Stability of self-reported psychopathic traits in at-risk adolescents in youth welfare and juvenile justice institutions.

BACKGROUND: The purpose of this study was to evaluate the self-reported stability of psychopathic traits in adolescents in residential care (both child welfare and juvenile justice placed juveniles) and potential influencing factors. METHODS: We applied the Youth Psychopathic traits Inventory (YPI) in a sample of 162 adolescents (M = 15.0 years, SD = 1.3) over a mean time interval of 11 months (min. 6, max. 21 months, SD = 3.14). RESULTS: There was no significant difference in YPI total score nor in the three underlying dimensions Grandiose-Manipulative (GM), Callous-Unemotional (CU), and Impulsive-Irresponsible (II) between t1 and t2. Furthermore, approximately 70% of the adolescents showed no clinically significant reliable change on the YPI total score (as measured with the reliable change index), 15% improved, 15% deteriorated. The strongest predictor for psychopathic traits at t2 were psychopathic traits at t1. Additional predictors for higher levels of general psychopathic traits was male sex, for CU-traits male sex and lower levels of internalizing mental health problems, and for II-traits higher levels of externalizing mental health problems. Generally, the three reliable change groups (increase, no change, decrease) did not seemed to differ on relevant factors. CONCLUSIONS: Our results add to the findings that psychopathic traits are relatively stable in this at-risk group over approximately a 1-year time interval. Research with a longer follow-up time and more time points is warranted to better interpret these results.

The mediating role of COVID-19-related burden in the association between adverse childhood experiences and emotional exhaustion: results of the egePan - VOICE study.

Background: Adverse childhood experiences (ACEs) increase the risk for mental health problems. However, there is a lack of data targeting the role of ACEs for one of the most prevalent mental health problems in health-care professionals: burnout. Objective: We aimed to assess the relationship between ACEs and the core burnout dimension 'emotional exhaustion' (EE). As health-care professionals have been facing particular challenges during the COVID-19 pandemic, we furthermore aimed to assess the role of COVID-19 associated burden in the interplay between ACEs and EE. Methods: During the first lockdown in Germany, a total of 2500 medical healthcare professionals were questioned in a cross-sectional online survey. Questions targeted, among others, sociodemographics, ACEs, COVID-19-associated problems (e.g. increase of workload, worries about relatives and patients) and emotional exhaustion, measured by the respective dimension of the Maslach Burnout Inventory (MBI). Results: In German health-care professionals, ACEs were associated with a higher EE score. The number of experienced ACEs was associated with the majority of assessed COVID-19-associated problems. An increasing number of ACEs predicted higher EE scores, controlling for gender. The association between ACEs and EE was mediated significantly by COVID-19-associated problems. These included maladaptive coping strategies such as increased smoking, drinking and use of antidepressants/tranquilizers, feeling less protected by measures of the employee or the state, a greater feeling of being burdened by COVID-19-associated problems and greater exhaustion and sleep problems. Conclusion: Our findings suggest ACEs as significant risk factor for EE in German health-care professionals. The current pandemic means a significant burden that further pronounces this risk.

Antecedentes: Las experiencias adversas en la niñez (ACEs en sus siglas en inglés) aumentan el riesgo de problemas de salud mental. Sin embargo, faltan datos sobre el papel de las ACEs en uno de los problemas de salud mental más prevalentes en los profesionales de la salud: el agotamiento (burnout).Objetivo: Nuestro objetivo fue evaluar la relación entre las ACEs y la dimensión central del agotamiento 'agotamiento emocional' (AE). Dado que los profesionales de la salud se han enfrentado a desafíos particulares durante la pandemia de COVID-19, además nos propusimos evaluar el papel de la carga asociada a COVID-19 en la interacción entre las ACEs y la AE.Métodos: Durante la primera cuarentena en Alemania, se interrogó a un total de 2500 profesionales de la salud en una encuesta transversal en línea. Las preguntas fueron dirigidas, entre otros, a datos sociodemográficos, ACEs, problemas asociados a COVID-19 (por ejemplo, aumento de la carga de trabajo, preocupaciones sobre familiares y pacientes) y agotamiento emocional, medidos por la dimensión respectiva del Maslach Burnout Inventory (MBI).Resultados: En los profesionales sanitarios alemanes, las ACEs se asociaron con una puntuación de AE más alta. El número de ACEs experimentados se asoció con la mayoría de los problemas asociados a COVID-19 evaluados. Un mayor número de ACEs predijo puntuaciones de AE más altas, controlado por género. La asociación entre ACEs y AE fue mediada significativamente por problemas asociados con COVID-19. Estos incluyeron estrategias de afrontamiento desadaptativas, como fumar, beber y usar antidepresivos/tranquilizantes, sentirse menos protegido por las medidas del empleador o el estado, una mayor sensación de estar agobiado por los problemas asociados con COVID-19 y un mayor agotamiento y problemas de sueño.Conclusión: Nuestros hallazgos sugieren que las ACEs son un factor de riesgo significativo para la AE en los profesionales de la salud alemanes. La pandemia actual implica una carga importante que acentúa aún más este riesgo.

#patientstoo - Professional sexual misconduct by healthcare professionals towards patients: a representative study.

AIMS: Sexual border violations are a severe problem in the healthcare system. Studies using non-probability samples indicate a high prevalence of professional sexual misconduct (PSM) towards patients. However, valid prevalence rates are lacking. METHODS: We did a cross-sectional, observational study in Germany from February to April 2020. By different sampling steps, a probability sample of the German population above the age of 14 was generated. The final sample consisted 2503 persons (50.2% female, mean age: 49.5 years). Participants were asked about sexual contacts with and sexual harassment by healthcare professionals. Using descriptive statistics, prevalence rates of PSM were estimated. RESULTS: PSM was reported by 56 (4.5%) female and 17 (1.4%) male participants. In detail, 28 (2.2%) female and 10 (0.8%) male participants reported sexual contacts with healthcare professionals. One third of these sexual contacts took place before the age of 18 and one third against the will of the patients. 40 (3.2%) female and 8 (0.6%) male participants reported unnecessary physical examinations, 31 (2.5%) female and 7 (0.6%) male participants reported sexual harassment. The majority of perpetrators were male. CONCLUSIONS: Our data provide an important first insight into the prevalence of PSM by healthcare professionals towards patients in a representative sample. Results suggest a high prevalence of PSM in the general population of Germany. Preventive measures to increase awareness of PSM and concepts for protection of patients are needed.

[Discharge management in pediatric and adolescent psychiatry : Expectations and realities from the parental perspective]. / Entlassmanagement in der Kinder- und Jugendpsychiatrie : Erwartungen und Realitäten aus Sicht der Eltern.

BACKGROUND: Interface management after inpatient care for mentally ill children and adolescents has been proven to be a breaking point in good transition of care between child and adolescent psychiatry, social welfare services, schools, job centre and the judicial system. Criteria for successful discharge management do not exist in child and adolescent psychiatry. Aim of the study ASpeKT was to survey parents on their perception of interface management and to derive recommendations for discharge management. METHODS: Data regarding interface management were retrieved from parents (T3, n = 124, T4, n = 81) 6 months (T3) and 12 months (T4) after discharge. RESULTS: The parents stated that accessible help after discharge from inpatient treatment is essential for stability and requires a good coordination. Parents named that they perceived helpful for successful interface management: a case manager, early round table meetings, support in returning to school, seamless access to outpatient follow-up appointments as well as information on further treatment options and contact data. CONCLUSION: From the perspective of affected families a proactive early individual and reliable care coordination by a constant contact person is essential for a good discharge management.

Neural correlates of script-driven imagery in adolescents with interpersonal traumatic experiences: A pilot study.

In adults, trauma imagery has proven to be a useful tool to assess the neural mechanisms of psychological trauma processing. In adolescents, heterogeneous results could be found for other tasks, however, a trauma imagery paradigm has not been evaluated. For this purpose, we investigated a trauma imagery paradigm with control scripts to assess neural correlates of traumatic experiences in youth. 15 adolescents, who had experienced a traumatic interpersonal event in the past and have developed clinically relevant symptoms, underwent an fMRI scan while listening to their individual trauma- versus two control scripts (positive/negative). We analysed a parametric contrast of the imagery phases (trauma > negative > positive) which revealed activity in the thalamus, dorsal anterior cingulate cortex, cuneus, dorsomedial prefrontal cortex and amygdala. Additionally, amygdala-activity correlated positively with depression-symptom-severity. Our data provide evidence for the feasibility of fMRI during a trauma imagery task in adolescents to investigate networks previously related to hyperarousal in adults with PTSD. Further, we demonstrate the specificity of the activated networks for trauma imagery as compared to imagery of other emotional situations. The task might be particularly useful to evaluate neural correlates of treatment in adolescents when hyperarousal is a target symptom.

Sex-dependent associations of childhood neglect and bodyweight across the life span.

Eating disorders and weight problems across the life span have been linked to adverse childhood experiences. Previous research often focused on child abuse and omitted investigating effects of child neglect. The present study evaluates effects of neglect on bodyweight across the life span and how emotional neglect and bodyweight are linked via mental distress. Within a large survey representative of the German population (N = 2,500), individuals completed measures of mental distress, childhood trauma, and height and weight. We conducted logistic regression analyses on bodyweight extremes and a moderated mediation analysis. In men, physical neglect aggravated the risk to be underweight. In women, emotional neglect was linked to severe obesity. In both sexes, emotional neglect was related to mental distress. We found an indirect effect of emotional neglect on bodyweight via mental distress, however, it was only present in women. Our results attest to long-term consequences of adverse early experiences. We showed a possible mechanism for women's higher vulnerability towards eating disorders. In general, investigations of eating and weight disorders should also include men and employ sex-specific methods of analyses. Lastly, neglect should also receive more attention to prevent suffering and negative sequelae over the life span.

[Prevention for children with parents with depression or anxiety : National and international approaches and their age specificity]. / Prävention bei Kindern mit depressiven oder angsterkrankten Eltern : Nationale und internationale Ansätze und deren Altersspezifizität.

BACKGROUND: Children of mentally ill parents are exposed to a multitude of burdens due to the diseases of their parents. Age-related preventive measures and interventions are needed to minimize the risk for the development of psychiatric disorders by the children themselves. OBJECTIVE: The aim of the study was the documentation of preventive options on a national and international level for children of different age groups between 3 and 14 years with parents with depressive or anxiety disorders. MATERIAL AND METHODS: A systematic literature search was conducted to identify current evidence-based preventive interventions measures for these target groups and analyzed with respect to age-specific aspects and evidence. RESULTS: From screening 107,573 publications 43 interventions could be found. After examining the evidence of the interventions 25 projects could be included in the analysis For each of the different age groups the intervention with the best evidence is presented in this article. CONCLUSION: Many interventions were found but most of them were not sufficiently evaluated or psychometrically defined; however, the few well-evaluated evidence-based projects for children mostly addressed the age-specific needs. Projects for preschool age children mostly worked with the parents and referred to elements of parental training. For schoolchildren there were various preventive projects that especially worked with increasing the self-esteem and the development of coping strategies. Projects for adolescents worked with psychoeducation and increasing social connectedness. Across all age groups there was no comprehensive and cross-system networking between the interventions.

[Children of mentally ill parents : Also a topic in the context of child protection]. / Kinder psychisch erkrankter Eltern : Auch ein Thema im Rahmen des Kinderschutzes.

BACKGROUND: Severe mental illness in parents increases the risk of neglect, physical and sexual abuse (adverse childhood experiences, ACE) of children. OBJECTIVE: Presentation of the current situation of child protection issues in psychiatric care in Germany and the derivation of needs and potential solution strategies. MATERIAL AND METHODS: Based on a selective literature search, the needs and the current situation in Germany are presented and potential solution strategies are pointed out. The analysis is supplemented by a descriptive evaluation of specific consultation requests to the medical child protection hotline, which were descriptively evaluated and served as a starting point for the selective literature search. RESULTS: Despite the well-known comprehensive influence of mental illnesses of parents on their children, psychiatric patients have not yet been systematically registered regarding whether they have to care for underage children. There is a lack of systematic and comprehensive support for families at risk. Of all calls to the project medical child protection hotline, calls from the field of adult psychiatry and psychosomatics make up by far the highest proportion from the field of adult medicine. CONCLUSION: An increased awareness of child protection issues is necessary in the field of adult psychiatric treatment. Systematic counselling services for acute cases and also networking and structured cooperation with other medical fields, such as child and youth psychiatry, pediatrics and child and youth welfare should be addressed.

Psychosocial problems in traumatized refugee families: overview of risks and some recommendations for support services.

This article is an abridged version of a report by an advisory council to the German government on the psychosocial problems facing refugee families from war zones who have settled in Germany. It omits the detailed information contained in the report about matters that are specific to the German health system and asylum laws, and includes just those insights and strategies that may be applicable to assisting refugees in other host countries as well. The focus is on understanding the developmental risks faced by refugee children when they or family members are suffering from trauma-related psychological disorders, and on identifying measures that can be taken to address these risks. The following recommendations are made: recognizing the high level of psychosocial problems present in these families, providing family-friendly living accommodations, teaching positive parenting skills, initiating culture-sensitive interventions, establishing training programs to support those who work with refugees, expanding the availability of trained interpreters, facilitating access to education and health care, and identifying intervention requirements through screening and other measures.

The relationships between gender, psychopathic traits and self-reported delinquency: a comparison between a general population sample and a high-risk sample for juvenile delinquency.

BACKGROUND: Studies have shown that youths with high psychopathic traits have an earlier onset of delinquent behavior, have higher levels of delinquent behavior, and show higher rates of recidivism than youths with low psychopathic traits. Furthermore, psychopathic traits have received much attention as a robust indicator for delinquent and aggressive behavior in both boys and girls. However, there is a notable lack of research on gender differences in the relationship between psychopathic traits and delinquent behavior. In addition, most of the studies on psychopathic traits and delinquent behavior were conducted in high-risk samples. Therefore, the first objective of the current study was to investigate the relationship between psychopathic traits and specific forms of self-reported delinquency in a high-risk sample for juvenile delinquency as well as in a general population sample. The second objective was to examine the influence of gender on this relationship. Finally, we investigated whether the moderating effect of gender was comparable in the high-risk sample for juvenile delinquency and the general population sample. METHODS: Participants were 1220 adolescents of the German-speaking part of Switzerland (N = 351 high-risk sample, N = 869 general population sample) who were between 13 and 21 years of age. The Youth Psychopathic traits Inventory (YPI) was used to assess psychopathic traits. To assess the lifetime prevalence of the adolescents' delinquent behavior, 15 items derived from a self-report delinquency instrument were used. Logistic regression analyses were used to examine the relationship between gender, psychopathic traits and self-reported delinquency across both samples. RESULTS: Our results demonstrated that psychopathic traits are related to non-violent and violent offenses. We found no moderating effect of gender and therefore we could not detect differences in the moderating effect of gender between the samples. However, there was a moderating effect of sample for the relationship between the callous and unemotional YPI scale and non-violent offenses. In addition, the regression weights of gender and sample were, for non-violent offenses, reduced to non-significance when adding the interaction terms. CONCLUSIONS: Psychopathic traits were found to be present in a wide range of youths (i.e., high-risk as well as general population sample, young children as well as adolescents, boys as well as girls) and were related to delinquent behavior. The influence of age and YPI scales on self-reported delinquency was more robust than the influence of gender and sample. Therefore, screening for psychopathic traits among young children with psychosocial adjustment problems seems relevant for developing effective intervention strategies.

Aripiprazole and Riluzole treatment alters behavior and neurometabolites in young ADHD rats: a longitudinal 1H-NMR spectroscopy study at 11.7T.

Attention deficit hyperactivity disorder (ADHD), Tourette syndrome (TS) as well as obsessive compulsive disorder (OCD) are co-occurring neurodevelopmental diseases that share alterations of frontocortical neurometabolites. In this longitudinal study we investigated the behavioral and neurochemical effects of aripiprazole and riluzole treatment in juvenile spontaneously hypertensive rats (SHR), a model for ADHD. For neurochemical analysis we employed in vivo magnetic resonance spectroscopy (MRS). Spectra from voxels located at the central striatum and prefrontal cortex were acquired postnatally from day 35 to 50. In the SHR strain only, treatments reduced repetitive grooming and climbing behavior. The absolute quantification of cerebral metabolites in vivo using localized 1H-MRS at 11.7T showed significant alterations in SHR rats compared to controls (including glutamine, aspartate and total NAA). In addition, drug treatment reduced the majority of the detected metabolites (glutamate and glutamine) in the SHR brain. Our results indicate that the drug treatments might influence the hypothesized 'hyperactive' state of the cortico-striatal-thalamo-cortical circuitries of the SHR strain. Furthermore, we could show that behavioral changes correlate with brain region-specific alterations in neurometabolite levels in vivo. These findings should serve as reference for animal studies and for the analysis of neurometabolites in selected human brain regions to further define neurochemical alterations in neuropsychiatric diseases.

Alterations of hair cortisol and dehydroepiandrosterone in mother-infant-dyads with maternal childhood maltreatment.

BACKGROUND: Child maltreatment (CM) has severe effects on psychological and physical health. The hypothalamic-pituitary-adrenal (HPA) axis, the major stress system of the body, is dysregulated after CM. The analysis of cortisol and dehydroepiandrosterone (DHEA) in scalp hair presents a new and promising methodological approach to assess chronic HPA axis activity. This study investigated the effects of CM on HPA axis activity in the last trimester of pregnancy by measuring the two important signaling molecules, cortisol and DHEA in hair, shortly after parturition. In addition, we explored potential effects of maternal CM on her offspring's endocrine milieu during pregnancy by measuring cortisol and DHEA in newborns' hair. METHODS: CM was assessed with the Childhood Trauma Questionnaire (CTQ). Cortisol and DHEA were measured in hair samples of 94 mothers and 30 newborns, collected within six days after delivery. Associations of maternal CM on her own and her newborn's cortisol as well as DHEA concentrations in hair were analyzed with heteroscedastic regression models. RESULTS: Higher CM was associated with significantly higher DHEA levels, but not cortisol concentrations in maternal hair. Moreover, maternal CM was positively, but only as a non-significant trend, associated with higher DHEA levels in the newborns' hair. CONCLUSIONS: Results suggest that the steroid milieu of the mother, at least on the level of DHEA, is altered after CM, possibly leading to non-genomic transgenerational effects on the developing fetus in utero. Indeed, we observed on an explorative level first hints that the endocrine milieu for the developing child might be altered in CM mothers. These results need extension and replication in future studies. The measurement of hair steroids in mothers and their newborns is promising, but more research is needed to better understand the effects of a maternal history of CM on the developing fetus.

Psychosocial interventions for children and adolescents after man-made and natural disasters: a meta-analysis and systematic review.

Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre-post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.

[Diagnostics and initial estimation of refugee minors]. / Diagnostik und Ersteinschätzung bei minderjährigen Flüchtlingen.

The number of underage refugees arriving in Germany has rapidly increased since 2015. Many of these children and adolescents have been and still are, exposed to a large number of stressful circumstances. The group of those helping refugee minors is heterogeneous with both volunteers and professional workers from the fields of child welfare and healthcare services. Easily applicable instruments to assess both burdens and resources are needed in order to plan appropriate interventions. This paper focuses on instruments for assessing the circumstances of refugee minors and includes pilot data of an online-based screening instrument to assess burdens and resources (providing online resource and trauma assessment for refugees, PORTA). Field application was tested by the staff of a clearing and preclearing institution with 33 cases and good practical feasibility was reported. Applying a simple to use screening instrument for refugee minors and their helpers, which is available in several languages creates the possibility of a shared definition of problems and solutions and is beneficial to helpers (e.g. volunteers, youth welfare services and medical doctors) as well as refugee minors.

Relationship between Massachusetts Youth Screening Instrument-second version and psychiatric disorders in youths in welfare and juvenile justice institutions in Switzerland.

BACKGROUND: There is growing evidence that it is important to have well-standardized procedures for identifying the mental health needs of youths in welfare and juvenile justice institutions. One of the most widely used tools for mental health screening in the juvenile justice system is the Massachusetts Youth Screening Instrument-second version (MAYSI-2). To contribute to the body of research examining the utility of the MAYSI-2 as a mental health screening tool; the first objective of the current study was to examine the relationship between the MAYSI-2 and the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL) in a sample of Swiss youths in welfare and juvenile justice institutions using a cross-sectional design. Secondly, as the sample was drawn from the French-, German- and Italian-speaking parts of Switzerland, the three languages were represented in the total sample and consequently differences between the language regions were analyzed as well. The third objective was to examine gender differences in this relationship. METHODS: Participants were 297 boys and 149 girls (mean age = 16.2, SD = 2.5) recruited from 64 youth welfare and juvenile justice institutions in Switzerland. The MAYSI-2 was used to screen for mental health or behavioral problems that could require further evaluation. Psychiatric classification was based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL). Binomial logistic regression analysis was used to predict (cluster of) psychiatric disorders from MAYSI-2 scales. RESULTS: The regression analyses revealed that the MAYSI-2 scales generally related well to their corresponding homotypic (cluster of) psychiatric disorders. For example, the alcohol/drug use scale identified the presence of any substance use disorder and the suicide ideation scale identified youths reporting suicide ideation or suicide attempts. Several MAYSI-2 scales were also related to heterotypic (cluster of) psychiatric disorders. For example, the MAYSI-2 scale alcohol/drug use, was positively related to any disruptive disorder. Furthermore, the results revealed gender differences in the relationship between the MAYSI-2 and K-SADS-PL (e.g., in the boys' subsample no MAYSI-2 scale was significantly related to any affective disorder; whereas, in the girls' subsample the MAYSI-2 scales depressed-anxious and somatic complaints were significantly related to any affective disorder). CONCLUSIONS: Overall, The MAYSI-2 seems to serve well as a first-stage screen to identify service needs for youths in welfare and juvenile justice institutions in Switzerland. Its effectiveness to identify the presence of (cluster of) psychiatric disorders differs between genders.

Psychosocial Risk Factors for Child Welfare among Postpartum Mothers with a History of Childhood Maltreatment and Neglect.

Background: Childhood maltreatment (CM) can increase the risk of psychosocial risk factors in adulthood (e. g. intimate partner violence, financial problems, substance abuse or medical problems). The transition to parenthood presents those affected by CM with particular challenges, in addition to usual birth-related stressors. Methods: In this cross-sectional study a total of 240 women were interviewed in the puerperium with respect to CM experiences, using the German version of the Childhood Trauma Questionnaire (CTQ). Current psychosocial risk factors (e. g. financial concerns, maternal mental illness, single parent) were assessed using the Constance Index (KINDEX) for early childhood risk factors. Associations between CM experience and psychosocial risk factors were calculated using simple correlation. Results: The average age of participants was 33 years. On the CTQ 13.8 % of participants reported emotional abuse, 6.7 % physical abuse and 12.5 % sexual abuse, while 32.1 % reported emotional neglect and 7.5 % physical neglect during childhood. With rising severity of CM, more psychosocial risk factors (KINDEX) were present. Conclusions: This study shows a clear association between experiences of maltreatment during childhood and the presence of psychosocial stressors among women in the puerperium. Regular screening for a history of CM and parental psychosocial stressors should be conducted early, i.e. during pregnancy, to avoid negative consequences for the child.

Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial.

BACKGROUND: Admission rate to child and adolescent mental health inpatient units in Germany is high (54,467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support. METHODS: Of 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n=54) and control groups (n=46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non-health care costs) was calculated on an intention-to-treat basis at T2 and T3. RESULTS: Significant treatment effects were observed for both groups between T1/T2 and T1/T3 (P<0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: -6900.47€, P=0.013) and T3 (difference: -8584.10€, P=0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3. CONCLUSIONS: Hot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. ( REGISTRATION NUMBER: ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

[Sexual harassment among students - prevalence, developmental factors and potential ways of intervention]. / Sexuell belästigendes Verhalten unter Schülern - Häufigkeit, Entstehungsbedingungen und Handlungsoptionen.

Sexual harassment among adolescents has long been neglected in Germany though it is frequent and leads to significant strain for the victims. In international studies, the prevalence of sexual harassment ranges from 10 to 80 % among students. For the development of sexual harassment individual as well as school based factors play a role. Different pathways lead to this problematic behaviour. The effect of new media in the development of sexual harassment cannot be estimated so far. Frequent consequences of sexual harassment in addition to school associated difficulties are unspecific somatic complaints. General practitioners and pediatricians are frequently consulted tn the first place. Recommendations for consultation and interventions are presented.