[The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): risks and resources for the mental development of children and adolescents]

Eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic

Background

Disordered eating is highly prevalent among children and adolescents. Since the outbreak of the COVID-19 pandemic, hospitalizations due to eating disorders have peaked and overweight has risen. The aim of this study was to determine differences in the prevalence of eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic and to identify associated factors.

Materials and methods

Eating disorder symptoms and associated factors were examined in a sample of n = 1,001 participants of the nationwide population-based COPSY study in autumn 2021. Standardized and validated instruments were used to survey 11-17-year-olds along with a respective parent. To identify differences in prevalence rates, logistic regression was used to compare results with data from n = 997 participants of the prepandemic BELLA study. Multiple logistic regression analyses were performed to examine associations with relevant factors in the pandemic COPSY sample.

Results

Eating disorder symptoms were reported by 17.18% of females and 15.08% of males in the COPSY study. Prevalence rates were lower overall in the COPSY sample compared to before the pandemic. Male gender, anxiety, and depressive symptoms were associated with increased odds for eating disorder symptoms in the pandemic.

Conclusion

The pandemic underscores the importance of further research, but also prevention and intervention programs that address disordered eating in children and adolescents, with a focus on age - and gender-specific differences and developments. In addition, screening instruments for eating disorder symptoms in youths need to be adapted and validated.

Experiencing Violence among Children and Adolescents with Depression in the Aspect of Polish Law

Violence is not uncommon in the contemporary world. The consequences of harmful experiences in childhood are often educational problems, difficult behavior, failure to cope in adulthood, duplication of learned, negative behavior patterns and disorders in various spheres/areas of life. The experience of childhood violence is associated with the occurrence of about half of mental disorders with onset in childhood and one third of disorders that appear later in life. Various emotional and behavioral disorders are mentioned among the psychological effects of violence against a child, including depressive disorders. Regarding experiences of violence, there is strong evidence that exposure to sexual or physical violence is a predictor of depressive episodes and depressive symptoms in adolescents. Among adolescents, the impact of violence on depression has been shown to be sustained. Accordingly, evidence suggests that elevated depressive symptoms and episodes of depression may even persist for up to two years after experiencing cases of violence. Due to the destructive consequences of such behavior, international and national law devote much attention to the protection of children's rights. Under Polish law, there are regulations describing measures of reaction within the family, as well as provisions sanctioning violent behavior. Therefore, the study discusses the family and criminal law aspects of violence against minors. The whole study is imbued with considerations of the so-called the obligation to denounce, i.e., to notify about the disclosure of a prohibited act committed to the detriment of minors. This issue was presented in the context of medical secrets and its type-psychiatric discretion.

Overestimation and underestimation of youths' health-related quality of life are associated with youth and caregiver positive screens for depression: results of a population-based study among youths with longstanding type 1 diabetes

BACKGROUND

This study aimed to analyze the extent and direction of disagreement between self- and proxy-reported quality of life (QoL) and the factors associated with QoL overestimation and underestimation by caregivers compared with self-reports.

METHODS

This study used data from population-based questionnaire surveys conducted in 2012-2013 and 2015-2016 with 11- to 17-year-olds with a duration of type 1 diabetes of 10 years or longer and their caregivers (n = 1058). QoL in youth was assessed via 10-item KIDSCREEN (KIDSCREEN-10) self- and proxy-reported questionnaires. The scores ranged from 0 to 100, with higher scores indicating better QoL. Depression screening was performed via the Center for Epidemiological Studies Depression Scale for Children for youths (CES-DC screen positive: score > 15) and WHO-5 Well-being Index for parents/caregivers (WHO-5 screen positive: score ≤ 50).

RESULTS

The mean self- and proxy-reported normalized KIDSCREEN-10 scores were 64.2 (standard deviation [SD] 11.4) and 66.1 (11.5), respectively. More caregivers overestimated (self-reported minus proxy-reported score < - 0.5*SD self-reported score) than underestimated (self-reported minus proxy-reported score > 0.5*SD self-reported score) youths' QoL (37% versus 23%, p < 0.001). Youths who screened positive for depression (18%) were at higher risk of their QoL being overestimated and lower risk of their QoL being underestimated by caregivers than youths who screened negative for depression (RR_{Overestimation} 1.30 [95% CI 1.10-1.52], RR_{Underestimation} 0.27 [0.15-0.50]). Caregivers who screened positive for depression (28%) overestimated the QoL of their children less often and underestimated the QoL of their children more often than caregivers who screened negative for depression (RR_{Overestimation} 0.73 [0.60-0.89], RR_{Underestimation} 1.41 [1.14-1.75]).

CONCLUSIONS

Caregivers often over- or underestimated their children's QoL. Positive screens for depression among both youths and caregivers contributed to the observed differences between self- and caregiver-reported QoL.

Screening for generalized anxiety disorder (GAD) and associated factors in adolescents and young adults with type 1 diabetes: Cross-sectional results of a Germany-wide population-based study

AIMS

The aims of this study were to screen 14- to 30-year-olds with early-onset type 1 diabetes for generalized anxiety disorder (GAD) and to compare the characteristics of the study participants who had a positive result for GAD with those who had a negative result.

METHODS

This study used data from a questionnaire survey conducted from 2018 to 2019. The GAD-7 questionnaire was used to screen for GAD (positive: GAD-7 score ≥ 10). All regression analyses were adjusted for age, sex, depression diagnosis and considered multiple testing.

RESULTS

The 713 participants had a mean GAD-7 score of 4.32 (SD 4.18). A total of 12% of the study population (10% of adolescents, 13% of adults) was screened positive for GAD. Positive screening results were associated with impairments in various domains, such as self-assessed physical performance (RR _{poor versus good} 3.03 [95% CI 1.85-4.96]), difficulty falling asleep (RR _{≥3 times/week versus not during the last 4 weeks} 5.36 [2.86-10.07]), glycemic control (RR _{HbA1c per 1%} 1.16 [1.03-1.31]), and diabetes treatment satisfaction (RR _{poor versus good} 2.67 [1.43-5.00]).

CONCLUSIONS

Diabetologists should be aware that adolescents and young adults with GAD symptoms might experience extensive impairments in their daily lives.

Well-Being and Resources of Minors With Refugee Background in Comparison to Minors With Migration or Native Background

Abstract. Background: Studies on the health of minors with refugee background (RM) often focus on symptoms and risks. In contrast to these deficit-oriented approaches, the present study examined well-being and resources of RM. Aims: The aim was to get an overview of the extent to which RM differ from both minors with migration (MM) as well as native (NM) background regarding well-being and resources. In addition, the study sought to identify resources of RM that are significant for well-being. General personal and social resources, religious identity and practice as well as multicultural resources (bilingualism, ethnic identity) were examined. Method: The study was conducted in Germany with minors aged 8–16 years. RM ( n = 209), MM ( n = 535) and NM ( n = 858) completed questionnaires. Comparative analyses and multiple regression analyses were computed. Results: RM showed lower well-being and fewer social resources than MM and NM. For personal resources, the group differences were less consistent. Personal and social resources predicted the well-being of minors. While multicultural resources were not significant, especially the resources sense of coherence, integration into peer group, and religious identity positively predicted the well-being of RM. Limitations: The group of MM is very heterogeneous. Further studies should differentiate the group of MM more precisely. Conclusion: The differences in well-being among RM, MM and NM can largely be explained by differences in resources. Religious identity is an important available resource for RM. Sense of coherence and integration into peer groups should be given special attention in health promotion for RM.

Risks and Resources for Depressive Symptoms and Anxiety in Children and Adolescents During the COVID-19 Pandemic - Results of the Longitudinal COPSY Study

BACKGROUND

Mental health during the COVID-19 pandemic is of particularly high relevance. Especially for children and adolescents, the pandemic and its restrictions represent a significant burden. The present study aims to identify risks and resources for depressive symptoms and anxiety in children and adolescents during the pandemic in Germany.

MATERIALS AND METHODS

Self-reported data from the first wave of the longitudinal COVID-19 and Psychological Health (COPSY) study were used to investigate risks and resources among n = 811 children and adolescents aged 11-17 years. Depressive symptoms and anxiety were measured at the first follow-up 6 months later. Multivariate linear regression analyses were performed to investigate the effects of risks and resources on depressive symptoms and anxiety.

RESULTS

Parental depressive symptoms predicted depressive symptoms and anxiety in children and adolescents 6 months later. Female gender was identified as a risk factor for anxiety during the pandemic. None of the potential resources were associated with depressive symptoms or anxiety at the follow-up.

CONCLUSION

The findings provide evidence of risk factors for depressive symptoms and anxiety during the COVID-19 pandemic. Children and adolescents who face risk factors need to be identified early and monitored during the pandemic. Family-based intervention programs are needed to help vulnerable children and adolescents cope with the challenges of the pandemic.

Mental health issues in childhood and adolescence, psychosocial resources and socioeconomic status - An analysis of the KiGGS Wave 2 data

Mental health burdens are among the most common health issues in childhood and adolescence. Psychosocial resources can act as protective factors and can help in preventing the development and reduce the symptoms of mental health issues. This article discusses this relationship and the availability of these resources within the three different social status groups among 11- to 17-year-olds. The database is the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). Mental health issues were assessed via the Strengths and Difficulties Questionnaires; psychosocial resources via self-reported personal, family and social resources; social status was ascertained through a multidimensional index based on the information provided by parents on education, occupational status and income. The analyses show that 11- to 17-year-olds who have psychosocial resources are less likely to show mental health issues (independent of their social status) and that, compared to high social status, mental health issues are more frequently associated with low social status. Children from (socially) worse-off families have less access to resources. The results consequently highlight the importance of prevention and health promotion measures directed at strengthening resources. Focusing such measures on the needs of disadvantaged population groups should contribute to health equity.

Association between Physical Activity and Sleep Difficulties among Adolescents in Germany: The Role of Socioeconomic Status

We examined sleep difficulties among adolescents in Germany and the association with physical activity (PA). Furthermore, we analyzed whether the association varied with the socioeconomic status (SES) among adolescent girls and boys in Germany. Using data from the German Health Interview Examination Survey for Children and Adolescents (KiGGS) study (Wave 2), 6599 adolescents aged 11 to 17 years were included in the analyses. We conducted sex-stratified logistic regression analyses. Dependent variables were unrecommended sleep duration (defined as a duration of sleep that does not meet the recommended duration), sleep-onset difficulties, trouble sleeping, and daytime sleepiness. Most adolescent girls and boys reported sleep difficulties. While no associations between PA and sleep difficulties were observed, a significant interaction between PA and SES was found for sleep duration in boys and daytime sleepiness in girls. Thus, adolescents with low SES had fewer sleep difficulties if they met the recommendation for PA, compared with those in other SES groups. In Germany, a large proportion of adolescents have sleep difficulties. We found that the experience of sleep difficulties varied according to PA, sex, and the family SES. Future sleep promotion programs should consider these differences.

Associations between Parenting Style and Mental Health in Children and Adolescents Aged 11-17 Years: Results of the KiGGS Cohort Study (Second Follow-Up)

Few studies from Germany have investigated the associations between parenting style and children's and adolescents' health. Little attention has been directed to whether these associations vary with familial socioeconomic or migration status. The aim of this analysis was to investigate the association between parenting style and the mental health of children and adolescents aged 11-17 years using data from the KiGGS cohort study (second follow-up). We calculated mean Strengths and Difficulties Questionnaire (SDQ) total difficulties scores stratified by parenting style (authoritative, permissive, demanding-controlling, emotional distancing). Linear regression analyses adjusted for age, gender, socioeconomic status, migration status, and family status were performed. We also analyzed moderating effects of socioeconomic and migrations status on associations between parenting style and SDQ scores. There were only small differences between the permissive and the authoritative parenting styles. Significantly higher mean scores were observed for the demanding-controlling and emotional distancing styles for both the mother and father. These associations persisted after full adjustment and did not vary by socioeconomic or migration status. Parenting behavior is an important predictor of children's and adolescents' mental health. The promotion of good relationships within families and improving parenting skills offer promising approaches for health promotion in young people.

[Psychological Problems in Children and Adolescents for whom Children's Services Department was Utilized]

Psychological Problems in Children and Adolescents for whom Children's Services Department was Utilized Previous research proved a greater prevalence of mental health problems among children in residential youth care. In the present study, based on the KiGGS study, the prevalence of mental health problems is analyzed using the German version of the Strengths and Difficulties Questionnaire (SDQ) for those children and adolescents seeking youth welfare services, compared to those children not seeking youth welfare service. The possible differences between these two groups were tested using multivariate regression. The study covers two survey periods of KiGGS at intervals of six years. The result shows a significantly higher prevalence for mental health problems in adolescents seeking youth welfare services. The regression analysis shows that the association with mental health problems in these children persists even after adjusting for socioeconomic and demographic factors. There are hardly any changes in the results within the trend analysis. This indicates a high temporal stability of the association.

[Prevention reporting-a new impetus for health reporting?]

In 2015 the "Act to Strengthen Health Promotion and Prevention" (German Prevention Act) was passed. This act stipulates reporting on its implementation and impact by means of a regular prevention report by the National Prevention Conference. It also furthers prevention reporting at the regional level in the federal states. There are varying approaches and concepts of prevention reporting.The first prevention report by the National Prevention Conference was published in 2019. In the federal states, prevention reporting develops in different ways and at different rates, mirroring the heterogeneous conditions and concepts at the local level. This includes a varied interpretation of the relation of health reporting to prevention reporting: some see prevention reporting as part of health reporting, others tend not to and focus on aspects like the reporting of prevention structures and interventions.Challenges for the future of prevention reporting include the development of indicators and identification of data sources, particularly regarding resources for health, structural aspects, and living conditions. Further tasks are the development of feasible approaches to survey and report prevention interventions as well as the attempt to report outcomes and effects within causal models instead of merely reporting inputs and outputs.In conclusion, the dynamic induced by the German Prevention Act serves as a stimulus to health reporting-with a view to its contents, methods and policy relevance. Research to accompany and support the development of prevention reporting would be highly desirable.

Psychosocial stressors and protective factors for major depression in youth: evidence from a case-control study

BACKGROUND

Severe adverse life events, such as traumatic experiences, are well-known stressors implicated in (youth) major depression (MD). However, to date, far less is known about the role of more common psychosocial stressors in the context of MD, which are part of everyday life during youth. In addition, it is not well-understood whether and how distinct stressors interact with protective factors in youths diagnosed with MD. Thus, the present study aimed at examining several specific psychosocial stressors implicated in a first-episode juvenile MD and addressed the question whether protective factors might moderate the relationship between stressors and a diagnosis of MD.

METHODS

One-hundred male and female youths with MD and 101 typically developing (TD) controls (10-18 years) were included. A large number of qualitatively different psychosocial stressors occurring in various areas of life were assessed via self-report. Moreover, we also investigated sociodemographic and pre- and postnatal stressors, as well as the presence of familial affective disorders via parental-report. Social support and a positive family climate were conceptualized as protective factors and were assessed via self-report.

RESULTS

Results showed that the proportion of youths experiencing specific psychosocial stressors was higher in the MD than in the TD group. In particular, the proportion of youths indicating changes at home or at school, experiences of violence, delinquent behavior, as well as the proportion of youths who were exposed to sociodemographic stressors was higher in the MD than in the TD group. Moreover, the percentage of youths with a family history of an affective disorder, or whose mothers experienced psychological burdens during/after pregnancy was elevated in the MD group. Youths with MD experienced less social support and a less positive family climate than their TD peers. These factors, however, did not buffer the influence of specific stressors on MD.

CONCLUSION

We could show that next to more severe adverse life events, more common psychosocial stressors are linked to youth MD. Importantly, by identifying distinct stressors in youth MD, our results can increase treatment and prevention efforts aiming to improve the outcomes in youths affected by MD or in at-risk individuals.

Social inequalities in the participation and activity of children and adolescents with leukemia, brain tumors, and sarcomas (SUPATEEN): a protocol for a multicenter longitudinal prospective observational study

Background

About 2000 children and adolescents under the age of 18 are diagnosed with cancer each year in Germany. Because of current medical treatment methods, a high survival rate can be reached for many types of the disease. Nevertheless, patients face a number of long-term effects related to the treatment. As a result, physical and psychological consequences have increasingly become the focus of research in recent years. Social dimensions of health have received little attention in health services research in oncology so far. Yet, there are no robust results that allow an estimation of whether and to what extent the disease and treatment impair the participation of children and adolescents and which factors mediate this effect. Social participation is of great importance especially because interactions with peers and experiences in different areas of life are essential for the development of children and adolescents.

Methods

Data are collected in a longitudinal, prospective, observational multicenter study. For this purpose, all patients and their parents who are being treated for cancer in one of the participating clinics throughout Germany will be interviewed within the first month after diagnosis (t1), after completion of intensive treatment (t2) and half a year after the end of intensive treatment (t3) using standardized questionnaires. Analysis will be done by descriptive and multivariate methods.

Discussion

The results can be used to identify children and adolescents in high-risk situations at an early stage in order to be able to initiate interventions tailored to the needs. Such tailored interventions will finally reduce the risk of impairments in the participation of children and adolescents and increase quality of life.

Trial registration

ClinicalTrials.gov: NCT04101123.

Mental health problems and school performance in first graders: results of the prospective cohort study ikidS

We aimed to estimate unbiased effects of mental health problems (MHPs) on school performance in first graders, with an emphasis on rigorous adjustment for potential confounders. A population-based prospective cohort study was performed in the area of Mainz-Bingen (Germany). In 2015, all preschoolers were approached, and the presence and type of MHP (externalising/internalising) and other physical chronic health conditions were identified by the preschool health examination and study-specific questionnaires. At the end of the first grade, school performance (reading, writing, numeracy, and science) was assessed by the class teacher and rated on a four-item scale ranging from - 8 to + 8. Of 3683 children approached, 2003 (54%) were enrolled. School performance was available for 1462 children (51% boys, mean age 7.3 years). Of these, 41% had signs of at least one MHP. Compared to children without indications of mental and physical chronic health conditions, children with MHPs had lower school performance scores [adjusted mean difference - 0.98, 95% CI (- 1.35; - 0.61); P < 0.001]. Regarding the type of MHP, externalising MHPs were associated with poor school performance [adjusted mean difference - 1.44, 95% CI (- 1.83; - 1.05); P < 0.001], while internalising MHPs were not. Children with hyperactivity inattention problems were most affected [adjusted mean difference - 1.96, 95% CI (- 2.36; - 1.56); P < 0.001]. Externalising MHPs and in particular hyperactivity inattention problems may already affect school performance in early primary school. Identification of children with externalising MHPs prior to school entry may help to prevent impaired academic achievement in affected children.

Risk and protective factors of health-related quality of life in children and adolescents: Results of the longitudinal BELLA study

AIMS

Cross-sectional studies demonstrated associations of several sociodemographic and psychosocial factors with generic health-related quality of life (HRQoL) in children and adolescents. However, little is known about factors affecting the change in child and adolescent HRQoL over time. This study investigates potential psychosocial risk and protective factors of child and adolescent HRQoL based on longitudinal data of a German population-based study.

METHODS

Data from the BELLA study gathered at three measurement points (baseline, 1-year and 2-year follow-ups) were investigated in n = 1,554 children and adolescents aged 11 to 17 years at baseline. Self-reported HRQoL was assessed by the KIDSCREEN-10 Index. We examined effects of sociodemographic factors, mental health problems, parental mental health problems, as well as potential personal, familial, and social protective factors on child and adolescent HRQoL at baseline as well as over time using longitudinal growth modeling.

RESULTS

At baseline, girls reported lower HRQoL than boys, especially in older participants; low socioeconomic status and migration background were both associated with low HRQoL. Mental health problems as well as parental mental health problems were negatively, self-efficacy, family climate, and social support were positively associated with initial HRQoL. Longitudinal analyses revealed less increase of HRQoL in girls than boys, especially in younger participants. Changes in mental health problems were negatively, changes in self-efficacy and social support were positively associated with the change in HRQoL over time. No effects were found for changes in parental mental health problems or in family climate on changes in HRQoL. Moderating effects for self-efficacy, family climate or social support on the relationships between the investigated risk factors and HRQoL were not found.

CONCLUSION

The risk factor mental health problems negatively and the resource factors self-efficacy and social support positively affect the development of HRQoL in young people, and should be considered in prevention programs.

[Parental Social Status and other determinants of quality of life and behavioral problems: An analysis of German preterm births between 1987-2004]

BACKGROUND

Knowledge of the factors affecting the development of preterm children in Germany is limited. We analysed the prevalence of preterm birth in Germany using the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 and assessed factors associated with quality of life (QOL) and behavioural development in preterm children (< 37 weeks' gestational age).

METHODS

Data were weighted and preterm prevalence was calculated by socioeconomic status (SES) and year of birth for  1,106 preterm children. Using linear regression models, the relationship between sociodemographic, pre- and perinatal, lifestyle, and contextual determinants on the one hand, and the QOL (KINDL® parent questionnaire) and behavioural problems (the total problem behaviour scale, the Strengths and Difficulties Questionnaire [SDQ]) on the other was calculated.

RESULTS

Prevalence of preterm birth (mean 7.5 %) was higher in families with low compared with high SES (8.4 versus 7.0 %). In the final regression models, preterm children with high SES had higher QOL scores (+ 3.3 KINDL points, p = 0.024) compared with children with low SES, and adolescents (aged 14-17 years) had a higher QOL than children aged 7-13 years. All other variables (contextual, pre- and perinatal) were not related to QOL. In contrast, there were many determinants of behavioural development in preterms: the SDQ total score was lower in girls, children with older mothers, those from high SES and those with a high level of physical activity. However, both very low birth weight (< 1,500 g) and birth at > 34 weeks' gestation were associated with a higher SDQ total score.

CONCLUSION

Given its high prevalence, preterm birth is a relevant public health issue in Germany. While SES may be the most important determinant of QOL in preterms, determinants of behavioural problems are the same as those in term children and also encompass perinatal factors.

Allergy and school: nothing to be sneezed at!: A primary school project in Bielefeld, Germany, on epidemiology and health promotion in allergic diseases

Background:

Allergic diseases account for the largest proportion of chronic diseases in childhood and adolescence and place a significant burden on everyday family, social, and in particular school life. Without appropriate education, affected individuals often have little of the knowledge required to understand and deal safely with their allergic disease, and their social environment (school) generally offers insufficient information. An interdisciplinary project involving the Bielefeld Community Foundation (“Bielefelder Bürgerstiftung”), the Children’s Center Bethel, and the local school authority investigated the current knowledge, possibilities for increasing that knowledge, as well as pupils’ and teachers’ perception of the problems experienced by fellow pupils, while at the same time collecting current prevalence figures on allergic diseases among primary school children.

Methods:

All Bielefeld primary schools were invited to participate in the 3 years between 2008 and 2010. A teaching session on allergic diseases held by specialists from the pediatric hospital formed the core of the project. A standardized survey of children – which also addressed non-affected children for the first time in Germany – on the effects of, their knowledge of, and their attitudes toward allergic diseases, as well as an assessment of their quality of life (cross-sectional study), was conducted prior to and following each session. Parents were also surveyed.

Results:

In all, 24 schools per year, each with around 60 classes and 1,250 pupils aged 9 years, took part between 2008 and 2010. Approximately 30 % reported suffering from an allergic disease themselves, of which – with regard to single entries – 16 % were “allergies,” 4 % “asthma,” and 5 % atopic dermatitis. Figures collected from parents were only slightly lower than those from their children. Clear deficits that existed in terms of factual knowledge and/or correct conduct in allergic disease – among affected children as well as in their social environment – prior to the education program were noticeably improved by the teaching session.

Discussion:

The prevalence data gathered here confirm the high numbers recently found in the KiGGS study. Thus, allergic diseases represent a considerable disease risk and potential burden in school children. Providing affected children and their social environment (teachers, fellow pupils) with specialist education can bring about considerable improvements in everyday school life.

Migrationshintergrund als Risikofaktor für die Entwicklung Frühgeborener im Alter von zwei Jahren

Zusammenfassung. Im Rahmen der Aachener Frühgeborenennachsorge wurden N = 199 Frühgeborene (< 32 SSW und/oder < 1500 g) der Geburtsjahrgänge 2007 bis 2011 im Alter von korrigiert zwei Jahren entwicklungsneurologisch nachuntersucht und ihr MDI mit dem Bayley II ermittelt. Die Daten wurden retrospektiv analysiert, um herauszufinden, ob der Migrationshintergrund die kognitive Leistungsfähigkeit zum Untersuchungszeitpunkt beeinflusst. Es zeigten sich keine Unterschiede hinsichtlich des Geschlechts, medizinischer Komplikationen und der Inanspruchnahme von Therapie zwischen Kindern mit (42 %) und ohne (58 %) Migrationshintergrund. In Übereinstimmung mit der Literatur lag die gesamte Aachener Stichprobe mit einem mittleren MDI von 83,3 (SD 17,4) eine Standardabweichung unter dem Durchschnitt der Referenzpopulation. Kinder mit Migrationshintergrund lagen im kognitiven Outcome 10 Punkte unter Kindern ohne diesen, was entscheidend durch das Vorliegen familiärer Risikofaktoren bedingt wurde. Im regressionsanalytischen Modell hatten familiäre Risikofaktoren und das Geburtsgewicht den größten Einfluss auf den kognitiven Outcome; aber auch das Vorliegen eines Migrationshintergrundes leistete einen zusätzlichen Beitrag zur Vorhersage. Frühgeborene mit Migrationshintergrund sollten daher als besondere Risikogruppe erkannt werden, insbesondere wenn sie zusätzlich familiäre Risikofaktoren aufweisen, um sie frühzeitig differenzierter fördern zu können.

Subjective health, school victimization, and protective factors in a high-risk school sample

OBJECTIVE

School victimization has adverse effects on mental and physical health. However, little is known about the influence of protective factors, socioeconomic status (SES), or a migration background (MB) on this association. The authors analyzed data from a multicenter longitudinal school study with a high proportion of pupils with a low SES and an MB. Victimization was defined as bullying or the experiences of interpersonal violence.

METHODS

In a cross-sectional design, 2483 pupils of secondary schools in northern Germany completed standardized questionnaires measuring families' SES, MB, school victimization, psychosomatic complaints, life satisfaction, health-related quality of life (HRQoL), and social and personal protective factors. The authors tested the association between victimization, low protective factors, low SES and MB, and subjective health parameters using linear regression models.

RESULTS

A total of 39% of the pupils reported being bullied, and 16% had experienced interpersonal violence. Victimized children reported twice as many psychosomatic problems, lower life satisfaction, and reduced HRQoL (p < .001) compared with children without victimization experiences. Regression models confirmed this association; in addition to victimization, low social and especially low personal protective factors increased the risk for low subjective health parameters. The SES and MB had no influence on the outcomes.

CONCLUSION

The results underscore the strong association between school victimization and low subjective health factors. Strengthening pupils' self-efficacy and a supportive school climate can diminish the health consequences of victimization.

[Differences in sociodemographic characteristics, health, and health service use of children and adolescents according to their health insurance funds]

Differences in the socioeconomic characteristics and morbidity between members of German private and statutory health insurance funds and also between several statutory health insurances have been shown for adults. We used data from the National Health Survey for Children and Adolescents (KiGGS) to study differences in sociodemographic characteristics, health risks, morbidity, and health service use in child and adolescent insurants of different types of health insurance funds (Ersatzkasse, Allgemeine Ortskrankenkasse, Betriebskrankenkasse , Innungskrankenkasse, other statutory health insurance funds, private health insurance). Differences in the proportion of respondents with a migration background, somatic diseases, psychopathological problems, and contact with a dentist between the different health insurance fund types were found. These results should be considered in studies on health inequalities, which often focus solely on differences between statutory and private health insurance. Our results are also of relevance for health services research using the claims data of health insurance funds.

Positive versus negative mental health in emerging adulthood: a national cross-sectional survey

Background

The dual continuum model suggests that positive mental health not only implies the absence of mental illness, but also constitutes an entity of its own. Measures that encompass both positive and negative mental health in young adults are rare. Thus, we assessed whether dimensions corresponding to positive and negative mental health could be identified in a sample of young individuals. Additionally, we explored how such dimensions were associated with potential health-related factors.

Methods

We obtained data from the Swedish National Public Health Survey 2004–2009 (23,394 women, 18,274 men, aged 16–29 years). We used exploratory factor analysis (EFA) to identify relevant factors revealed by the 12-item General Health Questionnaire (GHQ-12) and confirmatory factor analysis (CFA) to verify the factor structure. We tested the significance of the difference between effects of potential health-related factors on positive mental health (PMH) and negative mental health (NMH).

Results

The EFA for the GHQ-12 revealed a two factor model with negative items that had high positive loadings on one factor and lower negative loadings on the other factor. The positive items had loading trends that were opposite those of the negative items. The fit of this model was supported by the CFA, which yielded a significantly better match than a unidimensional model. When we investigated the associations between GHQ-scores and potential predictors of health, we found that most potential predictors had significant and opposing effects on both PMH and NMH; with the strongest effects from suicidal ideation and perceived humiliation.

Conclusions

Our results could be seen to indicate that positive and negative mental health are distinct and complementary constructs. Still, the results of our factor analysis may specifically reflect the wording of the items. We conclude that the GHQ-12 is an appropriate tool for its original purpose, to detect “psychiatric morbidity”. More refined measures, including predictors of health, are needed to assess PMH and validate the bidimensionality hypothesis.

The Mental Health in Austrian Teenagers (MHAT)-Study: preliminary results from a pilot study

BACKGROUND

No epidemiological data on prevalence rates of mental disorders based on a representative sample are available for Austrian adolescents up to now. However, the knowledge of psychiatric disorders, related risk and protective factors is of great significance for treatment and prevention. The purpose of the MHAT-Study (Mental Health in Austrian Teenagers), the first epidemiological study on mental health in Austria, is to obtain prevalence rates of mental disorders and to examine risk factors, protective factors and quality of life in a representative sample of adolescents aged 10-18. Aims of this pilot study were to evaluate the feasibility and acceptability of the screening instruments, pre-estimate the frequency of mental health problems and estimate possible non-responder bias.

METHODS

Twenty-one schools in eastern Austria were asked to participate. Data on mental health problems were derived from self-rating questionnaires containing standardized screening measures (Youth Self-Report, measuring emotional and behavioral problems and the SCOFF, indicating eating problems. Quality of life as well as related risk and protective factors were also obtained.

RESULTS

Four hundred and eight adolescents of five schools were recruited. The prevalence of mental health problems was 18.9 % [CI 95 %: 14.9-22.7]. Moreover, emotional and behavioral problems were highly correlated with quality of life measures. A Non-Responder Analysis indicated that non-responders (16.7 %) differ from responders with regard of school related problems.

CONCLUSIONS

The results demonstrate that mental health problems affect approximately one fifth of the adolescents. A Non-Responder Analysis suggests that the prevalence of behavioral and emotional problems is underestimated.

Obese parents--obese children? Psychological-psychiatric risk factors of parental behavior and experience for the development of obesity in children aged 0-3: study protocol

BACKGROUND

The incidences of childhood overweight and obesity have increased substantially and with them the prevalence of associated somatic and psychiatric health problems. Therefore, it is important to identify modifiable risk factors for early childhood overweight in order to develop effective prevention or intervention programs. Besides biological factors, familial interactions and parental behavioral patterns may influence children's weight development. Longitudinal investigation of children at overweight risk could help to detect significant risk and protective factors. We aim to describe infants' weight development over time and identify risk and protective factors for the incidence of childhood obesity. Based on our findings we will draw up a risk model that will lay the foundation for an intervention/prevention program.

METHODS/DESIGN

We present the protocol of a prospective longitudinal study in which we investigate families with children aged from 6 months to 47 months. In half of the families at least one parent is obese (risk group), in the other half both parents are normal weight (control group). Based on developmental and health-psychological models, we consider measurements at three levels: the child, the parents and parent-child-relationship. Three assessment points are approximately one year apart. At each assessment point we evaluate the psychological, social, and behavioral situation of the parents as well as the physical and psychosocial development of the child. Parents are interviewed, fill in questionnaires, and take part in standardized interaction tasks with their child in a feeding and in a playing context in our research laboratory. The quality of these video-taped parent-child interactions is assessed by analyzing them with standardized, validated instruments according to scientific standards.

DISCUSSION

Strengths of the presented study are the prospective longitudinal design, the multi-informant approach, including the fathers, and the observation of parent-child interaction. A limitation is the variation in children's age.

Cohort profile: the Motorik-Modul Longitudinal Study: physical fitness and physical activity as determinants of health development in German children and adolescents

The Motorik-Modul (MoMo) Longitudinal Study aims to contribute to long-term improvement in the health of German children and adolescents by focusing on: (i) the development of physical fitness and physical activity (including period effects); (ii) the individual and physical/social environmental determinants of the development of physical fitness and physical activity; and (iii) the impact of physical fitness and physical activity on the development of physical and mental health. The MoMo Longitudinal Study began with a nationwide representative sample of 4529 children and adolescents who ranged in age from 4-17 years at the study baseline (2003-2006). The first survey wave of the MoMo Longitudinal Study was conducted between 2009 and 2012, with two subsequent survey waves to be conducted between 2014 and 2016 and 2018 and 2020, respectively. The MoMo Longitudinal Study includes a physical fitness test profile, a physical activity questionnaire, and subjective and objective measures of health from the German Health Interview and Examination Survey (KiGGS). Data access is provided on request (alexander.woll@kit.edu). For further information, including a complete list of publications please visit www.motorik-modul.de.

Migration background and juvenile mental health: a descriptive retrospective analysis of diagnostic rates of psychiatric disorders in young people

Introduction

This article presents diagnostic rates for specific mental disorders in a German pediatric inpatient population over a period of 20 years with respect to migration background and socioeconomic status (SES).

Methods

Diagnostic data were obtained over a period of 20 years from 8,904 patients who visited a child and adolescent psychiatry mental health service in Germany. Data from 5,985 diagnosed patients (ICD-9 and ICD-10 criteria) were included with respect to gender, migration background, and SES.

Results

Migration- and gender-specific effects were found for both periods of assessment. The group of boys with a migration background showed significantly higher rates of reactions to severe stress, adjustment disorders, and posttraumatic stress disorder compared to their male, non-migrant counterparts. Conversely, boys without a migration background showed a significantly higher percentage rate of hyperkinetic disorders than male migrants. Similar results were found for female migrants in the latter assessment period (ICD-10). In addition, female migrants showed lower rates of emotional disorders whose onset occurs in childhood compared to their non-migrant counterparts.

Conclusions

Data from this investigation provide preliminary evidence that the prevalence of various psychiatric disorders in children and adolescents is influenced by migration background and SES.

Health-related quality of life in rural children living in four European countries: the GABRIEL study

OBJECTIVE

Measuring children's health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS).

METHODS

The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL.

RESULTS

Austrian children reported highest KINDL-R scores (mean: 80.9; 95 % CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p = 0.002). Significantly lower scores were observed in children with allergic diseases (p < 0.001), with sleeping difficulties (p < 0.001) and in overweight children (p = 0.04). The German GABRIEL sample reported higher mean scores (age 7-10 years: 80.1, [79.9, 80.4]; age 11-13 years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7-10 years: 79.0, [78.7-79.3]; age 11-13 years: 75.1 [74.6-75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries.

CONCLUSIONS

Future increases in chronic diseases may negatively impact children's HRQOL.

The LIFE child study: a life course approach to disease and health

BACKGROUND

Profound knowledge about child growth, development, health, and disease in contemporary children and adolescents is still rare. Epidemiological studies together with new powerful research technologies present exciting opportunities to the elucidation of risk factor-outcome associations with potentially major consequences for prevention, diagnosis and treatment.

AIM

To conduct a unique prospective longitudinal cohort study in order to assess how environmental, metabolic and genetic factors affect growth, development and health from fetal life to adulthood.

METHODS

The 'Leipzig Research Centre for Civilization Diseases (LIFE) Child Study' focuses on two main research objectives: (1) monitoring of normal growth, development and health; (2) non-communicable diseases such as childhood obesity and its co-morbidities, atopy and mental health problems. Detailed assessments will be conducted alongside long-term storage of biological samples in 2,000 pregnant women and more than 10,000 children and their families.

RESULTS

Close coordination and engagement of a multidisciplinary team in the LIFE Child study successfully established procedures and systems for balancing many competing study and ethical needs. Full participant recruitment and complete data collection started in July 2011. Early data indicate a high acceptance rate of the study program, successful recruitment strategies and the establishment of a representative cohort for the population of Leipzig. A series of subprojects are ongoing, and analyses and publications are on their way.

DISCUSSION

This paper addresses key elements in the design and implementation of the new prospective longitudinal cohort study LIFE Child. Given the recognized need for long-term data on adverse effects on health and protective factors, our study data collection should provide magnificent opportunities to examine complex interactions that govern the emergence of non-communicable diseases.

[Psychoanalytic psychotherapy with adolescents: challenges, technical problems, and treatment outcome]

Psychoanalytic treatment of adolescents has a long tradition and is currently one of the most frequent treatments in this age group. However, not many studies document the efficacy of psychoanalytic treatments of adolescents. This article analyses the background of this deficit by focusing on recent changes in symptomatology, the widespread diagnostic insecurity and the special challenges, which such treatment demands of the therapist. The task of researching the efficacy of adolescent psychotherapy is of considerable complexity. Recent own studies about efficacy of adolescent therapy will be presented. The evidence suggests that different approaches in therapy (psychoanalytic vs. psychodynamic) are of similar efficacy. However, long-term treatments ensure a consolidation of symptom reduction. The inclusion of different perspectives (adolescent, parents, therapist) and work with parents may be effective.

[Coping in children and adolescents with migrant origin]

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.

Verhaltensauffälligkeiten und Lebensqualität bei Kindern im Vorschulalter und deren Mütter

Zusammenfassung. Im Mittelpunkt der Arbeit steht die Frage, ob und in welcher Weise sich Verhaltensauffälligkeiten sowie die Lebensqualität bei Kindern im Vorschulalter mit und ohne Migrationshintergrund unterscheiden. Ergänzend soll auch die Lebensqualität der Mütter beleuchtet werden, da diese eine zentrale Einflussgröße für die Entwicklung der Kinder darstellt. Insgesamt gingen 188 Kinder im Alter von 44 bis 68 Monaten in die Stichprobe ein, welche aus 16 Kindergärten in Bremen und Niedersachen gewonnen wurden. 57 dieser Kinder wiesen einen Migrationshintergrund auf. Es zeigte sich, dass Kinder mit Migrationshintergrund sowohl im Eltern- als auch im Erzieherinnenurteil höhere Werte für Verhaltensauffälligkeiten erhielten als Kinder ohne Migrationshintergrund. Die Erzieherinnen gaben daneben für Kinder mit Migrationshintergrund höhere Werte für Hyperaktivität an und erlebten diese weniger prosozial als Kinder ohne Migrationshintergrund. Die Eltern gaben höhere Werte für Probleme mit Gleichaltrigen an. Für die Lebensqualität der Kinder mit Migrationshintergrund ergab sich unter multivariater Betrachtung kein Unterschied. Betrachtet man diese auf univariater Ebene, ergab sich für die Kinder mit Migrationshintergrund ein schlechteres Selbstwertgefühl und niedrigeres psychisches Wohlbefinden im Elternurteil. Für die Mütter zeigte sich, dass die Mütter von Kindern mit Migrationshintergrund über eine bessere endogene Lebensqualität verfügten als deutsche Mütter. Hier gaben die Mütter der Kinder mit Migrationshintergrund höhere Werte für ihre tägliche Energie an und beschrieben sich als zufriedener mit sich selbst und ihren persönlichen Beziehungen. Für die umweltbezogene Lebensqualität wurde jedoch deutlich, dass diese mit dem sozioökonomischen Status der Familie zusammenhängt. Diese Ergebnisse zeigen, dass die Lebensqualität dieser Gruppe sehr differenziert betrachtet werden muss. Die Bereiche der endogenen Lebensqualität sollten als Ressourcen weiter ausgebaut und gefördert werden, um an diesen Potentialen anzuknüpfen.

[The promotion of resilience and protective factors in children of alcoholics and drug addicts]

Children from families of alcoholics and drug addicts are a high-risk group for developing a mental or substance-related disorder. The parental substance-related disorder can cause different effects on the physical, mental, and cognitive health of children in various stages of development, particularly internalizing and externalizing disorders. For the development of the mental health of these children, the promotion of resilience and protective factors play a crucial role. General and specific resilience and protective factors, which are relevant for prevention and intervention for children of alcoholics and substance users, are presented based on empirical studies. Resilience is commonly understood as a mental hardiness of children and adolescents to biological, mental, and psychosocial developmental risks. Important is the multilevel consideration of internal and external protective factors. In doing so, resilience is understood as a process that is subject to fluctuations over the course of life. The "stress-strain-coping-support" model is suitable for the theoretical concept of preventive measures for children of alcoholics and drug addicts.

The association between socioeconomic status and exposure to mobile telecommunication networks in children and adolescents

A potential association between socioeconomic status (SES) and self-reported use of mobile phones has been investigated in a few studies. If measured exposure to mobile phone networks differs by SES in children, it has not yet been studied. Interview data of 1,481 children and 1,505 adolescents on participants' mobile phone use, socio-demographic characteristics and potential confounders were taken from the German MobilEe-study. Sociodemographic data was used to stratify participants into three "status groups" (low, middle, high). Using a personal dosimeter, we obtained an exposure profile over 24 h for each of the participants. Exposure levels during waking hours were expressed as mean percentage of the reference level. Children with a low SES were more likely to own a mobile phone (OR 2.1; 95% CI: 1.1-3.9) and also reported to use their mobile phone longer per day (OR 2.4; 95% CI: 1.1-5.4) than children with a high SES. For adolescents, self-reported duration of mobile phone use per day was also higher with a low SES (OR: 3.4; 95% CI: 1.4-8.4) compared with a high SES. No association between SES and measured exposure to mobile telecommunication networks was seen for children or adolescents. Mobile phone use may differ between status groups with higher use among disadvantaged groups. However, this does not result in higher overall exposure to mobile telecommunication networks. Whether short duration of own mobile phone use or the small numbers of participants with a low SES are causal, have to be investigated in further studies.

[Mental impact and gender differences in adolescents in stationary welfare service]

Compared to the general population children and adolescents in stationary youth welfare service show higher prevalence of mental disorders. Object of the recent study was to record mental impact and gender differences in adolescents living in accommodations of the welfare youth service using a dimensional approach. The survey was realized in all stationary welfare services in the area of Bad Doberan/Germany. 42 adolescents answered Achenbach's Youth Self Report and their teachers the Teachers Report Form for mental problems. In Self Report 57% of the adolescents showed clinical relevant disorders. Girls were significantly more impaired in internal characteristics than boys. The registration of mental disorders by dimensional method confirms the high prevalence. But an adequate local psychiatric-psychotherapeutic care and therapy is rare. The results argue for a stronger integration of children and adolescent psychiatry and youth welfare system.

Psychosoziale Risiko- und Schutzfaktoren bei Kindern und Jugendlichen mit Gewalterfahrungen

Zusammenfassung. Insgesamt 17 641 Kinder und Jugendliche und ihre Eltern nahmen zwischen Mai 2003 und Mai 2006 am bundesweiten repräsentativen Kinder- und Jugendgesundheitssurvey KiGGS teil. Davon beantworteten 6 619 Kinder und Jugendliche im Alter von elf bis 17 Jahren einen Selbstbeurteilungsbogen mit Fragen zu ihren Gewalterfahrungen als Täter und Opfer und zu instrumentellen und expressiven Gewalteinstellungen. Außerdem wurden Informationen über den familiären Zusammenhalt, soziale Unterstützung und personale Ressourcen sowie zum besuchten Schultyp über den Kinder- und Jugendlichenfragebogen erhoben. Angaben zu bekannten psychosozialen Risikofaktoren wie Aufwachsen in einer Ein-Eltern- oder Stieffamilie, hoher Geschwisterzahl, früher Elternschaft (Mutter bei der Geburt des Kindes jünger als 18 Jahre), Arbeitslosigkeit, niedriger Schul- oder fehlender Berufsausbildung und Migrationshintergrund stammen aus der parallelen Elternbefragung. Mit multinomialer logistischer Regression wurden die Effekte der Risiko- und Schutzfaktoren auf eine Rolleneinnahme simultan überprüft. Hypothesen zu den unterschiedlichen Risiko- und Schutzfaktoren für die jeweiligen Täter-Opfer-Rollen wurden mittels Einzelvergleichen und der Formulierung von Interaktions-Slices überprüft. Die Variablenauswahl und die Kontrastsetzung für das endgültige Modell erfolgten in einem mehrstufigen Filterprozess und unter Berücksichtigung inhaltlicher Erwägungen. In diesem Modell wurden für die Täter/Opfer-Rolle die Risiko erhöhenden Faktoren männliches Geschlecht, jüngeres Alter, instrumentelle und expressive Einstellungen zu Gewalt sowie Aufwachsen in einer Ein-Eltern-Familie identifiziert. Keine Effekte hingegen wurden gefunden für frühe Elternschaft der Mutter, fehlende Berufsausbildung der Eltern oder Migrationshintergrund. Für die Chance, eine Täter-Rolle einzunehmen, waren männliches Geschlecht, instrumentelle und expressive Gewalteinstellungen sowie Hauptschulbesuch signifikante Prädiktoren. Kompensatorische Einflüsse der Schutzfaktoren auf psychosoziale Risikofaktoren des Täterstatus konnten nicht festgestellt werden. Migranten hatten entgegen der deskriptiven Analyse keine höheren Chancen, die Täter-Rolle einzunehmen. Auch für die Opfer-Rolle wurde ein signifikanter Geschlechtseffekt zu Ungunsten der Jungen festgestellt. Sowohl für den Alters- als auch für den Geschlechtseffekt ergaben sich höhere Odds Ratios, als nach getrennten Analysen für die Risiko- und Schutzfaktoren zu erwarten waren. In der Zusammenschau von Risiko- und Schutzfaktoren zeichneten sich protektive Effekte vor allem mit Blick auf die familiäre Situation ab, während Effekte umgebungsbezogener sozialer Risikofaktoren wie Besuch eines bestimmten Schultyps, elterliche Arbeitslosigkeit oder fehlende Berufsausbildung der Eltern sich wenig bis kaum durch Schutzfaktoren beeinflussbar zeigten. Die Effekte der Skala „Familiärer Zusammenhalt” waren für alle drei Täter/Opfer-Rollen im kombinierten Risiko-Schutzfaktorenmodell signifikant. Die Varianzaufklärung des Modells betrug 29.8%, wobei sich der inkrementelle Beitrag der Schutzfaktorskalen auf lediglich 1.4% belief.

Health-related quality of life in children and adolescents in Germany: results of the BELLA study

BACKGROUND

The self-perceived health or health-related quality of life of children and adolescents is increasingly recognised as a relevant outcome in medical practice and public health research. Identifying children and adolescents with particularly low health-related quality of life allows for an early detection of hidden morbidity and health care needs.

OBJECTIVES

The present study investigates health-related quality of life in children and adolescents in Germany.

METHODS

In the Mental Health Module (BELLA study) of the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 2,863 children and adolescents aged 7-17 years, and 1,700 children and adolescents aged 11-17 years completed the KINDL-R quality of life questionnaire.

RESULTS

The reliability (Cronbach's alpha=0.86) and validity of the measurements using the parent-reported KINDL-R were confirmed. Means and percentiles were calculated for the total sample as well as for strata defined by age, sex, geographical region (east/west), migration status and socioeconomic status. Expected differences in health-related quality of life of children and adolescents from different social backgrounds and with different health statuses were demonstrated by differences in the KINDL-R scores (effect size d up to 1.29).

CONCLUSION

This study provides representative, normative data (self-report and parent-report) on the test scores of health-related quality of life (KINDL-R) for the population of children and adolescents in Germany in general, as well as in sociodemographic and socioeconomic subpopulations.

Psychometric properties of the KINDL-R questionnaire: results of the BELLA study

BACKGROUND

The concept of health-related quality of life (HRQoL) involves the respondents' perception of well-being and functioning in physical, emotional, mental, social, and everyday life areas. Research in the area of subjective health has resulted in the development of a multitude of HRQoL instruments that meet satisfying psychometric standards with regard to reliability, validity, and sensitivity of the scales. One frequently used generic measure for children and adolescents is the KINDL-R questionnaire developed by Ravens-Sieberer and Bullinger (Qual Life Res 7:399-407, 1998).

METHODS

Within the representative sample of the BELLA study, analyses regarding psychometric properties (namely reliability as well as discriminant and construct validity) are performed.

RESULTS

Psychometric testing of the KINDL-R questionnaire reveals good scale utilisation and scale fit as well as moderate internal consistency. Correlations with the KIDSCREEN-52 subscales are shown. Differences in KINDL-R scores exist between chronically ill and healthy children as well as between SDQ problem scores.

CONCLUSION

The KINDL-R is a suitable instrument for measuring HRQoL in children and adolescents through self-report. The testing of the instrument in a representative sample of German children and adolescents as well as their parents provides reference values extending the potential of the KINDL-R questionnaire.

[Personal, familial and social resources and health-related quality of life in children and adolescents with chronic conditions]

INTRODUCTION

The present publication describes chronic conditions of children and adolescents (asthma, ADHD, obesity) in relation to personal, familial and social resources and to health-related quality of life (HRQOL). A database of these investigations is the German health interview and examination survey of children and adolescents (KiGGS), which is representative for 0 to 17 year-olds. The above mentioned chronic conditions occur frequently in this age group and are assumed to have an influence on quality of life and to be related to a lower level of protective factors.

METHODS

The investigations used the data of 6813 children and adolescents within the age group of 11 to 17 who participated in the KiGGS study. Information about diagnosed chronic conditions was given by the parents within the framework of the computerassisted medical interview (CAPI) and by completing questionnaires. The personal, familial and social protection factors as well as the quality of life were assessed by the questionnaires, filled in by the adolescents themselves. Instruments used were the Social Support Scale, the Family Climate Scale and KINDL-R.

RESULTS

Children and adolescents with asthma seem to have no deficits in the health-related quality of life and in the field of protective factors. This differs from the situation of the obese children as well as from the children with ADHD. Both groups show significant deficits in the health-related quality of life and protection factors.

DISCUSSION

The chronic conditions investigated show remarkable differences in the scale values for measuring protective factors and health-related quality of life. Possible explanations are: For asthma as a chronic disease with somatic manifestation effective treatments and therapies exist, so that it has nearly no influence on the self-assessed quality of life. ADHD and obesity result in a decrease of quality of life and in the field of protective factors, possibly caused by social stigmatisation, isolation and demotivation of the concerned children and adolescents. Therefore it is important to support those children and adolescents to cope with their disease-related problems. The results illustrate that in addition to the immediate effects of chronic conditions on the concerned children and their families, it is the quality of life and the familial and social environment that should be specifically addressed in further studies.

[Health-related quality of life of children and adolescents in Germany. Norm data from the German Health Interview and Examination Survey (KiGGS)]

This study investigates the health-related quality of life of children and adolescents in Germany, using the internationally employed KINDL-R questionnaire for measuring the health-related quality of life of children and adolescents. In the National Health Interview and Examination Survey for Children and Adolescents (KiGGS) the parents of 14,836 children and adolescents aged 3-17 years completed the KINDL-R, as well as 6,813 children and adolescents (11-17 years old). The reliability (Cronbach's alpha = 0.85) and validity of the measurements using the KINDL-R were confirmed. The differences in health-related quality of life of children and adolescents from different social backgrounds and with different health statuses, which were to be expected on theoretical grounds, were demonstrated by the KINDL-R scores (size of effect "d" up to 1.52). The means and percentiles were calculated for the total sample as well as stratified by age group, sex, geographical region (East/West), migratory status and socio-economic status. The results of this study can be used as representative, normative data for the population of children and adolescents in Germany in general, as well as stratified for sociodemographic and socio-economic subpopulations, in order to interpret test scores on health-related quality of life (KINDL-R).