Lebensqualität bei psychisch kranken Kindern und Jugendlichen

SARS-CoV-2 and Adolescent Psychiatric Emergencies at the Tübingen University Hospital: Analyzing Trends, Diagnoses, and Contributing Factors

Psychiatric emergencies have increased in recent decades, particularly with the onset of the SARS-CoV-2 pandemic, and far too little is known about the backgrounds of these emergencies. In this study, we investigated the extent to which the number of psychiatric emergencies changed during and in the aftermath of the SARS-CoV-2 pandemic at the Child and Adolescent Psychiatry (CAP) Tübingen. We considered age and psychiatric diagnoses. Additionally, we evaluated the backgrounds of the emergencies. We applied a mixed- (quantitative and qualitative) methods approach to data on emergency presentations at the CAP Tübingen from the pre-SARS-CoV-2 pandemic period (October 2019-January 2020) to Restriction Phase 1 (October 2020-January 2021), Restriction Phase 2 (October 2021-January 2022), and endemic phase (October 2022-January 2023). The total number of emergencies and those with eating disorders and affective disorders increased, while obsessive-compulsive disorders, expansive disorders and anxiety disorders decreased. The patients presenting in the pre-SARS-CoV-2 pandemic period were younger than those in the subsequent periods. We content-coded the reasons behind the emergency presentations. We also identified four areas of stressors and personality characteristics associated with the emergency presentations. In light of the increasing number of psychiatric emergencies, the long-term aim should be to meet the growing demands and create options for prevention.

Outcome Quality of Inpatient and Day-Clinic Treatment in Child and Adolescent Psychiatry—A Naturalistic Study

Background: Child and adolescent psychiatry has only recently been established as a separate specialty and is practiced in different settings. The epidemiology of psychological problems in childhood is high and varied, thus qualitative work is essential. Assessment of outcome as part of quality management is central to assure the service of psychiatric care to be effective. Method: Over a three-year period consecutively admitted patients from inpatient and day-clinic treatment were prospectively evaluated. A total of 200 from 442 patients (m = 80, f = 120; age 15.1 ± 2.8 y) agreed to participate. Patients, caregivers, and therapists answered a range of questionnaires to provide a multi-personnel rating. Questionnaires used for outcome assessment were Child Behavior Checklist (CBCL) and Youth-Self-Report (YSR) (at admission, discharge, and 6 weeks after discharge) and the problem score of the Inventory of Quality of Life for children (ILK), treatment satisfaction, and process quality by the Questionnaire for Treatment Satisfaction (FBB, at discharge) and as real-life outcome control assessment of quality of life (ILK) was added (admission, discharge, and 6 wks after discharge). Results: There was a significant reduction in psychopathologicalsymptoms (CBCL, YSR) and in the problem score. Furthermore, there was a significant increase in quality of life. QoL score and YSR/CBCL scores returned to normal levels. Treatment satisfaction was high and so was satisfaction with process quality. Factors significantly influencing outcome were severity of disease and the relationship to the therapist. No differences were found for gender and setting. Conclusion: The quality management analysis revealed significant improvements of symptom load, a significant increase in QoL and a high treatment satisfaction. Furthermore, process quality was scored highly by parents and therapists.

Long-term outcome of intensive home treatment for children and adolescents with mental health problems - 4 years after a randomized controlled clinical trial

BACKGROUND

Admission rates to child and adolescent mental health inpatient units in Germany are substantial (58.831 admissions in 2019). Historically, different treatment pathways have not been available. The evidence suggests that home treatment could be an alternative. The objective of this study was to assess the long-term stability of treatment gains among children and adolescents treated for serious mental health problems with home treatment (HT) as compared with inpatient treatment-as-usual (TAU).

METHODS

Hundred patients were enrolled and randomized into an intervention (HT n = 54) and control group (TAU n = 46). Follow-up data were available after 8.4 months (n = 78) (T3) and after 4.3 years (n = 51) (T4). The primary outcome measured was overall level of functioning, for which the Children's Global Assessment Scale (CGAS) was used. Secondary outcomes included severity of patient impairment and parental competency in dealing with their child's symptoms, measured using the Health of the Nation Outcome Scales (HoNOSCA). A qualitative interview with parents was performed at T3 and T4.

RESULTS

Treatment effects remained stable for both groups at T3 and T4 (p < .001). After 4.3 years 70% of the parents in the intervention group stated satisfaction with the treatment received, while only 36.8% of the parents within the control group rated themselves as satisfied. 43.7% of parents in the home treatment group reported that the most helpful aspect of this pathway was the prompt and intensive professional help and advice they received as primary caregivers at home.

CONCLUSIONS

Home treatment may be considered a viable alternative to inpatient care.

Kinder- und jugendpsychiatrische stationsäquivalente Behandlung (StäB): Therapieoption – für alle oder für wenige?

Zusammenfassung. Fragestellung: Aufsuchende stationsäquivalente Behandlung (StäB) ist seit dem 01.01.2017 in Deutschland möglich und seit dem 01.01.2018 abrechenbar. Dennoch wird StäB unter Infragestellung der Machbarkeit der Rahmenbedingungen derzeit nur an wenigen Standorten der Kinder- und Jugendpsychiatrie und Psychotherapie in Deutschland regelhaft angeboten. Ziel war es, anhand der ersten 58 stationsäquivalent behandelten Kinder und Jugendlichen am ZfP Südwürttemberg (2018–2019) die Machbarkeit und Kosten von StäB zu evaluieren. Methodik: Es wurden alle seit dem 01.01.2018 konsekutiv stationsäquivalent behandelten Fälle eingeschlossen und anhand von rein deskriptiven Analysen in SPSS.25 evaluiert. Ergebnisse: Die durchschnittliche Behandlungsdauer betrug 37.95 Tage (SD 15.35), 86.2 % aller Familien beendeten die Behandlung regelgerecht, es kam nur bei drei Patientinnen und Patienten zu einem einvernehmlichen Behandlungsabbruch, fünf mussten in eine stationäre Behandlung verlegt werden. Es wurden primär internalisierende Störungen indiziert (70.7 %), während externalisierende Störungen nur ein Viertel der Behandlungsfälle ausmachten (27.8 %). Kosten einer StäB beliefen sich im Durchschnitt auf 8779,25 €. Schlussfolgerungen: StäB stellt eine neue Behandlungsform im familiären Umfeld dar, welche täglich stattfindet. Multiprofessionalität der Behandlung ist Voraussetzung. Eine Umsetzung in den gegebenen Rahmenbedingungen ist möglich. Eine Akzeptanz von den Familien ist gegeben, die durchschnittliche Behandlungsdauer liegt leicht über dem stationären Bundesdurchschnitt.

The Perspective Matters: A Multi-informant Study on the Relationship Between Social-Emotional Competence and Preschoolers' Externalizing and Internalizing Symptoms

Recent research demands a multi-informant and multi-factorial assessment of preschool-age psychopathology. Based on a tripartite model, we tested the relationship between emotional and social competence and their contribution to externalizing and internalizing symptoms in a preschool-age community sample (N = 117, M = 4.67 years, SD = 2.75 months). We assessed teachers' (N = 109) and parents' (N = 77) perspective using the Strengths-and-Difficulties-Questionnaire and children's perspective using the Berkeley-Puppet-Interview and a standardized emotional-competence-test (MeKKi). We found externalizing symptoms being negatively related to prosocial behavior in teachers' and parents' reports and positively related to social initiative in teachers' reports. In teachers' reports only, a mediation effect of emotional competence via social competence on externalizing symptoms was shown. Children, but not caregivers, reported internalizing symptoms being positively related to prosocial behavior. These results highlight the importance of multiple informants and especially of children's self-perception in preschool-age psychopathology.

Predictive factors for changes in quality of life among children and adolescents in youth welfare institutions

PURPOSE

Children and adolescents living in youth welfare institutions often have a below average quality of life (QoL), for reasons that include developmental difficulties, history of traumatic experiences, and mental disorders. Youth welfare measures are needed that would have a positive impact, but there is a lack of longitudinal research on which measures are most effective. This study investigated what factors are associated with an improvement in QoL during residential stay.

METHODS

Residents of youth care facilities in Switzerland and their professional caregivers completed questionnaires that addressed QoL, psychopathology, and experience of traumatic events at two time points. In addition, information regarding mental disorders was obtained through structured clinical interviews. Analyses were conducted on the data obtained from 204 respondents aged 11-18 years. Comparisons with a school sample were conducted.

RESULTS

Compared to a school sample, a majority of participants rated their QoL equal, whereas their caregivers rated it as lower. Factors predictive of a poorer QoL were high levels of internalizing and externalizing psychopathology, presence of co-morbidities, and female gender. At the second assessment, the caregivers reported a small improvement, which was associated with reductions in both internalizing and externalizing psychopathology.

CONCLUSIONS

The finding that a reduction in severity of psychopathology may result in an improvement in QoL underlines the importance of providing professional support for mentally ill residents of youth welfare institutions. Further research is needed to determine the causality of this association.

[Intensive psychiatric care of children and adolescents in their natural environment : Alternatives to inpatient treatment]

Mental health disorders are one of the main diseases in children and adolescents, the persistence rate into adulthood being around 50%. Early intervention is therefore essential. However, present treatment options reach only 50% of children and adolescents with mental health problems.The objective of this article is to depict why legal deficits complicated the establishment of outreach treatment in the past and to illustrate recent legal changes that now allow innovative outreach treatment programs that meet the need of children and adolescents with mental health issues.This review is based on pertinent publications that were retrieved by a selective literature search in PubMed and Cochrane Library concerning types of home treatment in child and adolescent psychiatry, with due reference to the authors' own experience with intensive home treatment.The literature shows that outreach work has been effective in many other countries. In Germany however, clear separation in finances between outpatient and inpatient treatment did not allow the establishment of outreach teams in the past. On 01.01.2017 a new law, the PsychVVG, entered into force, and now provides a sound legal basis for outreach work. Home treatment in the form of, for example, intensive outreach work that equals the intensity and frequency of inpatient treatment (StäB) or continuum of care school (CCSchool), a project that joins school-based diagnostic elements with school-based treatment, can now be installed and evaluated.Intensive outreach work, especially in child and adolescent psychiatry, will now be a good alternative to inpatient treatment that integrates parents into the treatment approach.

The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up

PURPOSE

To investigate, in adolescents referred for psychiatric services, the associations of initial self-esteem and family functioning with level and change of quality of life (QoL) over a 3-year period, over and above the effect of their emotional problems.

METHODS

Of 1648 eligible 13-18 years old patients attending the child and adolescent psychiatric clinic (CAP) at least once, 717 (54.8% females) were enrolled at baseline (a response rate of 43.5%). Self- and parent reports on the McMaster Family Assessment Device were obtained. Adolescents reported self-esteem on the Rosenberg Scale, and emotional problems on the Symptom Check List-5. Adolescents completed the Inventory of Life Quality in Children and Adolescents (ILC). After 3 years, 570 adolescents again completed the ILC, and for 418 adolescents parent information was available. The longitudinal analysis sample of 418 adolescents was representative of the baseline sample for age, gender, emotional problems, and QoL. We used modified growth-model analysis, adjusted for SES, age, gender and time of contact with CAP, where residual variances for ILC at baseline and follow-up were fixed to 0.

RESULTS

A poorer family functioning at baseline, reported by parents, was significantly associated with worsening QoL during the 3 years follow-up period (p = 0.001).

CONCLUSIONS

Parents have important knowledge about their families that may reflect long-term influences on QoL development in adolescent psychiatric patients. Health care providers and policy makers should optimize treatment outcomes by addressing family functioning in adolescents with emotional problems.

Social competence and psychopathology in early childhood: a systematic review

The acquisition of social competence, such as showing prosocial behaviour (fulfilling others' needs) and social initiative (fulfilling own needs), constitutes one major developmental task in childhood and adolescence. Previous research suggests that in middle childhood, impaired social competences are related to childhood psychopathology, such as externalizing and internalizing disorders. As the period of preschool age is a particularly important time for both the development of social competence and early psychopathological symptoms, we conducted a systematic review to investigate the role of social competence in relation to early childhood psychopathology. Twenty-one clinical as well as subclinical studies published prior to September 2016 were included in a qualitative analysis of the relation between prosocial behaviour, social initiative, and early externalizing and internalizing symptoms in preschool age children (age 3-6). Effect sizes for each study were calculated if required information was available. Our review suggests that from early on in childhood development, externalizing symptoms are accompanied by prosocial behaviour deficits such as lower levels of helping or cooperating, whereas internalizing symptoms may be accompanied by either deficient or excessive levels of prosocial behaviour. Exhibiting social initiative such as initiating contact with others or communicating one's own needs seems to be impaired in children with internalizing symptoms. Implications for current theory and future research are discussed.

Psychopathology and Quality of Life in Traumatized or Victimized Underage Individuals as Factors for Forensic Multilevel Assessment-A Pilot Investigation

Background: Psychological sequels to criminal violence can be long lasting and severe. They are in many countries not sufficiently considered in court cases as an important circumstance that could be used to assess the severity of the crime, also guiding redress, compensation, and rehabilitation of the victim, and-in children-child custody considerations. So far, the focus of forensic assessment has often been limited to diagnostic categories, especially "posttraumatic stress disorder" (PTSD), a diagnosis that presently is subjected to rapidly changing definitions both in and between diagnostic systems. Other indicators such as quality of life (QoL) might be of equal importance as compared to clinical or research diagnostic categories to understand and evaluate the impact of a crime and the amount of help needed and, in the legal context, redress to be asked. Symptoms might differ depending on the crime encountered. Objective and Methods: QoL and general symptom patterns including a PTSD diagnosis were assessed in a group of 10- to 17-year-old minors with (n = 33) and without (n = 49) PTSD diagnosis who all had experienced sexual abuse, physical abuse, death of a parent, or their parents' divorce, using standardized diagnostic instruments. Results: PTSD patients reported a significantly lower QoL than non-PTSD controls. Reported symptom patterns with potential impact on life, such as intrusive thoughts, differed between the victims of different crime types, with the highest rates of both intrusive symptoms and combined symptom profile in victims of sexual abuse. Data indicate that the changes between older and present criteria and between DSM and recently published ICD 11 might help identify different groups and symptom profiles. Conclusion: Specific trauma-related symptom profiles integrating the type of crime encountered and its individual impact on QoL may help improve future forensic assessment and guide compensation and rehabilitation plans. Carefully designed studies are now needed to further explore the use and forensic usability of complex indicators and the impact of violence in different forensic settings.

Quality of life and satisfaction with inpatient treatment in adolescents with psychiatric disorders : A comparison between patients', parents', and caregivers' (self-)assessments at admission and discharge

OBJECTIVES

The purpose of this study was to compare results of patients', parents', and caregivers' (nursing staff and educators) (self-)assessments of quality of life, treatment outcomes, and satisfaction with inpatient treatment in a child and adolescent psychiatric hospital. In addition, the investigation included a comparison between admission and discharge of the three investigated groups.

METHODS

The study considered adolescents at the Department of Child and Adolescent Psychiatry and Psychotherapy, Hinterbruehl, along with their parents and caregivers. Following questionnaires at admission and discharge were used: the Youth Self-Report (YSR) or Child Behavior Checklist (CBCL/4-18), Inventory for Assessing Quality of Life in Children and Adolescents (ILK), and Questionnaires of the Evaluation of Treatment (FBB).

RESULTS

Adolescents (58 patients, aged 14-18 years, standard deviation = 1.06) with different psychiatric diagnoses consecutively admitted for a diagnostic or therapeutic stay were included. The quality of life score was significantly different between patients' and parents' rating at discharge. The results of the treatment satisfaction revealed no significant correlations between patients', parents', and caregivers' ratings. A reduction in the psychopathology between admission and discharge was measured in all groups of raters. In addition, an increase in quality of life between admission and discharge was observed in patients, parents, and caregivers. Treatment satisfaction was moderate in all groups of raters.

CONCLUSION

The views of patients' treatment measured by patients themselves, parents, and caregivers during a psychiatric ward stay are different and more or less unrelated. This indicates that each group applies different criteria when assessing treatment satisfaction.

[Cross-sectional data of inpatient residents of a rehabilitation center with schizophrenic psychosis diagnosis]

Cross-sectional data of inpatient residents of a rehabilitation center with schizophrenic psychosis diagnosis Abstract.

OBJECTIVE

The objective of this study is to evaluate the level of neuropsychological functioning, quality of life, content of treatment, abnormal psychology as well as the level of functioning and medication in children and adolescents who suffer from a schizophrenia spectrum disorder, treated as rehabilitation inpatients.

METHODS

Forty-two patients could be examined, therefore, the IRAOS, the WAIS-IV, the TMT-A/-B, the FBB-P (patient's version), the ILK-P, the SANS/SAPS, the BPRS, the BSCL, the GAF, the CGAS, and the CGI were used.

RESULTS

Patients' average age at onset of the disorder was 14.49 years (± 2.90). The total value of IQ was 87.00 (± 15.02), the value of TMT-A was 73.05 (± 14.51), and of the TMT-B 75.62 (± 15.15). The value for the content of treatment in the summary-score of the FBB-P was 3.05 (± 0.49). The value of the total-score in ILK-P was 2.10 (± 0.70). The summary-score of the SANS was 5.00 (± 2.90) and of the SAPS 3.00 (± 2.70). The BPRS-summary-score's value was 30.70 (± 7.80), the BSCL-GSI's value was 0.90 (± 0.50). GAF and CGAS were at 48.30 (± 12.80), respectively 51.00 (± 12.30). Clozapin has been prescribed in 25.0 % of the cases as first or second neuroleptic medication.

CONCLUSION

We investigated patients with VEOS and EOS living in a rehabilitation center. Usually, the course of their illness is much more severe and chronic than it is seen in a common department for child and adolescent psychiatry. Findings indicate a clear impairment in the level of neuropsychological and global functioning in contrast to rather low to moderate burden of positive/negative deficits. Satisfactory results of treatment and quality of life could be evaluated in spite of the aforementioned impairments. Medication did not conform to current guidelines, especially concerning Clozapin. Findings of the subsequent follow-up will show, if the impairment will improve under inpatient rehabilitation conditions.

Suicidal Risk, Psychopathology, and Quality of Life in a Clinical Population of Adolescents

BACKGROUND

According to literature data, psychopathology is associated with both quality of life (QoL) and suicidal risk in adolescents, but the literature does not fully support a direct association between psychopathology and suicidal thoughts and behaviors. The aim of this study was to investigate the possible mediational role of QoL in the relationship between psychopathology and level of suicidal risk in a clinical sample of adolescents.

METHOD

The authors examined a clinical population of 134 adolescents, aged 13-18 years. Suicidal risk-having any current suicidal ideations and/or previous suicide attempt-was assessed by the Mini International Neuropsychiatric Interview. QoL was evaluated by the adolescent self-rated versions of "Das Intervertar zur Erfassung der Lebensqualität Kindern und Jugendlichen" (ILK: Measure of Quality of Life for Children and Adolescents) and psychopathology was measured by adolescent self-rated versions of the Strengths and Difficulties Questionnaire (SDQ). A mediational model, in which QoL mediated the relationship between psychopathology and suicidal risk controlling for gender and age, was tested by means of regression analyses.

RESULTS

Gender and age were both associated with suicidal risk. Self-reported QoL significantly mediated the relationships between emotional problems (=1.846; 95% BCa CI: 0.731-2.577), as well as peer problems (=0.883; 95% BCa CI: 0.055-1.561) and suicidal risk: more emotional and peer problems were associated with lower QoL, which in turn was related to higher level of suicidal risk.

CONCLUSION

Based on this study, which aims to make further steps in suicidal prevention, our findings suggest that clinicians should routinely screen the QoL of their patients, especially in adolescents with emotional and peer problems. Furthermore, it is important to focus intervention and treatment efforts on improving the QoL of adolescents with emotional and peer problems.

Economic Evaluation of Interventions for Children with Neurodevelopmental Disorders: Opportunities and Challenges

Economic evaluation is a tool used to inform decision makers on the efficiency of comparative healthcare interventions and inform resource allocation decisions. There is a growing need for the use of economic evaluations to assess the value of interventions for children with neurodevelopmental disorders (NDDs), a population that has increasing demands for healthcare services. Unfortunately, few evaluations have been conducted to date, perhaps stemming from challenges in applying existing economic evaluation methodologies in this heterogeneous population. Opportunities exist to innovate methods to address key challenges in conducting economic evaluations of interventions for children with NDDs. In this paper, we discuss important considerations and highlight areas for future work. This includes the paucity of appropriate instruments for measuring outcomes meaningful to children with NDDs and their families, difficulties in the measurement of costs due to service utilization in a wide variety of sectors, complexities in the measurement of caregiver and family effects and considerations in estimating long-term productivity costs. Innovation and application of evaluation approaches in these areas will help inform decisions around whether the resources currently spent on interventions for children with NDDs represent good value for money, or whether greater benefits for children could be generated by spending money in other ways.

Status and perception of oral health in 6-17-year-old psychiatric inpatients-randomized controlled trial

AIM

The following are the aims of the study: assessment of oral health status, oral health-related quality of life (OHRQoL) and the effect of oral health care training over OHRQoL in children and adolescents hospitalized with mental disorders.

METHODOLOGY

This randomized case controlled prospective interventional study involved 81 child and adolescent psychiatric inpatients (CAP) aged between 6 and 17 years (mean age 10.6 ± 2.4 years), compared to 81 mentally healthy patients attending routine dental examinations (DC group) matched according to age and sex of the CAP group. Oral examinations were performed by two calibrated dentists. OHRQoL was assessed with the German version of the Child Perceptions Questionnaire. CAP inpatients were randomly divided in two equal subgroups, an intervention (IG) and a non-intervention group (non-IG). The IG received oral health care training at admission to the hospital.

RESULTS

CAP inpatients, especially those with stress-related disorders, revealed significantly higher caries prevalence and experience than DC patients. Although OHRQoL did not differ from the German reference values, CAP inpatients compensated higher impairment due to oral symptoms and functional limitations with lower impairment due to emotional and social well-being. OHRQoL increased in all CAP patients during hospitalization, regardless of receiving oral health care training.

CONCLUSION

Poorer oral health of CAP inpatients was not accompanied by higher impairment of OHRQoL. Oral problems seem to be overshined by better self-perceived emotional and social well-being. OHRQoL was not improved by individualized oral health care training.

CLINICAL RELEVANCE

Children and adolescents with mental disorders are at risk for oral diseases and need referral to dental services.

Annual Research Review: Quality of life and childhood mental and behavioural disorders - a critical review of the research

BACKGROUND

An individual's subjective perception of well-being is increasingly recognized as an essential complement to clinical symptomatology and functional impairment in children's mental health. Measurement of quality of life (QoL) has the potential to give due weight to the child's perspective.

SCOPE AND METHODOLOGY

Our aim was to critically review the current evidence on how childhood mental disorders affect QoL. First, the major challenges in this research field are outlined. Then we present a systematic review of QoL in children and adolescents aged 0-18 years formally diagnosed with a mental and behavioural disorder, as compared to healthy or typically developing children or children with other health conditions. Finally, we discuss limitations of the current evidence base and future directions based on the results of the systematic review and other relevant literature.

FINDINGS AND CONCLUSIONS

The systematic review identified 41 eligible studies. All were published after the year 2000 and 21 originated in Europe. The majority examined QoL in neurodevelopmental disorders, including attention-deficit hyperactivity disorder (k = 17), autism spectrum disorder (k = 6), motor disorders (k = 5) and intellectual disability (k = 4). Despite substantial heterogeneity, studies demonstrate that self-reported global QoL is significantly reduced compared to typical/healthy controls across several disorders and QoL dimensions. Parents' ratings were on average substantially lower, casting doubt on the validity of proxy-report. Studies for large diagnostic groups such as depressive disorders, anxiety disorders, (early onset) schizophrenia and eating disorders are largely lacking. We conclude that representative, well-characterized normative and clinical samples as well as longitudinal and qualitative designs are needed to further clarify the construct of QoL, to derive measures of high ecological validity, and to examine how QoL fluctuates over time and is attributable to specific conditions or contextual factors.

Verhaltensauffälligkeiten und Lebensqualität bei männlichen unbegleiteten minderjährigen Flüchtlingen in Jugendhilfe einrichtungen in Deutschland

Zusammenfassung. Unbegleitete minderjährige Flüchtlinge (UMF) gelten als Hochrisikogruppe für die Entwicklung psychischer Erkrankungen. Hinsichtlich Häufigkeit und Art psychischer Störungen sowie gesundheitsbezogener Lebensqualität (LQ) fehlen für Deutschland bislang Originalarbeiten. Anhand der Daten von 191 männlichen UMF, erhoben in Jugendhilfeeinrichtungen in Deutschland, wurden emotionale und Verhaltensauffälligkeiten (SDQ) sowie gesundheitsbezogene LQ (ILK) untersucht und Vergleiche zur Normstichprobe durchgeführt. Internalisierende Verhaltensauffälligkeiten zeigten sich laut Selbst- und Fremdbeurteilung bei 35 bis 61 % der Jugendlichen signifikant häufiger als in der Normstichprobe (20 %). Hyperaktivitätssymptome waren dagegen sehr selten (4 bis 7 %). Externalisierende Verhaltensprobleme wurden von Betreuungspersonen häufiger (20 %) berichtet als von den Jugendlichen (8 %). Gesundheitsbezogene LQ wurde niedrig eingeschätzt, als Ressource konnte prosoziales Verhalten identifiziert werden.

Welche Faktoren beeinflussen, ob psychisch belastete Kinder mit einem psychisch kranken Elternteil Hilfen erhalten?

Zusammenfassung. Trotz der erheblichen Risiken für die Entwicklung der Kinder von psychisch kranken Eltern zeigen viele Studien, dass die betroffenen Familien psychosoziale Hilfsangebote aus den unterschiedlichsten Gründen nicht ausreichend nutzen können. Zentrale Fragestellungen der Studie sind sowohl die Inanspruchnahme von Hilfsangeboten in der Region Basel (Schweiz) durch psychisch kranke Eltern als auch Gründe, weshalb Angebote nicht genutzt werden. Zudem wurde nach Prädiktoren gesucht, wieso verhaltensauffällige Kinder mit geringerer Lebensqualität in dieser Risikopopulation keine adäquate psychiatrische Unterstützung erhalten. Untersucht wurden psychisch kranke Eltern (N = 101, 58.4 % weiblich) in (teil–) stationärer und ambulanter psychiatrischer Behandlung. Die Resultate zeigen, dass auch in einer psychosozial gut versorgten Region viele Familien von Hilfsangeboten nicht erreicht werden konnten. Gründe waren, dass die Angebote nicht bekannt waren, zu hohe Kosten oder Ängste der Eltern bezüglich Sorgerechtsentzugs. Elterlicher Stress erwies sich als signifikanter Prädiktor, weshalb verhaltensauffällige Kinder mit geringer Lebensqualität keine adäquate Hilfe erhalten. Diese Ergebnisse belegen, dass die vorhandenen Hilfsangebote die betroffenen Familien nicht erreichen. Die Elternschaft und der damit verbundene Stress sollten in der therapeutischen Arbeit mit diesen Eltern thematisiert werden.

Self- and proxy reports of quality of life among adolescents living in residential youth care compared to adolescents in the general population and mental health services

Background

Child welfare services are aimed at providing care and protection, fostering well-being and prosocial behaviour. Thus, Quality of Life (QoL) should be an important outcome measure in Residential Youth Care (RYC) institutions. However, the dearth of research in this area gives rise to serious concern. The present study is the first large scale, nationwide study assessing QoL among adolescents living in RYC. To provide a reference frame, adolescent self- and primary contact proxy reports were compared to the general population and to adolescent outpatients in Child and Adolescent Mental Health Service (CAMHS). Also, we investigated the association between self-report of QoL in adolescents living in RYC and proxy reports of their primary contacts at the institution.

Methods

All residents between the ages of 12–23 years living in RYC in Norway were the inclusion criteria. Eighty-six RYC institutions (with 601 eligible youths) were included, 201 youths/ parents did not give their consent. Finally, 400 youths aged 12–20 years participated, yielding a response rate of 67 %. As a reference frame for comparison, a general population (N = 1444) and an outpatient sample of adolescents in CAMHS (N = 68) were available. We used the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). General Linear Model analyses (ANCOVA) were conducted with five KINDL life domains as dependent variables and group as independent variable.

Results

Self- and proxy reports of QoL in adolescents living in RYC revealed a significantly (p < 0.001) poorer QoL compared to the general population on the life domains Physical- and Emotional well-being, Self-esteem, and relationship with Friends. Adolescents evaluated their physical well-being as worse compared to adolescents in CAHMS. Self- and proxy reports in RYC differed significantly on two of five life domains, but correlated low to moderate with each other.

Conclusions

The results in this study raise major concerns about the poor QoL of the adolescents living in RYC, thereby challenging the child welfare system and decision makers to take action to improve the QoL of this group. The use of QoL as outcome measures is highly recommended.

[Psychopathological problems and psychosocial impairment in children and adolescents aged 3-17 years in the German population: prevalence and time trends at two measurement points (2003-2006 and 2009-2012): results of the KiGGS study: first follow-up (KiGGS Wave 1)]

Child and adolescent mental health problems burden not only the individual, but also their families and their social environment and may, therefore, be regarded as a highly relevant public health issue. The data on mental health problems of children and adolescents from the KiGGS Wave 1 study (sample period 2009-2012) make it possible to report on both current prevalence rates and time trends over the 6-year period beginning with the KiGGS baseline survey (2003-2006). The assessment of emotional and behavioral problems in KiGGS Wave 1 was carried out with the symptoms questionnaire of the Strengths and Difficulties Questionnaire (SDQ) in a telephone interview with 10,353 guardians of children and adolescents aged 3-17 years. Moreover, using the SDQ impact supplement, the KIGGS Wave 1 data provide information on psychosocial impairment following child and adolescent mental health problems. Subjects with a borderline or abnormal SDQ score, according to German normative data, were considered at risk. A total of 20.2% (95% CI: 18.9-21.6%) of the study subjects were identified as being at risk for a mental health disorder, compared with 20.0% (19.1-20.9%) during the KiGGS baseline study (age-standardized based on population from 12 December 2010). Thus, no significant changes over time in the prevalence of mental health problems were detected. Also, there were no statistically significant differences in prevalence by sex, age group, or socioeconomic status between the KiGGS baseline survey and KiGGS Wave 1. The statistical comparison of the subscale mean values for both girls and boys showed higher values with respect to the subscales for emotional problems, behavioral problems, and prosocial behavior and lower mean values for the peer problems subscale in KiGGS Wave 1. These partly small temporal trends, however, may be due to possible mode effects (written questionnaire in the KiGGS baseline study versus telephone interview in KiGGS Wave 1). The hyperactivity subscale remained stable across the two sample periods. Regarding impairments following mental health problems at the second sample period, boys were more affected in the areas of chronicity, family burden, and impact score. The high and stable prevalence rates and magnitude of emotional and behavioral problems should prompt increased preventive efforts.

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

BACKGROUND

Admission rate to child and adolescent mental health inpatient units in Germany is high (54,467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support.

METHODS

Of 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n=54) and control groups (n=46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non-health care costs) was calculated on an intention-to-treat basis at T2 and T3.

RESULTS

Significant treatment effects were observed for both groups between T1/T2 and T1/T3 (P<0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: -6900.47€, P=0.013) and T3 (difference: -8584.10€, P=0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3.

CONCLUSIONS

Hot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. (

REGISTRATION NUMBER

ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

Disorder-specific cognitive-behavioral therapy for separation anxiety disorder in young children: a randomized waiting-list-controlled trial

BACKGROUND

Separation anxiety disorder (SAD) is one of the earliest and most common mental disorders in childhood, and a strong predictor of adult psychopathology. Despite significant progress in psychotherapy research on childhood anxiety disorders, no randomized controlled trial has been conducted with a disorder-specific treatment program for young children suffering from SAD.

METHODS

Forty-three children (ages 5-7) with SAD and their parents were assigned to either a 16-session disorder-specific SAD treatment program including parent training and classical cognitive-behavioral therapy (CBT) components, or to a 12-week waiting list group. Categorical and/or continuous data for anxiety, impairment/distress and quality of life were collected at baseline, after treatment/waiting list condition, and at a 4-week follow-up.

RESULTS

Intention-to-treat analyses indicate that 76.19% of children allocated to the treatment group definitively no longer fulfilled DSM-IV criteria for SAD at follow-up, compared to 13.64% in the waiting list group. Between 91 and 100% of children rated themselves or were rated by their father, mother or therapist as very much or much improved on the global success rating immediately after treatment. Results indicated large time by treatment condition interaction effect sizes (d = 0.98-1.41) across informants for reduction of distress/avoidance in separation situations after the test for the treatment condition. Further, parents reported significant improvements in impairment/distress in the child's major life domains and the child's quality of life. Treatment gains were maintained at the 4-week follow-up assessment.

CONCLUSIONS

Results indicate the short-term efficacy of a disorder-specific treatment approach for SAD, and are among the first to indicate that CBT programs work with young children.

Improved functionality, health related quality of life and decreased burden of disease in patients with ADHD treated with OROS® MPH: is treatment response different between children and adolescents?

BACKGROUND

To compare clinical and health-related quality of life (HRQoL) outcomes between children and adolescents with ADHD treated with OROS® MPH, using data from two large similarly-designed multicenter, prospective, open-label, single-arm, non-interventional studies.

METHODS

Pooled analysis (42603ATT4037, 42603 - ATT - 4001) including patients (6 to 18 years) with a confirmed diagnosis of ADHD. Patients were treated with OROS® MPH for 12 weeks; ADHD symptoms, functioning, HRQoL, safety and tolerability parameters were assessed.

RESULTS

822 patients (583 children [6-12 years], 239 adolescents [13-18 years]) were included in the pooled analysis. Mean daily OROS® MPH starting doses in the child and adolescent subgroups were 29.0 ± 11.7 and 37.6 ± 15.6 mg, respectively (p < 0.001). At study end (week 12), the overall mean daily dose was 35.5 ± 14.0 mg, with children and adolescents receiving 32.8 ± 12.7 and 42.0 ± 15.1 mg/day, respectively (p < 0.001). Significant (p < 0.0001: overall population, children, adolescents) symptomatic, functional and HRQoL improvements were observed from baseline to study end using the Conners' Parents Rating Scale (overall: 29.2 ± 10.7 [baseline] to 19.3 ± 11.3 [endpoint]), Children's Global Assessment Scale (overall: 58.5 ± 14.5 [baseline] to 69.6 ± 16.1 [endpoint]), and ILC-LQ0-28. At week 12, between-age group differences were seen in the individual ILC-LQ0-28 parameters: school performance (p = 0.001 [parents' assessment], p = 0.032 [childrens' assessment]), global QoL (p = 0.012 [parents']) and interests and hobbies (p = 0.023 [childrens']). Treating physician's planned continued use of OROS® MPH in 76.9%, 86.0% and 79.3% of children, adolescents and the total population, respectively, at study end (p = 0.029 between-age subgroups). 195 of 822 patients (23.7%) experienced at least one treatment-emergent adverse event; most commonly reported AEs in the total group (≥4%) were insomnia (7.2%), anorexia (4.3%) and involuntary muscle contractions (4.1%). No clinically relevant changes in body weight or vital signs were observed.

CONCLUSIONS

Clinically relevant differences between children and adolescents with ADHD are present. Adolescents appeared to have a lower health related quality of life and functioning compared to children at baseline, however, they were able to reach comparable ratings at endpoint for most items. Similarly, burden of disease decreased in patients and their carers. OROS MPH was generally safe and well tolerated.

Effect of transitioning from extended-release methylphenidate onto osmotic, controlled-release methylphenidate in children/adolescents with ADHD: results of a 3-month non-interventional study

BACKGROUND

To explore the clinical outcomes of children/adolescents with ADHD who transitioned from extended-release methylphenidate (ER MPH, Medikinet Retard) to osmotic release oral system (OROS) MPH (Concerta). Medikinet Retard is a registered trade name of Medice, Bad Iserlohn, Germany. Concerta is a registered trade name of Janssen-Cilag GmbH, Neuss, Germany.

METHODS

This prospective, non-interventional study included patients aged 6 to 18 years with a confirmed diagnosis of ADHD who experienced insufficient clinical response and/or poor tolerability on ER MPH. Patients transitioned onto OROS MPH and were followed for 12 weeks. Symptoms, functional outcome, health-related quality of life, safety and tolerability were assessed.

RESULTS

180 patients were included in the intention-to-treat analysis. The mean ER MPH dose before switching was 28.2 mg/day; mean OROS MPH starting dose was 38.1 mg/day, increasing to 41.2 mg/day at the final visit. Mean treatment duration was 79.49 ± 24.22 days (median 85; range 7-136). Several symptomatic and functional outcomes under OROS MPH treatment changed from baseline and included the Conners' Parent Rating Scale (CPRS; -11.7 ± 11.3; p < 0.0001), C-GAS (12.3 ± 15.2; p < 0.0001) and ILC-LQ0-28 (parents' rating 2.9 ± 4.3 and patients' rating 2.8 ± 3.8; both p < 0.0001). Improvements in social interactions, playing with other children, doing household chores, or school homework, going to bed, and behavior towards visitors/at visits were noted (p < 0.0001). Approximately 40% of patients reported better sleep quality and appetite (p < 0.0001), and 72.8% expressed satisfaction with OROS MPH therapy compared to previous ER MPH. OROS MPH was well tolerated; the most common AEs after switching, with an incidence >2% and possibly related to therapy, were involuntary muscle contractions (tics; 8.9%), insomnia (7.2%) and anorexia (5.0%). No relevant changes in body weight or vital signs were observed. Three patients reported four serious AEs, but none were considered related to OROS MPH. Limitations included those associated with the uncontrolled, open-label design, possible inclusion bias and non-validation of the CPRS in a German population.

CONCLUSIONS

Transitioning onto OROS MPH improved functionality, symptom control and decreased burden of disease in patients with ADHD who had insufficient response to, and/or poor tolerability of ER MPH. Similarly, care givers benefited from patients' treatment and reported significant reduction in their burden of disease and improvement of their quality of life upon the child's transition onto OROS MPH.

The Separation Anxiety Daily Diary: child version: feasibility and psychometric properties

This report describes the feasibility and psychometric properties of the child version of the Separation Anxiety Daily Diary (SADD-C) in 125 children (ages 7-14 years) from German-speaking areas of Switzerland. Children with separation anxiety disorder (SAD; n = 58), "other" anxiety disorders (n = 36), and healthy controls (n = 31) recorded the frequency of parent-child separations, along with associated anxiety, thoughts, reactions and subsequent parental responses. Compliance rates were modest, consistent with past research on self-report diaries with anxious children. The SADD-C was better at discriminating children with SAD from controls than "other anxious" children. The SADD-C demonstrated good convergent validity with maternal and child self-reported anxiety (Revised Child Manifest Anxiety Scale, Separation Anxiety Inventory) and perceived quality of life (Inventory for Quality of Life in Children and Adolescents). Results provide support for the SADD-C as an acceptable and valid method of assessing child symptoms and parent behavior on separation. Findings are discussed with regard to the clinical utility of the SADD-C and strategies to improve compliance.

Quality of Life as reported by children and parents: a comparison between students and child psychiatric outpatients

BACKGROUND

During the recent decade, a number of studies have begun to address Quality of Life (QoL) in children and adolescents with mental health problems in general population and clinical samples. Only about half of the studies utilized both self and parent proxy report of child QoL. Generally children with mental health problems have reported lower QoL compared to healthy children. The question whether QoL assessment by both self and parent proxy report can identify psychiatric health services needs not detected by an established instrument for assessing mental health problems, i.e. the Child Behavior Checklist (CBCL), has never been examined and was the purpose of the present study.

METHODS

No study exists that compares child QoL as rated by both child and parent, in a sample of referred child psychiatric outpatients with a representative sample of students attending public school in the same catchment area while controlling for mental health problems in the child. In the current study patients and students, aged 8-15.5 years, were matched with respect to age, gender and levels of the CBCL Total Problems scores. QoL was assessed by the self- and parent proxy-reports on the Inventory of Life Quality in Children and Adolescents (ILC). QoL scores were analyzed by non-parametric tests, using Wilcoxon paired rank comparisons.

RESULTS

Both outpatients and their parents reported significantly lower child QoL on the ILC than did students and their parents, when children were matched on sex and age. Given equal levels of emotional and behavioural problems, as reported by the parents on the CBCL, in the two contrasting samples, the outpatients and their parents still reported lower QoL levels than did the students and their parents.

CONCLUSIONS

Child QoL reported both by child and parent was reduced in outpatients compared to students with equal levels of mental health problems as reported by their parents on the CBCL. This suggests that it should be helpful to add assessment of QoL to achieve a fuller picture of children presenting to mental health services.

Maternal daily diary report in the assessment of childhood separation anxiety

The current study evaluated the feasibility and validity of a parent-report measure of separation anxiety, the Separation Anxiety Daily Diary (SADD). Mother and child participants consisted of three groups: 96 children (aged 4-15 years) with separation anxiety disorder, 49 children with "other" anxiety disorders, and 43 healthy controls. The SADD assesses the frequency of anxiety-provoking and non-anxiety-provoking separations, along with associated parental anxiety, thoughts, child behaviors, and corresponding parental reactions. The SADD demonstrated acceptable compliance and convergent validity with hypothesized measures. Substantial improvement in the prediction of diagnostic group membership was shown when SADD items assessing child symptoms were added to information gathered from a separation anxiety symptom questionnaire.

Quality of Life as reported by school children and their parents: a cross-sectional survey

BACKGROUND

Comprehensive evidence exists regarding the discrepancy between children's reports and parents' by proxy reports on emotional and behavioural problems. However, little is yet known about factors influencing the extent to which child self- and parent by proxy reports differ in respect of child Quality of Life (QoL). The aim of the study was to investigate the degree of discrepancy between child and parent by proxy reports as measured by two different QoL instruments.

METHODS

A representative Norwegian sample of 1997 school children aged 8-16 years, and their parents were studied using the Inventory of Life Quality (ILC) and the 'Kinder Lebensqualität Fragebogen' (KINDL). Child and parent reports were compared by t-test, and correlations were calculated by Pearson product moment coefficient. Psychometric aspects were examined in regard to both translated QoL instruments (internal consistency by Cronbach's alpha and test-retest reliability by intraclass correlation coefficients).

RESULTS

Parents evaluated the QoL of their children significantly more positively than did the children. Correlations between mother-child and father-child reports were significant (p < 0.01) and similar but low to moderate (r = 0.32; and r = 0.30, respectively, for the KINDL, and r = 0.30 and r = 0.26, respectively, for the ILC). Mother and father reports correlated moderately highly (r = 0.54 and r = 0.61 for the KINDL and ILC, respectively). No significant differences between correlations of mother-daughter/son and father-daughter/son pairs in regard to reported child QoL were observed on either of the two instruments.

CONCLUSION

In the present general population sample, parents reported higher child QoL than did their children. Concordance between child and parent by proxy report was low to moderate. The level of agreement between mothers and fathers in regard to their child's QoL was moderate. No significant impact of parent and child gender in regard to agreement in ratings of child QoL was found. Both the child and parent versions of the Norwegian translations of the KINDL and ILC can be used in surveys of community populations, but in regard to the self-report of 9-10 years old children, only the KINDL total QoL scale or the ILC are recommended.

20-Jahres-Katamnese der kinder- und jugendpsychiatrischen und psychosomatischen Klinik Haus Vogt

Zusammenfassung: Fragestellung: Die vorliegende Studie behandelt die Frage, wie sich Patienten nach einer stationären psychotherapeutischen Behandlung in einer jugendpsychiatrischen Klinik im Langzeitverlauf entwickelt haben. Methodik: Im Rahmen dieser Studie wurde eine Stichprobe ehemaliger Patienten (N = 104) interviewt, die im Zeitraum von 1983 bis 1988 einen mindestens halbjährigen stationären Aufenthalt im Haus Vogt hatten. Bei der Durchführung der Nachuntersuchung wurden folgende Instrumente eingesetzt: Freiburger Strukturiertes Interview (FrStI), World Health Organisation Quality of Life Interview - Kurzversion (WHOQOL-BREF), Symptom-Checkliste von Derogatis - Deutsche Version (SCL-90-R) und Fragebögen zur Beurteilung der Behandlung (FBB). Ergebnisse: Die Lebenszufriedenheit (entsprechend WHOQOL-BREF) der ehemaligen Patienten ist auf allen relevanten Skalen signifikant schlechter als in der Allgemeinbevölkerung. Die psychische Gesundheit (entsprechend SCL-90-R) der untersuchten Stichprobe muss im Vergleich mit der Allgemeinbevölkerung als unter dem Durchschnitt eingestuft werden. Die im Rückblick erhobene Behandlungszufriedenheit ergibt anhand des FBB deutliche Unterschiede zu einer Vergleichsstichprobe einer jugendpsychiatrischen, universitären Versorgungsklinik. Die größten Unterschiede der Behandlungszufriedenheit bestehen auf der Skala «Beziehung zum Therapeuten», die in dieser Katamnese als sehr viel negativer eingeschätzt werden als in der Vergleichspopulation. Schlussfolgerungen: Die Studie zeigt positive Langzeitergebnisse bzgl. der später erreichten Schul- und Berufsausbildung. Gleichzeitig zeigen die ehemaligen Patienten zu einem erheblichen Anteil fortbestehende psychiatrische Symptome und deutliche Einschränkungen der Lebensqualität.

Zur Lebensqualität von psychisch kranken Kindern und ihren Eltern

Zusammenfassung. Ausgangspunkt der Untersuchung sind Studien, in denen psychisch gestörte Kinder und Jugendliche zu ihrer Lebensqualität befragt wurden. Die vorliegende Studie ist der Frage nachgegangen, ob sich ähnliche Ergebnisse zeigen, wenn die Eltern von psychisch gestörten Kindern und Jugendlichen zur Lebensqualität ihrer Kinder befragt werden. Hierzu wurden 604 Eltern von ambulant und stationär behandelten kinder- und jugendpsychiatrischen Patienten die Elternversion des Inventars zur Erfassung der Lebensqualität bei Kindern und Jugendlichen (ILK-Elternbogen) vorgelegt. Ergebnisse: (1) Auch bei den Elternangaben sind die Ergebnisse bei stationären Patienten auf allen ILK-Skalen ungünstiger als bei den ambulanten Patienten. Darüber hinaus zeigen sich bei einer Reihe von Skalen signifikante Alters- und Geschlechtseffekte. (2) Die Eltern fühlen sich selbst durch die aktuelle Problematik des Kindes/Jugendlichen und durch die Tatsache, dass ihr Kind/Jugendlicher behandelt wird, zu einem hohen Prozentsatz erheblich beeinträchtigt; die entsprechenden Beeinträchtigungen der Kinder bzw. Jugendlichen werden von den Eltern als weniger gravierend beschrieben. Bei der Planung der therapeutischen Maßnahmen sollte die Frage nach der Lebensqualität der Kinder und ihrer Eltern stärker berücksichtigt werden, um die Effektivität der therapeutischen Interventionen zu erhöhen.