[Traumatic Experiences and Posttraumatic Stress Disorder of Adolescents in Boarding Schools]. / Traumatische Erfahrungen und Posttraumatische Belastungsstörungen von Jugendlichen in Internaten.

In the context of abuse cases in boarding schools, stress among children and adolescents in boarding schools in Germany was discussed for the first time. So far, however, there is a lack of studies dealing with post-traumatic stress disorders of adolescents in boarding schools.The aim was to analyze the extent of trauma experiences and symptoms of post-traumatic stress disorders as well as psychopathological abnormalities in adolescents in boarding schools on the basis of self-reports using a secondary analysis of theMAYSI-2 and UCLA PTSD Reaction Index for DSM-IV screening questionnaires and to derive implications for research and care concepts. Data was available from155 adolescents, 70%of whomweremale.The adolescents had been in boarding schools for an average of 3.26 years (SD = 2.48). A traumatic experience was evident in 69.7%(n = 108) of the adolescents, and 51.6%(n = 80) of the adolescentswere "conspicuous" in at least one of the six scales of theMAYSI-2. Taken together, 33.5%(n = 52) of the adolescents met the criteria for a suspected post-traumatic stress disorder according to ICD-10. Screening procedures should be established in boarding schools to identify traumatic experiences and psychopathological abnormalities in a timely manner. Concepts from youth welfare institutions can be used to deal with trauma experiences.There is a need for further research on traumatic experiences directly related to the boarding school placement situation.

[Attitudes of Healthcare Professionals to Extremism and Treatment Options]. / Einstellung von Fachkräften aus den Heilberufen zum Thema Extremismus und zu Behandlungsoptionen.

OBJECTIVE: In view of the cruelty of acts of terrorism and violent extremism, it is often inconceivable what the underlying motives are. Analyzes of the attacks in Ansbach (2016), Halle (2019) and Hanau (2020) showed a picture of different psychological conspicuities among the perpetrators, which highlights the need to involve health care professionals in the prevention of extremism. Against this background, the treatment of people with extremist attitudes appears to be crucial in order to prevent negative consequences for those affected, but also for society. METHODS: Within the framework of an anonymous online survey, physicians and psychological psychotherapists were asked about previous experiences, attitudes and wishes regarding the treatment of patients with extremist attitudes. Furthermore, data on their own work was collected. RESULTS: A total of 364 physicians (18%), psychological psychotherapists (72%) and participants with other job descriptions (10%) took part in the study. Only one fifth state that they felt well trained in the subject. About half of the respondents would offer a place in therapy (if they could decide on the patients themselves), likewise about half have already dealt with the topic of extremism and the majority see a need to deal with the topic more in the future and indicate a need for further training. The analyses show that physicians have so far dealt with the topic somewhat more than those with psychological psychotherapeutic training, and professionals in private practive are more likely to see a connection between extremism and psychiatric illnesses than professionals in hospitals, but would be less willing to offer patients with extremist attitudes a place in therapy. DISCUSSION: Physicians and psychotherapists need further training on extremisms and should be better prepared fo the challenges of treating patients in this context. CONCLUSION: In order to increase the chances of providing adequate care for mentally ill people with extremist attitutdes, health professionals should be better prepared for the topic in the future, for example through further training or opportunities for cooperation.

[Experiences of dangerous situations in psychiatry and psychotherapy involving patients with extremist attitudes]. / Erfahrungen mit Gefährdungssituationen in Psychiatrie und Psychotherapie bei Patienten mit extremistischer Einstellung.

BACKGROUND AND OBJECTIVES: Dangerous situations in connection with the treatment of persons with suspected extremist attitudes have become increasingly relevant. A survey of physicians and psychotherapists is intended to provide information about concrete dangerous situations among these patients. MATERIALS AND METHODS: By means of an anonymous online survey, which comprised 16 main questions and up to 95 additional questions, a total of 364 health professionals were asked about the general situation and about patients, as well as relatives with suspected extremist attitudes. RESULTS: In all, 17.5% of the participants were physicians, 72.1% psychotherapists. 47.7% work exclusively in a hospital, 34.2% in a private practice. A total of 57.7% of the participants have already treated patients with suspected extremist attitudes (46.7% treated relatives); 27.6% were confronted with situations of self-endangerment (30.1% in the case of relatives), 49.5% with situations of danger to others (18.3% in the case of relatives), in which they often did not feel safe. Altogether, 20.3% of the professionals informed security authorities, and not quite half found this contact to be comparatively unhelpful/not at all helpful (45.5% among relatives). The majority of the participants had no contact to other agencies, such as specialized counselling centres for deradicalization. Physicians experienced the situations of endangerment more often than non-medical psychotherapists. A comparison between professionals from hospitals and private practices shows no significant differences. DISCUSSION: The study was able to show that extremism and the associated dangerous situations are an important topic in the treatment of patients and that physicians and non-medical psychotherapists should be well prepared. Networking with extremism prevention agencies and good cooperation with security authorities would be important and desirable for the future.

[Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020]. / Entwicklung von psychischen Auffälligkeiten bei Mädchen und Jungen in stationären Jugendhilfeeinrichtungen zwischen den Jahren 2008 und 2020.

Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020 Abstract. Objective: Studies show a high prevalence of mental health problems in children and adolescents in youth-welfare facilities compared to the general population. However, to date, studies on this development over time are lacking. The present study examines the development of mental health problems and psychosocial functioning in the years 2008 to 2020. Method: Mental health problems were assessed with the CBCL, psychosocial functioning with Axis VI of the MAS. In total, data from 3,269 children and adolescents from residential-care facilities located throughout Germany were included in the analysis. Results: a decrease in externalizing behaviour was observed regarding the frequency of mental health problem in children and adolescents in youth-welfare facilities from 2008 to 2020. Particularly boys aged 12 and older show less deviant behavior. Older girls show high internalizing behavior problem scores over time, but there is no consistent trend. More than a quarter of the institutionalized children in youth-welfare institutions show severely impaired psychosocial functioning at a consistent level over time. Conclusions: In light of the age and gender effects associated with the development of mental health problems over time, there is a need to regard the care situation in youth-welfare institutions.

Elite athletes' experiences of interpersonal violence in organized sport in Germany, the Netherlands, and Belgium.

Interpersonal violence in sport occurs in different forms, from emotional abuse, overtraining, bullying, physical aggression and pressuring to punishment and sexual abuse. Due to the use of different definitions, a comparison of prevalence estimates between studies in different countries has not been possible to date. The aim of the current study was thus to present the prevalence estimates of interpersonal violence in elite sport for the Netherlands, Belgium (Flanders), and Germany and to examine the overlap of three types of interpersonal violence. Data from two different surveys (one in the Netherlands and Flanders and another in Germany) of a total of 1,665 elite athletes (n = 533 from the Netherlands and Flanders, n = 1,132 from Germany) were used. Athletes were asked to answer questions about their experiences of psychological, physical, and sexual violence in the context of organized sport. In general, lifetime prevalence estimates for all three types of interpersonal violence are more than 24% in elite athletes, with the highest numbers for psychological violence. Compared to representative population samples the prevalence rate of psychological violence seems to be particularly high. Gender differences were only evident for sexual violence, with female athletes showing higher prevalence estimates than male athletes. Furthermore, a high overlap of experiences of the three different forms of interpersonal violence was found for all three countries. The differences in prevalence estimates between the three countries are discussed.

[Do Children and Adolescents with Different Reasons for Admission Equally Benefit from Institutional Care?] / Profitieren Kinder und Jugendliche mit unterschiedlichen Aufnahmegründen gleichermaßen von einer Heimunterbringung?

Do Children and Adolescents with Different Reasons for Admission Equally Benefit from Institutional Care? Currently, almost 150.000 children and adolescents are placed in institutional care in Germany with the aim to improve their living conditions. Various studies showed positive effects concerning the development of those institutionalized children and adolescents. Within the present study, 500 children and adolescents in institutional care were examined regarding the improvement of quality of life and social competencies during their care placement depending on the respective reason for admission (group A: admission due to mental health and behavior problems; group S: problems in the context of the school; group O: no mental health problems, but other reasons). Furthermore, differences in the development of children and adolescents who initiated the placement by themselves and those who did not were examined. Results show that over a period of 18-24 months, all three groups developed effectively equally. Group A had a lower initial level regarding quality of life and social competencies compared to group S and group O and therefore reached lower outcomes within the investigation period. Development was irrespective of whether or not children and adolescents initiated the institutional placement by themselves. The results demonstrate that all three groups were able to benefit from institutional care, although children and adolescents with mental health problems had a notable potential for further development.

[Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities]. / Lebensqualität und Verhaltensauffälligkeiten bei unbegleiteten minderjährigen Flüchtlingen in Einrichtungen der Jugendhilfe.

Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities Unaccompanied minor refugees (UMR) who arrive in Germany are generally placed in institutional child care facilities. UMR are a very burdened group, however other children and adolescents in institutional care are burdened as well, and their quality of life is often reduced. The aim of the current study was thus to compare quality of life and behavioral problems of UMR in child care facilities with those of other resident adolescents. For a total of 50 UMR, data regarding behavioral problems was available, for 41 UMR ratings on quality of life, both from external assessments. Two parallel comparison samples of other adolescents in the same institutional care facilities were drawn with adolescents with and without a migration background. Results show that in general, UMR show fewer behavioral problems than the other two groups, especially in externalizing behavior. For internalizing behavior, no differences were evident. For quality of life, no differences could be found between the three groups of inhabitants in institutional care. This indicates that the same factors determining quality of life are present in all three groups, but that the underlying mental problems are different in UMR than in other adolescents. Thus, staff in institutional care should possibly work differently with these group of adolescents than with other inhabitants and should be educated respectively.

[Childhood Experiences of Adolescents in Boarding Schools. A Comparison with Adolescents in Residential Care and with the General Population]. / Kindheitserlebnisse von Jugendlichen in Internaten. Ein Vergleich mit Jugendlichen aus Jugendhilfeeinrichtungen und der Allgemeinbevölkerung.

Childhood Experiences of Adolescents in Boarding Schools. A Comparison with Adolescents in Residential Care and with the General Population Various studies indicate that students in boarding schools experience a lot of violence during their accommodation. However, it is not proved whether adolescents in boarding schools are also a burdensome group regarding early childhood experiences such as neglect and abuse. The aim of the study was to find out more about the experiences of adolescents in boarding schools and to determine whether there are differences between adolescents in residential care and between the general population. Furthermore, it should be examined whether boys and girls differ in their experiences. In the study, adolescents of boarding schools and of residential care all over Germany, starting at the age of 15 (n = 322), were asked regarding physical and emotional neglect/abuse, light/severe parent violence, negative/positive educational behavior of the parents. The results show that students in boarding schools were less likely to be affected by childhood maltreatment and more likely to have experienced positive parental behavior compared to children in residential care. Compared to the general population, students in boarding schools were more often and more severely affected by parental violence. Moreover, girls had experienced parental violence more often than boys. The results indicate that in boarding schools there is a need for support offers for adolescents with a history of violent experiences and that the risk group should be identified directly at the admission to the school.

[Mental Disorders of Adolescents in Boarding Schools: A Germany-Wide Survey]. / Psychische Auffälligkeiten von Jugendlichen in Internaten: Eine deutschlandweite Befragung.

Mental Disorders of Adolescents in Boarding Schools: A Germany-Wide Survey Overall, research on children and adolescents in boarding schools is still scarce. Especially mental disorders of students in boarding schools have not been investigated. As part of this study, a standardized questionnaire survey helped to ask adolescents starting from the age of 15 in boarding schools about mental disorders and depressive symptoms. 169 adolescents from a total of twelve boarding schools in Germany participated in the study. The results of the present Germany-wide survey of adolescents in boarding schools show that the students are a group of rather inconspicuous adolescents, especially the group of boys. Girls show increased risk of depressive behavior and externalizing problems in comparison to the general population. Therefore, child and adolescent psychiatric care should be considered when placed in a boarding school.

Sexual Violence by Juveniles in Institutions: A Descriptive Study on Prevalence and Circumstances.

Adolescents in institutionalized care are at a particularly high risk of exhibiting sexually aggressive behavior including sexual harassment. So far, however, studies about the prevalence of sexually aggressive behavior in institutions are lacking. In this survey, 322 adolescents (43% female, average age 16.7 years) from 32 residential care facilities and boarding schools across Germany were asked about sexually aggressive behavior via a standardized questionnaire. Overall, 23.5% of the participants engaged in some form of sexually aggressive behavior in their lives, and 4.6% reported having committed a sexual assault with (actual or attempted) penetration. A closer look at the circumstances of those offenses shows that the victims were in most cases acquainted with and of the same age as the offenders, that threats and violence were used in some cases, and especially in the case of actual or attempted penetration, and that only a minority of offenders suffered any consequences for their acts. The implementation of protective measures for institutions and the treatment of adolescents in institutions will be discussed.

[The relationship between a sense of security and psychological problems in adolescents living in boarding schools and youth-welfare institutions]. / Zusammenhang von Sicherheitsgefühl und psychischen Auffälligkeiten bei Jugendlichen in Internaten und Jugendhilfeeinrichtungen.

Objective: The willingness to participate and a sense of security are important aspects to be fostered in the institutional care of adolescents. Although these aspects are increasingly being examined from the perspective of the affected adolescents, it has yet to be considered whether psychological problems can be attributed to their experiences with the above-mentioned aspects. Methods: A total of 216 adolescents aged 14 to 18 years answered an online questionnaire the sense of security in their institution and their perception of the institution. Their willingness to participate was also examined. Psychological symptoms were assessed with the Strengths and Difficulties Questionnaire Self-Report (SDQ-S). Results: There is a significant correlation between sense of security and the overall SDQ score, with prosocial behavior, and with the positive perception of the institution. In addition, sense of security had a significant influence on the SDQ factors, the positive perception of the institution, and the items on the willingness to participate of the adolescents. The subsequent t-tests also showed significant results. Among other things, it was shown that the factor problems of adolescents is related to sense of security. Conclusion: The results provide an initial indication that there is a link between sense of security and psychological symptoms as well as willingness to participate and perception of the institution. Especially problems of adolescents in dealing with peers must be taken into account.in the development of protective concepts to increase the sense of security and their willingness to participate.

[Mental Stress of Professionals in Residential Care for Children and Adolescents]. / Belastungen von Fachkräften in stationären Einrichtungen für Kinder und Jugendliche.

An increasingly important issue is the mental strain of professionals in residential care for children and adolescents. However, only few studies investigate mental strain and overload of professionals in an educational context in general and even less in youth welfare institutions. The goal of this study was to examine mental strain experiences of professionals with the "Perceived Stress Questionnaire" (PSQ) in youth welfare institutions, as well as to investigate the relationship between age, duration of employment in this work environment and gender of participants. A total of 426 care providers participated in the online survey. The results tend to show higher stress levels among younger professionals and significantly higher values in tension compared to older employees, but no effect of gender. Furthermore, there is no relation between stress experience and duration of employment in this work environment, but a significant correlation between a feeling of security from violence in this institution and stress level. The total score for stress experience of professionals is similar to that of healthy adults, while in the subscales compared to the norm sample professionals show higher scores on requirements in terms of deadlines and time pressure as well as on tension. The results indicate a high vulnerability of young professionals, which could be addressed by institutional interventions. More studies are needed to clarify causal relationships.

Comparison of Psychopathological Symptoms in Adolescents Who Experienced Sexual Violence as a Victim and/or as a Perpetrator.

Research on sexual violence victims and perpetrators indicates that victims in general are found to report higher levels of psychopathological symptoms, especially internalizing behavior, whereas perpetrators often show externalizing behavior. Little is known, however, about the psychopathology of perpetrators of sexual violence who have also experienced sexual victimization (victim-perpetrators). Thus, the aim of the current study was to examine this group within a sample of adolescents living in residential care or federal boarding schools. Participants reported their lifetime experience with sexual violence (both as victim and perpetrator) and completed the Youth Self Report. Results indicate that all three groups of adolescents with sexual violence experience report higher total problem scores than adolescents without this experience. Victim-perpetrators show results more similar to those of perpetrators only than those of victims only. The discussion deals with the implications of our findings for the treatment of victims of sexual violence.

Lifetime prevalence and incidence of sexual victimization of adolescents in institutional care.

The frequency of sexual victimization in high-risk populations like adolescents in institutional care has hardly been studied. In this study, we report lifetime prevalence and incidence from a nationwide German sample including 322 adolescents (mean age 16.69 years, 43% female) from 20 residential care facilities and 12 boarding schools. Lifetime prevalence for severe sexual victimization (in and outside of institution) was 46.7% for girls and 8.0% for boys. Moreover, 5% of all adolescents experienced severe sexual victimization for the first time after they were admitted to the current institution (mean duration of stay in the current institution 3.08 years). Offenders were mostly adolescents of the same age whereas staff members played a minor role as perpetrators. We conclude that the high rate of sexual victimization among adolescents in institutional care should be considered during decision-making processes concerning out-of-home placement and during a stay in residential care.

[Disclosure of Adolescents in Residential Care Institutions and Boarding Schools after Exposure to Sexual Violence]. / Disclosure von Jugendlichen in Jugendhilfeeinrichtungen und Internaten nach sexueller Gewalterfahrung.

Disclosure of Adolescents in Residential Care Institutions and Boarding Schools after Exposure to Sexual Violence In international research, many papers exist about the issue of disclosure after having experienced sexual violence. However, specific research regarding disclosure processes of children and adolescents in institutional care are missing, even though those are particularly often affected by sexual violence. In the Germany-wide study "Sprich mit!", adolescents from the age of 15 up (n = 322; average age 16,69 (SD = 1,3); 57,1 % males) who live in residential care or boarding schools were asked for experiences of sexual violence and their consequences by means of a self-report questionnaire. Results showed that the majority of the adolescents (82 %) entrusted themselves to someone, mostly towards peers (56 %) and less frequent towards adults (24 %). Boys and girls opened up equally often, regardless of the severity of the experienced violence. Adolescents who entrusted themselves towards their peers indicated retrospectively more satisfaction than those entrusting themselves towards adults, even if there were no consequences following the disclosure. Considering that the disclosure towards peers did not initiate a process of help, adolescents in institutional care should be better informed about relevant possibilities to entrust themselves and receive support.

Nonsuicidal self-injury and its relation to personality traits in medical students.

Nonsuicidal self-injury (NSSI) has a high prevalence among the general undergraduate population, but as yet, no study has investigated the rate of NSSI among medical students despite the high levels of depression and suicidal ideation found in this population. Our study aimed to estimate the prevalence of NSSI and suicide attempts in German medical students and explore the associations between these behaviors and the five major personality traits. Seven hundred fourteen medical students (67% women; age range, 18-35 years; mean age, 23.1 years) participated in an online survey. We report a lifetime prevalence of 14.3% for NSSI and 1.5% for suicide attempt. The students with NSSI showed higher levels of neuroticism and openness to experience but lower levels of conscientiousness and extraversion on the NEO Five-Factor Inventory. Our results are in line with previous research from other countries regarding the prevalence of NSSI among students and its association with personality.

Suicidality among medical students - a practical guide for staff members in medical schools.

Although suicidality in medical students is important, few studies dealt with this issue regarding German universities. Our aims were to describe the epidemiology as well as factors leading to suicidality in medical students. Furthermore we wanted to raise awareness for this topic among university employees and show options for handling suicidal crises in students. This manuscript especially aims to address university employees working in direct contact with students (such as student counselors or teachers).

How high are the personnel costs for OSCE? A financial report on management aspects.

OBJECTIVE: The OSCE (objective structured clinical examination) was put to the test in order to assess the clinical practical skills of students in medical studies in the medical faculties. For the implementation of an OSCE, a large number of personnel is necessary. In particular for subjects with limited resources, therefore, efficient cost planning is required. In the winter semester 09/10, the Department of Neurology at the Medical Faculty of the University of Ulm introduced the OSCE as a pilot project. A financial report retrospectively shows the personnel expenses. The report is intended as an example for an insight into the resources needed for the OSCE with simulated patients. METHOD: Included in the calculation of the financial costs of the OSCE were: employment, status of staff involved in the OSCE, subject-matter and temporal dimension of the task. After the exam, acceptance of the examination format was reviewed by a focus group interview with the teachers and students. RESULT: The total expenses for the personnel involved in the OSCE amounted to 12,468 €. The costing of the clinic's share was calculated at 9,576 €. Tuition fees from the students have been used to the amount of 2.892 €. For conversion of total expenditure to the number of examines the sum of 86 € per student was calculated. Both students and teachers confirmed the validity of the OSCE and recognised the added value in the learning effects. CONCLUSION: The high acceptance of the OSCE in neurology by both students and teachers favours maintaining the test format. Against the background of the high financial and logistical costs, however, in individual cases it should be assessed how in the long-term efficient examination procedure will be possible.