Depressive symptoms of children and adolescents in a German representative sample: Results of the BELLA study

Senate Department for Health, Environment and Consumer Protection Berlin, Oranienstr. 106, 10969, Berlin, Germany.
European Child & Adolescent Psychiatry (Impact Factor: 3.34). 12/2008; 17 Suppl 1(S1):71-81. DOI: 10.1007/s00787-008-1008-x
Source: PubMed


In Europe, a considerable proportion of children and adolescents is affected by depressive symptoms, impairing their everyday life and social functioning.
The aim of this paper is to provide an overview of the depressive symptoms in children and adolescents in Germany, addressing risk factors, comorbidity, and impact of depressive symptoms on everyday life.
In the BELLA study, the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a representative sample of young people aged 7-17 years was enrolled. Depressiveness, assessed by the CES-DC, as well as other mental health problems were examined in the context of risk and protective factors.
Depressive symptoms showed high prevalence in parent- and self-reports. Higher depression scores were found in those with a high number of psychosocial risks existing in the family, and they decreased as the number of protective factors the children and adolescents had at their disposal increased. Although only half of the boys and girls with high depression scores were regarded as significantly impaired, all of them had a much higher risk for additional mental health problems. Furthermore, their health-related quality of life was limited compared to their peers who had low depression scores.
To differentiate between clinically significant depression and milder forms, it is necessary to take into account the different perspectives of children and their parents. Prevention and intervention should acknowledge the widespread distribution of depressive symptoms in children and adolescents, the high comorbidity of depressive and other mental health problems and the impact of depression on the aspects of everyday life.

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    • "In a recent study we found that, compared to children with pure anxiety disorders and children without psychiatric disorders, children with anxiety disorders and depressive comorbidity were more impaired in aspects of daily life and the social and environmental characteristics of their families—even if the depressive comorbidity was on a subclinical level (von Klitzing et al. 2014). Anxiety and depressive symptoms on a subclinical level (which do not yet fulfill the requirements of clinical diagnoses) show higher prevalence rates, of around 14 %, than diagnoses (Bettge et al. 2008; Ravens- Sieberer et al. 2008). Overall, internalizing symptoms demonstrate moderate to high stability during preschool age (Bilancia and Rescorla 2010; Edwards et al. 2010; Sterba et al. 2007), and may serve as precursors to internalizing disorders such as anxiety disorders or mood disorders (Bittner et al. 2007; Roza et al. 2003). "
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    ABSTRACT: This study investigated parenting behaviors of mothers and fathers of clinically anxious preschool children (with or without depressive comorbidity) and healthy comparison children. Studies assessing children from early school age onwards have found that parental control, rejection, and inconsistent discipline are associated with the presence of children’s internalizing symptoms/disorders. Despite the scarcity of studies investigating these associations at preschool age, we assumed that findings with older children would also apply to children in this age group. In a cross-sectional study we assessed N = 176 children of preschool age (M = 5; 2 years) and both of their parents. A diagnostic interview (Preschool Age Psychiatric Assessment) was conducted to determine children’s psychiatric diagnoses, yielding the following results: a group of n = 67 children with pure anxiety disorders (AD group), a group of n = 38 children with anxiety disorders with depressive comorbidity (AD/DC group), and a comparison group of n = 71 children without psychiatric disorders. Both parents completed the German extended version of the Alabama Parenting Questionnaire. We evaluated maternal depressive symptoms and children’s temperament as further correlates. All variables that differed significantly between groups were entered into multinomial logistic regression analyses to test which variables predict group membership. When comparing each of the two anxiety groups with the comparison group we obtained the following results: (1) Inconsistent paternal discipline and maternal depressive symptoms increased and children’s positive affectivity decreased the probability of children of being in the AD group rather than in the comparison group. (2) Maternal overinvolvement, maternal depressive symptoms and children’s negative affectivity increased and children’s positive affectivity decreased the probability of children of belonging to the AD/DC group rather than to the comparison group. When comparing the two anxiety groups with each other, we found that inconsistent paternal discipline increased and children’s negative affectivity decreased the probability of children of being in the AD group rather than in the AD/DC group. The results suggest that paternal parenting behaviors show different associations with internalizing disorders at preschool age than maternal parenting behaviors. This underlines the importance of including fathers in the prevention and treatment of internalizing disorders at preschool age.
    Journal of Child and Family Studies 06/2015; DOI:10.1007/s10826-015-0242-3 · 1.42 Impact Factor
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    • "The rate of depressive disorders in German adolescents aged 11–17 years is reported to be 4.7% for males and 9.7% for females [1]. Up to two-thirds of depressed adolescents suffer from co-morbid disorders [2], and depression is often associated with poor health behaviours and social challenges as well as with an elevated risk for suicide [3]. "
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    ABSTRACT: The goal of this pilot study was to examine the feasibility and clinical outcomes of a brief (6-session) group therapy programme in adolescent outpatients with depression. The programme had previously been assessed in in-patients, with positive results. A total of 15 outpatients aged 13 to 18 years took part in the programme between October 2010 and May 2011, in 3 separate groups of 4-6 participants each. The outcomes measured were feasibility of the programme, as assessed by attendance rate, user feedback, fidelity of implementation, and response to treatment, as assessed by pre- and post-intervention measurement of depressive symptoms, quality of life, and suicidal ideation. The programme demonstrated good feasibility, with a mean attendance rate of 5.33 out of 6 sessions, a mean rating by participants on overall satisfaction with the programme of 7.21 out of 10 (SD = 1.89), and a 93% concurrence between the contents of the sessions and the contents of the treatment manual. Compared to baseline scores, depressive symptoms at follow-up test were significantly reduced, as assessed by the Children's Depression Rating Scale Revised (F(1, 12) = 11.76, p < .01) and the Beck Depression Inventory Revision (F(1, 32) = 11.19, p < .01); quality of life improved, as assessed by the Inventory of Quality of Life (F(1, 31) = 5.27, p < .05); and suicidal ideation was reduced. No significant changes were seen on the measures of the Parent Rating Scale for Depression and the Clinical Global Impression scale. Based on the results of this pilot study, it is feasible to further assess this brief outpatient treatment programme in a randomized controlled trial without further modifications.
    Child and Adolescent Psychiatry and Mental Health 03/2014; 8(1):9. DOI:10.1186/1753-2000-8-9
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    • "The median estimate for depression of 4,4% [15,36] can be reflected by the results from ICD-10 criteria regarding mild and moderate depressive episodes. Even though, results show the typical higher scores in boys on externalizing problems and in girls on internalizing problems, questionnaire methods applying symptom ratings are limited and might lead to overestimation [7]. The cut-off criteria of some screening instruments used for this study could be considered as too liberal, with the result of low specificity and overestimated rates of children with the common mental health problems. "
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    ABSTRACT: Child and adolescent mental health problems are ubiquitous and burdensome. Their impact on functional disability, the high rates of accompanying medical illnesses and the potential to last until adulthood make them a major public health issue. While methodological factors cause variability of the results from epidemiological studies, there is a lack of prevalence rates of mental health problems in children and adolescents according to ICD-10 criteria from nationally representative samples. International findings suggest only a small proportion of children with function impairing mental health problems receive treatment, but information about the health care situation of children and adolescents is scarce. The aim of this epidemiological study was a) to classify symptoms of common mental health problems according to ICD-10 criteria in order to compare the statistical and clinical case definition strategies using a single set of data and b) to report ICD-10 codes from health insurance claims data. a) Based on a clinical expert rating, questionnaire items were mapped on ICD-10 criteria; data from the Mental Health Module (BELLA study) were analyzed for relevant ICD-10 and cut-off criteria; b) Claims data were analyzed for relevant ICD-10 codes. According to parent report 7.5% (n = 208) met the ICD-10 criteria of a mild depressive episode and 11% (n = 305) showed symptoms of depression according to cut-off score; Anxiety is reported in 5.6% (n = 156) and 11.6% (n = 323), conduct disorder in 15.2% (n = 373) and 14.6% (n = 357). Self-reported symptoms in 11 to 17 year olds resulted in 15% (n = 279) reporting signs of a mild depression according to ICD-10 criteria (vs. 16.7% (n = 307) based on cut-off) and 10.9% (n = 201) reported symptoms of anxiety (vs. 15.4% (n = 283)). Results from routine data identify 0.9% (n = 1,196) with a depression diagnosis, 3.1% (n = 6,729) with anxiety and 1.4% (n = 3,100) with conduct disorder in outpatient health care. Statistical and clinical case definition strategies show moderate concordance in depression and conduct disorder in a German national sample. Comparatively, lower rates of children and adolescents with diagnosed mental health problems in the outpatient health care setting support the assumptions that a small number of children and adolescents in need of treatment receive it.
    BMC Public Health 03/2014; 14(1):229. DOI:10.1186/1471-2458-14-229 · 2.26 Impact Factor
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