[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.

Long-term changes in serum levels of lipoproteins in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of children worldwide. The causal mechanisms of ADHD remain unclear as the aetiology of this disorder seems to be multifactorial. One research field addresses the impact on lipid metabolism and particularly serum lipid fractions on the development of ADHD symptoms. This post hoc analysis aimed to investigate long-term changes in serum levels of lipoproteins in children and adolescents with ADHD and controls. Data of German children and adolescents from the nationwide and representative "Kinder- und Jugendgesundheitssurvey (KiGGS)" study were analysed at baseline and at a ten-year follow-up. At the two time points, participants in the control group were compared with those in the ADHD group, both before and after propensity score matching. Differences in total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides were assessed between matched children with and without ADHD. In addition, subgroups with versus without methylphenidate use were compared at both time points. At baseline before matching, there were no significant differences for lipid parameters between participants in the ADHD group (n = 1,219) and the control group (n = 9,741): total cholesterol (Exp(ß) = 0.999, 95%-CI 0.911-1.094, p = .979), LDL (Exp(ß) = 0.967, 95%-CI 0.872-1.071, p = .525), HDL (Exp(ß) = 1.095, 95%-CI 0.899-1.331, p = .366) and triglycerides (Exp(ß) = 1.038, 95%-CI 0.948-1.133, p = .412). Propensity score matching confirmed the non-significant differences between the ADHD and non-ADHD group at baseline. At the 10-year follow-up, n = 571 participants fulfilled complete inclusion criteria, among them 268 subjects were classified as ADHD. The two groups did not significantly differ in lipid fractions, neither cross-sectionally nor with regard to long-term changes. There was also no significant difference between methylphenidate subgroups. In this sample of children and adolescents we could not reveal any significant associations between serum lipid fractions and the diagnosis of ADHD, neither cross-sectionally nor longitudinally; even when methylphenidate use was considered. Thus, further studies using larger sample sizes are required to investigate putative long-term changes in serum lipid fractions related to ADHD.

Quality of life and mental health in children and adolescents during the first year of the COVID-19 pandemic: results of a two-wave nationwide population-based study.

BACKGROUND: The COVID-19 pandemic has disrupted the lives of children and adolescents worldwide. The German COPSY study is among the first population-based longitudinal studies to examine the mental health impact of the pandemic. The objective of the study was to assess changes in health-related quality of life (HRQoL) and mental health in children and adolescents and to identify the associated risk and resource factors during the pandemic. METHODS: A nationwide longitudinal survey was conducted with two waves during the pandemic (May/June 2020 and December 2020/January 2021). In total, n = 1923 children and adolescents aged 7 to 17 years and their parents participated (retention rate from wave 1 to wave 2: 85%). The self-report and parent-proxy surveys assessed HRQoL (KIDSCREEN-10), mental health problems (SDQ with the subscales emotional problems, conduct problems, hyperactivity, and peer problems), anxiety (SCARED), depressive symptoms (CES-DC, PHQ-2) and psychosomatic complaints (HBSC-SCL). Mixed model panel regression analyses were conducted to examine longitudinal changes in mental health and to identify risk and resource factors. RESULTS: The HRQoL of children and adolescents decreased during the pandemic, and emotional problems, peer-related mental health problems, anxiety, depressive and psychosomatic symptoms increased over time, however the change in global mental health problems from wave 1 to wave 2 was not significant, and some changes were negligible. Socially disadvantaged children and children of mentally burdened parents were at particular risk of impaired mental health, while female gender and older age were associated with fewer mental health problems. A positive family climate and social support supported the mental health of children and adolescents during the pandemic. DISCUSSION: Health promotion, prevention and intervention strategies could support children and adolescents in coping with the pandemic and protect and maintain their mental health.

Gender and Age Differences in ADHD Symptoms and Co-occurring Depression and Anxiety Symptoms Among Children and Adolescents in the BELLA Study.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most diagnosed neurodevelopmental disorders of childhood. Current studies addressing gender and age differences in ADHD are lacking. The present study aims to fill this research gap by dimensionally evaluating gender and age differences in ADHD symptoms, as measured by a DSM-5-based parent rating scale, in children and adolescents who participated in the two-year follow-up of the community-based BELLA study (n = 1326). Associations between ADHD symptoms and depression symptoms and anxiety symptoms were also examined. Multiple linear regressions revealed significant associations between gender and all ADHD symptoms. Age was significantly associated with hyperactive/impulsive symptoms. Additional multiple linear regressions demonstrated significant positive associations between depression and anxiety symptoms and ADHD symptoms. Further, female gender was found to be positively associated with both depression and anxiety symptoms. These findings may suggest a need for more gender-specific approaches to ADHD diagnosis and treatment, as well as more research into the intersections of ADHD and depression and anxiety symptoms in children and adolescents.

[Epidemiology of mental well-being in childhood and adolescence. Results from three epidemiological studies before and during the COVID-19 pandemic]. / Epidemiologie seelischen Wohlbefindens von Kindern und Jugendlichen in Deutschland. Ergebnisse aus 3 Studien vor und während der COVID-19-Pandemie.

BACKGROUND: Continuous nationwide health monitoring is important to track the well-being of children and adolescents and to map developmental trajectories. Based on the results of three selected epidemiological studies, developments in child well-being over the past 20 years are presented. METHODS: Data are based on (1) the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (BELLA study, 2003-2017, N = 1500 to 3000), which is a module of the KiGGS study; (2) the COvid-19 and PSYchological Health Study (COPSY, 2020-2022, N = 1600-1700), which is based on the BELLA Study; and (3) the International Health-Behaviour in School-aged Children Study (HBSC, 2002-2018, N = 4300-7300). Well-being was assessed in 7­ to 17-year-olds using indicators of health-related quality of life (KIDSCREEN-10), life satisfaction (Cantril Ladder), and mental health problems (Strenghts and Difficulties Questionnaire (SDQ), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Center for Epidemiological Studies Depression Scale for Children (CES-DC)). RESULTS: Overall, children and adolescents show consistently high health-related quality of life and high overall life satisfaction pre-pandemic (2002-2018), which initially worsened with the onset of the 2020 COVID-19-pandemic. Two years later, improvements are evident but have not yet reached baseline levels. Psychological problems, as well as symptoms of anxiety and depression, increased by up to 12 percentage points at the beginning of the pandemic and are still higher two years after the onset of the pandemic compared to pre-pandemic studies. CONCLUSION: The epidemiology of child well-being provides a necessary data basis to assess the support needs of children and adolescents and to use this as a basis for developing measures of health promotion, prevention, and intervention.

Prevalence and Time Trends of Self-Reported Mental Health Problems Among Children and Adolescents Between 11 and 17 Years in the KiGGS Study.

Objective: Knowledge about the prevalence of mental disorders in childhood and adolescence is important for clinicians and policymakers. This study examines the prevalence and trends in self-reported mental health problems among 11- to 17-year-olds in Germany. Method: We evaluated data from the self-report version of the Strength and Difficulties Questionnaire (SDQ) of 6,725 children and adolescents from the baseline of the German Health Interview and Examination Survey (KiGGS, 2003-2006) and 6,145 from its second wave (KiGGS wave 2, 2014-2017). Results: According to the SDQ total difficulties score, the prevalence estimates did not vary significantly between the study waves, neither regarding the category "abnormal" (9.3 % vs. 9.4 %) nor the pooled categories "borderline/abnormal" (16.9 % vs. 15.4 %). We confirmed the results by linear regression analyses using mean values instead of the SDQ categories. Analyses of the SDQ subscales revealed gender and age-specific time trends. Conclusions: These findings differ from those based on the SDQ parent report, which suggests significant declines in symptom load between the study waves. The results indicate the importance of integrating youth self-reports when measuring mental health problems, at least as part of a multi-informant approach.

Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany.

The COVID-19 pandemic has caused unprecedented changes in the lives of 1.6 billion children and adolescents. First non-representative studies from China, India, Brazil, the US, Spain, Italy, and Germany pointed to a negative mental health impact. The current study is the first nationwide representative study to investigate the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) and mental health of children and adolescents in Germany from the perspective of children themselves. A representative online survey was conducted among n = 1586 families with 7- to 17-year-old children and adolescents between May 26 and June 10. The survey included internationally established and validated instruments for measuring HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). Results were compared with data from the nationwide, longitudinal, representative BELLA cohort study (n = 1556) conducted in Germany before the pandemic. Two-thirds of the children and adolescents reported being highly burdened by the COVID-19 pandemic. They experienced significantly lower HRQoL (40.2% vs. 15.3%), more mental health problems (17.8% vs. 9.9%) and higher anxiety levels (24.1% vs. 14.9%) than before the pandemic. Children with low socioeconomic status, migration background and limited living space were affected significantly more. Health promotion and prevention strategies need to be implemented to maintain children's and adolescents' mental health, improve their HRQoL, and mitigate the burden caused by COVID-19, particularly for children who are most at risk.

[The Role of the Socioeconomic Status in Mental Health Care Utilization by Children and Adolescents in Germany: Results of the BELLA Study]. / Zur Rolle des sozioökonomischen Status bei der Inanspruchnahme fachspezifischer Versorgung von psychisch auffälligen Kindern und Jugendlichen in Deutschland: Ergebnisse der BELLA-Studie.

OBJECTIVE: Children and adolescents with a low socioeconomic status (SES) are significantly more often affected by mental health problems than their peers with a high SES. So far, little is known about the association between family's SES and utilization of mental health care. This study examines the mental health care utilization by children and adolescents depending on their SES and symptoms of mental health problems as well as the impact of mental health problems. METHODS: The analysis comprisesd data from the population-based BELLA-study, which investigates mental health in a representative subsample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Between 2014 and 2017, 1,580 participants aged 7 to 17 years were examined. SES was measured by the indicators of household income, parental educational attainment and parental occupation status. Symptoms and impairment of mental health problems were measured using the Strength and Difficulties Questionnaire (SDQ and SDQ-Impact). To investigate mental health care, the consultation of child and adolescent psychiatrists, medical and psychological psychotherapists and psychologists was considered. A hierarchic binary logistic regression model was calculated predicting mental health care use. In addition, effects of SES-indicators on associations between symptoms and impairment as well as mental health care utilization (moderator analysis) were investigated. RESULTS: Children and adolescents with a low SES were more likely to utilize mental health care services than their peers with a high SES. Mental health care utilization was significantly predicted by symptoms of mental health problems (OR=1.15, p≤0.001) as well as by the impairment caused by these problems (OR=1.68, p≤0.001); we found no significant moderation effects for household income, parental education or parental occupation. CONCLUSION: The probability of mental health care utilization by children and adolescents is significantly predicted by the symptoms and the impairments caused by mental health problems, but not by household income, parental education or parental occupation.

[Mental health and psychological burden of children and adolescents during the first wave of the COVID-19 pandemic-results of the COPSY study]. / Seelische Gesundheit und psychische Belastungen von Kindern und Jugendlichen in der ersten Welle der COVID-19-Pandemie ­ Ergebnisse der COPSY-Studie.

BACKGROUND: The drastic changes during the COVID-19 pandemic may have a negative impact on the psychological wellbeing of children and adolescents. OBJECTIVES: COPSY is the first national, representative German study to examine mental health and quality of life of children and adolescents during the pandemic. Results are compared with data of the representative longitudinal BELLA study conducted before the pandemic. MATERIALS AND METHODS: Internationally established instruments for measuring health-related quality of life and mental health (including anxiety and depressive symptoms) were administered to n = 1586 parents with 7­ to 17-year-old children and adolescents, of whom n = 1040 11- to 17-year-olds also provided self-reports, from 26 May to 10 June 2020. Data were analyzed using descriptive statistics and bivariate tests. RESULTS: Seventy-one percent of the children and adolescents and 75% of the parents felt burdened by the first wave of the COVID-19 pandemic. Compared to the time before the pandemic, the children and adolescents reported a lower health-related quality of life, the percentage of children and adolescents with mental health problems almost doubled, and their health behavior worsened. Socially disadvantaged children felt particularly burdened by the COVID-19 pandemic. Two-thirds of the parents would like to receive support in coping with their child during the pandemic. CONCLUSIONS: The COVID-19 pandemic poses a mental health risk to children and adolescents. Schools, doctors, and society are called to react by providing low-threshold and target-group-specific prevention and mental health promotion programs.

[Symptoms of eating disorders in children and adolescents: frequencies and risk factors : Results from KiGGS Wave 2 and trends]. / Essstörungssymptome bei Kindern und Jugendlichen: Häufigkeiten und Risikofaktoren : Ergebnisse aus KiGGS Welle 2 und Trends.

Eating disorders are of high clinical and societal relevance. They are among the most common chronic mental illnesses in adulthood, but show a high incidence rate and peak of disease onset even in adolescence. Eating disorders are associated with far-reaching costs, such as acute or chronic comorbidities and educational or professional attainment.Thus, from a public mental health perspective, it is essential to explore symptoms and risk factors of eating disorders and to monitor prevalence rates across time to evaluate the relevance and effectiveness of prevention measures.In the present study, the recent prevalence of eating disorder symptoms among 11- to 17-year-old children and adolescents living in Germany is reported based on the Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017, N = 6599, 51.7% boys) and compared to the prevalence rates 10 years ago (KiGGS Baseline, 2003-2006, N = 6633, 51.5% boys). Moreover, we investigate a selection of risk factors for eating disorder symptoms.In KiGGS Wave 2, 19.8% of the children and adolescents showed eating disorder symptoms, a drop of 2.8 percentage points in the prevalence rate as compared to the KiGGS Baseline. The drop in the prevalence rate pertains to 11- to 13-year-old boys while the risk for 14- to 17-year-old adolescents and particularly among girls remained comparably high. Children and adolescents with emotional problems, low family cohesion, low self-efficacy, or who perceive themselves as too thick or thin, show an increased risk for eating disorder symptoms.Previous approaches and possible supplements for the prevention of eating disorders are discussed.

Effects of long-term methylphenidate use on growth and blood pressure: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS).

BACKGROUND: Concerns have been raised over the safety of methylphenidate (MPH), with regard to adverse effects on growth and blood pressure. Our study investigates whether, and to what extent, methylphenidate use in boys with ADHD is associated with having low body mass index (BMI), having low height, and increased systolic and diastolic blood pressure. METHODS: Data used for this study stem from the German KiGGS dataset. Three different groups of boys aged 6-15 years were included in the analysis: ADHD patients who used MPH for less than 12 months; ADHD patients who used MPH for 12 months or more; and ADHD patients without current MPH treatment. Each of these three groups was compared to a non-ADHD control group regarding low weight (BMI ≤ 3rd percentile), low height (≤3rd percentile) and raised systolic and diastolic blood pressure. For growth outcomes, boys were categorized according to age (< 11 years/≥11 years, to account for pubertal maturation). Multivariable logistic regression was conducted to test for associations. RESULTS: 4244 boys were included in the study; MPH < 12 months: n = 65 (n = 36 < 11 years), MPH ≥ 12 months: n = 53 (n = 22 < 11 years), ADHD controls: n = 320 (n = 132 < 11 years), non-ADHD controls: n = 3806 (n = 2003 < 11 years). Pre-pubertal boys with MPH use less than 12 months and pubertal/postpubertal boys with MPH use of 12 months or greater were significantly more likely to have a BMI ≤ 3rd percentile compared to non-ADHD controls. Boys from the ADHD control group were significantly less likely to have a raised systolic blood pressure compared to non-ADHD controls. Beyond that, no significant between group differences were observed for any other growth and BP parameter. CONCLUSION: The analyses of the KiGGS dataset showed that MPH use in boys with ADHD is associated with low BMI. However, this effect was only observed in certain groups. Furthermore, our analysis was unable to confirm that MPH use is also associated with low height (≤3rd percentile) and changes in blood pressure.

Normative Data of the Self-Report Version of the German Strengths and Difficulties Questionnaire in an Epidemiological Setting.

OBJECTIVE: This study served to establish German norms for the Strengths and Difficulties Questionnaire self-report (SDQ-S) by using data from a representative epidemiological sample from the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS study). Although the German version of the SDQ has been widely used and normative data for the parent version (SDQ-P) exist, no German norms for the self-report version have been reported, so that practitioners had to rely on the available British norms. In addition, we investigated whether sex- and age-specific norms are necessary. METHODS: At the baseline of the KiGGS study, SDQ-S ratings were collected from n = 6,726 children and adolescents between 11 and 17 years (n = 3,440 boys und n = 3,286 girls). We assessed the internal consistency and age/sex effects of the SDQ-S. Confirmatory factor analysis was conducted to assess the factor structure of the SDQ-S. Banding scores were developed to differentiate children and adolescents with levels of difficulties and categorized them as "normal," "borderline," and "abnormal." General as well as age- and sex-specific bandings were created for both total score and subscales of SDQ-S. In addition, the German norms of the SDQ-S were compared with those of the UK, Norway, and Thailand. RESULTS: The five-factor solution of the SDQ-S (including Emotional symptoms, Conduct problems, Hyperactivity/Inattention, Peer problems, and Prosocial behavior) provided a satisfactory fit to the data. Moderate internal consistencies (Cronbach's α) were observed for the scales Emotional symptoms, Hyperactivity/Inattention, and Total difficulties score, whereas insufficient internal consistency was found for the scales Peer problems and Conduct problems. However, using McDonald's ω as a more appropriate measure of homogeneity, internal consistencies were found to be satisfactory for all subscales and for Total difficulties. Normative banding scores were established conservatively to avoid producing too many false positives in the category "abnormal." In line with previous research, girls showed more emotional problems but fewer Peer problems than boys. German normative bandings of SDQ-S were similar to the original British bandings and those of other countries. CONCLUSIONS: This study of the German SDQ-S in a large representative epidemiological sample presents evidence of partly moderate to good psychometric properties. It also supports the usefulness of SDQ-S as an effective and efficient instrument for child and adolescent mental health problems in Germany. German normative banding scores of SDQ-S established in this study were comparable with the original British norms as well as with those of other countries, so that SDQ-S can be recommended as a psychopathological broadband-screening tool.

Electronic media use and insomnia complaints in German adolescents: gender differences in use patterns and sleep problems.

Electronic media play an important role in the everyday lives of children and adolescents and have been shown to be associated with sleep problems. The objective of this study was to assess the associations between time spent using different electronic media and insomnia complaints (IC) in German adolescents with particular respect to gender differences in use patterns and associations with IC. Cross-sectional data of a weighted total of 7533 adolescents aged 11-17 stem from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS study) that was conducted from 2003 to 2006. The assessment of IC and time spent using different electronic media (television, computer/internet, video games, total screen time, mobile phones, and music) was included in a self-report questionnaire. Binary logistic regression analyses were performed to assess associations between time spent per day with each electronic media and IC. Age, SES, emotional problems (anxiety/depression) and presence of a medical condition were considered as covariates in the adjusted model. Boys and girls were considered separately. For boys: computer/internet use of ≥3 h/d (AOR = 2.56, p < 0.05) and total screen time of ≥8 h/d (AOR = 2.45, p < 0.01) were associated with IC in users. Playing video games for 0.5-2 h/d reduced the odds for IC (AOR = 0.60, p < 0.05) compared to nonusers. For girls: Listening to music for ≥3 h/d was associated with IC (AOR = 4.24, p < 0.05) compared to non-listeners. Everyday use of electronic media devices is associated with IC in adolescents. Clinicians dealing with adolescents referred for sleep problems should be aware of gender-specific patterns of media use and sleep problems.

Insomnia complaints and substance use in German adolescents: did we underestimate the role of coffee consumption? Results of the KiGGS study.

The purpose of the study was to study the associations of tobacco, alcohol, marijuana, and coffee use and insomnia complaints (IC) in adolescents with special consideration of the influence of coffee consumption on these relationships. 7698 Subjects aged 11-17 years were investigated in a cross-sectional study within the German Health Interview and Examination Survey for Children and Adolescents. Self-report questionnaires were distributed to the participants. Hierarchical regression analyses were performed to assess possible effects of coffee consumption on the association of tobacco, alcohol, and marijuana use with IC. Common risk factors for insomnia were included in the adjusted analyses. Tobacco, alcohol, marijuana and coffee use displayed significant bivariate associations with IC. After adjusting the first three substances for coffee consumption, their associations with IC were reduced considerably. After additionally adjusting for other potential confounders (age, gender, socio-economic status, externalizing and internalizing psychiatric problems, media use, bodyweight, medical condition), frequent coffee consumption, high alcohol intake and frequent smoking contributed to the prediction of IC in male subjects while frequent coffee consumption and high alcohol intake predicted the occurrence of IC in females. Coffee consumption could be an important risk factor for IC in adolescents and it significantly affects the association of smoking, alcohol, and marijuana with IC. Future research that includes long-term studies about psychoactive substance use (PSU) and sleep should also consider coffee consumption. Parents, educators, clinicians, and researchers should be aware of the potentially hazardous influence of PSU, especially coffee, alcohol and tobacco, on sleep in young individuals.

Risk and protective factors for the development of depressive symptoms in children and adolescents: results of the longitudinal BELLA study.

Mental health problems in children and adolescents are frequent, with a high risk of persistence into adulthood. Therefore, the investigation of determinants of onset and course of mental health problems is of high importance. The present paper investigates the impact of protective and risk factors on the development of depressive symptoms in children and adolescents. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KIGGS). Based on the first three measurement points of the BELLA study (covering a period of 2 years), the present analysis focused on children and adolescents aged 11-17 years at baseline (n = 1,643; 50.6 % female). A longitudinal growth modelling approach was used. Mental health problems in parents (parent-reports) predicted depressive symptoms in children and adolescents (self-reports) as well as the development of these symptoms over time. Further, child-reported protective factors of self-efficacy, positive family climate and social support were associated with less depressive symptoms at baseline. Additionally, positive changes in protective factors were associated with the development of less depressive symptoms over time. Finally, family climate and social support moderated the detrimental influence of parental psychopathology on child's depressive symptoms. The addressed determinants for the development of depressive symptoms in children and adolescents are highly relevant for prevention and intervention strategies. Future research should investigate specific risk and protective factors focusing in detail on further mental health disorders and their development in children and adolescents.

Modelling trajectories of psychosomatic health complaints in children and adolescents: results of the BELLA study.

Psychosomatic health complaints (PHC) can significantly impair psychosocial development of children and adolescents and are therefore of considerable interest in health sciences and public health surveillance. Questions addressed the type of function that describes individual trajectories best, potential differences between these, and corresponding predictors from the perspective of both children and their parents. Based on the German population-based and representative BELLA cohort sample, 2,857 children and adolescents between 7 and 17 years of age at baseline were analysed over a period of 3 years with yearly follow-ups using mixed growth curve analyses. PHC were measured in accordance with the health behaviour in school-aged children-symptom checklist. The mean level of PHC was rather low, slightly lower for the parent report than for the self-report and significantly different between subjects. Concerning the parent report, the 2-year course is best described by a slowly increasing linear trend that decelerates somewhat over time. The increasing linear trend was more pronounced in the self-report from 11 to 17 years of age, but was significantly different for each subject and correlated with baseline scores. Trajectories could be explained by known predictors, most importantly by mental health problems of the child or adolescent. The results confirm the findings of previous studies and provide representative data about the individual short-term development of PHC in children and adolescents in Germany.

[Subjective Weight Perception in Normal-Weight Adults - Results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Subjektives Gewichtsempfinden bei normalgewichtigen Erwachsenen - Ergebnisse aus der bundesweiten Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

This study investigates the prevalence and socio-demographic distribution of subjective weight perceptions in 2,552 subjects aged 18-79 years with normal weight (according to the WHO classification) who took part in the nationally representative DEGS1 study of the Robert Koch Institute, Berlin. In total, barely half of normal-weight adults-both men and women- considered themselves "a little/much too thick" or "a little/much too thin" (discordant weight perception). Normal-weight women assessed themselves predominantly as too thick (38,6%; 95% CI: 35,7-41,6). A quarter of normal-weight men assessed themselves as too thin, whereas another fifth of normal-weight men considered themselves too thick. The proportion of discordant weight perceptions declined with rising age. In multivariate assessment, socio-economic status was no significant predictor. Results are discussed in reference to potential implications for prevention programs.

Somatic and mental health service use of children and adolescents in Germany (KiGGS-study).

Only a limited number of national surveys have investigated both somatic and mental health service use in children and adolescents. The current study aimed to assess service use in Germany as based on at least a single contact with a somatic (pediatrician, general practitioner, nonmedical practitioner) and/or mental health (psychiatrist, psychologist, youth welfare) care specialist within the last 12 months. Questionnaire responses of 6,475 children and adolescents aged 11.0-17.9 years and their parents were analyzed based on data ascertained by the German Child and Adolescent Health Survey (KiGGS) conducted between 2003 and 2006. For assessment of mental symptom loading the Strengths and Difficulties Questionnaire (SDQ) was completed by parents, thus allowing the determination of the relationship between symptom loading and service use. ANOVA and logistic regression were performed to determine help-seeking behavior overall and of different health professional groups upon inclusion of the SDQ Total Difficulties score, gender, age and socio-economic status (SES). A total of 81.9 % of all children and adolescents had used any kind of service within the past 12 months. Seventy-seven percent and 0.8 % used only the somatic and mental health services, respectively; 4.1 % had frequented both services. Amongst youths with a 'borderline' and 'abnormal' Total Difficulties score, 11.8 and 18.6 %, respectively, sought help from mental health partners. Age, SES and Total Difficulties score were predictors of any service use; the logistic regression model explained 7.6 % of the variance. Use of mental health service was significantly predicted by only age and Total Difficulties score, the respective model explained 26.2 % of the variance. The comparison of health services use on an international level is rendered difficult by national differences in health-care provision. Nevertheless, several of our findings are similar to results obtained in other nationally representative surveys.

Prevalence and gender patterns of mental health problems in German youth with experience of violence: the KiGGS study.

BACKGROUND: Research examining mental health in violence-affected youth in representative samples is rare. Using data from the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) this study reports on gender-specific prevalence rates and associations of a broad range of internalizing and externalizing mental health problems: emotional problems, conduct problems, ADHD, disordered eating, somatic pain and substance use in youth variously affected by violence. While internalizing is generally more common in girls and externalizing in boys, observations of prior non-normative studies suggest reverse associations once an individual is affected by violence. The occurrence of such "gender cross-over effects" is therefore examined in a representative sample. METHODS: The sample consisted of 6,813 adolescents aged 11 to 17 from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS): Applying multivariate logistic regression analyses, associations between each type of violence history and mental health indicator were determined for perpetrators, victims, and perpetrating victims of youth violence. Moderating effects of gender were examined by using product term interaction. RESULTS: Victim status was associated primarily with internalizing problems, while perpetrators were more prone to externalizing problems. Perpetrating victims stood out with respect to the number and strength of risk associations with all investigated mental health indicators. However, the risk profiles of all violence-affected youth included both internalizing and externalizing mental health problems. Gender cross-over effects were found for girls and boys: despite lower overall prevalence, girls affected by violence were at far higher risk for conduct problems and illicit drug use; by contrast, somatic pain, although generally lower in males, was positively associated with perpetrator status and perpetrating victim status in boys. All violence-affected youth exhibited significantly higher rates of cumulative mental health problems. CONCLUSIONS: The results highlight the importance of violence for the mental health of youth. They reveal a particular vulnerability as a function of gender. Implications for policy making, clinical practice and research are discussed.