The predictive value of supervised machine learning models for insomnia symptoms through smartphone usage behavior.

Introduction: Digital phenotyping can be an innovative and unobtrusive way to improve the detection of insomnia. This study explores the correlations between smartphone usage features (SUF) and insomnia symptoms and their predictive value for detecting insomnia symptoms. Methods: In an observational study of a German convenience sample, the Insomnia Severity Index (ISI) and smartphone usage data (e.g., time the screen was active, longest time the screen was inactive in the night) for the previous 7 days were obtained. SUF (e.g., min, mean) were calculated from the smartphone usage data. Correlation analyses between the ISI and SUF were conducted. For the specification of the machine learning models (ML), 80 % of the data was allocated to training, 20 % to testing, and five-fold cross-validation was used. Six algorithms (support vector machine, XGBoost, Random Forest, k-Nearest-Neighbor, Naive Bayes, and Logistic Regressions) were specified to predict ISI scores ≥15. Results: 752 participants (51.1 % female, mean ISI = 10.23, mean age = 41.92) were included in the analyses. Small correlations between some of the SUF and insomnia symptoms were found. In the ML models, sensitivity was low, ranging from 0.05 to 0.27 in the testing subsample. Random Forest and Naive Bayes were the best-performing algorithms. Yet, their AUCs (0.57, 0.58 respectively) in the testing subsample indicated a low discrimination capacity. Conclusions: Given the small magnitude of the correlations and low discrimination capacity of the ML models, SUFs, as measured in this study, do not appear to be sufficient for detecting insomnia symptoms. Further research is necessary to explore whether examining intra-individual variations and subpopulations or employing alternative smartphone sensors yields more promising outcomes.

Long-term health consequences among individuals with SARS-CoV-2 infection compared to individuals without infection: results of the population-based cohort study CoMoLo Follow-up.

BACKGROUND: Most of the previous studies on health sequelae of COVID-19 are uncontrolled cohorts and include a relatively short follow-up. This population-based multi-center cohort study examined health consequences among individuals about 1 to 1.5 years after SARS-CoV-2 infection compared with non-infected. METHODS: The study population consisted of adults (≥ 18 years) from four municipalities particularly affected by the COVID-19 pandemic in the year 2020 who completed a detailed follow-up questionnaire on health-related topics. Exposure was the SARS-CoV-2 infection status (based on IgG antibodies, PCR test, or physician-diagnosis of COVID-19) at baseline (May to December 2020). Outcomes assessed at follow-up (October 2021 to January 2022; mean: 452 days) included recurrent or persistent health complaints, incident diseases, health-related quality of life (PROMIS-29), subjective health, and subjective memory impairment. Logistic and linear regression models were adjusted for baseline sociodemographic and lifestyle characteristics (age, sex, municipality, education, smoking, body mass index), pre-existing health conditions (chronic disease/health problem, health-related activity limitation, depressive/anxiety disorder), and follow-up time. RESULTS: Among 4817 participants, 350 had a SARS-CoV-2 infection at baseline and 4467 had no infection at baseline or during follow-up. Those with an infection statistically significantly more often reported 7 out of 18 recurrent or persistent health complaints at follow-up: smell/taste disorders (12.8% vs. 3.4%, OR 4.11), shortness of breath (23.0% vs. 9.5%, 3.46), pain when breathing (4.7% vs. 1.9%, 2.36), fatigue (36.9% vs. 26.1%, 1.76), weakness in legs (12.8% vs. 7.8%, 1.93), myalgia/joint pain (21.9% vs. 15.1%, 1.53) and cough (30.8% vs. 24.8%, 1.34) and 3 out of 6 groups of incident diseases: liver/kidney (2.7% vs. 0.9%, 3.70), lung (3.2% vs. 1.1%, 3.50) and cardiovascular/metabolic (6.5% vs. 4.0%, 1.68) diseases. Those with an infection were significantly more likely to report poor subjective health (19.3% vs. 13.0%, 1.91), memory impairment (25.7% vs. 14.3%, 2.27), and worse mean scores on fatigue and physical function domains of PROMIS-29 than non-infected. CONCLUSION: Even after more than one year, individuals with SARS-CoV-2 infection showed an increased risk of various health complaints, functional limitations, and worse subjective well-being, pointing toward profound health consequences of SARS-CoV-2 infection relevant for public health.

Support- and meaning-focused coping as key factors for maintaining adult quality of life during the COVID-19 pandemic in Germany.

Introduction: During the COVID-19 pandemic, questions about both consequences and helpful strategies to maintain quality of life (QoL) have become increasingly important. Thus, the aim of this study was to investigate the distribution of coping factors during the COVID-19 pandemic, their associations with QoL and the moderating role of certain sociodemographic characteristics. Methods: Analyses were based on cross-sectional self-reports from German adult participants (N = 2,137, 18-84 years, 52.1% female) of the CORONA HEALTH APP Study from July 2020 to July 2021. Multivariate regression analyses were used to predict (a) coping factors assessed with the Brief COPE and (b) QoL assessed with the WHOQOL-BREF while taking measurement time, central sociodemographic, and health characteristics into account. Results: During the COVID-19 pandemic, German adults mostly pursued problem- and meaning-focused coping factors and showed a relatively good QoL [Mean values (M) from 57.2 to 73.6, standard deviations (SD) = 16.3-22.6], except for the social domain (M = 57.2, SD = 22.6), and with a decreasing trend over time (ß from -0.06 to -0.11, ps < 0.01). Whereas, escape-avoidance coping was negatively related to all QoL domains (ß = -0.35, p < 0.001 for psychological, ß = -0.22, p < 0.001 for physical, ß = -0.13, p = 0.045 for social, ß = -0.49, p < 0.001 for environmental QoL), support- and meaning-focused coping showed positive associations with various QoL domains (ß from 0.19 to 0.45, ps < 0.01). The results also suggested differences in the pursuit of coping factors as well as in the strength of associations with QoL by sociodemographic characteristics. Escape-avoidance-focused coping was negatively associated with QoL levels in older and less educated adults (simple slopes differed at ps < 0.001), in particular. Conclusions: The results demonstrated what types of coping may be helpful to avoid QoL deterioration (i.e., support- and meaning-focused coping) and provide implications for future universal or targeted health promotion (i.e., older or less educated adults who lack social or instrumental support) and preparedness in the face of unknown challenging societal situations similar to that of the COVID-19 pandemic. Cross-sectional trends of enhanced use of escape-avoidance-focused coping and QoL deterioration point toward a need for increased attention from public health and policy.

Co-occurrence, stability and manifestation of child and adolescent mental health problems: a latent transition analysis.

BACKGROUND: Complex constellations of socio-emotional and behavioural problems (i.e., mental health problems) in childhood and adolescence are common and heighten the risk for subsequent personality, anxiety and mood disorders in adulthood. Aims of this study included the examination of patterns of mental health problems (e.g., externalizing-internalizing co-occurrence) and their transitions to reported mental disorders by using a longitudinal person-centered approach (latent class and latent transition analysis). METHODS: The sample consisted of 1255 children and adolescents (51.7% female, mean age = 12.3 years, age range 8-26 years) from three time points of the comprehensive mental health and wellbeing BELLA study. Children and their parents completed the German SDQ (Strength and Difficulties Questionnaire, Goodman, 1997) and reported on diagnoses of ADHD, depression, and anxiety. RESULTS: Latent class analysis identified a normative class, an emotional problem class, and a multiple problem class. According to latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time; 14.7% of individuals showed a persistent pattern of mental health problems. Diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class. CONCLUSIONS: Results highlight the need for early prevention of mental health problems to avoid accumulation and manifestation in the transition to adolescence and young adulthood.

Adult quality of life patterns and trajectories during the COVID-19 pandemic in Germany.

Early investigations of subjective well-being responses to the COVID-19 pandemic indicated average deterioration but also high variability related to vulnerability of population groups and pandemic phase. Thus, we aimed to gain new insights into the characteristics of certain groups and their differences in subjective well-being response patterns over time. First, we performed Latent Class Analyses with baseline survey data of 2,137 adults (mean age = 40.98, SD = 13.62) derived from the German CORONA HEALTH APP Study to identify subgroups showing similarity of a comprehensive set of 50 risk and protective factors. Next, we investigated the course of quality of life (QoL) as an indicator of subjective well-being grouped by the identified latent classes from July 2020 to July 2021 based on monthly and pandemic phase averaged follow-up survey data by means of Linear Mixed-Effects Regression Modeling. We identified 4 latent classes with distinct indicators and QoL trajectories (resilient, recovering, delayed, chronic) similar to previous evidence on responses to stressful life events. About 2 out of 5 people showed a resilient (i.e., relative stability) or recovering pattern (i.e., approaching pre-pandemic levels) over time. Absence of depressive symptoms, distress, needs or unhealthy behaviors and presence of adaptive coping, openness, good family climate and positive social experience were indicative of a resilient response pattern during the COVID-19 pandemic. The presented results add knowledge on how to adapt and enhance preparedness to future pandemic situations or similar societal crises by promoting adaptive coping, positive thinking and solidary strategies or timely low-threshold support offers. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03628-4.

Age at menarche relates to depression in adolescent girls: Comparing a clinical sample to the general pediatric population.

CONTEXT: The timing of puberty, physical features of pubertal development, and hormones are closely intertwined but may also individually contribute to the risk for depression and depression severity. Additionally, their effects on mood may depend on depression severity, but previously this has only been studied in mostly subclinical depression. METHODS: In 184 girls from a single psychiatric hospital with significant depressive symptoms (Beck Depression Inventory-II score > 13), the relationship between depression severity and age at menarche (AAM), pubertal status, and gonadal/adrenal hormones (estradiol, progesterone, DHEA-S, androstenedione, testosterone, dihydrotestosterone) was investigated. Moreover, AAM in depressed girls was compared to that from a representative sample of German adolescents without a psychiatric disorder (N = 1674). Androgen levels were compared to those of age- and sex-matched controls (N = 59). RESULTS: AAM but not pubertal stage or biochemical parameters related to depression. Girls with AAM at the lower normative range of pubertal development were 61 % more likely to develop depression and scored 4.9 points higher on the depression scale than girls experiencing menarche at the population average. Androstenedione levels were increased in the psychiatric sample, but neither androgen nor gonadal hormone levels were associated with depression severity. LIMITATIONS: The study is cross-sectional. CONCLUSIONS: These observations confirm previous studies in mostly subclinical depression and highlight the importance of AAM for adolescent depression. Thus, AAM could be considered a prognostic factor for a clinical risk score assessing the probability of adolescent depression. Moreover, these findings suggest fostering efforts that address risk factors that contribute to an earlier AAM.

The role of personality traits and social support in relations of health-related behaviours and depressive symptoms.

BACKGROUND: Previous evidence has suggested that physically inactive individuals and extensive media users are at high risk for experiencing depressive symptoms. We examined personality traits and perceived social support as potential moderators of this association. Personality and perceived social support were included as two of the most frequently considered variables when determining predispositioning factors for media use phenomena also discussed in relation to physical activity. METHODS: We analysed cross-sectional data from 1402 adults (18-31 years old) who participated in a national health survey in Germany (KiGGS, Study on the health of children and adolescents in Germany, wave 2). The data included one-week accelerometer assessments as objective indicators of physical activity, self-reported media use, depressive symptoms, perceived social support and Big 5 personality traits. An elastic net regression model was fit with depressive symptoms as outcome. Ten-fold cross-validation was implemented. RESULTS: Amongst the main effects, we found that high media use was positively correlated with depressive symptoms, whereas physical activity was not correlated. Looking at support and individual differences as moderators, revealed that PC use was more strongly correlated with depressive symptoms in cases of low levels of perceived social support. Positive associations of social media use with depressive symptoms were more pronounced, whereas negative associations of moderate to vigorous physical activity with depressive symptoms were less pronounced in extraverts than they were in introverts. CONCLUSIONS: Results highlight the importance of considering individual factors for deriving more valid recommendations on protective health behaviours.

The role of weight- and appearance-related discrimination on eating disorder symptoms among adolescents and emerging adults.

BACKGROUND: Eating disorder symptoms (EDs) have been discussed as a prominent problem among late adolescent girls with serious health risks and long-term consequences. However, there is a lack of population-based evidence on EDs comprising the age range from early adolescence to emerging adulthood as well as considering both females and males equally. Additionally, the differential role of a comprehensive set of several relevant risk factors and particularly weight- and appearance-related discrimination warrants further attention. Thus, we aimed to contribute to a better understanding of sex- and age-related differences in associations between discrimination experience and other relevant personal risk factors (body image, social media use, self-efficacy, social support) with EDs. Furthermore, we were interested in the exploration of underlying mechanisms enhancing the risk of EDs by taking discrimination experience into account. METHODS: Based on a logistic regression model, we investigated associations between weight- and appearance-related discrimination and EDs while controlling for other relevant personal risk factors in a subsample of N = 8504 adolescents and emerging adults (54.4% female, mean age = 20.71 years, SD = 4.32 years) drawn from a German representative health survey (KiGGS Wave 2). In a second step, we investigated the mediating role of discrimination experience between the other risk factors and EDs with the help of a path model. RESULTS: While controlling for other relevant personal risk factors, weight- and appearance-related discrimination was significantly related to EDs. Whereas the risk of EDs was significantly enhanced in males and emerging adults frequently experiencing weight-related discrimination, adolescents showed a higher risk of EDs when experiencing appearance-related discrimination. Moreover, discrimination experience partly explained the associations between body image dissatisfaction, low self-efficacy, high media use and ED symptoms. CONCLUSIONS: The results highlight weight- and appearance-related discrimination as one central factor to be considered in the pathogeneses of EDs and underpin the need for discrimination prevention as well as the promotion of adaptive coping with discrimination experience to reduce the risk of developing ED symptoms. Males and emerging adults need particular attention when facing weight-related discrimination whereas risk constellations and EDs particularly affecting females need further investigation.

"How Come You Don't Call Me?" Smartphone Communication App Usage as an Indicator of Loneliness and Social Well-Being across the Adult Lifespan during the COVID-19 Pandemic.

Loneliness and lack of social well-being are associated with adverse health outcomes and have increased during the COVID-19 pandemic. Smartphone communication data have been suggested to help monitor loneliness, but this requires further evidence. We investigated the informative value of smartphone communication app data for predicting subjective loneliness and social well-being in a sample of 364 participants ranging from 18 to 78 years of age (52.2% female; mean age = 42.54, SD = 13.22) derived from the CORONA HEALTH APP study from July to December 2020 in Germany. The participants experienced relatively high levels of loneliness and low social well-being during the time period characterized by the COVID-19 pandemic. Apart from positive associations with phone call use times, smartphone communication app use was associated with social well-being and loneliness only when considering the age of participants. Younger participants with higher use times tended to report less social well-being and higher loneliness, while the opposite association was found for older adults. Thus, the informative value of smartphone communication use time was rather small and became evident only in consideration of age. The results highlight the need for further investigations and the need to address several limitations in order to draw conclusions at the population level.

Corona Health-A Study- and Sensor-Based Mobile App Platform Exploring Aspects of the COVID-19 Pandemic.

Physical and mental well-being during the COVID-19 pandemic is typically assessed via surveys, which might make it difficult to conduct longitudinal studies and might lead to data suffering from recall bias. Ecological momentary assessment (EMA) driven smartphone apps can help alleviate such issues, allowing for in situ recordings. Implementing such an app is not trivial, necessitates strict regulatory and legal requirements, and requires short development cycles to appropriately react to abrupt changes in the pandemic. Based on an existing app framework, we developed Corona Health, an app that serves as a platform for deploying questionnaire-based studies in combination with recordings of mobile sensors. In this paper, we present the technical details of Corona Health and provide first insights into the collected data. Through collaborative efforts from experts from public health, medicine, psychology, and computer science, we released Corona Health publicly on Google Play and the Apple App Store (in July 2020) in eight languages and attracted 7290 installations so far. Currently, five studies related to physical and mental well-being are deployed and 17,241 questionnaires have been filled out. Corona Health proves to be a viable tool for conducting research related to the COVID-19 pandemic and can serve as a blueprint for future EMA-based studies. The data we collected will substantially improve our knowledge on mental and physical health states, traits and trajectories as well as its risk and protective factors over the course of the COVID-19 pandemic and its diverse prevention measures.

The whole is greater than the sum of its parts: profiles of multiple mental health risk factors using Latent class analysis.

BACKGROUND: The exposure to an accumulation of various risk factors during childhood and adolescence relative to a single risk is associated with poorer mental health. Identification of distinct constellations of risk factors is an essential step towards the development of effective prevention strategies of mental disorders. A Latent class analysis (LCA) extracts different combinations of risk factors or subgroups and examines the association between profiles of multiple risk and mental health outcomes. METHODS: The current study used longitudinal survey data (KiGGS) of 10,853 German children, adolescents and young adults. The LCA included 27 robust risk and protective factors across multiple domains for mental health. RESULTS: The LCA identified four subgroups of individuals with different risk profiles: a basic-risk (51.4%), high-risk (23.4%), parental-risk (11.8%) and social-risk class (13.4%). Multiple risk factors of the family domain, in particular family instability were associated with negative mental health outcomes (e.g. mental health problems, depression, ADHD) and predominately comprised late adolescent girls. The social environment represented a more common risk domain for young males. CONCLUSION: The understanding of multiple risk and different risk "profiles" helps to understand and adjust targeted interventions with a focus on vulnerable groups.

Indications of Depressive Symptoms During the COVID-19 Pandemic in Germany: Comparison of National Survey and Twitter Data.

BACKGROUND: The current COVID-19 pandemic is associated with extensive individual and societal challenges, including challenges to both physical and mental health. To date, the development of mental health problems such as depressive symptoms accompanying population-based federal distancing measures is largely unknown, and opportunities for rapid, effective, and valid monitoring are currently a relevant matter of investigation. OBJECTIVE: In this study, we aim to investigate, first, the temporal progression of depressive symptoms during the COVID-19 pandemic and, second, the consistency of the results from tweets and survey-based self-reports of depressive symptoms within the same time period. METHODS: Based on a cross-sectional population survey of 9011 German adolescents and adults (n=4659, 51.7% female; age groups from 15 to 50 years and older) and a sample of 88,900 tweets (n=74,587, 83.9% female; age groups from 10 to 50 years and older), we investigated five depressive symptoms (eg, depressed mood and energy loss) using items from the Patient Health Questionnaire (PHQ-8) before, during, and after relaxation of the first German social contact ban from January to July 2020. RESULTS: On average, feelings of worthlessness were the least frequently reported symptom (survey: n=1011, 13.9%; Twitter: n=5103, 5.7%) and fatigue or loss of energy was the most frequently reported depressive symptom (survey: n=4472, 51.6%; Twitter: n=31,005, 34.9%) among both the survey and Twitter respondents. Young adult women and people living in federal districts with high COVID-19 infection rates were at an increased risk for depressive symptoms. The comparison of the survey and Twitter data before and after the first contact ban showed that German adolescents and adults had a significant decrease in feelings of fatigue and energy loss over time. The temporal progression of depressive symptoms showed high correspondence between both data sources (ρ=0.76-0.93; P<.001), except for diminished interest and depressed mood, which showed a steady increase even after the relaxation of the contact ban among the Twitter respondents but not among the survey respondents. CONCLUSIONS: Overall, the results indicate relatively small differences in depressive symptoms associated with social distancing measures during the COVID-19 pandemic and highlight the need to differentiate between positive (eg, energy level) and negative (eg, depressed mood) associations and variations over time. The results also underscore previous suggestions of Twitter data's potential to help identify hot spots of declining and improving public mental health and thereby help provide early intervention measures, especially for young and middle-aged adults. Further efforts are needed to investigate the long-term consequences of recurring lockdown phases and to address the limitations of social media data such as Twitter data to establish real-time public mental surveillance approaches.

Quality of life during the COVID-19 pandemic - Results of the CORONA HEALTH App study.

The COVID-19 pandemic has brought about great changes to the everyday lives of the population in Germany. Social distancing, working from home and other measures to contain the pandemic are essentially dominating everyday life. With data from the CORONA HEALTH App study we analysed the quality of life of the adult population in Germany during the COVID-19 pandemic and identified possible risk factors for a poor quality of life. In the app-based survey carried out between July and December 2020, 1,396 respondents (women 46.5%, men 52.7%, diverse 0.9%; mean age (mean) 42.0 years (standard deviation=13.4)) provided information on their quality of life using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). Univariate and multivariate regression was used to examine differences in quality of life between different groups of people during the COVID-19 pandemic and their associations with selected predictors. In summary, women, younger persons and job seekers or those who saw their work hours reduced or who could not pursue their regular jobs presented a lower quality of life in individual areas of life than the respective reference group. On the other hand, a setting that combines working from home and at the regular workplace, as well as living together with other people, showed partly positive associations with quality of life. The results have implications for public health interventions as they highlight groups requiring closer attention and sufficient support services.

Health-related quality of life in children and adolescents with overweight and obesity: results from the German KIGGS survey.

BACKGROUND: The well-being of persons with overweight and obesity, in particular of children and adolescents, may be impaired. The present study investigates the health-related quality of life (HRQoL) of girls and boys with overweight and obesity living in Germany as compared to those of normal-weight, while taking a selection of relevant determinants of HRQoL into account. METHODS: The sample comprises 1771 children and adolescents aged 11 to 17 years that took part in the cross-sectional German Health Interview and Examination Survey for Children and Adolescents (KIGGS Wave 2, 2014-2017). Sex-and age-specific BMI (kg/m2) percentiles were utilized to classify overweight and obesity. HRQoL was measured with the KIDSCREEN-27 questionnaire, which gathers detailed information about the five dimensions physical and psychological well-being, well-being regarding peers (i.e., social acceptance), parents (i.e., autonomy) and within the school environment. Multiple regression analyses were performed with HRQoL dimensions as outcomes to test for differences between children and adolescents with normal-weight vs. those with overweight and vs. those with obesity, separately for girls and boys. In a next step, age, physical activity, media consumption, social support and self-efficacy were considered as potential confounders in the analyses. RESULTS: 18.7% of the children and adolescents under study were affected by overweight and among them 8.0% by obesity. After adjusting for potential confounders, overweight and obesity were associated with lower physical well-being as compared to normal weight in both sexes (boys with overweight: standardized beta [ß] = -.14, standard error [SE] = .03, p < .001, and obesity: ß = -.16, SE = .03, p < .001; girls with overweight: ß = -.09, SE = .04, p = .011, and obesity: ß = -.11, SE = .03, p = .003). Results moreover suggest lower levels of psychological (ß = -.10, SE = .04, p = .002) and parent-related well-being (ß = -.08, SE = .04, p = .036) of boys with obesity as compared to normal-weight peers. CONCLUSION: HRQoL of German children and adolescents with overweight and obesity is impaired according to physical well-being in general, while psychological and parent-related well-being is particularly affected in boys. Public health approaches should therefore promote children and adolescents with overweight and obesity by improving diverse facets of HRQoL as well as relevant associated factors (i.e., media consumption, self-efficacy) in general and in boys in particular.

Self-Efficacy and Emotional Stability Buffer Negative Effects of Adverse Childhood Experiences on Young Adult Health-Related Quality of Life.

PURPOSE: The impact of adverse childhood experiences (ACEs) on various health outcomes is a major public health concern. This study aimed to provide a comprehensive overview of direct and indirect effects of ACEs on young adult mental and physical health-related quality of life (HRQoL) and to identify protective factors that could be addressed by public health interventions. METHODS: We used structural equation modeling to investigate associations between ACE exposure and mental and physical HRQoL in 3,704 young adults (44.5% male) who participated at baseline (2003-2006; mean age = 12.2 years, 95% confidence interval = 12.1-12.3) and at the second follow-up (2014-2017; mean age = 25.0 years, 95% confidence interval = 24.9-25.1) of the KiGGS cohort study, a population-based study of children and adolescents in Germany. We investigated the mediating role of protective factors in associations between ACEs and adult HRQoL while controlling for child/adolescent HRQoL. RESULTS: A substantial proportion of young adults (65.6%) reported an ACE. Emotional abuse, neglect, depression/suicide of a household member, and ACE co-occurrence affected HRQoL negatively. Some of the negative effects of ACEs on HRQoL were attenuated, and cumulative effects from ACE co-occurrence were buffered by protective factors. CONCLUSIONS: Self-efficacy and emotional stability seem to play a key role in buffering the effects of ACEs on mental and physical HRQoL. To reduce the negative impact of ACEs, public health measures should pay additional attention to emotional abuse and promote coping and adaption competencies in children and adolescents with ACE and in general.

Persistent depressive disorder across the adult lifespan: results from clinical and population-based surveys in Germany.

BACKGROUND: Although the individual and economic disease burden of depression is particularly high for long-term symptoms, little is known of the lifetime course of chronic depression. Most evidence derives from clinical samples, and the diagnostic distinction between persistent depressive disorder (PDD) and non-chronic major depression (NCMDD) is still debated. Thus, we examined characteristics of PDD among clinical vs. non-clinical cases, and the associated disease burden at a population level. METHODS: Data were drawn from the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009-2012, n = 4483) and a clinical sample of PDD inpatients at Charité - Universitätsmedizin Berlin (2018-2019, n = 45). The DSM-5 definition of PDD was operationalized a priori to the study using interview-based DSM-IV diagnoses of dysthymia and major depression lasting at least 2 years in both surveys. Additional depression characteristics (depression onset, self-classified course, suicidality, comorbid mental disorders, treatment history and current depressive symptoms [Patient Health Questionnaire-9]) were assessed. In the DEGS1-MH, health-related quality of life (Short Form Health Survey-36, SF-36), chronic somatic conditions, number of sick days (past 12 months) or days with limitations in normal daily life activities (past 4 weeks), and health service utilization (past 12 months) were compared for PDD vs. NCMDD. RESULTS: PDD cases from the clinical sample had a significantly earlier depression onset, a higher proportion of self-classification as persistent course, and treatment resistance than PDD and NCMDD cases in DEGS1-MH. At a population level, PDD cases showed worse outcomes compared with NCMDD cases in terms of somatic comorbidity, SF-36 mental component score, and activity limitations owing to mental health problems, as well as a higher risk for outpatient mental health care contact. CONCLUSIONS: The distinction between PDD and NCMDD proposed for DSM-5 seems warranted. Early onset depression, self-classification as persistent depressive course, and treatment resistance are suggested as markers of more severe and chronic depression courses. At a population level, PDD is associated with remarkably higher individual and economic disease burden than NCMDD, highlighting the need to improve medical recognition of chronic courses and establish specific treatment concepts for chronic depression.

[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.

[Health-related quality of life and its relation to chronic diseases and mental health problems among children and adolescents : Results from KiGGS Wave 2]. / Gesundheitsbezogene Lebensqualität und Zusammenhänge mit chronischen Erkrankungen und psychischen Auffälligkeiten bei Kindern und Jugendlichen : Ergebnisse aus KiGGS Welle 2.

BACKGROUND: Health-related quality of life (HRQoL) is increasingly established as an indicator for the subjective health of children and adolescents. The aim of this study was to describe the current HRQoL among children and adolescents in Germany aged between 11 and 17 years taking into account common chronic diseases (bronchial asthma, atopic dermatitis, obesity, ADHD) and mental health problems. METHODS: The analysis is based on information obtained from 6,599 children and adolescents (51.9% girls; 48.1% boys) from KiGGS Wave 2 (2014-2017). HRQoL was measured with the multidimensional KIDSCREEN-27. The chronic diseases and mental health problems under investigation were assessed by several indicators. RESULTS: Differences in HRQoL could be found as a function of age and gender. The HRQoL among girls was lower at an older age across all dimensions. These age-related differences are less pronounced among boys. The HRQoL of children and adolescents with chronic diseases and mental health problems was lower compared to their healthy peer groups. The comparison of the investigated chronic diseases and mental health problems revealed significant differences. Particularly, HRQoL was lower for children and adolescents with obesity and mental health problems. DISCUSSION: The distinction of several dimensions of HRQoL allows a comprehensive understanding of age- and gender-related effects and provides a detailed assessment of the impact of chronic diseases and mental health problems. The present findings underline the importance of HRQoL as an indicator for the subjective health of children and adolescents.

Depressive symptoms in a European comparison - Results from the European Health Interview Survey (EHIS) 2.

Depression is associated with a significant individual and social burden of disease. The European Health Interview Survey (EHIS) provides data that can be used to compare the situation in Germany to that of other European countries. Data was evaluated from 254,510 interviewees from Germany and 24 additional Member States of the European Union (EU). Depressive symptoms as defined by the Patient Health Questionnaire (PHQ-8) were used as an indicator of depression. The prevalence in Germany (9.2%) is higher than the European average (6.6%). However, when the severity of depression is taken into account, only the prevalence of mild depressive symptoms is higher (6.3% versus 4.1%). In Germany, young people display depressive symptoms more frequently (11.5% versus 5.2%) than older people (6.7% versus 9.1%). These results should be discussed against the backdrop of differences in age and social structure and point toward a need for prevention and provision of care targeting younger people in Germany, in particular.