[Anxiety and depression in adolescents]. / Angst und Depression bei Jugendlichen.

Anxiety and depression among young people had already increased in the years before the COVID-19 pandemic and then experienced a significant increase again during the pandemic. In this article the different clinical forms of expression of these emotional syndromes are presented in detail and the developmental paths of a combination of both disorders are also explained. Even subclinical forms of anxiety and depression already have clear clinical implications and impair the developmental tasks of adolescence. The "avolitional depression" (depression with severe drive disorders) is mentioned as a special form. Pathogenetic building blocks-from genetic vulnerability to psychosocial stressors-come up for discussion in light of the fact that anxiety and depression are about twice as common in adolescent females as in males. The embedding of the disorders in current events shows the special importance of the self-reflective emotion of shame in the adolescent development process. The scarcity and dysfunctionality of emotional dialogue between significant caregivers and children must be cautioned against. Its role in adolescents' self-regulation and affect regulation should not be underestimated. Finally, an overview of the most important therapeutic measures for anxiety and depression in adolescence is presented.

Under the skin: does psychiatric outcome of bullying victimization in school persist over time? A prospective intervention study.

BACKGROUND: Research has shown a direct path between peer victimization and poor mental health outcomes. However, the impact of bullying prevention on mental health is a largely unexplored field. Therefore, our study examined the longitudinal association between bullying development and trajectories of psychiatric symptoms (emotional problems, total difficulties, nonsuicidal self-injury, and suicidality) and health-related quality of life (HRQL) during the implementation of school-based bullying prevention. METHODS: Data of 4,873 pupils (grades 5-13) were collected in 23 schools implementing the Olweus Bullying Prevention Program (OBPP). Self-report questionnaires were administered at three annual assessment waves and individual codes enabled the association of repeated assessments to the same pupil. Latent growth curve models (LGCMs) were used to examine the relation among bullying status and mental health outcome with mixed-effects linear regressions estimating the association of changes in bullying with changes in continuous scores and mixed-effects logistic regressions for categorical variables. RESULTS: Latent growth curve models revealed an improvement of mental health and HRQL through the termination of bullying for every outcome variable of interest (all p < .001). Correspondingly, we found an explicit increase in psychopathology as well as decrease in HRQL within one year as a result of developing victimization (all p < .001). Interestingly, the growth of psychopathology associated with the onset of bullying was significantly steeper than its decline associated with the termination of bullying. The postulated cumulative effect of ongoing bullying for a further year could only be shown for HRQL (p = .025) and total difficulties (p = .034), but not for specific mental health problems (all p > .117). CONCLUSIONS: Latent growth curve models clearly showed that the adverse psychosocial consequences of bullying arise quickly but seem to reduce much slower and partly persist over time. Future long-term studies are necessary to clarify if mental health problems will return to baseline after several years or if residual symptoms will remain.

Psychobiological Correlates of Aggression in Female Adolescents with Borderline Personality Disorder.

INTRODUCTION: Aggressive behavior in reaction to threats, frustration, or provocation is prevalent in borderline personality disorder (BPD). This study investigated aggressive behavior and its biological correlates in adolescents with BPD. METHODS: Twenty-one female adolescents with a DSM-IV BPD diagnosis and 25 sex- and age-matched healthy controls participated in the Taylor Aggression Paradigm (TAP), a laboratory-based experiment measuring aggressive behavior in the interpersonal context. Heart rate was measured and saliva samples were taken throughout the experiment. RESULTS: Multilevel mixed-effects linear regression analyses revealed no significant group difference in aggressive behavior induced by the TAP. Additionally, the two groups did not differ in cortisol, testosterone, and heart rate responses to the aggression induction. The BPD group showed a significant cortisol increase in the time preceding the start of the TAP in contrast to the healthy control group, in whom a significant heart rate increase from baseline to the first block of the TAP was observed. DISCUSSION: There was no evidence, either at the phenomenological or the biological level, of increased task-induced aggression in adolescents with BPD. The results may indicate that adolescents with BPD experienced fearful stress in anticipation of the experimental task in contrast to healthy controls who showed an adaptive response of the autonomic nervous system necessary to deal with the upcoming demand.

Effects of acute transcutaneous vagus nerve stimulation on emotion recognition in adolescent depression.

BACKGROUND: Transcutaneous vagus nerve stimulation (tVNS) is a promising therapeutic option for major depressive disorder (MDD) in adults. Alternative third-line treatments for MDD in adolescents are scarce. Here we aimed to assess the effects of acute tVNS on emotion recognition in adolescents with MDD. METHODS: Adolescents (14-17 years) with MDD (n = 33) and non-depressed controls (n = 30) received tVNS or sham-stimulation in a cross-sectional, case-control, within-subject cross-randomized controlled trial, while performing different tasks assessing emotion recognition. Correct responses, response times, and errors of omission and commission on three different computerized emotion recognition tasks were assessed as main outcomes. Simultaneous recordings of electrocardiography and electro dermal activity, as well as sampling of saliva for the determination of α-amylase, were used to quantify the effects on autonomic nervous system function. RESULTS: tVNS had no effect on the recognition of gradually or static expressed emotions but altered response inhibition on the emotional Go/NoGo-task. Specifically, tVNS increased the likelihood of omitting a response toward sad target-stimuli in adolescents with MDD, while decreasing errors (independent of the target emotion) in controls. Effects of acute tVNS on autonomic nervous system function were found in non-depressed controls only. CONCLUSIONS: Acute tVNS alters the recognition of briefly presented facial expressions of negative valence in adolescents with MDD while generally increasing emotion recognition in controls. tVNS seems to specifically alter early visual processing of stimuli of negative emotional valence in MDD. These findings suggest a potential therapeutic benefit of tVNS in adolescent MDD that requires further evaluation within clinical trials.

Effects and moderators of the Olweus bullying prevention program (OBPP) in Germany.

Bullying is a common and significant risk factor for mental and physical health problems. The aim of the outlined study was to evaluate the German version of the Olweus Bullying Prevention Program (OBPP) and to investigate potential moderators of its effectiveness. 23 schools started with the implementation and all students were invited to complete the Olweus Bullying Questionnaire annually. For our analyses, the data from grades 5 to 9 were used (t0: n = 5759; t1: n = 5416; t2: n = 4894). 16 out of the 23 schools completed the 18-months implementation period. The effectiveness of the program statistically depended on its complete implementation (χ2(2) = 7.62, p = 0.022). In the group of non-completers, the prevalence of victimization did not change during the observation period of 2 years (χ2(2) = 4.64, p = 0.099). In the group of the completer schools, a significant decrease in bullying between t0 and t1 was found for victims (t0: 9.14%; t1: 6.87%; OR = 0.74; 95% CI 0.62-0.88; p = 0.001) and perpetrators (t0: 6.16%; t1: 4.42%; OR = 0.70; 95% CI 0.55-0.89; p = 0.004). After 24 months (t2), this decrease could be retained (victims: t2: 6.83%; OR = 0.73; 95%CI = 0.61-0.88; p = 0.001; perpetrators: t2: 4.63%; OR = 0.72; 95% CI 0.57-0.92; p = 0.009). Furthermore, we found the following moderators of program effectiveness in the completer schools: (1) gender (with a stronger decrease among victimized girls; p = 0.004) and (2) school grade (with a stronger decrease of victimization among grades 5-7; p = 0.028). The German version of the OBPP significantly reduced the bullying prevalence in the completer schools. Effective prevention needs time and resources: fulfilling the 18-months implementation period was the basis for positive results.

High-frequency ecological momentary assessment of emotional and interpersonal states preceding and following self-injury in female adolescents.

Non-suicidal self-injury (NSSI) is a considerable health problem among adolescents. Affect regulation by means of self-injury may promote the maintenance of NSSI. However, existing findings have limited ecological validity. The present study aimed to assess emotional and interpersonal states preceding and following incidents of NSSI in female adolescents. Adolescents with NSSI-disorder completed ecological momentary assessments of affective and interpersonal states on an hourly basis for multiple days. Multilevel mixed-effect regression analyses were conducted to assess antecedences and consequences of acts of self-injury. Data from n = 73 female adolescents covering a total of 52 acts of self-injury were available for analyses. The urge to self-injure on the between subject-level and negative affect on the within-level were best predictors of self-injury. Surprisingly, self-injury increased negative affect and decreased feelings of attachment (mother only) in the following hour. In line with findings in adults, results illustrate the important association between negative affect and self-injury in female adolescents. However, the occurrence of NSSI itself was related to concurrent increases in negative affect, and even prospectively predicted a consecutive increase in negative affect. Therefore, improvements of negative affect following (or during) self-injury, as previously reported, are at best short-lived (< 1 h).

Effectiveness of a brief psychotherapeutic intervention compared with treatment as usual for adolescent nonsuicidal self-injury: a single-centre, randomised controlled trial.

Although nonsuicidal self-injury (NSSI) is a clinically significant behavior, evidence-based, specific, time-, and cost-effective treatment approaches are lacking. The aim of this study was to compare the efficacies of a brief cognitive-behavioral psychotherapy manual, the Cutting Down Programme (CDP), and treatment as usual (TAU) in the treatment of adolescent NSSI. We conducted a single-centre randomised controlled trial (RCT). Eligible participants were aged 12-17 years engaging in repetitive NSSI (at least 5 times within the past 6 months). We randomly allocated 74 participants to CDP (n = 37) or TAU (n = 37; in a 1:1 ratio). Outcome measures were administered before treatment (T0), directly after CDP or 4 months after baseline evaluation in the TAU group (T1), and another 6 months later (T2; primary endpoint). Primary outcome was a 50% reduction in NSSI frequency within the past 6 months at 10-month follow-up (T2). Regarding the primary outcome, there were no significant differences between the CDP (n = 26; 70.3%) and TAU group [n = 27; 73.0%; χ2(1) = 0.07; p = 0.797]; NSSI frequency within the past 6 months was significantly reduced at T2 [χ2(1) = 12.45; p < 0.001] with no between-group difference [χ2(1) = 0.14; p = 0.704]. However, we found a significant group x point of measurement interaction [χ2(2) = 7.78; p = 0.021] regarding NSSI within the last month indicating at T1. CDP was equally effective and achieved faster recovery compared to a significantly more intensive TAU in treating adolescent NSSI. The CDP could provide a brief and pragmatic first treatment within a stepped-care model for NSSI in routine clinical care.Clinical Trial Registration The trial was prospectively registered in the German Registry of Clinical Trials (https://www.drks.de; DRKS00003605) and is now complete.

Stress, mental and physical health and the costs of health care in German high school students.

Stress is a mind-body phenomenon, which affects both mental and physical health and is highly relevant to the health care system. Yet, knowledge on the costs of stress and related health problems in adolescence is missing. The present study addresses this gap by investigating direct health care costs in relation to stress, mental health problems and physical health in high school students. The sample comprised 284 pupils from four schools in Heidelberg (mean age 16.75 ± 0.64 years, 59.64% female). Self-reported health care utilization and medication intake within 1 month were translated into costs. We established correlative associations of the dichotomized overall costs (no vs. any) with stress, mental health problems and physical health within generalized structural equation models. In particular, mental health problems and physical health were examined as mediators of the association between stress and costs. An increase of stress by 1 SD corresponded increased chances for costs by OR 1.39 (Odds Ratio; 95% CI 0.13-0.53, p = 0.001). When mediators were analysed separately, both mental and physical health (problems) fully mediated the association. Yet, when examined together, only mental health problems acted as a mediator. Our results indicate the health economic relevance of stress-related mental health problems in high school students. The finding is meant to set the stage for further cost-of-illness studies of stress and related health problems, as well as economic evaluations. Longitudinal research is needed to allow conclusions on directionality.

[The Association Between Illicit Drug Use, Borderline Personality Disorder and Depression in a Help-Seeking Sample of Adolescents]. / Zusammenhänge von Drogenkonsum und der Borderline-Persönlichkeitsstörung sowie Depressivität in einer klinischen Stichprobe an Jugendlichen.

The Association Between Illicit Drug Use, Borderline Personality Disorder and Depression in a Help-Seeking Sample of Adolescents Risk-taking behavior is a common phenomenon in adolescence. Even prevalence rates for illicit drug use are considerably high in youth and associated with a range of psychiatric disorders, especially depression and Borderline Personality Disorder (BPD). However, there is a lack of data investigating differences in psychopathology between different substance user groups. Therefore, aim of the study was to investigate occurrence of depression and BPD symptoms in different drug risk groups (no use vs. occasional use vs. frequent use). Further aim of the study was to examine risk profiles regarding single BPD criteria. Data of n = 347 adolescents (81.7 % female, mean age 14.95, SD = 1.50) presenting at the specialized outpatient clinic for risk-taking and self-harming behavior (AtR!Sk) in Heidelberg were analyzed. Results show that BPD is clearly associated with illicit drug use in adolescence. There is no difference between occasional and frequent users in terms of mean number of BPD criteria. However, frequent users differ from occasional users regarding greater number of impulsivity and anger criteria. After adjusting for sociodemographic variables there was no association between drug use and depression. Since even single events of illicit drug use are associated with higher levels of BPD, clinicians should rapidly target to stop consumption. Further, psychotherapeutic interventions for BPD in high-risk consumers should especially focus on facilitating adaptive emotion regulation skills in regards to impulsivity and anger.

[Indicated Stress Prevention for Adolescents in the Group Setting - A manual based on Acceptance- and Commitment-Therapy]. / Indizierte Stressprävention bei Jugendlichen im Gruppensetting ­ Manual für einen Akzeptanz- und Commitment-Therapie-basierten Ansatz.

Indicated Stress Prevention for Adolescents in the Group Setting - A manual based on Acceptance- and Commitment-Therapy Stress in adolescence has become a topic of interest in recent years. Long-term exposure to stress can play a significant role in the development and maintenance of mental disorders. Previous studies have shown that especially the more severely stressed adolescents benefit from targeted interventions. However, evidence-based treatment concepts targeting this group are scarce. In this article we introduce the first German-language treatment manual for indicated stress prevention, addressing adolescents based on Acceptance and Commitment Therapy (ACT). ACT is part of the third wave of behavioral therapies, designed for treatment across disorders, which makes it suitable for the treatment of chronic stress symptoms. Previous studies show good efficacy of the ACT-approach in the treatment of adult stress and first promising successes in treatment of adolescents in non-German-speaking countries. The focus of our training lies in practical exercises based on ACT which are conveyed by the use of metaphors, art therapy techniques, role plays and group discussions. The concept is complemented by psychoeducation on stress, mindfulness exercises and training in problem solving. Worksheets and tasks for the week facilitate the transfer into everyday life. Alongside the presentation of the treatment manual, first experiences in the implementation of the program are discussed.

Childhood adversity and parenting behavior: the role of oxytocin receptor gene polymorphisms.

Previous research revealed experiences of childhood adversity (CA) to be related to less favorable parenting behavior. It can further be expected that maternal oxytocin receptor (OXTR) genes may influence parenting behavior and moderate relationships between CA and parenting behavior. Moreover, associations between the OXTR gene and plasma oxytocin (OT) have been discussed. The present study investigated main effects of the OXTR gene on parenting behavior and plasma OT of mothers, and moderating effects of the OXTR gene on the relationship between mothers' experiences of CA and parenting behavior. We relied on a sample of 193 mothers and their on average 8-year-old children. Maternal experiences of CA were assessed using a standardized interview. A questionnaire for the assessment of child abuse potential and observations of mother-child interaction were used as indicators of parenting behavior. For mothers, we analyzed three polymorphisms (rs53576, rs1042778, rs2254298) of the OXTR gene and plasma OT. Only the rs53576 was associated with mothers' parenting behavior, specifically with maternal sensitivity. The rs2254298 significantly moderated relations between mothers' experiences of CA and parenting behavior. Significant relations could be found only for mothers who were homozygous for the G allele. The G allele of the rs2254298 was further related to increased plasma OT levels. Our findings underline the importance of considering genetic variation when investigating consequences of CA and developing intervention programs that are adapted to an individual's needs.

The cost incurred by victims of bullying from a societal perspective: estimates based on a German online survey of adolescents.

Being a victim of bullying is linked to various social, emotional and behavioral problems potentially leading to a reduced quality of life. Furthermore, victims of bullying may cause extensive costs for society, for example by an above-average need for healthcare services. The present study was designed to quantify the costs and the loss of quality of life attributable to bullying by comparing victims with a control group of non-bullied students. A cross-sectional sample of 1293 adolescents (mean age 14.07, SD = 1.36) and their parents reported on bullying victimization, quality of life (adolescents' self-report), and annual direct (medical and non-medical) as well as indirect costs (parents' self-report) from a societal perspective (all expressed in €, year 2014 and 2015). For frequent (20.6% of our sample; costs: €8461.80 p.a.) but not occasional (13.3%; costs: €2850.06) bullying, victimization was associated with significantly higher costs compared to non-bullied adolescents (costs: €3138.00; annual difference between frequently bullied students and controls: €5323.01 p.a.; p = 0.008). Cost drivers included increased direct medical costs, but mostly indirect costs caused by productivity losses of the parents. Self-reported quality of life of frequent victims was considerably reduced (T = - 10.96; p < 0.001); also occasional bullying showed significantly reduced values in global quality of life (T = - 5.73; p < 0.001). The present findings demonstrate that frequent bullying is associated with substantial cost to society and reduced quality of life of victims. This observation underscores the need for effective school-based bullying prevention and suggests a high potential of effective programs to be cost effective as well.

[Relationship Between (Pathological) Internet Use and Sleep Problems in a Longitudinal Study]. / Zusammenhänge von (pathologischer) Internetnutzung mit Schlafproblemen im Längsschnitt.

Relationship Between (Pathological) Internet Use and Sleep Problems in a Longitudinal Study Excessive or pathological Internet use has already been associated with sleep disorders, but the direction of the connection remains still uncertain. The relationship between (pathological) Internet use and sleep problems in adolescence was investigated by a representative longitudinal survey of data from a sample of 1,060 students from Heidelberg and the surrounding area (SEYLE study). The students, on average 15 years old, responded at a baseline and after one year to a survey on sleep and Internet use. In addition to the number of hours of Internet use, pathological Internet use was assessed using the Young Diagnostic Questionnaire (YDQ). Sleep duration and sleep problems were surveyed by self-assessment. The prevalence of adolescents with pathological Internet use was 3.71 % in the follow-up survey. Furthermore, 20.48 % of adolescents reported sleep problems. Pathological and excessive Internet use were predictors of sleep problems over the course of one year. Adolescents who met the criteria for Internet addiction to the baseline had a 3.6 times greater risk of developing sleep problems in the course of one year. Whereas sleep problems to the baseline increased the YDQ symptoms only by 0.22. Sleep problems often occur as a result of pathological Internet use and could have an addiction-enhancing effect as well as mediating further psychiatric comorbidities. Thus, sleep problems should be targeted for early intervention and therapeutic measures.

Childhood Adversity and Psychophysiological Reactivity to Pain in Adolescent Nonsuicidal Self-Injury.

BACKGROUND: Nonsuicidal self-injury (NSSI), the intentional, self-directed act of injuring one's own body tissue, is a behavioral phenomenon closely linked to stress and its maladaptive regulation. NSSI is associated with childhood adversity that may underlie altered hypothalamic-pituitary-adrenal axis and autonomic nervous system response to stress in adolescents engaging in NSSI. Adolescents engaging in NSSI show decreased pain sensitivity and increased psychophysiological response to pain that may underlie the maintenance of the behavior and its stress-regulating function. SAMPLING AND METHODS: In a secondary analysis of previously published data we aimed to address the relationship between childhood adversity and altered psychophysiological pain response in an outpatient sample of n = 30 adolescents engaging in repetitive NSSI. RESULTS: Greater childhood adversity is associated with greater cortisol secretion and increased and prolonged autonomic arousal following pain induction. CONCLUSIONS: The findings illustrate a potential neurobiological pathway linking childhood adversity to hyporesponsiveness of endogenous stress response systems that in turn show increased reactivity to the experience of pain. This hyperreactivity may counterbalance an inadequate stress response and in turn help to cope with stressful experiences. Directions for future research are discussed.

[Cluster-randomized, controlled evaluation of stress management training for high school students]. / Clusterrandomisierte kontrollierte Untersuchung eines Stressbewältigungs-Trainings in der gymnasialen Oberstufe.

Cluster-randomized, controlled evaluation of stress management training for high school students Abstract. OBJECTIVE: One fifth of German adolescents show elevated levels of mental health problems. The development of mental health problems is often closely related to experiences of stress. Hence, fostering competences in coping with stress offers an approach for counteracting the development of psychological problems. The aim of the present study is to test a stress management training of 3 x 90 minutes in a German high school, 11th grade. METHOD: A cluster-randomized, controlled design was used. The primary outcome was stress. Secondary outcome criteria were knowledge about stress, coping behaviour, emotional and behavioural problems as well as health-related quality of life. Students from twenty-one courses from four schools participated in the study. RESULTS: The sample comprised 286 students (58.25 % girls; mean age 16.58 ± 0.65). Changes in stress levels from pre- to post-evaluation did not differ significantly between intervention and control group. With regard to secondary criteria, apart from a significant increase in knowledge no further effects were observed. An exploratory moderation analysis hints at a positive association between baseline levels of stress and effectiveness of the training. CONCLUSIONS: The results question whether the universal application of a brief cognitive behavioural intervention is appropriate to prevent stress in this population. Future research should, inter alia, investigate the potential of indicated prevention regarding stress.

Prospective risk for suicidal thoughts and behaviour in adolescents with onset, maintenance or cessation of direct self-injurious behaviour.

Direct self-injurious behaviour (D-SIB) is associated with suicidal behaviour and suicide risk. It is not known if D-SIB cessation reduces these risks. The aim of this study was to explore trajectories of D-SIB and their prospective influence on suicidal thoughts and behaviour during adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the Saving and Empowering Young Lives in Europe study were analysed. D-SIB and suicidal thoughts and behaviour were assessed at baseline (T0), 1- (T1) and 2-year follow-up (T2). Onset and maintenance of D-SIB between T0 and T1 were associated with a two to threefold increased odds ratio for suicidal thoughts and behaviour at T2. Suicidal thoughts and behaviour in those terminating D-SIB before T1 were similar compared to those with no life-time history of D-SIB. Late onset and maintenance of D-SIB prospectively indicate risk for suicidal thoughts and behaviour. This is the first study showing that D-SIB cessation reduces later risk for suicidal thoughts and behaviour in adolescence. Suicide prevention efforts should set one focus on reducing adolescent D-SIB.

Psychopathology and Borderline Personality Pathology Associated with Lifetime Self-Injurious Behavior in Adolescent Psychiatric Inpatients and Detainees.

OBJECTIVE: Self-injurious behavior (SIB) is a widespread phenomenon among adolescent psychiatric inpatients. It is also reported among delinquent adolescents detained in correctional facilities. While previous studies have addressed different functions of SIB within offender populations, here we investigate particular patterns of borderline personality pathology and psychopathology underlying SIB in both adolescent psychiatric inpatients and detainees. METHOD: Adolescent psychiatric inpatients and detainees were recruited consecutively. Participants completed self-reports on SIB, suicidal thoughts and behavior, borderline personality pathology, and general psychopathology. Predictors of lifetime SIB by group were analyzed. RESULTS: Psychiatric inpatients (n = 77) and detainees (n = 50) did not differ with respect to lifetime SIB (57.14 % versus 54.00 %), whereas SIB within the past year did (67.53 % versus 14 %; χ2(1) = 6.158, p = .013). Psychiatric inpatients reported greater emotional problems (t(125) = 5.109, p < .0001) and greater borderline personality pathology. Those with lifetime SIB were characterized by greater emotional problems and borderline personality pathology, independent of their group. Results from regression analyses suggest no group-specific predictors of lifetime SIB. CONCLUSIONS: Although psychiatric inpatients endorse greater psychopathological distress, lifetime SIB among adolescent psychiatric inpatients and detainees is associated with similar patterns of psychopathology and borderline personality pathology.

Association of Adolescent Dimensional Borderline Personality Pathology with Past and Current Nonsuicidal Self-Injury and Lifetime Suicidal Behavior: A Clinical Multicenter Study.

Descriptive diagnoses of nonsuicidal self-injury (NSSI) and suicide attempts (SAs) may detract from underlying dimensional borderline personality pathology (D-BPP). This study aimed to investigate D-BPP in adolescent inpatients with NSSI and SAs. A consecutive sample of 359 adolescent inpatients was assessed for current and past NSSI and life-time SAs. D-BPP and current mental health problems were measured using the Dimensional Assessment of Personality Pathology and the Strengths and Difficulties Questionnaire, respectively. D-BPP was significantly associated with both current (p < 0.001) and past NSSI (p = 0.025) and life-time SAs (p < 0.001) compared to their non-self-harming peers. Patients with current and past NSSI did not differ in terms of D-BPP or current mental health problems. A multivariate model did not show any additional influence of current mental health problems over and above D-BPP in predicting NSSI and SAs. It can be hypothesized that D-BPP underlies adolescent self-harm and may persist even after its termination, promoting a higher burden of mental health problems.

Dual-task performance under acute stress in female adolescents with borderline personality disorder.

Research to elucidate early alterations of higher cognitive processes in adolescents with BPD is rare. This study investigated differences in dual-task performance in adolescents with BPD during stress and non-stress conditions. The study sample comprised 30 female adolescents with BPD and 34 healthy controls. The impact of stress on dual-task performance was measured using a standardized stressor. Self-reports of distress and measures of heart rate (HR) were obtained to measure stress reactivity. There were no group differences in task performance. Under stress conditions, the performance on the auditory task decreased in both groups but without significant group differences. Healthy controls showed an increase of mean HR after stress induction compared to no change in the BPD group. The finding of attenuated HR response to acute stress in adolescent patients with BPD may contradict current theories that the affective hyperresponsivity in BPD is based on a biologically determined mechanism.

A 2-year longitudinal study of prospective predictors of pathological Internet use in adolescents.

Longitudinal studies of prospective predictors for pathological Internet use (PIU) in adolescents as well as its course are lacking. This three-wave longitudinal study was conducted within the framework of the European Union-funded project "Saving and Empowering Young Lives in Europe" over a 2-year period. The sample consisted of 1444 students at the baseline investigation (T0); 1202 students after 1 year (T1); and 515 students after 2 years (T2). Structured self-report questionnaires were administered at all three time points. PIU was assessed using the Young Diagnostic Questionnaire (YDQ). In addition, demographic (i.e., gender), social (i.e., parental involvement), psychological (i.e., emotional problems), and Internet use-related factors (i.e., online activities) were assessed as prospective predictors. The prevalence of PIU was 4.3 % at T0, 2.7 % at T1 and 3.1 % at T2. However, only 3 students (0.58 %) had persistent categorical PIU (YDQ score of ≥5) over the 2-year period. In univariate models, a variety of variables that have been previously identified in cross-sectional investigations predicted PIU at T2. However, multivariate regression demonstrated that only previous PIU symptoms and emotional problems were significant predictors of PIU 2 years later (adjusted R (2) 0.23). The stability of categorical PIU in adolescents over 2 years was lower than previously reported. However, current PIU symptoms were the best predictor of later PIU; emotional symptoms also predicted PIU over and above the influence of previous problematic Internet use. Both PIU symptoms and emotional problems may contribute to the vicious cycle that supports the perpetuation of PIU.