[Increase of depressive symptoms among adolescents during the first COVID-19 lockdown in Germany : Results from the German family panel pairfam]

Feasibility and effectiveness of a group therapy combining physical activity, surf therapy and cognitive behavioral therapy to treat adolescents with depressive disorders: a pilot study

Introduction

The high prevalence of depression among adolescents underlines the need for further research into effective treatment options. Previous research has demonstrated the effectiveness of physical activity in reducing depressive symptoms. Recently, studies on surf therapy, as an innovative approach of physical activity, have shown promising results regarding the reduction of depressive symptoms in adults and the improvement of general mental health problems in adolescents. However, research in this area is still limited. The aim of the current study was to investigate the feasibility and effectiveness of a group therapy program that combines physical activity, including surf therapy, with cognitive behavioral therapy for treating depression among adolescents.

Methods

Thirty-two outpatients (28 female, four male) aged 13-18 years with a mean age of 15.58 years (SD = 1.52) and a primary diagnosis of depression were included. They participated in a 3-month group therapy program in groups of eight adolescents. The dropout rate was calculated as an aspect of feasibility. To evaluate effectiveness, depressive symptoms were assessed using the "Children's Depression Rating Scale-Revised" (CDRS-R) as the primary outcome measure at pre-program, post-program, and at 3-month follow-up. In addition, questionnaires assessing depressive symptoms ["Beck Depression Inventory II" (BDI-II)], emotion regulation strategies ["Fragebogen zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen" (FEEL-KJ)] and self-esteem ["Selbstwertinventar für Kinder und Jugendliche" [SEKJ)] were administered as secondary outcome measures.

Results

Results showed a low dropout rate of 9.38% (n = 3). Depressive symptoms, assessed by the CDRS-R, were significantly reduced over time, with a large effect size. Symptom reductions were maintained at the 3-month follow-up.

Discussion

Study results suggest that the group therapy program is feasible and can reduce depressive symptoms. Further research that includes control groups is needed. As a clinical implication, novel treatment forms which integrate elements of physical activity, should be considered as a treatment option for depressed adolescents.

Association of chronic stress during studies with depressive symptoms 10 years later

The long-tern implications of stress during university for individuals' mental health are not well understood so far. Hence, we aimed to examine the potential effect of stress while studying at university on depression in later life. We analysed data from two waves of the longitudinal Study on Occupational Allergy Risks. Using the 'work overload' and 'proving oneself' scales of the Trier Inventory for Chronic Stress and the Patient Health Questionnaire-2 (PHQ-2), participants reported chronic stress during university (2007-2009, mean age 22.2 years, T1) and depressive symptoms ten years later (2017-2018, mean age 31.6 years, T2). We performed linear regression analyses to explore the association between stress during university (T1) and later depressive symptoms (T2). Participants (N = 548, 59% female) indicated rather low levels of stress and depression (PHQ-2 mean score: 1.14 (range: 0-6)). We observed evidence for a linear association between overload at T1 and depression at T2 (regression coefficient (B) = 0.270; 95% confidence interval (CI) = 0.131 to 0.409; standardised regression coefficient (β) = 0.170). Our analyses yielded evidence for an association between chronic stress while studying and risk of depressive symptoms later in life. This finding underlines the importance of implementing sustainable preventive measures against stress among students.

Treatment of Proximal Humeral Fractures in Older Patients During COVID-19 Pandemic in Germany

Purpose

The COVID-19 pandemic had a severe influence on the entire health sector. Until today, the effect of a SARS-CoV-2 infection on older patients with a proximal humeral fracture (PHF) is unknown. This study examined the following questions: Did the incidence of PHF of older people in Germany vary during the pandemic? Did the treatment change between the lockdown and non-lockdown periods? Was a SARS-CoV-2 infection associated with a worse outcome?

Methods

Retrospective claims data of the BARMER health insurance were analysed. All in- and outpatient cases of insurance holders ≥65 years from 01/2010 to 09/2022, with coded diagnosis of PHF were analysed. Primary endpoints were the 1-month incidence of PHF per 100,000 insurance holders, number of operative therapies, in-hospital death and in-hospital major adverse events (MAEs).

Results

174,898 inpatient PHF cases were included. During the lockdown periods, the total incidence fell, while the outpatient incidence partially increased during the pandemic-period. Regarding the therapy allocation, there were no relevant persisting changes. In a detailed analysis of 23,979 PHF cases from 01/2020 to 09/2022, 4.1% patients suffered from a SARS-CoV-2 infection and showed a notably higher in-hospital mortality (8.1% vs 2.5%; risk adjusted OR 2.79, 95% CI 2.11-3.70, p < 0.001) and more MAEs (17.0% vs 7.8%; risk adjusted OR 1.43, 95% CI 1.15-1.77, p < 0.001).

Conclusion

During the COVID-19 pandemic, the overall incidence of PHF in older patients was reduced. The treatment allocation did not change between the pre- and intra-pandemic period. An infection with SARS-CoV-2 was associated with higher mortality and more MAEs.

[Current State of Research on Surf Therapy and its Possible Application as an Intervention for Adolescent Depression]

Current State of Research on Surf Therapy and its Possible Application as an Intervention for Adolescent Depression Abstract: Depression is one of the most common mental health disorders experienced in adolescence. Because of its high prevalence rates and significant impact on affected individuals, alternative and complementary interventions are being explored. In recent years, physical activity has received increasing attention as a form of treatment. Current reviews highlight the potential benefits of this therapeutic approach in reducing depressive symptoms. Surf therapy is an innovative approach in the field of physical activity that additionally utilizes the therapeutic effects of the ocean. It combines surfing with structured exercises to promote mental and physical well-being. Internationally, surf therapy is already being applied to children and adolescents dealing with mental health problems as well as to adults diagnosed with conditions such as depression and posttraumatic stress disorder. Initial studies suggest positive effects of surf therapy in terms of symptom reduction, although the research is limited and requires further investigation. We present our pilot study investigating the feasibility and effectiveness of surf therapy for the treatment of adolescent depression in Germany.

Contact Tracing Different Age Groups During the COVID-19 Pandemic: Retrospective Study From South-West Germany

BACKGROUND

Contact tracing was implemented in many countries during the COVID-19 pandemic to prevent disease spread, reduce mortality, and avoid overburdening health care systems. In several countries, including Germany, new systems were needed to trace potentially infected individuals.

OBJECTIVE

Using data collected in the Rhine-Neckar and Heidelberg (RNK/HD) districts in southwest Germany (population: 706,974), this study examines the overall effectiveness and efficiency of contact tracing in different age groups and stages of the pandemic.

METHODS

From January 27, 2020, to April 30, 2022, the RNK/HD Health Authority collected data on COVID-19 infections, quarantines, and deaths. Data on infection, quarantine, and death was grouped by age (young: 0-19 years; adult: 20-65 years; and senior citizens: >65 years) and pandemic phase (infectious wave plus subsequent lull periods) and analyzed for proportion, risk, and relative risk (RR). The overall effectiveness and efficiency of contact tracing were determined by calculating quarantine sensitivity (proportion of the infected population captured in quarantine), positive predictive value (PPV; proportion of the quarantined population that was infected), and the weighted Fβ-score (combined predictive performance).

RESULTS

Of 706,974 persons living in RNK/HD during the study period, 192,175 (27.2%) tested positive for SARS-CoV-2, 74,810 (10.4%) were quarantined, and 932 (0.132%) died following infection. Compared with adults, the RR of infection was lower among senior citizens (0.401, 95% CI 0.395-0.407) and while initially lower for young people, was ultimately higher for young people across all 5 phases (first-phase RR 0.502, 95% CI 0.438-0.575; all phases RR 1.35, 95% CI 1.34-1.36). Of 932 COVID-19-associated deaths during the study period, 852 were senior citizens (91.4%), with no deaths reported among young people. Relative to adults, senior citizens had the lowest risk of quarantine (RR 0.436, 95% CI 0.424-0.448), while young people had the highest RR (2.94, 95% CI 2.90-2.98). The predictive performance of contact tracing was highest during the second and third phases of the pandemic (Fβ-score=0.272 and 0.338, respectively). In the second phase of the pandemic, 5810 of 16,814 COVID-19 infections were captured within a total quarantine population of 39,687 (sensitivity 34.6%; PPV 14.6%). In the third phase of the pandemic, 3492 of 8803 infections were captured within a total quarantine population of 16,462 (sensitivity 39.7%; PPV 21.2%).

CONCLUSIONS

The use of quarantine aligned with increasing risks of COVID-19 infection and death. High levels of quarantine sensitivity before the introduction of the vaccine show how contact tracing systems became increasingly effective at capturing and quarantining the infected population. High levels of PPV and Fβ-scores indicate, moreover, that contact tracing became more efficient at identifying infected individuals. Additional analysis of transmission pathways is needed to evaluate the application of quarantine in relation to infection and death risks within specific age groups.

Assessing the Prevalence of School Burnout in German High Schools: Psychometric Properties, Gender Differences, and Cut-Off Criteria

School-related stress and burnout can have serious consequences for students' well-being and academic outcomes. However, there are few studies that assess the prevalence of school burnout, especially in Germany. The present study aims to determine the percentage of N = 1117 high school students who are likely to suffer from school burnout-also with regard to differences in gender and grade level. For this purpose, two different cut-off criteria are compared. Prior to this, the psychometric quality of the MBI-SuS adapted to the school context is examined. The validity and reliability of the three-factor MBI-SuS could be confirmed. Scalar measurement invariance was found for grade level but only partially for gender. The overall prevalence of school burnout of 20.9% found with the common cut-off criterion fits international prevalences, whereas the prevalence of 4.6% (determined with our recommended content-related cut-off criterion) is in line with observations from clinical practice. Depending on the cut-off value, girls suffer slightly more from school burnout, but no differences were found with respect to grade level. Results indicate that a substantial proportion of students are at risk for school burnout, highlighting the importance of prevention and intervention. Criteria for cut-off values should be applied with caution.

[The Relationship between Social and Family Structures and Behavioral Problems in Preschool Children]

BACKGROUND

Behavioral problems in children are indicators of compromised mental health. Their development is influenced by family and social factors, with limited understanding of interactions among family structure, educational status, migration background, and parental employment concerning behavioral problems. These associations were investigated in children between 5-6 years of age.

METHODS

Data (n=15,271) were collected between 09/2018 and 08/2019 in the federal state of Schleswig-Holstein as part of school entry examinations. Children's behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Statistical analyses included descriptive assessments and the calculation of a bivariate logistic regression model, with SDQ's outcomes "problematic" and "non-problematic" as dependent variables, and social and family factors as independent variables (gender, family structure, number of siblings, language proficiency, migration background, parental education level, parental employment, and sports participation in a sports club).

RESULTS

Logistic regression analyses revealed that children living with single parents had a 2.1-fold (odds ratio; OR) higher likelihood [95% confidence interval (CI): 1.7-2.6] of displaying behavioral problems compared to children living with both biological parents. Only children had a 1.4-fold higher likelihood [95% CI: 1.2-1.8] compared to children with one or two siblings. Children with a unilateral migration background exhibited a lower likelihood of behavioral problems [OR: 0.58; 95% CI: 0.38-0.87] than children without a migration background. Children from families with low educational attainment had a 3-fold higher likelihood of behavioral problems [95% CI: 2.3-3.8] compared to those from high educational attainment families. When both parents (or the single parent) were employed at least part-time, there was a lower likelihood of behavioral problems [OR: 0.58; 95% CI: 0.47-0.71] in the child compared to situations where at least one parent was unemployed.

CONCLUSIONS

This study identified sociodemographic factors associated with manifestation of behavioral problems. Particularly, single parents, families with lower educational levels and families with at least one unemployed parent should be targeted for intervention.

[Families with infants and toddlers in the COVID-19 pandemic: parental stress and child development considering social class]

INTRODUCTION

It is now well established empirically that families and children who could not attend educational and childcare institutions during the COVID-19 pandemic experienced disadvantages. This is particularly true for families in poverty. However, little is known about the situation of families with young children. The aim of the paper is to investigate (1) to what extent families with infants and toddlers also experienced their situation during the pandemic as stressful, (2) whether there were differences depending on social class, (3) how the pandemic affected the healthy development of infants and toddlers, and (4) to what extent class-related differences can also be identified in this.

METHODS

The German National Centre for Early Prevention conducted a nationally representative survey of families with children of age 0 to 3 years in April to December 2022, "Kinder in Deutschland 0‑3 2022" (N = 7821). The KiD 0‑3 study combines a parent survey on family psychosocial burden and resources with pediatric documentation of child development.

RESULTS

Parents with very young children experienced their situation in the COVID-19 pandemic as stressful. A clear difference depending on social class emerged. Both from the parents' perspective and in pediatric judgment, the pandemic had a negative impact on social and affective development even in young children. These effects were more pronounced in children from families experiencing poverty than in children from families not receiving basic government benefits.

DISCUSSION

In order to mitigate the psychosocial consequences of the COVID-19 pandemic for families and to improve children's chances of growing up in a healthy way that promotes their development, it is necessary to support families in need without stigmatization.

Mental health in Europe during the COVID-19 pandemic: a systematic review

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

Three years into the pandemic: results of the longitudinal German COPSY study on youth mental health and health-related quality of life

Purpose

For the past three years, the German longitudinal COPSY (COVID-19 and PSYchological Health) study has monitored changes in health-related quality of life (HRQoL) and the mental health of children and adolescents during the COVID-19 pandemic.

Methods

A nationwide, population-based survey was conducted in May-June 2020 (W1), December 2020-January 2021 (W2), September-October 2021 (W3), February 2022 (W4), and September-October 2022 (W5). In total, n = 2,471 children and adolescents aged 7-17 years (n = 1,673 aged 11-17 years with self-reports) were assessed using internationally established and validated measures of HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), depressive symptoms (CES-DC, PHQ-2), psychosomatic complaints (HBSC-SCL), and fear about the future (DFS-K). Findings were compared to prepandemic population-based data.

Results

While the prevalence of low HRQoL increased from 15% prepandemic to 48% at W2, it improved to 27% at W5. Similarly, overall mental health problems rose from 18% prepandemic to W1 through W2 (30-31%), and since then slowly declined (W3: 27%, W4: 29%, W5: 23%). Anxiety doubled from 15% prepandemic to 30% in W2 and declined to 25% (W5) since then. Depressive symptoms increased from 15%/10% (CES-DC/PHQ-2) prepandemic to 24%/15% in W2, and slowly decreased to 14%/9% in W5. Psychosomatic complaints are across all waves still on the rise. 32-44% of the youth expressed fears related to other current crises.

Conclusion

Mental health of the youth improved in year 3 of the pandemic, but is still lower than before the pandemic.

Psychological Factors as Risk Contributors for Poor Hip Function after Periacetabular Osteotomy

Psychologic comorbidities have been identified as risk factors for poor outcomes in orthopedic procedures, but their influence on the outcome of hip-preserving periacetabular osteotomy (PAO) remains uncertain. This retrospective cohort study aimed to assess the impact of patients' psychological health on the outcome of PAO in patients with hip dysplasia (HD) and acetabular retroversion (AR). The study included 110 patients undergoing PAO for HD or AR between 2019 and 2021. Standardized questionnaires were administered to assess psychological factors, postoperative hip function, and activity level (mean follow-up: 25 months). Linear regression analyses were used to examine the associations between psychological factors and postoperative hip function and activity level. Both HD and AR patients showed improved postoperative hip function and activity levels. Linear regression analyses revealed that depression significantly impaired postoperative outcomes in both groups, whereas somatization negatively influenced the outcome in AR patients. General health perceptions significantly contributed to an improved postoperative outcome. These findings highlight the importance of concomitantly addressing psychologically relevant factors in order to improve patient outcomes after PAO procedures. Future prospective studies should continue to investigate the impact of various psychological factors and explore possibilities of incorporating psychological support into routine postoperative care for these patient cohorts.

Changes in mental health in the German child and adolescent population during the COVID-19 pandemic - Results of a rapid review

Background

This rapid review examines changes in the mental health of the German child and adolescent population during the COVID-19 pandemic.

Methods

The basis are 39 publications, which were identified by means of systematic literature search (until 19.11.2021) and manual search. The databases of the included publications were systematized with regard to their representativeness for the general population, and the indicators used were categorized with regard to the depicted constructs and their reliability.

Results

The large majority of the studies took place at the beginning of the pandemic until the summer plateau 2020. Representative studies mainly reported high levels of pandemic-related stress, increases in mental health problems, and negative impacts on the quality of life. Non-representative studies showed mixed results. Vulnerable groups could only be identified to a limited extent. Both routine and care-related data showed declines in the outpatient and inpatient service utilisation during the various waves of the pandemic followed by catch-up effects. Children and adolescents turned out to be more vulnerable during the pandemic compared to adults, but their stress levels varied with the waves of the pandemic and the related containment measures.

Conclusions

A future forward-looking crisis and pandemic management requires a close-knit and continuous surveillance of the mental health of children as well as an improved identification of risk groups.

[School health promotion in pandemic times. Results of the COVID-HL school principal study]

Hintergrund

Die vorliegende Studie untersucht, in welchem Ausmaß Schulen Maßnahmen der Gesundheitsförderung und Prävention während der COVID-19-Pandemie umsetzen. Von besonderem Interesse sind hierbei Unterschiede nach demografischen Variablen, Schulform, Bundesland und die Beteiligung an Landesinitiativen der Gesundheitsförderung.

Methodik

Im Rahmen des COVID-Health-Literacy-Netzwerks wurde von März bis April 2021 eine Onlinestudie mit 2186 Schulleitungen in Baden-Württemberg, Hessen, Niedersachsen und Nordrhein-Westfalen durchgeführt. Der Umsetzungsstand der COVID-19-bezogenen schulischen Gesundheitsförderung und Prävention wurde mittels eines eigenentwickelten Instruments untersucht. Nach Analyse der faktoriellen Struktur des Instruments erfolgten uni- und bivariate Auswertungen.

Ergebnisse

Es lassen sich 3 Dimensionen des Umsetzungsstandes der schulischen Gesundheitsförderung identifizieren (1. COVID-19-bezogene Unterstützung der Schüler*innen, 2. Gesundheitsförderliche Gestaltung von Lehr‑, Lern- und Arbeitsbedingungen, 3. Prinzipien der Gesundheitsfördernden Schule). Eine geringe Umsetzung liegt für Aspekte der Lehr‑, Lern- und Arbeitsbedingungen sowie für Partizipation und die Kooperation mit schulexternen Akteuren vor. Signifikante Unterschiede des Umsetzungsstands ergeben sich zugunsten von weiblichen und älteren Schulleitungen sowie Grundschulen. Außerdem zeigen sich nicht homogene Unterschiede nach Bundesland. Differenziert nach Teilnahme an einem Landesprogramm findet sich lediglich für Schulen mit Zertifikat im Bereich Gesundheitsförderung ein höherer Umsetzungsstand.

Diskussion

Die Ergebnisse geben Hinweise darauf, dass die COVID-19-Pandemie für Schulen ein disruptives Ereignis darstellt, welches die Umsetzung schulischer Gesundheitsförderung erschwert. Vor allem gesundheitsförderliche Arbeitsbedingungen, Partizipation und Kooperation sollten in den Fokus genommen werden.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03535-w) enthalten

The Impact of Migration Status on Adolescents’ Mental Health during COVID-19

The purpose of this study was to compare mental health in adolescents with and without migration background after a semester of remote schooling and almost a year of social distancing in Austria. An online survey, supported by the Austrian Federal Ministry of Education, Science and Research, was conducted from 3rd February to 28th February 2021 measuring well-being (WHO-5), depression (PHQ-9), anxiety (GAD-7), sleep quality (ISI), stress (PSS-10), and disordered eating (EAT-8). A matched-pairs analysis with and without migration background was conducted and was checked with whole sample analysis. From a total of 3052 participants, N = 508 had a migration background (first or second generation) and N = 479 could be matched according to age, gender, region, and education with adolescents without migration background. Matched-pairs analyses showed that migration background is associated with poorer mental health concerning well-being, depression, anxiety, and insomnia scores (all p-values < 0.05). Prevalence of depressive symptoms (64.5% vs. 56.5%), anxiety symptoms (53.5% vs. 46.0%), as well as insomnia (31.9% vs. 21.0%) is higher in adolescents with migration background (all p-values ≤ 0.02). Comparison of the whole sample (N = 3052) confirmed these results. Results suggest that migration status is a risk factor for mental health problems among adolescents during the COVID-19 pandemic and highlight the need to implement easily accessible culture- and language-specific health promotion and prevention strategies.