Gender role attitudes and well-being of German and refugee adolescents-same or different?

BACKGROUND: Assumed differences in gender role attitudes (GRAs) of German adolescents and refugee adolescents from the Middle East are often discussed, but rarely investigated. Presumed differences in GRAs across cultures and genders are assumed to be involved in emerging gender differences in well-being and mental health symptoms. Overall, appropriate measurements for investigating GRAs of adolescents with different cultural backgrounds are scarce. METHODS: Hence, the present study exemplarily investigates (1) the measurement invariance (MI) of a German translation of the Social Role Questionnaire (SRQ) for German (n = 114) and German-speaking Middle Eastern refugee adolescents from Syria, Afghanistan, or Iraq (n = 115), using a Multiple Indicator Multiple Cause (MIMIC) model to account for age and gender. Moreover, (2) differences between GRAs of both groups, (3) relationships of GRAs with different facets of affective well-being, as well as (4) differences in these relationships between German and refugee adolescents are examined by extending the MIMIC-model to a full structural equation model (SEM). RESULTS: Results indicate (1) that scalar MI for the SRQ can be assumed. Furthermore, (2) German adolescents show less traditional gender-linked GRAs than refugee adolescents, but no further differences in GRAs. Furthermore, no differences between the relationships of GRAs with well-being and mental health symptoms were found between the groups (4). Also, (3) GRAs showed no relation with any of the outcomes, but gender and age predicted mental health symptoms. CONCLUSION: The findings show that the SRQ is a useful measurement for investigating the GRAs of adolescents living in Germany and could be used in further cross-cultural research.

The impact of COVID-19 related lockdown measures on self-reported psychopathology and health-related quality of life in German adolescents.

The impact of school-closings on adolescents' mental health and well-being in the management of the ongoing COVID-19 pandemic is subject to ongoing public debate. Reliable data to inform a balanced discussion are limited. Drawing on a large ongoing multi-site project in Germany, we assessed differences in self-reported psychopathology in a matched convenience-sample of adolescents assessed pre- (November 26, 2018 to March 13, 2020; n = 324) and post the first lockdown (March 18, 2020 to August 29, 2020; n = 324) early 2020 in Germany. We found no evidence for an increase in emotional and behavioral problems, depression, thoughts of suicide or suicide attempts, eating disorder symptoms, or a decrease in general health-related quality of life. Reported suicide plans significantly decreased from 6.14 to 2.16%. Similarly, conduct problems decreased in the post-lockdown period. Family risk-factors did not moderate these findings. The influence of socioeconomic status on emotional and behavioral problems as well as depression decreased during the lockdown. Based on the present findings, the first school-closing in Germany had no immediate and severe impact on adolescents' well-being. However, caution is warranted as our data covers a fairly small, affluent sample over a limited time-span and long-term consequences cannot be ruled out.

Help-seeking attitudes and behaviours for mental health problems in adolescents before and during the first COVID-19 school closures in Germany.

AIM: Comparing measures of psychological wellbeing and help-seeking in youths before and within the first school closures due to the coronavirus disease 2019 (COVID-19) pandemic enables a better understanding of the effects the pandemic has for those seeking professional help for mental health problems. METHODS: Data were obtained from the Germany-based ProHEAD school study. Pre-lockdown and lockdown samples (n = 648) were compared regarding pupils' psychological wellbeing, help-seeking attitudes and help-seeking behaviour. RESULTS: Participants from the lockdown sample showed greater positive attitudes towards seeking professional help, whereas psychological wellbeing and help-seeking behaviour remained stable. CONCLUSIONS: Possible explanations may include an increased public discourse on mental health or self-selection bias for participation during lockdown.

The reciprocal interplay of physical activity and health-related quality of life in children and adolescents: Evidence for both upward and downward spirals.

OBJECTIVE: This study examines the bidirectional effect between physical activity (PA) and health-related quality of life in children and adolescents, focusing on within-person effects. METHODS: PA and health-related quality of life were assessed in children and adolescents (N = 685, age: M = 10.29 years, SD = 1.35, range = 8-14), via self-report across four waves, each 6 months apart, and a random-intercept cross-lagged panel model with time-invariant cross-lagged effects was calculated. RESULTS: Positive cross-lagged effects between prior PA and health-related quality of life 6 months later ( γ y = 0.536, 95% CI [0.016, 1.055], p = .043, d = 0.11) and vice versa ( γ x = 0.015, 95% CI [0.001, 0.030], p = .039, d = 0.12) were found. Furthermore, the random intercept correlation was significant ( T xy = 3.622, 95% CI [2.204, 5.041], p < .001, d = 0.27). CONCLUSIONS: The findings confirm known correlations between PA and health-related quality of life and extends them by indicating both an upward and downward spiral of PA and health-related quality of life in children and adolescents.

Reasons for non-participation of children and adolescents in a large-scale school-based mental health project.

Background: Non-participation in mental health studies is an under-explored but very important topic. Investigating reasons for non-participation holds promise for the planning of future study designs and recruitment strategies. This study aimed at investigating reasons for children and adolescents (C&A) not participating in a school-based mental health research project. Methods: Data collection took place within the school-based recruitment of a large-scale multi-site project ("ProHEAD-Promoting Help-seeking using E-technology for Adolescents") in Germany. Participants were N = 534 C&A aged ≥ 12 years attending secondary schools. The present cross-sectional study analyzed anonymous survey data of C&A who themselves or whose parents, respectively, did not provide written consent to participate in the mental health research project. The questionnaire consisted of 14 items covering potential reasons for non-participation, and four free text fields. Besides descriptive statistics, free text field answers were analyzed using qualitative content analysis. Results: Students indicated an average of M = 2.94 (SD = 1.75) reasons for their non-participation in the project. In the descriptive analysis of indicated items, the three most frequently reported reasons for non-participation included students reporting to not be concerned by the topic "mental health" (n = 290, 54.3%), not having returned the consent form to the teacher (n = 175, 32.8%), and not having time for participation (n = 149, 27.9%). In the qualitative content analysis, the most frequently assigned categories were organizational reasons (n = 216, 57.1%), general disinterest in study participation (n = 139, 36.8%), and personal attitudes toward the topic "mental health" (n = 84, 22.2%), such as not being concerned with the topic "mental health" (n = 23, 6.1%) or being too concerned with the topic "mental health" (n = 16, 4.2%). Conclusion: The study provides unique insights into reasons for C&A and their caregivers not participating in a large federally funded mental health research project. The results suggest that in order to increase participation rates, stigma should be reduced, parents as well as teachers should be involved where possible, and the use of incentives might be helpful. The study highlights the importance of assessing reasons for non-participation, especially in online intervention studies on mental health.

Moderators of pre-post changes in school-based mental health promotion: Psychological stress symptom decrease for adolescents with mental health problems, knowledge increase for all.

Background: School-based mental health promotion aims to strengthen mental health and reduce stress. Results on the effectiveness of such programs are heterogeneous. This study realized a school-based mental health promotion program (StresSOS) for all students and aimed to identify moderators (mental health status, gender, grade level) of pre- to post-changes in stress symptoms and knowledge. Methods: Participants were N = 510 adolescents (from 29 classes; 46.7% female) aged 12-18 years (M = 13.88, SD = 1.00; grade levels 7-10). They were without mental health problems (65.9%), at risk for mental health problems (21.6%), or with mental health problems (12.5%) and participated in a 90 min per week face-to-face training with 8 sessions in class at school. Demographic variables, mental health status, stress symptoms, and knowledge about stress and mental health were collected at baseline. Program acceptance, stress symptoms, and knowledge were collected post-intervention. Multilevel mixed effects models were conducted with the fixed effects time (within factor), mental health status, gender, and grade level (between factors). Random effects for students within classes were included. Results: In the pre-post comparison, mental health status moderated the changes on psychological stress symptoms (p < 0.05). In adolescents with mental health problems the largest reduction in stress symptoms was observed between pre- and post-assessment. Gender and grade level were less relevant. For all adolescents knowledge gains were revealed (p < 0.001). Program acceptance was moderated by mental health status and grade level (p < 0.01). Mentally healthy adolescents and within the group of adolescents at-risk or with mental health problems, especially younger students (7th/8th grade), rated program acceptance higher. Conclusion: Psychological stress symptoms decreased among adolescents with mental health problems and not among adolescents at risk for or without mental health problems. Mental health-related knowledge increased for all adolescents. The results add to knowledge on school-based mental health intervention research and practice. Its implications for different prevention strategies (universal, selective or a combination of both) are discussed.

[Examination of the Multidimensional Anxiety Inventory for Children and Adolescents (MAICA) in Clinical Samples]. / Überprüfung des Mehrdimensionalen Angstinventars für Kinder und Jugendliche (MAI-KJ) an klinischen Stichproben.

Questionnaires such as the Multidimensional Anxiety Inventory for Children and Adolescents (MAICA) provide a diagnostic approach to alert for anxiety- or depression-related problems. The aim is to examine the MAICA within two clinical samples.We first investigated whether children having anxiety- or depression-related problems (n = 94) scored higher on anxiety (i.e., emotionality and worry) and depression (i.e., dysthymia and low joy) than a non-clinical control group (n = 282). Then, we contrasted a clinical sample with other mental disorders unrelated to anxiety or depression (n = 45) with another non-clinical control group (n = 135). Across all scales of the MAICA, children with anxiety- or depression-related problems showed less favourable values than the non-clinical control group (d = 0.34 to 0.54 for anxiety, 0.55 to 0.68 for depression). Children with other mental problems showed no differences in either the anxiety or depression scales. For the use as a screening instrument, preliminary cutoff scores for identifying anxiety- or depression-related problems with the MAICA are given.

Polytraumatization in young male refugees from the Middle East and its association with internalizing and externalizing symptoms.

BACKGROUND: Young Middle Eastern male refugees are currently among the most vulnerable groups in Europe. Most of them have experienced potentially traumatic events (PTEs) such as rape, torture, or violent assaults. Compared to their peers, young refugees suffer more from internalizing and externalizing symptoms, especially when unaccompanied. Little is known about the cumulative impact of experiencing different types of PTEs on mental health outcomes (polytraumatization) of young male refugees from the Middle East. We investigated (1) whether there is a dose-response relationship between multiple PTE types experienced and mental health outcomes, (2) whether individual types of PTEs are particularly important, and (3) to what extent these are differentially associated with mental health outcomes among unaccompanied or accompanied peers. METHODS: In total, 151 young Middle Eastern male refugees in Germany (Mage = 16.81 years, SDage = 2.01) answered questionnaires on PTEs, mental health, and post-migration stress. RESULTS: Hierarchical regression analyses revealed, while controlling for age, duration of stay, unaccompanied status, and post-migration stress, (1) a dose-effect between PTE types on both internalizing and externalizing symptoms. Moreover, (2) regarding internalizing symptoms, violent family separation and experiencing life-threatening medical problems were particularly crucial. The latter was driven by unaccompanied refugees, who also reported higher levels of substance use. CONCLUSIONS: The results extend findings from the literature and suggest that not only may greater polytraumatization be related to greater depression among refugees, but also to a range of other mental health outcomes from the internalizing and externalizing symptom domains. Furthermore, the results highlight the mental health risks that unaccompanied and accompanied refugee adolescents face after exposure to PTEs, and provide information for practitioners as well as researchers about event types that may be particularly relevant.

Stress-symptoms and well-being in children and adolescents: factor structure, measurement invariance, and validity of English, French, German, Russian, Spanish, and Ukrainian language versions of the SSKJ scales.

OBJECTIVE: The present cross-cultural study examined the factor structure, measurement invariance, and convergent validity of the Stress-Symptom and Well-Being Scales from the Stress and Coping Questionnaire for Children and Adolescents (SSKJ), originally in German, across gender and for five newly developed language versions: English, French, Russian, Spanish, and Ukrainian. DESIGN: Children and adolescents (N = 5,227) from Germany, France, Russia, the Dominican Republic, Ukraine, and several English-speaking countries participated in the survey study. MAIN OUTCOME MEASURES: The SSKJ Stress-Symptom and Well-Being Scales capture stress symptomatology and well-being with five subscales: Somatic Symptoms, Anger, Sadness, Anxiety, and Well-Being. The Strengths and Difficulties Questionnaire (SDQ) was used for validation. RESULTS: The factorial structure (five factors) was confirmed. In multi-group comparisons, confirmatory factor analyses showed partial metric invariance across the different languages. Regarding gender, results showed scalar invariance for all languages, except for Spanish. Gender differences were shown with girls scoring higher on somatic symptoms, sadness, anxiety (German-, French-, Russian-speaking samples), anger (French), and well-being (German, Ukrainian). Correlations with indicators of mental health and behavioral problems demonstrated convergent validity. CONCLUSION: The SSKJ Stress-Symptom and Well-Being Scales showed psychometric evidence for equivalence across the different languages and gender. Thus, this instrument is a useful tool for cross-cultural research in children and adolescents.

Editorial Perspective: A plea for the sustained implementation of digital interventions for young people with mental health problems in the light of the COVID-19 pandemic.

The coronavirus disease 2019 pandemic and the consequent global lockdown posed a particular challenge for youths with mental health problems. Crucial interference with their everyday lives likely increased psychological distress while accessibility of conventional mental health care was limited. Ongoing online trials offer a unique opportunity to analyse mental health status and help-seeking behaviour of adolescents during the pandemic. The ProHEAD-online trial aims at improving help-seeking behaviour of children and adolescents with significant psychological impairment. From January to May 2020, 1,042 students had access to the ProHEAD-online platform providing information on mental illness, monitoring, peer support and professional counselling. In the week from 11 March, when schools were closed in Germany, a drastic (more than 2 standard deviations) but time-limited increase in utilization of the ProHEAD-online services became apparent. This may indicate a worsened mental health status and an increased help seeking via digital services during the lockdown. Although this finding is purely observational, it speaks to the importance of evidence-based online service in the field of mental health within the current crisis and beyond.

Efficacy and cost-effectiveness of Internet-based selective eating disorder prevention: study protocol for a randomized controlled trial within the ProHEAD Consortium.

BACKGROUND: The development of efficacious, cost-effective, and widely accessible programs for the prevention of eating disorders (EDs) is crucial in order to reduce the ED-related burden of illness. Programs using dissonance-based and cognitive behavioral approaches are most effective for the selective prevention of ED. Internet-based delivery is assumed to maximize the reach and impact of preventive efforts. However, the current evidence for Internet-based ED prevention is limited. The present trial evaluates the efficacy and cost-effectiveness of two new interventions (based on dissonance theory and principles of cognitive behavioral therapy (CBT)) that are implemented as add-ons to the existing Internet-based ED prevention program ProYouth. METHODS: The trial is one of five sub-projects of the German multicenter consortium ProHEAD. It is a three-arm, parallel, randomized controlled superiority trial. Participants will be randomized to (1) the online program ProYouth (active control condition) or (2) ProYouth plus a structured dissonance-based module or (3) ProYouth plus a CBT-based chat group intervention. As part of ProHEAD, a representative school-based sample of N = 15,000 students (≥ 12 years) will be screened for mental health problems. N = 309 participants at risk for ED (assessed with the Weight Concerns Scale (WCS) and the Short Evaluation of Eating Disorders (SEED)) will be included in the present trial. Online assessments will be conducted at baseline, at end of intervention (6 weeks), at 6 months follow-up, and - as part of ProHEAD - at 12 and 24 months follow-up. The primary outcome is ED-related impairment (assessed with the Child version of the Eating Disorder Examination-Questionnaire (ChEDE-Q)) at the end of the intervention. Secondary outcomes include ED-related symptomatology at follow-up, ED-related stigma, ED-related help-seeking, and acceptance of and compliance with the interventions. For the health economic evaluation data on costs of the interventions, healthcare utilization and health-related quality of life will be assessed. DISCUSSION: This is the first study augmenting a flexible prevention approach such as ProYouth with structured evidence-based modules in order to overcome some of the key limitations in the current practice of ED prevention. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00014679 . Registered on 25 April 2018.

Promoting Help-seeking using E-technology for ADolescents with mental health problems: study protocol for a randomized controlled trial within the ProHEAD Consortium.

BACKGROUND: The highest incidence and prevalence of mental health problems across the lifespan as well as the first onset of most long-term mental health conditions are reported for youths between 14 and 25 years of age. At the same time, only 25% of adolescents with mental health problems receive professional treatment. One explanation for poor treatment access in youths is their low help-seeking behavior. Barriers that can keep children and adolescents (C&A) from seeking professional help include a lack of perceived need, structural barriers, or stigma. Interventions based on e-technology might present an effective approach, overcoming these barriers by reducing stigma and providing low-threshold access with enhanced reach, ultimately facilitating help-seeking for mental health problems among youths. METHODS: The study is designed as a multi-center, randomized controlled trial. In total, an estimated number of n = 1,500 C&A with mental health problems, drawn from a school-based sample of n = 15,000 pupils attending school grades 6 to 13 (≥ 12 years of age), recruited in five regions of Germany, will be randomized either to an intervention (ProHEAD online) or a control condition. C&A in the intervention group will receive online access to tailored information and individual advice on where to seek professional help for their specific needs close to their place of living, case reports of and interaction with peers, as well as the opportunity for online and telephone counseling. C&A in the control intervention will receive a recommendation to seek help and online information on where to find professional help. All participants will be asked to complete questionnaires concerning their help-seeking behavior at baseline, during the intervention (monitoring), and also at a 1 and 2 year follow-up. The primary endpoint is the number of C&A seeking conventional face-to-face professional help in the real-world setting within 1 year after their initial screening. DISCUSSION: The trial will investigate if an Internet-based intervention can increase professional help-seeking in C&A with mental health problems. With its randomized controlled design and large-scale school-based sampling, the study aims to overcome the shortages of previous research. The intervention has the potential to narrow the treatment gap in C&A and to ultimately improve the mental health care system. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00014685 . Registered on 7 July, 2018.

Efficacy and cost-effectiveness of two online interventions for children and adolescents at risk for depression (E.motion trial): study protocol for a randomized controlled trial within the ProHEAD consortium.

BACKGROUND: Depression is a serious mental health problem and is common in children and adolescents. Online interventions are promising in overcoming the widespread undertreatment of depression and in improving the help-seeking behavior in children and adolescents. METHODS: The multicentre, randomized controlled E.motion trial is part of the German ProHEAD consortium (Promoting Help-seeking using E-technology for ADolescents). The objective of the trial is to investigate the efficacy and cost-effectiveness of two online interventions to reduce depressive symptomatology in high-risk children and adolescents with subsyndromal symptoms of depression in comparison to an active control group. Participants will be randomized to one of three conditions: (1) Intervention 1, a clinician-guided self-management program (iFightDepression®); (2) Intervention 2, a clinician-guided group chat intervention; and (3) Control intervention, a psycho-educational website on depressive symptoms. Interventions last six weeks. In total, N = 363 children and adolescents aged ≥ 12 years with Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) scores in the range of 5-9 will be recruited at five study sites across Germany. Online questionnaires will be administered before onset of the intervention, at the end of the intervention, and at the six-month follow-up. Further, children and adolescents will participate in the baseline screening and the one- and two-year school-based follow-up assessments integrated in the ProHEAD consortium. The primary endpoint is depression symptomatology at the end of intervention as measured by the PHQ-A score. Secondary outcomes include depression symptomatology at all follow-ups, help-seeking attitudes, and actual face-to-face help-seeking, adherence to and satisfaction with the interventions, depression stigma, and utilization and cost of interventions. DISCUSSION: This study represents the first randomized controlled trial (RCT) investigating efficacy and cost-effectiveness of two online interventions in children and adolescents aged ≥ 12 years at risk for depression. It aims to provide a better understanding of the help-seeking behavior of children and adolescents, potential benefits of E-mental health interventions for this age group, and new insights into so far understudied aspects of E-mental health programs, such as potential negative effects of online interventions. This knowledge will be used to tailor and improve future help offers and programs for children and adolescents and ways of treatment allocation. TRIAL REGISTRATION: German Register for Clinical Trials (DRKS), DRKS00014668 . Registered on 4 May 2018. International trial registration took place through the "international clinical trials registry platform" with the secondary ID S-086/2018.

School-based mental health promotion in children and adolescents with StresSOS using online or face-to-face interventions: study protocol for a randomized controlled trial within the ProHEAD Consortium.

BACKGROUND: Schools are an ideal setting in which to promote health. However, empirical data on the effectiveness of school-based mental health promotion programs are rare, and research on universal Internet-based prevention in schools is almost non-existent. Following the life skills approach, stress management training is an important component of health promotion. Mental health literacy is also associated with mental health status, and it facilitates formal help-seeking by children and adolescents (C&A). The main objectives of this study are (1) the development and evaluation of an Internet-based version of a universal school-based health promotion program called StresSOS and (2) demonstrating non-inferiority of the online setting compared to the face-to-face setting. StresSOS aims to improve stress management and mental health literacy in C&A. METHODS/DESIGN: A school-based sample of 15,000 C&A (grades 6-13 and older than 12 years) will be recruited in five regions of Germany within the ProHEAD Consortium. Those with a screening result at baseline indicating no mental health problems will be invited to participate in a randomized controlled trial comparing StresSOS online to an active online control condition (Study A). In addition, 420 adolescents recruited as a separate school-based sample will participate in the StresSOS face-to-face intervention. Participants in both intervention groups (online or face-to-face) will receive the same eight treatment modules to allow for the comparison of both methods of delivery (Study B). The primary outcome is the number of C&A with symptoms of mental health problems at a 12 months follow-up. Secondary outcomes are related to stress/coping (i.e., knowledge, symptoms of stress, coping resources), mental health literacy (knowledge and attitudes toward mental disorders and help-seeking), program usage patterns, cost-effectiveness, and acceptability of the intervention. DISCUSSION: This study represents the first adequately powered non-inferiority trial in the area of school-based mental health promotion. If online StresSOS proves efficacious and non-inferior to face-to-face delivery, this offers great potential for health promotion in youths, both in and outside the school environment. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00014693 . Registered on 14 May 2018.

Effectiveness of a web-based screening and brief intervention with weekly text-message-initiated individualised prompts for reducing risky alcohol use among teenagers: study protocol of a randomised controlled trial within the ProHEAD consortium.

BACKGROUND: Early and excessive alcohol use is a significant threat to healthy development. Evidence supports the effectiveness of electronic alcohol interventions for young drinkers. However, effects are typically small and studies targeting under 18-year-olds are scarce. This trial is the first to evaluate the effectiveness of a single-session, brief, motivational, web-based intervention (ProWISE) plus weekly text-message-initiated individualised prompts (TIPs) in reducing alcohol consumption and alcohol-related harm among children and adolescents aged ≥ 12 years. TIPs are designed to decrease risky alcohol use by reaching youth in the contexts of their everyday lives and by providing individualised feedback on drinking intentions, actual drinking and succession in achieving personal goals for low-risk drinking or abstinence. METHODS/DESIGN: The trial is part of the multicentre consortium ProHEAD testing e-interventions for mental health problems in children and adolescents. Participants in grades 6-13 aged ≥ 12 years will be recruited in schools which participate in ProHEAD (target N = 15,000). Main criterion for inclusion in the ProWISE-TIP trial is a positive screening for at-risk alcohol use in the CRAFFT-d questionnaire (target n = 1076). In a multicentre, four-arm, randomised controlled design the following groups will be compared: (A) web-based intervention plus TIPs for 12 weeks; (B) web-based intervention plus text-message-initiated assessment of alcohol consumption for 12 weeks; (C) web-based intervention only; and (D) alcohol-related psychoeducation. TIPs will be delivered shortly before and after high-risk situations for excessive alcohol use and will be tailored to age, gender, drinking motives and alcohol consumption. Study participants will be followed up at three, six and nine months in the ProWISE-TIP trial and at one and two years in the ProHEAD consortium. Primary outcome is alcohol use in the past 30 days at nine months after enrolment. Secondary outcomes are alcohol-related problems, co-occurring substance use, health service utilisation, mental health problems and quality of life. DISCUSSION: Trial results will generate important evidence on how to enhance effectiveness of single-session, web-based alcohol interventions for youth. The ProWISE-TIP intervention, if effective, can be used as a stand-alone alcohol intervention or as an add-on to school-based or community-based alcohol prevention programs. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00014606 Registered on 20 April 2018.

Fear of Being Laughed at in Children and Adolescents: Exploring the Importance of Overweight, Underweight, and Teasing.

Weight bias toward obese youths is often accompanied by the experience of psychological stress in those affected. Therefore, the fear of being laughed at (i.e., gelotophobia) in overweight children and adolescents can be rather serious. In four explorative studies, the importance of relative weight, self-awareness of weight (incl. satisfaction with weight), experiences of teasing and ridicule, as well as the role of social-evaluative situations in school were analyzed with regard to gelotophobia. In two online interviews of adults with pronounced gelotophobia (Study I: 102 English-speaking participants, Study II: 22 German-speaking participants) relating to reasons they assumed for their development of gelotophobia, there was evidence of injurious appearance-related experiences during childhood and adolescence. In Study III (75 Swiss adolescents) associations between the experience of weight-related teasing and mockery with overweight, self-perceptions of weight, and gelotophobia were analyzed. Especially in girls, overweight was associated with the experience of weight-related teasing and ridicule, which in turn was accompanied by gelotophobia. Study IV included 178 German adolescents who were asked to report their body image ("Do you think you are… too thin, just the right weight, or too fat?"). In addition, gelotophobia, teasing, BMI based on self-reports, and joy at school were measured. In particular, girls who felt too fat and boys who felt too thin reported teasing. Teasing was related to diminished joy at school and to gelotophobia. Among boys, underweight mediated by weight-related teasing contributed to gelotophobia. The results suggest that more research should be devoted to gelotophobia and the experience of weight-related teasing and mocking to better understand factors contributing to the well-being of children and adolescents with weight problems.

Daily Stress, Hearing-Specific Stress and Coping: Self-reports from Deaf or Hard of Hearing Children and Children With Auditory Processing Disorder.

This study evaluated stressors and coping strategies in 70 children who are deaf or hard of hearing (D/HH) or with auditory processing disorder (APD) attending Grades 5 and 6 of a school for deaf and hard-of-hearing children. Everyday general stressors and more hearing-specific stressors were examined in a hearing-specific modified stress and coping questionnaire. Reports were compared with normative data for hearing children. Regarding everyday general stressors, stress levels for children who are D/HH or with APD did not differ from those of hearing children. Within children with hearing problems, everyday stressors were experienced as more stressful than hearing-specific stressors. For coping strategies, differences between children with hearing problems (D/HH, APD) and hearing children were shown (i.e., problem solving, anger-related emotion regulation). Girls scored higher in seeking social support whereas boys reported higher amounts of media use as a way of coping. Differences regarding stress and coping between children who are D/HH and children with APD were minor; D/HH children reported more social support seeking. Implications for assessment and resource promotion are discussed.

Self-regulation of healthy nutrition: automatic and controlled processes.

BACKGROUND: Self-regulatory behaviour refers to both controlled and automatic processes. When people are distracted, automatic over controlled processes prevail. This was analysed with regard to nutritional behaviour (food choices, beverage intake) in situations of low or high distraction. METHODS: A self-concept Implicit Association Test (IAT) was adapted to assess the implicit associations of self (vs. other) with healthy (vs. unhealthy) food. Explicit preferences for healthy and unhealthy food and the diet's healthiness were measured by self-report. Both implicit and explicit measures were used as predictors of nutritional behaviour. Among 90 undergraduates, the choice of fruit versus snack in a food choice task (low distraction) and the amount of mineral water and soft drinks consumed in a taste comparison task to cover liquid intake (high distraction) were observed. RESULTS: In the low distraction situation, food choice was predicted solely by explicit measures. Fruits were chosen less, when unhealthy foods were explicitly liked. In the high distraction situation, mineral water intake was predicted solely by the IAT. Participants implicitly associating themselves with healthy foods drank more mineral water than those implicitly associating themselves with unhealthy foods. CONCLUSIONS: Nutritional behaviour is influenced by both automatic and controlled processes depending on the available capacity for self-regulation.

Perception makes the difference: the association of actual and perceived weight status with self-reported and parent-reported personal resources and well-being in adolescents.

The study analyzed associations between actual weight status and weight perceptions with personal resources, physical and psychological health, as well as physical performance among adolescents (N = 5,518; age: 11-17 years). Analyses are based on data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Self-report measures, parental reports, as well as objective test data were considered. Results indicate that weight perceptions, rather than actual weight status, were associated with personal resources, health, and perceived physical performance. Comparing groups, we found that adolescents who felt they had "just the right weight" achieved more favourable results than those who perceived themselves as "too fat", regardless of their actual weight status. However, actual physical performance was predicted better by actual weight status. Furthermore, weight perceptions were found to mediate the link between actual weight status and all the assessed outcomes (personal resources, health, and physical performance). With respect to self-reports, the mediational effect was consistently stronger for girls, whereas the reverse was true regarding physical performance. Parental reports were not moderated by sex. Findings provide further evidence that among overweight adolescents there are subgroups that differ significantly with regard to risks and resources. Implications for practice are discussed.

[Coping in children and adolescents with migrant origin]. / Stressprävention bei Kindern und Jugendlichen mit Migrationshintergrund.

Children and adolescents of migrant origin often have disadvantages regarding education opportunities and health. This paper reports on the extra-curricular "Special Instruction Project for Children and Adolescents of Migrant Origin'", launched by the Stiftung Mercator and administered in Schwäbisch Gmünd. The project aims to improve education opportunities for children and adolescents of migrant origin by providing language and subject support. During the years 2006 to 2008 full-time holiday courses were realized in addition to the weekly subject instructions in German, Mathematics and English. In these holiday schools creative, sportive and health promoting aspects were integrated in language support. In terms of resource promotion and empowerment a module on stress and coping was developed and realized in the holiday courses. This module on stress and coping in context of the language support project is presented and discussed.