patient Health Questionnaire 9-item (PHQ-9) and 2-item (PHQ-2) version as a depression-screening instrument for adolescents. METHODS: Three hundred twenty-two adolescents aged 13-16 were recruited from pediatric hospitals. Criterion validity of the PHQ-9 and PHQ-2 was assessed against diagnoses of any depressive disorder provided by a structured diagnostic interview. Areas under the receiver operating characteristics curve (AUCs) and sensitivities and specificities at optimal cutoff points were computed for both versions of the PHQ. Besides the dimensional algorithm, a categorical algorithm was applied for the PHQ-9. Validity measures of both scoring procedures of the PHQ-9 as well as PHQ-2 were compared statistically. In addition, unaided clinical depression diagnoses by the attending pediatricians were evaluated. RESULTS: Using the dimensional algorithm, the AUCof the PHQ-9 (93.2%) was significantly higher than that of the PHQ-2 (87.2%). At optimal cutoffs, there was no significant difference in sensitivity (PHQ-9: 90.0%, PHQ-2: 85.0%), but in specificity (PHQ-9: 86.5%, PHQ-2: 79.4%). Although the categorical algorithm of the PHQ-9 was most specific (94.7%), sensitivity was just above chance (52.5%). The unaided clinical diagnoses yielded a sensitivity of 12.5% and a specificity of 96.0%. CONCLUSIONS: The dimensional algorithm of the PHQ-9 demonstrated high criterion validity, whereas the categorical algorithm should not be applied due to its low sensitivity. Even though the PHQ-2 performed well, validity of the PHQ-9 was still superior. Hence, the PHQ-9 can be recommended as depression screener for adolescents to improve recognition rates in pediatric care.

Sensitivity to changes during antidepressant treatment: a comparison of unidimensional subscales of the Inventory of Depressive Symptomatology (IDS-C) and the Hamilton Depression Rating Scale (HAMD) in patients with mild major, minor or subsyndromal depression.

In the efficacy evaluation of antidepressant treatments, the total score of the Hamilton Depression Rating Scale (HAMD) is still regarded as the 'gold standard'. We previously had shown that the Inventory of Depressive Symptomatology (IDS) was more sensitive to detect depressive symptom changes than the HAMD17 (Helmreich et al. 2011). Furthermore, studies suggest that the unidimensional subscales of the HAMD, which capture the core depressive symptoms, outperform the full HAMD regarding the detection of antidepressant treatment effects. The aim of the present study was to compare several unidimensional subscales of the HAMD and the IDS regarding their sensitivity to changes in depression symptoms in a sample of patients with mild major, minor or subsyndromal depression (MIND). Biweekly IDS-C28 and HAMD17 data from 287 patients of a 10-week randomised, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural group therapy in patients with MIND were converted to subscale scores and analysed during the antidepressant treatment course. We investigated sensitivity to depressive change for all scales from assessment-to-assessment, in relation to depression severity level and placebo-verum differences. The subscales performed similarly during the treatment course, with slight advantages for some subscales in detecting treatment effects depending on the treatment modality and on the items included. Most changes in depressive symptomatology were detected by the IDS short scale, but regarding the effect sizes, it performed worse than most subscales. Unidimensional subscales are a time- and cost-saving option in judging drug therapy outcomes, especially in antidepressant treatment efficacy studies. However, subscales do not cover all facets of depression (e.g. atypical symptoms, sleep disturbances), which might be important for comprehensively understanding the nature of the disease depression. Therefore, the cost-to-benefit ratio must be carefully assessed in the decision for using unidimensional subscales.

Children's Depression Screener (ChilD-S): development and validation of a depression screening instrument for children in pediatric care.

The aim of the present study was to develop and validate the Children's Depression Screener (ChilD-S) for use in pediatric care. In two pediatric samples, children aged 9-12 (N(I) = 200; N(II) = 246) completed an explorative item pool (subsample I) and a revised item pool (subsample II). Diagnostic accuracy of each of the 22 items from the revised pool was evaluated in order to select the best items for the brief instrument ChilD-S. Areas under the curve (AUCs) of the revised item pool and the ChilD-S were compared. A diagnostic interview, the Kinder-DIPS, served as gold standard. For the purpose of screening for depressive disorders in children, the eight-item ChilD-S (AUC = 0.97) performed just as well as the revised 22-item pool (AUC = 0.94). For the ChilD-S the optimal cut-off point of ≥11 yielded a sensitivity of 0.91 and a specificity of 0.89. The ChilD-S shows high potential for depression screening of children in pediatric care.

[Early detection of major depression in paediatric care: validity of the beck depression inventory-second edition (BDI-II) and the beck depression inventory-fast screen for medical patients (BDI-FS)]. / Früherkennung von Depressionen in der Pädiatrie: Kriteriumsvalidität des Beck Depressions-Inventar Revison (BDI-II) und des Beck Depressions-Inventar-Fast Screen for Medical Patients (BDI-FS).

This study investigates the ability of the Beck Depression Inventory-Second Edition (BDI-II) and the Beck Depression Inventory-Fast Screen for Medical Patients (BDI-FS) to discriminate between depressed and non-depressed youths. 5.7% of 314 adolescents, aged 13-16 years, from paediatric and paediatric surgery clinics were suffering from a Major Depression according to the diagnostic interview Kinder-DIPS. By means of this gold standard Receiver Operating Characteristic curves, the Area Under the Curve (AUC) and the optimal cut-offs were calculated. The validity of BDI-II was excellent (AUC=0.93, sensitivity=0.86 and specificity=0.93 at the optimal cut-off ≥19). The validity of BDI-FS did not differ significantly from BDI-II (AUC=0.92, sensitivity=0.81, specificity=0.90). For the first time we present cut-offs for the German version of BDI-II and the 7-item BDI-FS that are suitable for the early detection of depressed adolescents in paediatric care.

[Depression screening in pediatric patients - a comparison of the concurrent validity of the German version of the Children's Depression Inventory, the German Depression Test for Children, and the new Children's Depression Screener]. / Depressions-Screening bei pädiatrischen Patienten Ein Vergleich der konkurrenten Validitat des Depressions-inventars fur Kinder und Jugendliche, des Depressionstests fur Kinder und des Children's Depression Screeners.

OBJECTIVE: We compared the concurrent validity of several tests for screening depression in pediatric care with respect to ICD-10 depression diagnoses in medically ill children: the German version of the Children's Depression Inventory (Depressionsinventar für Kinder und Jugendliche, DIKJ), the scale Dysphoria of the Depression Test for Children (Depressionstest für Kinder, DTK), and the Children's Depression Screener (ChilD-S). METHOD: Data of 9- to 12-year-old patients (N = 228) were analyzed with receiver operating characteristics. Validity measures like area under the curve (AUC), sensitivity (SE), and specificity (SP) were calculated for each instrument and subsequently compared. ICD-10 depression diagnoses according to a structured clinical interview served as the gold standard. RESULTS: The concurrent validity was high for the 26-item DIKJ (AUC = 92.6 %), satisfactory for the 25-item scale Dysphoria (AUC = 86.2 %), and very high for the 8-item ChilD-S (AUC = 97.5 %); the ChilD-S was significantly superior to the DIKJ. According to the Youden-Index the following cutoff scores are recommended: DIKJ ≥ 12 (SE = 91.7 %, SP = 81.9 %), scale Dysphoria ≥ 10 (SE = 75.0 %, SP = 89.8 %) and ChilD-S ≥ 10 (SE = 100 %, SP = 86.6 %). CONCLUSIONS: DIKJ and ChilD-S showed excellent concurrent validity for depression screening in pediatric patients, while the scale Dysphoria achieved lower values. For implementation in time-limited pediatric settings, the economic ChilD-S is the preferred instrument.

[Agreement of clinical diagnosis, structured interviews, and self-report questionnaires for depression in children and adolescents]. / Übereinstimmung von klinischer Diagnose, strukturierten Interviews und Selbstbeurteilungsfragebögen bei Depression im Kindes- und Jugendalter.

OBJECTIVE: The present study examines the agreement of structured child and parent interviews as well as clinical diagnosis for depressive episodes in children and adolescents. Moreover, it compares the accuracy and optimal cutoff scores of self-report questionnaires with reference to each of these diagnostic assessments. METHOD: 81 children (9-12 years) and 88 adolescents (13-16 years) in psychiatric care and their parents completed the structured diagnostic interview Kinder-DIPS. The children answered the German Children's Depression Inventory (CDI), and the adolescents answered the German Center for Epidemiologic Studies Depression Scale (CES-D). Kappa coefficients quantified the agreement. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff scores, sensitivity, specificity, as well as positive and negative predictive values. RESULTS: The agreement between the child and parent interviews as well as between the interviews and clinical diagnosis was low to moderate. Clinicians diagnosed depressive episodes more frequently than the interviews. Cutoff scores and measures of accuracy varied between the reference standards, with less favorable results for clinical diagnosis. CONCLUSIONS: Clinicians may profit from conducting structured interviews. Strategies for dealing with conflicting information from children and parents should be tested empirically and described in detail.

Grief in women with previous miscarriage or stillbirth: a systematic review of cross-sectional and longitudinal prospective studies.

Background: Women who have had miscarriages or stillbirths are known to have a high risk for enduring grief. However, the course and frequency of enduring grief in this subgroup are not fully understood. Objective: Our aims were to assess the intensity of grief and its course in women with miscarriages or stillbirths and to estimate the frequency of severe grief reactions in this population. Additionally, we compared subgroups with miscarriages versus stillbirths and with single versus recurrent pregnancy loss. Method: A systematic literature search of the databases MEDLINE, psycINFO and PSYNDEX was conducted to consider all studies published between 2000 and 31 March 2022 in English or German on the prevalence and intensity of grief in women who had miscarriages or stillbirths. Studies that used validated assessment methods were included in this systematic review. The PRISMA guidelines were followed. Results: Study characteristics and grief data were extracted independently by two investigators from 13 cross-sectional and eight longitudinal studies from 11 countries (N = 2597). All studies used self-reporting instruments. According to 17 of 21 studies (81%), grief is markedly elevated in women after miscarriages or stillbirths. The studies are very heterogeneous regarding the samples, the length of pregnancies and the time of assessment regarding grief after miscarriages. Most studies document intense grief and frequent severe grief reactions - with a decrease over time - in women who have had miscarriages or stillbirths. Clear conclusions regarding corresponding differences between women with miscarriages and stillbirths or single and recurrent pregnancy losses cannot be drawn. Conclusions: Pronounced grief is frequent in women who had miscarriages or stillbirths. More longitudinal studies are needed to examine the course of grief in this group and to identify those women who develop prolonged grief disorder, depression or other mental-health problems.

Antecedentes: Se sabe que las mujeres que han tenido abortos espontáneos o mortinatos tienen un alto riesgo de sufrir un duelo persistente. Sin embargo, el curso y la frecuencia del duelo persistente en este subgrupo no se conocen del todo.Objetivo: Nuestros objetivos fueron evaluar la intensidad del duelo y su curso en mujeres con abortos espontáneos o mortinatos y estimar la frecuencia de las reacciones de duelo graves en esta población. Además, comparamos subgrupos con abortos espontáneos frente a mortinatos y con pérdidas de embarazo únicas frente a recurrentes.Método: Se realizó una búsqueda bibliográfica sistemática en las bases de datos MEDLINE, psycINFO y PSYNDEX para considerar todos los estudios publicados entre el año 2000 y el 31 de marzo de 2022 en inglés o alemán sobre la prevalencia e intensidad del duelo en mujeres que tuvieron abortos espontáneos o mortinatos. Se incluyeron en esta revisión sistemática los estudios que utilizaron métodos de evaluación validados. Se siguieron las directrices PRISMA.Resultados: Dos investigadores extrajeron de forma independiente las características de los estudios y los datos sobre el duelo de 13 estudios transversales y ocho longitudinales de once países (N=2597). Todos los estudios utilizaron instrumentos de autorreporte. Según 17 de 21 estudios (81%), el duelo es muy elevado en las mujeres después de un aborto espontáneo o un mortinato. Los estudios son muy heterogéneos en cuanto a las muestras, la duración de los embarazos y el momento de la evaluación del duelo tras los abortos espontáneos. La mayoría de los estudios documentan un duelo intenso y frecuentes reacciones de duelo severas -con una disminución en el tiempo- en mujeres que han tenido abortos espontáneos o mortinatos. No se pueden extraer conclusiones claras sobre las diferencias correspondientes entre las mujeres con abortos espontáneos y mortinatos o con pérdidas de embarazos únicos y recurrentes.Conclusiones: El duelo prolongado es frecuente en las mujeres que han tenido abortos espontáneos o mortinatos. Se necesitan más estudios longitudinales para examinar el curso del duelo en este grupo e identificar a las mujeres que desarrollan un trastorno de duelo prolongado, depresión u otros problemas de salud mental.