Changes in authoritarianism before and during the COVID-19 pandemic: Comparisons of latent means across East and West Germany, gender, age, and education.

Modern theories of authoritarianism have stressed the importance of threat to the expression of authoritarian attitudes and intolerance. Arguably, authoritarian tendencies may have increased during COVID-19 pandemic, a major threat to life and security. One issue arising when comparing mean scores is that of measurement invariance. Meaningful comparisons are only possible, if latent constructs are similar between groups and/or across time. This prerequisite is rarely ever tested in research on authoritarianism. In this study, we aim to analyze the short scale for authoritarianism KSA-3 by investigating its measurement invariance on two levels (three first-order and one second-order factors) and latent mean changes using two German representative samples (N = 4,905). Specifically, we look at differences before and during the pandemic (2017 vs. 2020). While measurement invariance holds across both levels in all conditions, we find a decrease in latent means in 2020, contrary to expectations and established theories. Moreover, latent means differ with regard to gender, education, and east-west Germany. We conclude that analyses of latent means and measurement invariance instead of mean comparisons with composites should become the standard. Future studies should focus on threat as a moderator between authoritarianism and intolerance, and on possible interactions with context variables.

Association of child maltreatment subtypes and long-term physical health in a German representative sample.

Background: Child maltreatment is a major public problem, associated with enormous consequences on the individual and socioeconomic level. Studies show a clear impact of child maltreatment on long-term physical health. However, there is a lack of analyses comprising a wide variety of subtypes of maltreatment and addressing cumulative effects of different maltreatment subtypes experienced during childhood on physical health. Objective: The objective of this analysis was to assess the association of different subtypes and the intensity of child maltreatment with long-term physical health outcomes. Methods: In a cross-sectional observational approach, a representative sample of the German population (N=2510) was assessed regarding socioeconomic information, their current health status, and their experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ). Chi2-Tests were performed to compare differences of physical health conditions in adulthood in association with child maltreatment and binary regression analyses to assess the relationship of physical health and number of different subtypes of maltreatment experienced during childhood. Results: Odds increased significantly for obesity (1.8), diabetes (1.26), cancer (1.28), hypertension (1.16), chronic obstructive pulmonary disease (1.51), history of myocardial infarction (1.29) and stroke (1.31) with increasingenhancing number of experienced subtypes of child maltreatment. Growing intensity of each subtype of maltreatment was associated with higher rates of all assessed physical health conditions, which could point towards a dose-dependency of the relationship between maltreatment and long-term physical health. Conclusions: Child maltreatment is associated with increased odds for the leading morbidity and mortality causes in Germany. Interventions encompassing secondary and primary preventive strategies are critical to target this major public health problem and its devastating consequences.

Antecedentes: El maltrato infantil es un problema público mayor, asociado a enormes consecuencias a nivel individual y socioeconómico. Los estudios muestran un impacto claro del maltrato infantil sobre la salud física a largo plazo. Sin embargo, existe una carencia de análisis que comprendan una amplia variedad de subtipos de maltrato y aborden los efectos acumulativos de diferentes subtipos de maltrato experimentados durante la infancia sobre la salud física. Objetivos: El objetivo de este análisis fue evaluar la asociación de diferentes subtipos y la intensidad del maltrato infantil con consecuencias en la salud física a largo plazo. Métodos: En un enfoque observacional transversal, se evaluó una muestra representativa de la población germana (N=2510) en cuanto a información socioeconómica, su estado de salud actual, y sus experiencias de maltrato infantil usando el Cuestionario de Trauma Infantil (CTQ por sus siglas en Inglés). Se realizaron tests de Chi2 para comparar diferencias de condiciones de salud física en la adultez en asociación con maltrato infantil y análisis de regresión binaria para evaluar la relación entre salud física y número de diferentes subtipos de maltrato experimentado durante la infancia. Resultados: Las probabilidades (expresadas en O.R.) aumentaron significativamente para obesidad (1.18), diabetes (1.26), cáncer (1.28), hipertensión arterial (1.16), enfermedad pulmonar obstructiva crónica (1.51), historia de infarto al miocardio (1.29) y apoplejía (1.31) con número mayor de subtipos de maltrato infantil experimentados. La intensidad creciente de cada subtipo de maltrato se asoció con tasas mayores de todas las condiciones de salud física evaluadas, lo que puede apuntar a una dependencia de dosis de la relación entre maltrato y salud física a largo plazo. Conclusiones: El maltrato infantil se asocia con aumento de probabilidades para las causas principales de morbilidad y mortalidad en Alemania. Intervenciones que abarquen estrategias preventivas secundarias y primarias son críticas para impactar este problema de salud publica mayor y sus consecuencias devastadoras.

Diagnostic performance and optimal cut-off scores of the Massachusetts youth screening instrument-second version in a sample of Swiss youths in welfare and juvenile justice institutions.

BACKGROUND: There is a growing consensus about the importance of mental health screening of youths in welfare and juvenile justice institutions. The Massachusetts Youth Screening Instrument-second version (MAYSI-2) was specifically designed, normed and validated to assist juvenile justice facilities in the United States of America (USA), in identifying youths with potential emotional or behavioral problems. However, it is not known if the USA norm-based cut-off scores can be used in Switzerland. Therefore, the primary purpose of the current study was to estimate the diagnostic performance and optimal cut-off scores of the MAYSI-2 in a sample of Swiss youths in welfare and juvenile justice institutions. As the sample was drawn from the French-, German- and Italian-speaking parts of Switzerland, the three languages were represented in the total sample of the current study and consequently we could estimate the diagnostic performance and the optimal cut-off scores of the MAYSI-2 for the language regions separately. The other main purpose of the current study was to identify potential gender differences in the diagnostic performance and optimal cut-off scores. METHODS: Participants were 297 boys and 149 girls (mean age = 16.2, SD = 2.5) recruited from 64 youth welfare and juvenile justice institutions (drawn from the French-, German- and Italian-speaking parts of Switzerland). The MAYSI-2 was used to screen for mental health or behavioral problems that could require further evaluation. Psychiatric classification was based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL). The MAYSI-2 scores were submitted into Receiver-Operating Characteristic (ROC) analyses to estimate the diagnostic performance and optimal 'caution' cut-off scores of the MAYSI-2. RESULTS: The ROC analyses revealed that nearly all homotypic mappings of MAYSI-2 scales onto (cluster of) psychiatric disorders revealed above chance level accuracy. The optimal 'caution' cut-off scores derived from the ROC curve for predicting (cluster of) psychiatric disorders were, for several MAYSI-2 scales, comparable to the USA norm-based 'caution' cut-off scores. For some MAYSI-2 scales, however, higher optimal 'caution' cut-off scores were found. CONCLUSIONS: With adjusted optimal 'caution' cut-off scores, the MAYSI-2 screens potential emotional or behavioral problems well in a sample of Swiss youths in welfare and juvenile justice institutions. However, as for choosing the optimal 'caution' cut off score for the MAYSI-2, both language as well as gender seems to be of importance. The results of this study point to a compelling need to test the diagnostic performance and optimal 'caution' cut-off scores of the MAYSI-2 more elaborately in larger differentiated language samples in Europe.

[Structural quality in inpatient and daycare child and adolescent psychiatry- indicators for planning future staff ratios for the era following the Psychiatry Personnel Act]. / Strukturqualität in der stationären und teilstationären Kinder- und Jugendpsychiatrie.

The German Psychiatry Personnel Act, which went into effect in 1990, has led to a decrease in the number of child and adolescent psychiatry inpatient beds, to a decrease in the length of stay, and to an increase in inpatient psychotherapy. Today, this act is outdated~ for a number of reasons, such as changes in the morbidity of the population, the rising number of emergencies, and new professional standards such as documentation. In addition, new legal provisions and conventions (like the UN Convention on the Rights of the Child) necessitate a complete reevaluation. Child and adolescent psychiatry needs a normative act to enable the necessary implementation. Many different rationales are available to support the debate.

[Nonnative guidelines for allocating human resources in child and adolescent psychiatry using average values under convergence conditions instead of price determination - analysis of the data of university hospitals in Germany concerning the costs of calculating day and minute values according to Psych-PV and PEPP-System]. / Normative Vorgaben zum Personaleinsatz in der Kinder- und Jugendpsychiatrie statt Preisfindung anhand von Mittelwerten unter Konvergenzbedingungen.

OBJECTIVE: Despite substantial opposition in the practical field, based on an amendment to the Hospital Financing Act (KHG). the so-called PEPP-System was introduced in child and adolescent psychiatry as a new calculation model. The 2-year moratorium, combined with the rescheduling of the repeal of the psychiatry personnel regulation (Psych-PV) and a convergence phase, provided the German Federal Ministry of Health with additional time to enter a structured dialogue with professional associations. Especially the perspective concerning the regulatory framework is presently unclear. METHOD: In light of this debate, this article provides calculations to illustrate the transformation of the previous personnel regulation into the PEPP-System by means of the data of §21 KHEntgG stemming from the 22 university hospitals of child and adolescent psychiatry and psychotherapy in Germany. In 2013 there was a total of 7,712 cases and 263,694 calculation days. In order to identify a necessary basic reimbursement value th1\t would guarantee a constant quality of patient care, the authors utilize outcomes, cost structures, calculation days, and minute values for individual professional groups according to both systems (Psych-PV and PEPP) based on data from 2013 and the InEK' s analysis of the calculation datasets. CONCLUSIONS: The authors propose a normative agreement on the basic reimbursement value between 270 and 285 EUR. This takes into account the concentration phenomenon and the expansion of services that has occurred since the introduction of the Psych-PV system. Such a normative agreement on structural quality could provide a verifiable framework for the allocation of human resources corresponding to the previous regulations of Psych-PV.

[Trauma history and posttraumatic stress symptoms among children and adolescents attending a mental health service]. / Traumaanamnese und posttraumatische Stresssymptomatik in einer kinder- und jugendpsychiatrischen Inanspruchnahmepopulation.

OBJECTIVE: Systematic exploration of potentially traumatic events and posttraumatic stress symptoms of patients attending a hospital for child and adolescent psychiatry and psychotherapy. METHODS: The UCLA PTSD Reaction Index for DSM-IV was filled in by 413 children and adolescents and 403 caregivers at their first attendance at the clinic. RESULTS: At least one traumatic event was reported by 46.9% of the children and adolescents and/or caregivers. Clinically relevant post-traumatic stress symptoms were reported in 22.9%. CONCLUSION: In the investigated sample routinely performed screening assessments can identify clinically relevant post-traumatic stress symptoms in almost one of four patients of child mental health services.

[Evaluation of a training program for child welfare case workers on trauma sequelae in foster children]. / Evaluation eines Projektes zur Sensibilisierung der Jugendhilfe für Traumafolgestörungen bei Pflegekindern.

Foster children are exposed to multiple psychosocial and biological risk factors and have an elevated risk for developmental delays and the development of mental disorders. Many children experienced compromising situations such as neglect, physical abuse, or sexual abuse before out-of-home placement. Consequently, they show a higher need for mental health services than other children. However, out-of-home placement is often considered as the sufficient measure to help these children. Hence this project had the aim to sensitize child welfare agencies and foster parent organisations for the special needs and history of foster children, to provide them with instruments for the assessment of emotional and behaviour problems and to promote the cooperation at the interface between child welfare system and mental health system. Twenty-four child welfare agencies and four foster parent organisations participated. The control group consisted of 16 non-participating child welfare agencies. After one year, participants recorded more often children's social history (p = .023), conducted more often standardized psychosocial assessments (p = .001), assessed more often the medical needs of foster children (p = .029), and informed foster parents more often about behaviour problems of their foster child (p = .034). In summary, child welfare agencies were very interested, could be sensitized for mental disorders following traumata and implemented the offered instruments in their work. Limits of resources could be observed due to the case workers' high case load.

[Assessment of suicidal ideation in adolescents: comparison of two instruments]. / Erhebung von Suizidgedanken bei Jugendlichen: Vergleich zweier Instrumente.

Standardized instruments are crucial for a valid assessment of suicidal behavior. In questionnaire assessments the wording of questions can influence the results. In this study we compared the congruence of the Self-Harm Behavior Questionnaire (SHBQ) and the Ottawa Self-Injury Inventory (OSI) as measures of prevalence of suicidal ideation in an adolescent sample (n = 665, mean age: 14.8, SD: 0.66). We found a life-time prevalence of 36.4 % in the SHBQ and a one-year-prevalence of 27.8 % in the OSI. There was good agreement between the two instruments in terms of the prevalence of suicidal ideation and the association with suicide attempts. The observed rates are comparable with other studies in adolescents; differences arise with varying study designs.

[Screening of psychopathology with juvenile deviants]. / Erfassung von Psychopathologien bei straffälligen Jugendlichen.

The aim of this article is to describe the psychometric properties of the German version of the BARO (Basis Raads Onderzoek/ Basic Council Examination), a mental health screening instrument for delinquent adolescents which are referred to juvenile court. The BARO was developed in 1999 by Theo Doreleijers in the Netherlands. The present article reports on a validation study concerning the German BARO. For this study, a sample of 125 Swiss German speaking youth, referred to forensic investigation for having committed an offence, was used. For purposes of validation, besides the BARO, the DIPS (Diagnostic interview for psychiatric disorders) and the SKID II (Structured Clinical Interview for DSM-IV Axis II Personality Disorders) were conducted. A specifically for this goal created questionnaire was filled out by the users, in order to judge the applicability of the BARO. With respect to reliability, both internal consistency, and interrater reliability ranged from good to very good (α = .80 and r= .84). For analysing the validity, a ROC estimation (receiver operator curve) was performed and showed an AUC (area under the curve) of .88 for the presence of a mental health disorder. This result can be considered as very good. An optimal cut-off-point of 16.5 corresponds with a sensitivity of 86% and a specificity of 84%. The applicability of the BARO was rated as satisfying by the mental health professionals who used the instruments. The good psychometric properties and discriminative power of the BARO indicates that it is a useful mental health screening instrument for youth in contact with juvenile justice. Further research should focus on the usefulness in other populations and on the predictive validity for long-term outcome.

[The new hospital reimbursement system: a chance and a challenge to child and adolescent psychiatry or «much ado about nothing¼?]. / Das neue Entgeltsystem.

New legislation in the financing of psychiatric hospitals in Germany stipulates the introduction of a new reimbursement system for psychiatric child and adolescent psychiatric and psychosomatic hospitals in Germany by 2013. In several steps norms are to be empirically defined and services to be documented, and the current per diem system of hospital charges has to be replaced by a more specific system reflecting differences in the level of distinct patient groups. This discussion paper gives an overview of the legal framework as well as the risks and chances of the new system. An increased effort in documentation will be one of the clear consequences of the new system («much ado¼ ...). Psychiatric inpatient treatment will be much more transparent in detail, though it is not yet clear whether there will be a real improvement for patients (... «about nothing¼). The new system also offers the chance to introduce modern treatment concepts like home treatment. Such chances for innovation should be implemented to the benefit of patients.

[Statement by the Commission on Youth Welfare Services of the Child and Adolescent Professional Societies on Integration Assistance according to Section Paragraph 35a SGB VIII]. / Stellungnahme zur Eingliederungshilfe nach S35a SGB VIII der Kommission Jugendhilfe der kinder- und jugendpsychiatrischen Fachgesellschaften.

Paragraph 35a SGB VIII of the German Social Code (assistance for minors with mental illness) in practise creates difficulties for child and adolescent psychiatrists. Uncertainty prevails with regard to the role of the child and adolescent psychiatrist in the course of the proceedings, as well as about his/her duties and rights, and how to structure collaboration with the youth services and the parents. The Commission for the Youth Welfare Services of the German societies of child and adolescent psychiatry has generated guidelines for the proceedings according to paragraph 35a SGB VIII in order to resolve recurrent questions. The statement by the commission indicates solutions to these questions. A form was prepared to help child and adolescent psychiatrists to fulfil the necessary requirements for the proceedings.

[Risk assessment of neglect and maltreatment in infants and toddlers. Chances of early preventive intervention]. / Risikoeinschätzung bei Vernachlässigung und Kindeswohlgefährdung im Säuglings--und Kleinkindalter--Chancen früher beziehungsorientierter Diagnostik.

The German child protection system lacks of interdisciplinary and standardized procedures for screening and diagnosing child maltreatment as well as for service delivery. Evidence based assessments of risk-screening in combination with consensus-based models for risk-judgement seem to predict the best possible results. A central part of determining whether an infant is at risk is to evaluate various domains of parental competencies and skills. In particular assessment procedures based on attachment research have proven to be practically and methodologically relevant. These include interactive and video-based observational methods as well as parental representations as sources of information for risk assessment. Attachment based intervention and treatment programs are effective, especially with regard to enhancing paternal sensitive behavior. However, these programs need to be adapted to delivery for specific risk groups. Overall an interdisciplinary approach with regard to the programs as well as to the training of the professionals has to be taken into account.

[The dilemma of court expertise--commentary on the SSRI-tapering verdict by the Saxonian social court]. / Fragwürdigkeit eines Gerichtsurteils zur Antidepressiva-verordnung bei Jugendlichen.

We comment on a Social Court verdict that sentenced a German health insurance carrier to pay for the tapering of fluoxetine in a case of adolescent depression but not to payment for ongoing SSRI treatment in view of their off-label status. Evidence presented to the competent court, including a statement by the German Association for Child and Adolescent Psychiatry (DGKJP), was inadequately interpreted or else misunderstood. The court abstained from substantiating its own competence, e.g. by means of an external expertise. Even though an earlier verdict by the Federal Social Court was taken into account, there were shortcomings with regard to its realisation. The physician in charge of such a case is confronted with therapeutical and ethical dilemmata, as well as with problems of liability, as the court-ordered discontinuation of pharmacological treatment could conceivably compromise the well-being of the patient. Due to the recent marketing authorisation by the EMEA for the use of fluoxetine in the treatment of depressed children above the age of eight years in Europe, the case may be settled. Yet the implications of juridical intrusions into medical practice and therapy regimes must still be addressed.