Different perspectives in psychiatry: how family-oriented are professionals in Germany?

ΒACKGROUND: Children of parents with a mental illness have up to 50% chance of developing a mental illness themselves. Numerous studies have shown that preventive family-oriented interventions can decrease the risk by 40% and that professionals are a decisive factor influencing family-oriented practice. There are also substantial differences between professions in terms of their family-oriented practices. This study examines the level of family-oriented practice for different professional groups in Germany. METHODS: Data were used from the baseline assessment of the two-group randomized controlled multicenter trial ci-chimps as a subproject of CHIMPS-NET, which took place from January 2020 to May 2021 in 18 clinical centers in Germany. Child and adolescent mental health systems as well as adult mental health systems took part and every professional involved in the treatment was invited to participate. Data was used from 475 mental health professionals including physicians, psychologists, psychotherapists for adults and for children and adolescents, occupational/ music/ physio/ art therapists/ (social) education workers and nursing/ education service. Family-oriented mental health practice was examined using the translated version of the Family-Focused Mental Health Practice Questionnaire (FFMHPQ) with means and standard deviations calculated for each of the 18 FFMHPQ-GV subscales. ANOVAs were computed to compare professions and significant differences were examined via post hoc analyses (Scheffé). Additionally, effect sizes were calculated (Omega squared). RESULTS: Differences were seen between the professions in all aspects of family-oriented practice: Both regarding organizational policy and support aspects, issues concerning working with parent-clients, as well as professional skills and knowledge aspects. Psychotherapists for children and adolescents scored the highest family-oriented practices compared to all other professional groups on almost all subscales. CONCLUSION: This study examines the level of family-oriented practice for different professional groups in Germany. Apart from skills and knowledge about the impact of mental illness and parenting, psychotherapists for children and adolescents had the highest scores and engaged most in family-oriented practice. Psychotherapists for adults got the least workplace support for family-oriented practice but were competent providing resources and referral information to the concerned families and feel confidence working with them. Due to these results, a training need exists to improve skills and knowledge about the impact of mental illness and parenting. Additionally, there is still potential for institutional support in promoting family-oriented work. TRIAL REGISTRATION: The CHIMPS-NET-study was registered with the German Clinical Trials Register on 2019-12-19 (DRKS00020380) and with Clinical Trials on 2020-4-30 (NCT04369625), the ci-chimps-study was registered with the German Clinical Trials Register (DRKS00026217) on 2021-08-27 and with Clinical Trials on 2021-11-04 (NCT05106673).

Are 6 more accurate than 4? The influence of different modes of delivery on postpartum depression and PTSD.

BACKGROUND: Empirical evidence shows that 4.6-6.3% of all women develop a post-traumatic stress disorder (PTSD) and approximately 10-15% postpartum depression (PPD) following childbirth. This study explores the relationship between delivery mode and the occurrence of PTSD and PPD, specifically examining four distinct caesarean section (CS) modes: primary on maternal request (Grade 4), medically indicated primary (Grade 3), secondary CS from relative indication (Grade 2) and emergency secondary CS (Grade 1), compared to vaginal and assisted vaginal delivery (AVD). The research aims to understand how these six subcategories of delivery modes impact PPD and PTSD levels. Common predictors, including the need for psychological treatment before childbirth, fear of childbirth, planning of pregnancy, induction of labor, birth debriefing, and lack of social support after childbirth, will be analyzed to determine their association with postpartum mental health outcomes. METHODS: The study was planned and carried out by a research team of the psychology department at the Medical School Hamburg, Germany. Within an online-study (cross-sectional design) N = 1223 German speaking women with a baby who did not die before, during or after birth were surveyed once between four weeks and twelve months postpartum via an anonymous online questionnaire on demographic and gynecological data, delivery mode, PTSD (PCL-5) and PPD (EPDS). RESULTS: For both psychiatric disorders, ANOVA revealed significant differences between delivery mode and PPD and PTSD. With weak effects for PPD and medium to strong effects for PTSD. Post-hoc tests showed increased levels of PPD for two CS types (Grade 1, Grade 3) compared to vaginal delivery. For PTSD, secondary CS from relative indication (Grade 2), emergency secondary CS (Grade 1) and assisted vaginal delivery (AVD) were associated with elevated levels of PTSD. Regression analysis revealed delivery mode as a significant predictor of EPDS- (medium effect size) and PCL-5-Score (medium to high effect size). LIMITATION: Delivery was considered as the potential traumatic event, and any previous traumas were not documented. Additionally, the categorization of delivery modes relied on subjective reports rather than medical confirmation. CONCLUSION: The study highlights the influence of delivery mode on the mental health of postpartum mothers: different modes influence postpartum disorders in various ways. However, the definition of delivery mode was only stated subjectively and not medically confirmed. Further research should investigate which aspects of the different delivery modes affect maternal mental health and explore how the perception of childbirth may be influenced by specific delivery experiences.

Health-Related Quality of Life and mental health of families with children and adolescents affected by rare diseases and high disease burden: the perspective of affected children and their siblings.

BACKGROUND: Advances in genetic and pharmaceutical technology and pediatric care have enabled treatment options for an increasing number of rare diseases in affected children. However, as current treatment options are primarily of palliative nature, the Health-Related Quality of Life (HRQoL) and mental health of this impaired population and their siblings are of increasing importance. Among children and adolescents with rare diseases, those who are technology-dependent carry a high disease burden and are selected as the target population in our study. In a cross-sectional observational design, the children's HRQoL was assessed with the DISABKIDS (DCGM-37) as well as KIDSCREEN-27, while mental health was assessed with the Strengths and Difficulties Questionnaire (SDQ) by both the affected children, their parents, and siblings. RESULTS: Results of the study sample were compared to normative data. Affected children scored significantly lower than the norm on almost all HRQoL subscales as reported by parent and child. From the parental perspective, more mental health subscales were significantly impaired compared to the child's perspective. Siblings showed no impairment in HRQoL as well as significantly fewer behavioral problems and higher prosocial behavior regarding their mental health compared to the norm. CONCLUSION: Children and adolescents with rare diseases seem particularly impaired in social and emotional aspects of HRQoL and mental health. Interventions may focus primarily on promoting social skills, fostering prosocial behavior and peer relationships.

How young psychotherapists experience working with older patients.

Preliminarily findings from experimental and survey research suggests that psychotherapy with older adults is an area of practice in which psychotherapists do not feel positive and confident. This qualitative study is the first to explore how young psychotherapists experience and perceive their therapeutic work with older patients. To do so, we provide an in-depth perspective of how young (aged 27-35) psychotherapists experience providing psychotherapeutic treatment for older patients (aged over 65). Semistructured interviews were conducted with 20 psychotherapists in training (14 women, six men). They were recruited via psychotherapeutic training institutions and geropsychiatry clinics in Germany. The grounded theory approach was used to analyze the data. We found that the participants had various attitudes toward older adults (respectful/admiring, caring/supportive, doubtful, and open) that were related to individual social and biographic experiences with older adults. The participants' attitudes and personal experiences were also found again in their reported therapeutic behavior toward older patients. The finding further showed that the treatment setting (inpatient vs. outpatient) had an additional impact on the participants' perception of and therapeutic behavior toward older patients. Our findings demonstrated that the participants experienced various challenges and particularities when working with older patients. Young psychotherapists who work with older patients should be supported by psychotherapeutic training institutions through supervision and guidance on how to deal with clinical challenges. Furthermore, it can be valuable for young psychotherapists to critically reflect their attitudes toward older adults and personal motives for their therapeutic behavior toward older patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

[DNVF-Discussion paper - Specificities, Challenges and Aims of Mental Health Service Research in Germany]. / DNVF-Diskussionspapier ­ Besonderheiten, Herausforderungen und Ziele der Versorgungsforschung im Feld der seelischen Gesundheit.

Research in mental health services in Germany is of increasing relevance. To this end, the recently founded "Mental Health Working Group" as part of the German Network of Health Services Research (DNVF) has written a discussion paper presenting key specifics, challenges, and goals of health service research in the field of mental health. Some research-relevant specifics in the area of mental health care, pragmatic challenges of research organization, ethical problems, and particular research topics in this field are presented and discussed critically.

[Preventive and therapeutic interventions for children of mentally ill parents]. / Präventive und therapeutische Interventionen für Kinder psychisch belasteter Eltern.

Preventive and therapeutic interventions for children of mentally ill parents Abstract. The risk of developing mental disorders increases markedly in children of mentally ill parents. Several risk factors have been identified and become possible targets of preventive and therapeutic interventions. Numerous studies investigated the efficacy of these interventions, which are very heterogeneous regarding content and methodology. One part of these studies focuses on infants of depressed and substance-addicted mothers; the other part focuses on children and adolescents of parents suffering from various mental disorders. Today, we have several meta-analyses at our disposal which yielded small effect sizes concerning the development of psychological symptoms or disorders in these affected children. The current review reveals a lack of high-quality studies, and analyses on cost-effectiveness are also needed. The preventive and therapeutic interventions now available show inadequate efficacy to effectively improve the situation of these children and adolescents. Future research is needed to develop and implement cost-effective interventions as well as high-quality studies to investigate the efficacy of these interventions.

The impact of long-term ventilator-use on health-related quality of life and the mental health of children with neuromuscular diseases and their families: need for a revised perspective?

BACKGROUND: Life extension by medical interventions and health-related quality of life (HRQOL) are sometimes conflicting aspects of medical care. Long-term ventilation in children with neuromuscular disease is a well-established life-extending procedure and often at the center of this conflict. HRQOL and the mental health of affected children and their families become even more important in respect to emerging therapies in neuromuscular diseases with longer life-expectancy of treated patients and considerable costs of medical treatment. METHODS: We performed a questionnaire survey in a total of forty-three families of children with neuromuscular disease treated in the University Medical Center Hamburg-Eppendorf and the Children's Hospital Altona. We evaluated self- and proxy-reported HRQOL and mental health outcomes of affected children and their parents using validated and age-appropriate instruments. RESULTS: Compared to normative data, children with neuromuscular diseases and their families experienced a lower HRQOL and mental health. However, there was no additional negative influence on the overall HRQOL by ventilator use. CONCLUSIONS: As ventilator use was not responsible for the reduction of HRQOL and mental health our data contributes an important aspect to the discussion about life-prolonging procedures, in particular mechanical ventilation, in severly disabled patients.

Evaluation of two family-based intervention programs for children affected by rare disease and their families - research network (CARE-FAM-NET): study protocol for a rater-blinded, randomized, controlled, multicenter trial in a 2x2 factorial design.

BACKGROUND: Families of children with rare diseases (i.e., not more than 5 out of 10,000 people are affected) are often highly burdened with fears, insecurities and concerns regarding the affected child and its siblings. Although families caring for children with rare diseases are known to be at risk for mental disorders, the evaluation of special programs under high methodological standards has not been conducted so far. Moreover, the implementation of interventions for this group into regular care has not yet been accomplished in Germany. The efficacy and cost-effectiveness of a family-based intervention will be assessed. METHODS/DESIGN: The study is a 2x2 factorial randomized controlled multicenter trial conducted at 17 study centers throughout Germany. Participants are families with children and adolescents affected by a rare disease aged 0 to 21 years. Families in the face-to-face intervention CARE-FAM, online intervention WEP-CARE or the combination of both will be treated over a period of roughly 6 months. Topics discussed in the interventions include coping, family relations, and social support. Families in the control condition will receive treatment as usual. The primary efficacy outcome is parental mental health, measured by the Structured Clinical Interview for DSM-IV (SCID-I) by blinded external raters. Further outcomes will be assessed from the parents' as well as the children's perspective. Participants are investigated at baseline, 6, 12 and 18 months after randomization. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed. DISCUSSION: This paper describes the implementation and evaluation of two family-based intervention programs for Children Affected by Rare Disease and their Family's Network (CARE-FAM-NET) in German standard care. A methodologically challenging study design is used to reflect the complexity of the actual medical care situation. This trial could be an important contribution to the improvement of care for this highly burdened group. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00015859 (registered 18 December 2018) and ClinicalTrials.gov : NCT04339465 (registered 8 April 2020). Protocol Version: 15 August 2020 (Version 6.1). Trial status: Recruitment started on 1 January 2019 and will be completed on 31 March 2021.

[Child Protection in Families with Parental Mental Illness]. / Kinderschutz in Familien mit einem psychisch erkrankten Elternteil.

Child Protection in Families with Parental Mental Illness Children and adolescents from families with parental mental illness face an increased risk to experience abuse, neglect and maltreatment. The effects of imminent, intermittent or chronic distress on the development of the child and to differentiate these from neglect or maltreatment are not easily assignable in such families. Questionnaires and diagnostic instruments can be supportive tools for professionals in hospitals and private practices to identify and differentiate between burdens of children and families and potential endangerment. Different instruments are presented for the assessment of child abuse: For professionals the "Wahrnehmungsbogen für Kinderschutz" (Thurn et al., 2017). As methods of screening at risk the "Eltern-Belastungsbogen zur Kindeswohlgefährdung" (Deegener, Spangler, Körner, Becker, 2009) and the Childhood Trauma Questionnaire (Wingenfeld et al., 2010). For the comprehensive assessment of abuse, we present the Maternal Interview Child Maltreatment (Cicchetti, Toth, Manly, 2003). The prevalence of mentally ill parents is presented based on two samples of patients attending the child protection outpatient clinic or and the trauma outpatient clinic of the Charité. In the child protection outpatient clinic 15.8 % of the mothers and 11.4 % of the fathers fulfilled criteria for psychiatric disorders. In the trauma outpatient clinic we diagnosed a parental mental disorder in 20 % of all cases. A fictitious case report reveals the emotional maltreatment of a child by its mentally ill mother, which suffers from an isolated delusional disorder. Empirical based classification tools seem to be very appropriate to ascertain physical and sexual maltreatment and child neglect in children of parents with mental disorders, as permanent or severe neglect is frequently detectable in these families.

[Effectiveness of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Psychopathology in a Naturalistic Treatment Setting]. / Wirksamkeit analytischer Psychotherapie bei Kindern und Jugendlichen mit klinischen Angstsyndromen im naturalistischen Behandlungssetting.

Effectiveness of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Psychopathology in a Naturalistic Treatment Setting The aim of the study was to evaluate naturalistic out-patient psychoanalytic youth psychotherapy in Germany. The study was a partly controlled effectiveness trial. While the first treatment interval (25 sessions, 6.13 months) was compared with a wait-list control group (5 supportive sessions, 2.94 months), the effects of long-term psychoanalytical treatment were analyzed using a time-series design. 86 children and adolescents (aged 4 to 21 years) and their parents who entered psychoanalytic therapy in private practices participated in this study. The wait-list control group comprised 35 patients. Questionnaires were administered at the beginning and the end of treatment, as well as 6 and 12 month follow-up (FU). Patients received on average 94.04 therapy sessions (range 8 to 300) over 25.70 months. Data analyses were carried out with multilevel mixed linear models on the intention-to-treat (ITT) sample. The patients in the intervention group reported moderate symptom improvements at the end of therapy (d = .57), these effects are stable at the 1-year follow-up and increase from the patient perspective (d = .80). When comparing the first therapy interval with the (minimal treatment) wait-list control group, both groups improved significantly with small effect sizes and no significant group differences. The results suggest that long-term psychoanalytic therapy is successful in alleviating anxiety pathology and improving quality of life for youth with anxiety disorders, and that improvements remain stable across a 1-year follow-up period.

Trajectories of mental health problems in children of parents with mental health problems: results of the BELLA study.

Children of parents with mental health problems (CPM) have an increased risk for behavioral and psychological problems. This study investigated the age- and gender-specific course as well as predictors of mental health problems in CPM using the longitudinal data (baseline 1- and 2-year follow-ups) of a German general population sample from the BELLA study. Children and adolescents aged 11-17 years (at baseline) who had a parent with mental health problems (n = 325) were analyzed. The mental health problems of the children were assessed by the self-reported version of the strengths and difficulties questionnaire (SDQ). We used individual growth modeling to investigate the age- and gender-specific course, and the effects of risk as well as personal, familial and social protective factors on self-reported mental health problems in CPM. Additionally, data were examined differentiating internalizing and externalizing mental health problems in CPM. Results indicated that female compared to male CPM showed increasing mental health problems with increasing age. Mental health problems in CPM were associated with lower self-efficacy, worse family climate and less social competence over time. Internalizing problems were associated with lower self-efficacy, less social competence and more severe parental mental health problems. Externalizing problems were associated with lower self-efficacy, worse family climate and lower social competence. The main limitations of the study are the short time period (2 years) covered and the report of mental health problems by only one parent. Our findings should be considered in the development of treatment and prevention programs for mental health problems in CPM.

Psychoanalytic Psychotherapy for Children and Adolescents with Severe Externalising Psychopathology: An Effectiveness Trial.

OBJECTIVES: This partly waitlist-controlled prospective field study aimed to evaluate the effectiveness of psychoanalytic psychotherapy for children and adolescents with severe externalising symptoms. Externalising symptoms are associated with diagnoses of conduct disorders, hyperkinetic disorders, and disorders of social functioning. METHODS: Participants were 93 children and adolescents in psychoanalytic therapy with a diagnosed psychiatric disorder with externalising symptomatology (intervention group: n = 65; minimal supportive treatment/waitlist control group: n = 28). Data was collected from parents and patients (≥ 11 years) at beginning/end of treatment, 6- and 12-month follow-up. The effects of long-term psychoanalytical treatment were analysed using a longitudinal design. RESULTS: At the end of therapy, externalising symptoms were significantly reduced rated by both parents and patients (parent-rated: d = .69, patient-rated: d = .63). This effect was stable at the 1-year follow-up (parent-rated: d = .77, patient-rated: d = .68). About 70% of the patients may be considered as recovered or improved by the end of therapy. CONCLUSIONS: Psychoanalytic therapy may be successful in alleviating psychiatric disorders with externalising symptoms with effects stable at the 1-year follow-up.

[The Need for Psychosocial Support in Parents of Chronically Ill Children]. / Psychosozialer Unterstützungsbedarf von Eltern mit schwer chronisch somatisch erkrankten Kindern.

The Need for Psychosocial Support in Parents of Chronically Ill Children Chronic illness in childhood and adolescence is associated with special requirements and demands on affected families. In particular, severe chronic diseases and rare diseases with a high level of health care needs or with progressive medical diagnoses permanently challenge the families' resources. The aim of this study was to assess the need for psychological, nursing, legal and organisational support from a parent's perspective. Using qualitative content analysis according to Mayring, data from 96 parents of 68 chronically ill children were evaluated. The findings suggest an increased need for psychosocial support, but, the ideas, needs, and goals of parents are very versatile. However, family-based psychosocial support programs, which are adapted to the specific family situations, are unanimously judged to be useful. Interventions should be flexible as well as tailored to the affected families' individual needs.

A Comparison of Psychoanalytic Therapy and Cognitive Behavioral Therapy for Anxiety (Panic/Agoraphobia) and Personality Disorders (APD Study): Presentation of the RCT Study Design.

OBJECTIVES: Anxiety disorders, most notably panic disorders and agoraphobia, are common mental disorders, and there is a high comorbidity with personality disorders. Randomized controlled trails addressing this highly relevant group of patients are missing. DESIGN: The multicenter Anxiety and Personality Disorders (APD) study investigates 200 patients with panic disorder and/or agoraphobia with comorbid personality disorder in a randomized control-group comparison of psychoanalytic therapy (PT) and cognitive behavioral therapy (CBT), including 100 patients in each group. Each patient will be examined over a period of six years, regardless of the duration of the individual treatment. The main issues that are addressed in this study are the comparison of the efficacy of PT and CBT in this special patient population, the comparison of the sustainability of the effects of PT and CBT, the comparison of the long-term cost-benefit-ratios of PT and CBT as well as the investigation of prescriptive patient characteristics for individualized treatment recommendations (differential indication). DISCUSSION: The APD study compares efficacy, sustainability, and cost-benefit-ratios of CBT and PT for anxiety plus personality disorders in a randomized controlled trail. The study design meets the requirements for an efficacy study for PT, which were recently defined. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12449681.

[Do Attachment Styles of Mentally Ill Parents Impact on the Health-related Quality of Life of their Children?]. / Beeinflusst der elterliche Bindungsstil die gesundheitsbezogene Lebensqualität der Kinder psychisch kranker Eltern?

Do Attachment Styles of Mentally Ill Parents Impact on the Health-related Quality of Life of their Children? Parents with a mental disorder often display a problematic attachment style which may impact on their children's health related quality of life (HrQoL). The current study cross-sectionally examines attachment styles (BEPE) in mentally ill parents with underage children (n = 62) and the effect of attachment on their children's HrQoL (KINDL-R). Results show that secure attachment is less represented in parents with a mental health condition than in a healthy reference group. Within the clinical sample, children of mentally ill parents with a secure attachment style exhibit a higher HrQoL than children of mentally ill parents with ambivalent or avoidant attachment styles. These findings indicate not only that problematic attachment styles frequently occur in families with a mentally ill parent, but also suggest that this negatively affects the children's HrQoL. Appropriate interventions should include attachment oriented concepts.

[Operationalized psychodynamic diagnostics in childhood and adolescence (OPD-CA): the axis during psychoanalytic child- and adolescent psychotherapy]. / Operationalisierte Psychodynamische Diagnostik im Kindes- und Jugendalter (OPD-KJ): die Achsen im Verlauf von analytischer Kinder- und Jugendpsychotherapie.

There is evidence for the effectiveness of psychodynamic therapies in terms of symptom reduction. Up to now, there is little evidence to what extend therapy translates to the improvement of core analytical concepts, like psychic structure, interpersonal relatedness, and intrapsychic conflicts. The current study focuses on these concepts over the course of therapy as well as in connection with outcome. The concepts are assessed with the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA). Additionally, the OPD-CA axis prerequisites of treatment is tested as a predictor of outcome. 16 therapists rated 146 participating patients at the beginning and the end of therapy within the framework of a study on the effectiveness of psychoanalytical psychotherapy. Therapists rated the OPD-CA as well as the level of psychosocial impairment. Psychic structure, interpersonal relatedness, and intrapsychic conflicts improved significantly over the course of therapy. Positive outcome was predicted by communicative abilities, positive self-relatedness and an undistinctive intrapsychic conflict at the beginning of therapy as well as the improvement of these during therapy. Among the prerequisites of treatment only the subjective level of mental impairment and the intrapsychic resources were predictive of outcome. Psychoanalytic psychotherapy for children and adolescents improved central psychodynamic concepts like psychic structure, interpersonal relatedness, and intrapsychic conflicts.

Older patients' perspectives on the therapeutic relationship with young psychotherapists.

The current demographic change means that young psychotherapists and older patients will increasingly come into contact. Unique for this constellation is the intergenerational therapeutic relationship, which forms the basis of psychotherapy, but has not yet been the focus of empirical research. This qualitative study provides preliminary insights into how older patients (aged over 65) experience and perceive the therapeutic relationship with young psychotherapists (aged in their mid-20s to mid-30s). We conducted semi-structured interviews with twelve older patients (8 women, 4 men) and analysed their data using the grounded theory approach. We found a connection between the type of transference a participant demonstrated and their biographical as well as social experiences, desires, and fantasies. Overall, a tendency to seek harmony was observed among the participants, which was reflected in their behaviour towards young psychotherapists: (a) conflict avoidance, (b) (fantasised) therapy discontinuation, (c) adaption/subordination, and (d) solidarity, support, and protection. Our findings demonstrated that various intergenerational transference phenomena, including the roles in which young therapists are perceived, are associated with certain particularities and challenges, such as the topic of sexuality. It can be valuable for young psychotherapists to become aware of a potential role reversal that may result in older patients trying to support them.

Health-related quality of life of children and adolescents with mental disorders.

BACKGROUND: The aim was to assess the association of internalising and externalising pathology with the child's health-related quality of life (QoL), and to determine which child and environmental characteristics beyond pathology were related to poor QoL. METHODS: Data was obtained for 120 children and adolescents (aged 6 to 18) commencing outpatient psychotherapy treatment. Parents and children (aged 11 years and older) filled out questionnaires. QoL was measured with the KIDSCREEN-27. RESULTS: QoL was more strongly associated with internalising than externalising pathology according to both self- and parent report. Multiple regression analyses showed that beyond internalising and externalising pathology, gender, age, family functioning, functional impairment, and prior mental health treatment were associated with individual QoL scales. CONCLUSIONS: The data underscored the relationship between mental pathology and impaired QoL even if potential item overlap was controlled for. This stresses the importance of extending therapy goals and outcome measures from mere pathology to measures of QoL in psychotherapy research particularly for patients with internalising pathology.

Health-related quality of life: cross-informant agreement of father, mother, and self-report for children and adolescents in outpatient psychotherapy treatment.

BACKGROUND: To study the cross-informant agreement between father, mother harm avoidance and child rating of health-related quality of life (HRQoL) in a psychiatric sample. METHODS: Data were obtained from 127 children and adolescents (aged 6-18) commencing outpatient psychotherapy treatment, mainly for anxiety, depressive, and externalising disorders. A total of 100 mothers, 69 fathers harm avoidance and 76 children (aged 11 years and older) filled out questionnaires. HRQoL was measured with the KIDSCREEN-27. RESULTS: Cross-informant agreement was moderate to high between parents and moderate to low between father-child and mother-child pairs. Both parents reported lower HRQoL than the children themselves. Standardised discrepancies correlated with gender, overall and internalising pathology, as well as harm avoidance to a small degree. CONCLUSIONS: Although there was moderate-to-high correspondence, mother and father reports were not interchangeable. When collecting a single-parent proxy rating on the child's HRQoL, researchers should be aware of the additional potential source of variance due to differing concordance of father and mother with the child's self-report especially for peer relations.

[Reliability and construct validity of the OPD-CA axes structure and prerequisites for treatment]. / Reliabilität und Konstruktvalidität der OPD-KJ-Achsen Struktur und Behandlungsvoraussetzungen.

As an instrument to assess specific psychodynamic dimensions, the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) is widely used in clinical care and psychotherapeutic training. However, the psychometric validation of its axes is partly still missing. The aim of this study was to test the reliability and construct validity of the axes structure and prerequisites of treatment. 171 children and adolescents (aged 4 to 21 years) with a diagnosed psychiatric disorder who began an analytic psychotherapy were additionally assessed with the OPD-CA by their therapists (n = 25) in the context of naturalistic care in private practice. Therapists were all qualified as analytic child and adolescent psychotherapists and underwent a standardized OPD-CA training. Results indicated conceptually meaningful factor structures for both axes tested. These factor structures predominantly followed the conceptually defined dimensions. Internal consistency was high for the axis structure, modest to low fort he axis prerequisites of treatment. Implications and recommendations for a future revision of the OPD-CA with particular respect of single items and their operationalization are discussed.