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1.
Lancet Psychiatry ; 8(1): 76-86, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33341172

RESUMO

A major barrier to improving care effectiveness for mental health is a lack of consensus on outcomes measurement. The International Consortium for Health Outcomes Measurement (ICHOM) has already developed a consensus-based standard set of outcomes for anxiety and depression in adults (including the Patient Health Questionnaire-9, the Generalised Anxiety Disorder 7-item Scale, and the WHO Disability Schedule). This Position Paper reports on recommendations specifically for anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder in children and young people aged between 6 and 24 years. An international ICHOM working group of 27 clinical, research, and lived experience experts formed a consensus through teleconferences, an exercise using an adapted Delphi technique (a method for reaching group consensus), and iterative anonymous voting, supported by sequential research inputs. A systematic scoping review identified 70 possible outcomes and 107 relevant measurement instruments. Measures were appraised for their feasibility in routine practice (ie, brevity, free availability, validation in children and young people, and language translation) and psychometric performance (ie, validity, reliability, and sensitivity to change). The final standard set recommends tracking symptoms, suicidal thoughts and behaviour, and functioning as a minimum through seven primarily patient-reported outcome measures: the Revised Children's Anxiety and Depression Scale, the Obsessive Compulsive Inventory for Children, the Children's Revised Impact of Events Scale, the Columbia Suicide Severity Rating Scale, the KIDSCREEN-10, the Children's Global Assessment Scale, and the Child Anxiety Life Interference Scale. The set's recommendations were validated through a feedback survey involving 487 participants across 45 countries. The set should be used alongside the anxiety and depression standard set for adults with clinicians selecting age-appropriate measures.


Assuntos
Ansiedade/diagnóstico , Depressão/diagnóstico , Transtorno Obsessivo-Compulsivo/diagnóstico , Psicometria/métodos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adolescente , Criança , Consenso , Humanos , Internacionalidade , Perfil de Impacto da Doença , Resultado do Tratamento , Adulto Jovem
2.
J Affect Disord ; 280(Pt A): 258-266, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33220562

RESUMO

INTRODUCTION: Depression is one of the most common mental disorders in adolescents and young adults worldwide, and causes a high burden for both individuals and society. The present study aims to investigate the role of risk and resource factors for depressive symptoms during adolescence and emerging adulthood in a German population-based cohort. METHODS: Within the longitudinal BELLA study, data on risk and resource factors were collected among n = 632 children and adolescents aged 11 to 17 years. Depressive symptoms were measured five years later. Multivariate linear regression models served to investigate effects of risk and resource factors on depressive symptoms. Regression models were stratified by gender. Moreover, we explored potential interaction effects. RESULTS: A negative mother-child relationship predicted depressive symptoms in girls, whereas school stress served as a risk factor in boys. Peer competence was associated with fewer depressive symptoms in girls, and family cohesion was identified as a resource factor in boys. In addition, few moderating effects of resource factors on the association between risk factors and depressive symptoms were found. LIMITATIONS: As the BELLA study is a population-based observational study, we only identified associations between risk and resource factors and no cause-effect relationships. CONCLUSIONS: Findings provide evidence of gender-specific risk and resource factors for depression. Individuals who are exposed to risk factors must be monitored during the transition into adulthood. Gender-sensitive prevention and early intervention programs are needed.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32918625

RESUMO

Mental health and well-being are of great interest in health policy and research. Longitudinal surveys are needed to provide solid population-based data. We describe the design and methods of an 11-year follow-up of the German BELLA study in children, adolescents and young adults, and we report on age- and gender-specific courses of general health and well-being, long-term health-related outcomes of mental health problems, and mental health care use. The BELLA study is the module on mental health and well-being within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Standardised measures were used at each of the five measurement points of the BELLA study. In the 11-year follow-up, young people aged 7-31 years participated (n = 3492). Individual growth modelling, linear regression and descriptive analyses were conducted. Self-reported general health and well-being were both better in younger (vs. older) and in male (vs. female) participants according to the data from all five measurement points. Mental health problems in childhood and adolescence (measured at baseline) predicted impaired health outcomes at 6-year and 11-year follow-ups. Approximately one out of four children with a diagnosed mental disorder was not undergoing mental health treatment. With its 11-year follow-up, the prospective longitudinal BELLA study provides new and solid data on mental health and well-being from childhood to adulthood in Germany, and these data are important for health promotion and prevention practices. These results are consistent with previous findings. Promising future analyses are planned.

4.
J Med Internet Res ; 21(11): e14947, 2019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31714252

RESUMO

BACKGROUND: The lack of continuity between health-related quality of life (HRQoL) instruments designed for children and adults hinders change analysis with a life course approach. To resolve this gap, EuroQol (EQ) developed the EQ-5D-Youth (EQ-5D-Y), derived from the EQ-5D for adults. Few studies have assessed the metric properties of EQ-5D-Y in children with specific chronic conditions, and none have done so for children with type I diabetes mellitus (T1DM). OBJECTIVE: This study aimed to evaluate the acceptability, validity, reliability, and responsiveness of the EQ-5D-Y in children and adolescents with T1DM, when administered online. METHODS: Participants with T1DM were consecutively recruited from July to December 2014, from a list of potential candidates aged 8-19 years, who attended outpatient pediatric endocrinology units. Before every quarterly routine visit, participants received an email/telephone reminder to complete the online version of two generic HRQoL questionnaires: EQ-5D-Y and KIDSCREEN-27. The EQ-5D-Y measures five dimensions, from which an equally weighted summary score was constructed (range: 0-100). Completion rate and distribution statistics were calculated. Construct validity was evaluated through known group comparisons based on general health, acute diabetic decompensations, mental health, family function, and a multitrait, multimethod matrix between EQ-5D-Y and KIDSCREEN by using Spearman correlations. Construct validity hypotheses were stated a priori. Reliability was assessed with the intraclass correlation coefficient and responsiveness by testing changes over time and calculating the effect size. Reliability and responsiveness were tested among the stable and improved subsamples defined by a KIDSCREEN-10 index change of <4.5 points or ≥4.5 points, respectively, from the first to the fourth visit. RESULTS: Of the 136 participants, 119 (87.5%) responded to the EQ-5D-Y at the last visit. The dimensions that showed higher percentages of participants with problems were "having pain/discomfort" (34.6%) and "worried/sad/unhappy" (28.7%). The mean (SD) of the EQ-5D-Y summary score was 8.5 (10.9), with ceiling and floor effects of 50.7% and 0%, respectively. Statistically significant HRQoL differences between groups defined by their general health (excellent/very good and good/regular/bad) and mental health (Strengths and Difficulties Questionnaire score ≤15 and >16, respectively) were found in three EQ-5D-Y dimensions ("doing usual activities," "having pain/discomfort," and "feeling worried/sad/unhappy"), summary score (effect size for general health and mental health groups=0.7 and 1.5, respectively), and KIDSCREEN-10 index (effect size for general health and mental health groups=0.6 and 0.9, respectively). Significant differences in the EQ-5D-Y dimensions were also found according to acute diabetic decompensations in "looking after myself" (P=.005) and according to family function in "having pain/discomfort" (P=.03). Results of the multitrait, multimethod matrix confirmed three of the four relationships hypothesized as substantial (0.21, 0.58, 0.50, and 0.46). The EQ-5D-Y summary score presented an intraclass correlation coefficient of 0.83. Statistically significant change between visits was observed in the improved subsample, with an effect size of 0.7 (P<.001). CONCLUSIONS: These results support the use of the EQ-5D-Y administered online as an acceptable, valid, reliable, and responsive instrument for evaluating HRQoL in children and adolescents with T1DM.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Qualidade de Vida/psicologia , Adolescente , Adulto , Criança , Doença Crônica , Feminino , Humanos , Internet , Masculino , Inquéritos e Questionários , Adulto Jovem
5.
Artigo em Alemão | MEDLINE | ID: mdl-31529184

RESUMO

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.


Assuntos
Doença Crônica/epidemiologia , Saúde Mental/estatística & dados numéricos , Qualidade de Vida , Adolescente , Saúde do Adolescente , Idoso , Criança , Saúde da Criança , Estudos Transversais , Feminino , Alemanha/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Inquéritos e Questionários
6.
BMC Psychiatry ; 19(1): 264, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477086

RESUMO

BACKGROUND: The terms affective dysregulation (AD) and irritability describe transdiagnostic dimensions and are characterized by an excessive reactivity to negative emotional stimuli with an affective (anger) and a behavioral component (aggression). Due to early onset, high prevalence and persistence, as well as developmental comorbidity, AD in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions. AD is especially prevalent in children in the youth welfare service. Despite continuous research, there remains a substantial need for diagnostic approaches and optimization of individualized treatment strategies in order to improve outcomes and reduce the subjective and economic burden. METHODS: The ADOPT (Affective Dysregulation - Optimizing Prevention and Treatment) Consortium integrates internationally established, highly experienced and interdisciplinary research groups. The work program encompasses (a) epidemiology, including prevalence of symptoms and disorders, (b) development and evaluation of screening and assessment tools, (c) stepped care approaches for clinically useful personalized medicine, (d) evaluation of an easily accessible and cost-effective online intervention as indicated prevention (treatment effects, moderation/mediation analysis), and (e) evaluation of an intensive personalized modular outpatient treatment in a cohort of children with AD who live with their parents and in a cohort of children with AD who live in out-of-home care (treatment effects, moderation/mediation analysis). DISCUSSION: The results will lead to significant recommendations for improving treatment within routine clinical care in two cohorts of children with AD and coexisting conditions, especially oppositional-defiant disorder, conduct disorder and disruptive mood dysregulation disorder. TRIAL REGISTRATION: Trial registration ADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963 . Registered 27 June 2018. Trial registration ADOPT Treatment: German Clinical Trials Register (DRKS) DRKS00013317 . Registered 27 September 2018. Trial registration ADOPT Institution: German Clinical Trials Register (DRKS) DRKS00014581 . Registered 04 July 2018.


Assuntos
Terapia Comportamental/métodos , Transtornos do Humor/prevenção & controle , Transtornos do Humor/terapia , Adolescente , Agressão , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/epidemiologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/prevenção & controle , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/terapia , Terapia Comportamental/economia , Criança , Comorbidade , Transtorno da Conduta/epidemiologia , Transtorno da Conduta/prevenção & controle , Transtorno da Conduta/terapia , Análise Custo-Benefício , Emoções , Feminino , Humanos , Masculino , Transtornos do Humor/epidemiologia , Pais/psicologia , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Artigo em Alemão | MEDLINE | ID: mdl-31440768

RESUMO

BACKGROUND: The basis for healthy development is established during the first years of one's life. In this early phase, parents can significantly influence the health conditions under which their child grows up. Parental education can play a key role in this regard. This study examines the association of maternal education with health and health behavior in infants. METHODS: A subsample of the representative German KiGGS study (Wave 1, 2009-2012) on the health of children and adolescents was investigated. Data from 1727 mothers who reported on health-specific characteristics of their infants (0 to 2 years), on their own educational background, and on characteristics of the family were analyzed. The influence of maternal education on indices of health and health behavior in infants was investigated by means of logistic regression; additional predictors were considered in regression models. RESULTS: Higher maternal education was associated with better health behavior, but not with overall infant health. The impact of maternal education on health behavior remained significant when considering other predictors (financial worries, low maternal age at childbirth, premature birth/low birth weight). Overall, low maternal education was accompanied by an accumulation of additional risks. CONCLUSIONS: Higher maternal education can help infants have a good start in their lives. The impact of poor health behavior on infant health may not become apparent until later in their lives. For prevention and intervention, it is important to identify sensitive stages of development during childhood and the underlying mechanisms of the relationship between maternal education and infant health behavior.


Assuntos
Escolaridade , Comportamentos Relacionados com a Saúde , Mães/educação , Criança , Feminino , Alemanha , Humanos , Lactente , Comportamento Materno , Pais , Gravidez
8.
J Pediatr Psychol ; 44(9): 1074-1082, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31233149

RESUMO

OBJECTIVE: To describe the development of the Patient-Reported Outcome Measurement Information System (PROMIS) Pediatric Meaning and Purpose item banks, child-report and parent-proxy editions. METHODS: Data were collected from two samples. The first comprised 1,895 children (8-17 years old) and 927 parents of children 5-17 years old recruited from an Internet panel, medical clinics, and schools. The second comprised a nationally representative sample of 990 children 8-17 years old and 1,292 parents of children 5-17 years old recruited from a different Internet panel. Item pool evaluation was done with Sample 1 and analyses were used to support decisions about item retention. The combined sample was used for item response theory (IRT) calibration of the item bank. Both samples were used in validation studies. RESULTS: Eleven items were deleted from the item pool because of poor psychometric performance. The final versions of the scales showed excellent reliability (>0.90). Short form scales (4 or 8 items) had a high degree of precision across over 4 SD units of the latent variable. The item bank positively correlated with extant measures of positive psychological functioning, and negatively correlated with measures of emotional distress, pessimism, and pain. Lower meaning and purpose scores were associated with adolescence and presence of a special healthcare need. CONCLUSION: The PROMIS Pediatric Meaning and Purpose item banks and their short forms are ready for use in clinical research and practice. They are measures of children's eudaimonic well-being and indicative of children's hopefulness, optimism, goal-directedness, and feelings that life is worth living.


Assuntos
Bem-Estar da Criança , Esperança , Otimismo/psicologia , Satisfação Pessoal , Qualidade de Vida/psicologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pais/psicologia , Medidas de Resultados Relatados pelo Paciente , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
9.
Qual Life Res ; 28(7): 1725-1750, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055778

RESUMO

PURPOSE: This meta-analytic review aimed to estimate the magnitude of health-related quality of life (HrQoL) impairments, as assessed by the KIDSCREEN questionnaires, both self- and parent-reported, in 8- to 18-years-old children/adolescents with chronic health conditions. METHODS: To identify studies using the KIDSCREEN questionnaires, three electronic databases (PubMed, PsycINFO, EBSCOhost Psychology & Behavioral Sciences) were searched. The final search (February 14-15, 2018) revealed 528 non-duplicated articles, of which 23 papers (21 studies) directly compared the HrQoL of pediatric patients to community/healthy controls and were included in the meta-analysis. Pooled mean differences (MD) with 95% CIs were estimated using the inverse-variance random-effects method. RESULTS: Of the 21 studies, 16 used self-reports, one used parent-reports and four adopted a multi-informant approach. Self-reported data were retrieved from 20 studies (4852 cases/28,578 controls), and parent-reported data were retrieved from four studies (511 cases/433 controls). Pediatric patients presented significant HrQoL impairments in the domains of physical well-being (MD = - 4.84, 95% CI - 6.44/- 3.24 for self-reports; MD = - 6.86, 95% CI - 10.42/- 3.29 for parent-reports) and peers and social support (MD = - 1.29, 95% CI - 2.25/- 0.34 for self-reports; MD = - 3.90, 95% CI - 5.28/- 2.52 for parent-reports), compared to community/healthy peers. Between-studies heterogeneity was explained by diagnostic categories, instrument version and informants. CONCLUSIONS: The identification of significant HrQoL impairments among pediatric patients, specifically in the physical and social domains, highlights the importance of routine psychosocial assessment and intervention in primary pediatric healthcare services. Specific recommendations include the use of profile measures, both self- and parent-reports, and the prioritization of oncology, endocrinology and neurology services.


Assuntos
Doença Crônica/psicologia , Nível de Saúde , Grupo Associado , Qualidade de Vida/psicologia , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Humanos , Pais/psicologia , Autorrelato , Apoio Social , Inquéritos e Questionários
10.
PLoS One ; 14(3): e0214412, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30908550

RESUMO

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood worldwide, and causes significant impairments in overall functioning. In order to develop effective prevention and intervention programs, knowledge of the determinants that have an impact on the onset and development of ADHD symptoms is essential. So far, little is known about factors affecting ADHD symptoms in children and adolescents over time. Therefore, this study investigates potential psychosocial risk and protective factors for ADHD symptoms based on cross-sectional and longitudinal data of a German population-based study. METHODS: Data on children and adolescents (n = 1,384 aged 11 to 17 years) were collected at three measurement points (baseline, 1-year and 2-year follow-ups) covering a period of two years. We used latent growth modelling to investigate effects of parental mental health problems (risk factor) and self-efficacy, family climate and social support (protective factors) on symptoms of ADHD based on cross-sectional as well as longitudinal data. Sociodemographic factors, pre- and postnatal factors, and comorbid symptoms of internalizing and externalizing mental health problems were considered as covariates. RESULTS: At baseline, male gender, younger age, stronger aggressive behavior, and stronger parental mental health problems were related to more ADHD symptoms. Longitudinal analyses showed that female gender, migration status, increasing symptoms of generalized anxiety, increasing aggressive behavior and increasing parental mental health problems were associated with stronger increase of ADHD symptoms over time. However, improving family climate was related to decreasing ADHD symptoms over time. We further found moderator effects for social support. CONCLUSION: The findings of the study provide important information concerning risk and protective factors in the context of ADHD. Hence, the results may be integrated into the planning and implementation of future prevention and early intervention strategies that target affected children and adolescents.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Pais/psicologia , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Saúde Mental , Fatores de Proteção , Autoeficácia , Apoio Social
11.
PLoS One ; 14(3): e0213700, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30865713

RESUMO

AIM: Children and adolescents with low socioeconomic status (SES) suffer from mental health problems more often than their peers with high SES. The aim of the current study was to investigate the direct and interactive association between commonly used indicators of SES and the exposure to stressful life situations in relation to children's mental health problems. METHODS: The prospective BELLA cohort study is the mental health module of the representative, population-based German National Health Interview and Examination Survey for children and adolescents (KiGGS). Sample data include 2,111 participants (aged 7-17 years at baseline) from the first three measurement points (2003-2006, 2004-2007 and 2005-2008). Hierarchical multiple linear regression models were conducted to analyze associations among the SES indicators household income, parental education and parental unemployment (assessed at baseline), number of stressful life situations (e.g., parental accident, mental illness or severe financial crises; 1- and 2-year follow-ups) and parent-reported mental health problems (Strength and Difficulties Questionnaire; 2-year follow-up). RESULTS: All indicators of SES separately predicted mental health problems in children and adolescents at the 2-year follow-up. Stressful life situations (between baseline and 2-year follow-up) and the interaction of parental education and the number of stressful life situations remained significant in predicting children's mental health problems after adjustment for control variables. Thereby, children with higher educated parents showed fewer mental health problems in a stressful life situation. No moderating effect was found for household income and parental employment. Overall, the detected effect sizes were small. Mental health problems at baseline were the best predictor for mental health problems two years later. CONCLUSIONS: Children and adolescents with a low SES suffer from multiple stressful life situations and are exposed to a higher risk of developing mental health problems. The findings suggest that the reduction of socioeconomic inequalities and interventions for families with low parental education might help to reduce children's mental health problems.


Assuntos
Inquéritos Epidemiológicos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Classe Social , Estresse Psicológico , Adolescente , Distribuição por Idade , Criança , Família , Feminino , Alemanha/epidemiologia , Humanos , Renda , Estudos Longitudinais , Masculino , Transtornos Mentais/psicologia , Saúde Mental , Pais/psicologia , Pobreza , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
12.
Front Pediatr ; 7: 17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30805321

RESUMO

Introduction: The improvement-or at least maintenance-of health-related quality of life (HRQoL) in children and adolescents is one of the main aims of chronic disease care. This study examines HRQoL of children and adolescents with three different chronic conditions (i.e., diabetes mellitus, asthma, juvenile arthritis) using the computer-adaptive test Kids-CAT, comprising five HRQoL domains: physical well-being, psychological well-being, parent relations, social support and peers, and school well-being. Further, associations between HRQoL and distinct clinical data and medical assessments are investigated to explore how much variability of the five domains can be explained by these variables. Methods: Cross-sectional data of the Kids-CAT study was analyzed. The Kids-CAT was used in two outpatient clinics in northern Germany gathering data on self-reported HRQoL in n = 309 children and adolescents aged 7-17 years. Additionally, general patient information, clinical data, and pediatrician-reported medical assessments were measured. Multiple regression analyses were conducted to explore associations between HRQoL and selected variables (i.e., disease duration, co-morbidity, disease control, overall health status). Results: Overall, self-reported HRQoL in all five domains were comparable to data of an age- and sex-matched reference population. Results of regression analyses indicated that the investigated variables only minimally explain variance in the five Kids-CAT domains. Sociodemographic, clinical data, and medical assessments explained 18.4% of the variance in physical well-being, 10.7% in psychological well-being, and < 10% of the variance in parent relations, social support and peers, and school well-being. Conclusion: Sociodemographic data, disease duration, co-morbidity, and medical assessments, such as disease control or pediatrician-assessed overall health status show low association with HRQoL of children and adolescents with chronic conditions. Data on self-reported HRQoL delivers valuable information on children's well-being and can improve healthcare professionals' understanding of the subjective well-being of their young patients. The implementation of tools like the Kids-CAT can facilitate the identification of potential problem areas, which should enable healthcare professionals to better address specific healthcare needs. Clinical Trial Registration: identifier: DRKS00006326 (retrospectively registered); Date of registry: August 1st, 2014.

13.
Front Pediatr ; 7: 566, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32039122

RESUMO

Introduction: To achieve optimized blood glucose concentrations (assessed by HbA1c) and high health-related quality of life (HRQL), children and adolescents with diabetes mellitus type 1 (T1DM) must follow strict disease management strategies. This study aims to investigate HRQL of children and adolescents with T1DM and its association with HbA1c values over the course of 6 months. Methods: Patients aged 7-17 years (n = 203) with T1DM provided HRQL data on a monthly basis. HRQL was measured using the Kids-CAT, a computer-adaptive test (CAT) comprising five generic HRQL domains. HbA1c concentrations were assessed at baseline, at 3 and 6 months. We explored the trajectory of HRQL at the domain level using linear mixed effects models. Further, we investigated the association between HRQL and HbA1c concentrations over time using path analysis models. Results: Children and adolescents with T1DM reported high scores across all HRQL domains over time. However, those with an HbA1c concentrations of >9.0% reported significantly lower scores in physical well-being and parent relations compared with those with an HbA1c concentration of <7.5%. Path analysis models revealed a minimal temporal relationship between HbA1c and HRQL, with a small negative impact of HbA1c on physical well-being, psychological well-being and parent relations. Conclusion: Although observed HRQL of young patients with T1DM was comparable to age-related German-speaking reference population over the course of 6 months, those with an HbA1c concentration >9.0% reported lower scores in selected HRQL domains. Thus, special attention should be drawn to HRQL of children and adolescents with higher HbA1c concentrations. The minimal relationship between HbA1c and HRQL indicates that the two therapy goals, i.e., achievement and maintenance of glycemic targets and high HRQL, should be considered and evaluated independently in clinical routine. Trial Registration: DRKS00006326 (German Clinical Trial Register), date of registration: August 1st, 2014.

14.
Health Qual Life Outcomes ; 16(1): 85, 2018 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-29720193

RESUMO

BACKGROUND: This study examined the reliability and validity of the Japanese versions of the DISABKIDS-37 generic modules, a tool for assessing the health-related quality of life (HRQOL) of children and adolescents with a chronic condition. METHODS: The study was conducted using a sample of 123 children/adolescents with a chronic medical condition, aged 8-18 years, and their parents. Focus interviews were performed to ensure content validity after translation. The classical psychometric tests were used to assess reliability and scale intercorrelations. The factor structure was examined with confirmatory factor analysis (CFA). Convergent validity was assessed by the correlation between the total score and the sub-scales of DISABKIDS-37 as well as the total score of KIDSCREEN-10. RESULTS: Both the children/adolescent and parent versions of the score showed good to high internal consistency, and the test-retest reliability correlations were r = 0.91 or above. The CFA revealed that the modified models for all domains were better fit than the original 37 item scale model for both self-report and proxy-report. Moderate to high positive correlations were found for the associations within DISABKIDS-37 sub-scales and between the subscales and total score, except for the treatment sub-scale, which correlated weakly with the remaining sub-scales. The total score of the child-reported version of KIDSCREEN-10 correlated significantly and positively with the total score and all the sub-scales of the child-reported version of DISABKIDS-37 except the Treatment sub-scale in adolescents. CONCLUSIONS: The modified models of Japanese version of DISABKIDS generic module were psychometrically robust enough to assess the HRQOL of children with a chronic condition.


Assuntos
Doença Crônica/psicologia , Qualidade de Vida , Autorrelato/normas , Adolescente , Criança , Análise Fatorial , Feminino , Humanos , Japão , Masculino , Pais/psicologia , Psicometria , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Traduções
15.
Z Kinder Jugendpsychiatr Psychother ; 46(6): 523-533, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29846123

RESUMO

OBJECTIVE: This study served to establish German norms for the Strengths and Difficulties Questionnaire self-report (SDQ-S) by using data from a representative epidemiological sample from the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS study). Although the German version of the SDQ has been widely used and normative data for the parent version (SDQ-P) exist, no German norms for the self-report version have been reported, so that practitioners had to rely on the available British norms. In addition, we investigated whether sex- and age-specific norms are necessary. METHODS: At the baseline of the KiGGS study, SDQ-S ratings were collected from n = 6,726 children and adolescents between 11 and 17 years (n = 3,440 boys und n = 3,286 girls). We assessed the internal consistency and age/sex effects of the SDQ-S. Confirmatory factor analysis was conducted to assess the factor structure of the SDQ-S. Banding scores were developed to differentiate children and adolescents with levels of difficulties and categorized them as "normal," "borderline," and "abnormal." General as well as age- and sex-specific bandings were created for both total score and subscales of SDQ-S. In addition, the German norms of the SDQ-S were compared with those of the UK, Norway, and Thailand. RESULTS: The five-factor solution of the SDQ-S (including Emotional symptoms, Conduct problems, Hyperactivity/Inattention, Peer problems, and Prosocial behavior) provided a satisfactory fit to the data. Moderate internal consistencies (Cronbach's α) were observed for the scales Emotional symptoms, Hyperactivity/Inattention, and Total difficulties score, whereas insufficient internal consistency was found for the scales Peer problems and Conduct problems. However, using McDonald's ω as a more appropriate measure of homogeneity, internal consistencies were found to be satisfactory for all subscales and for Total difficulties. Normative banding scores were established conservatively to avoid producing too many false positives in the category "abnormal." In line with previous research, girls showed more emotional problems but fewer Peer problems than boys. German normative bandings of SDQ-S were similar to the original British bandings and those of other countries. CONCLUSIONS: This study of the German SDQ-S in a large representative epidemiological sample presents evidence of partly moderate to good psychometric properties. It also supports the usefulness of SDQ-S as an effective and efficient instrument for child and adolescent mental health problems in Germany. German normative banding scores of SDQ-S established in this study were comparable with the original British norms as well as with those of other countries, so that SDQ-S can be recommended as a psychopathological broadband-screening tool.


Assuntos
Sintomas Afetivos/diagnóstico , Sintomas Afetivos/epidemiologia , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/epidemiologia , Determinação da Personalidade/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Sintomas Afetivos/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Transtornos do Comportamento Infantil/psicologia , Transtorno da Conduta/diagnóstico , Transtorno da Conduta/epidemiologia , Transtorno da Conduta/psicologia , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Valores de Referência , Autorrelato
16.
J Happiness Stud ; 19(3): 699-718, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29760578

RESUMO

Objective: The purpose of this study is to describe the psychometric evaluation and item response theory calibration of the PROMIS Pediatric Positive Affect item bank, child-report and parent-proxy editions. Methods: The initial item pool comprising 53 items, previously developed using qualitative methods, was administered to 1,874 children 8-17 years old and 909 parents of children 5-17 years old. Analyses included descriptive statistics, reliability, factor analysis, differential item functioning, and construct validity. A total of 14 items were deleted, because of poor psychometric performance, and an 8-item short form constructed from the remaining 39 items was administered to a national sample of 1,004 children 8-17 years old, and 1,306 parents of children 5-17 years old. The combined sample was used in item response theory (IRT) calibration analyses. Results: The final item bank appeared unidimensional, the items appeared locally independent, and the items were free from differential item functioning. The scales showed excellent reliability and convergent and discriminant validity. Positive affect decreased with children's age and was lower for those with a special health care need. After IRT calibration, we found that 4 and 8 item short forms had a high degree of precision (reliability) across a wide range of the latent trait (>4 SD units). Conclusion: The PROMIS Pediatric Positive Affect item bank and its short forms provide an efficient, precise, and valid assessment of positive affect in children and youth.

17.
Soc Sci Med ; 202: 170-178, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29554584

RESUMO

RATIONALE: Mental health problems in children and adolescents are widespread and are a primary public health concern worldwide. During childhood and adolescence different challenges must be met. Whether the corresponding developmental tasks can be mastered successfully and in a psychologically healthy manner depends on the availability of resources. OBJECTIVE: The aim of the current study was to examine the benefits of maternal education on the development of mental health in children and adolescents. METHOD: Data from 2810 participants (48.7% female, 7- to 19-years old) of the longitudinal BELLA study (mental health module of the representative German KiGGS study) were analyzed from up to four measurement points (2003-2012). Individual growth modeling was employed to estimate the benefits of maternal education (Comparative Analysis of Social Mobility in Industrial Nations, CASMIN) for the trajectories of mental health problems (parent-reported Strengths and Difficulties Questionnaire, SDQ) in children and adolescents. RESULTS: Children of mothers with low education had significantly more mental health problems compared to children of mothers with high education. This difference due to maternal education applied for girls as well as boys and especially for participants who did not live with both biological parents. Further, the difference in mental health problems due to varying maternal education decreased with increasing age of the participants. CONCLUSION: Prevention programs should focus on children of mothers with lower education who additionally live in single- or step-parent families as a high-risk group. Knowledge of the underlying mechanism between education and mental health is highly important.


Assuntos
Escolaridade , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , Adolescente , Criança , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Adulto Jovem
18.
Qual Life Res ; 27(4): 879-890, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29189988

RESUMO

PURPOSE: Health-related quality of life (HRQoL) is an important patient-reported outcome in clinical and health research. The EQ-5D-Y assesses child and adolescent HRQoL by five items on mobility, self-care, usual activities, pain/discomfort, and anxiety/depression as well as a visual analogue scale (VAS) on the current health state. This study investigates predictors of self-reported HRQoL according to the EQ-5D-Y in chronically ill children and adolescents using longitudinal data. METHODS: Data from the German Kids-CAT study on children and adolescents with asthma, diabetes, and juvenile arthritis gathered over a period of six months were analyzed (n = 310; 7-17 years old; 48% female). Self-, parent-, and pediatrician-reported data were collected from June 2013 to October 2014. Generalized linear mixed models and linear mixed models served to examine effects of socio-demographic as well as disease- and health-specific predictors on the items as well as on the VAS of the EQ-5D-Y. RESULTS: Ceiling effects for the EQ-5D-Y indicated low burden of disease in the analyzed sample. Longitudinal analyses revealed associations between less health complaints and better HRQoL for all investigated HRQoL domains. Further, age- and gender-specific effects, and associations of better disease control, longer duration of the disease and less mental health problems with better HRQoL were found. CONCLUSIONS: Subjective health complaints and mental health problems should be considered in the care of children and adolescents with asthma, diabetes, and juvenile arthritis. Future research should suggest administering the items of the EQ-5D-Y with five instead of three response options, and investigate HRQoL over a longer period.


Assuntos
Artrite Juvenil/psicologia , Asma/psicologia , Diabetes Mellitus/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Autorrelato/normas , Adolescente , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários
19.
Eur Child Adolesc Psychiatry ; 27(7): 867-876, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29177564

RESUMO

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


Assuntos
Filho de Pais Incapacitados/psicologia , Saúde Mental/tendências , Pais/psicologia , Adolescente , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Fatores de Proteção , Fatores de Risco
20.
Qual Life Res ; 27(1): 217-234, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28828568

RESUMO

PURPOSE: To describe the psychometric evaluation and item response theory calibration of the PROMIS Pediatric Life Satisfaction item banks, child-report, and parent-proxy editions. METHODS: A pool of 55 life satisfaction items was administered to 1992 children 8-17 years old and 964 parents of children 5-17 years old. Analyses included descriptive statistics, reliability, factor analysis, differential item functioning, and assessment of construct validity. Thirteen items were deleted because of poor psychometric performance. An 8-item short form was administered to a national sample of 996 children 8-17 years old, and 1294 parents of children 5-17 years old. The combined sample (2988 children and 2258 parents) was used in item response theory (IRT) calibration analyses. RESULTS: The final item banks were unidimensional, the items were locally independent, and the items were free from impactful differential item functioning. The 8-item and 4-item short form scales showed excellent reliability, convergent validity, and discriminant validity. Life satisfaction decreased with declining socio-economic status, presence of a special health care need, and increasing age for girls, but not boys. After IRT calibration, we found that 4- and 8-item short forms had a high degree of precision (reliability) across a wide range (>4 SD units) of the latent variable. CONCLUSIONS: The PROMIS Pediatric Life Satisfaction item banks and their short forms provide efficient, precise, and valid assessments of life satisfaction in children and youth.


Assuntos
Pais/psicologia , Satisfação Pessoal , Procurador/psicologia , Psicometria/métodos , Qualidade de Vida/psicologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Inquéritos e Questionários
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