[show abstract][hide abstract] ABSTRACT: In the German EvAKuJ observational cohort study, changes in the body mass index standard deviation score (BMI-SDS) of overweight and obese children and adolescents as primary outcome of multimodal (short, inpatient or long, outpatient) weight-loss interventions are difficult to interpret. Published intention-to-treat (ITT) and per protocol data obtained at the end of the intervention (T1), one year (T2), and two years (T3) after its end were used for sensitivity analysis of treatment success rates. The odds ratio and the number needed to treat (NNT) for BMI-SDS reduction of at least -0.2 (successful treatment) and at least -0.5 (good treatment success) were related to spontaneous BMI-SDS reduction rates in a hypothetical control group (control event rate, CER). At T1, treatment seems to be effective up to a CER of 10% in inpatients and of 5% in outpatients. ITT analysis, compromised by a loss to follow-up of 81 to 90% (inpatients) and 57 to 66% (outpatients), indicated that treatment may become less effective at a CER above 1% in inpatients (e.g., successful treatment at T2: NNT=106, at T3: NNT=51), and above 5% in outpatients (successful treatment at T2: NNT=7, at T3: NNT=8; good treatment success at T2 and T3: NNT=25). Positive short-term effects of inpatient treatment of overweight and obese children and adolescents may not be maintained in the long term. Long-term effectiveness of outpatient treatment may depend on age and the degree of overweight.
[show abstract][hide abstract] ABSTRACT: Für die steigende Zahl übergewichtiger und adipöser Kinder und Jugendlicher existieren in Deutschland zahlreiche Therapieangebote,
die jedoch heterogen strukturiert und nicht ausreichend evaluiert sind. Der Zugang zur Versorgung, kurz- und langfristige
Behandlungsergebnisse und Determinanten des Therapieerfolgs sollen erstmals mit einem einheitlichen Instrumentarium für somatische
und psychosoziale Variablen untersucht werden. 1916Kinder aus 48Einrichtungen (fünf Reha, 43 ambulant) im Alter von acht
bis 16Jahren wurden untersucht. Vor Therapiebeginn (t0), am Therapieende (t1) und ein Jahr danach (t2) wurden Größe, Gewicht,
Blutdruck und der Lipidstatus erhoben, außerdem wurden psychosoziale Variablen mittels Fragebögen für Eltern und Kinder erfasst.
Die mittlere BMI-SDS-Reduktion der gemessenen PatientInnen lag zu t1 bei −0,27, ein Jahr danach bei −0,23 (Intention-to-treat-Analyse:
t1 −0,24; t2 −0,06). Bei den nachuntersuchten Kindern verbesserten sich die anfangs deutlich beeinträchtigte psychische Gesundheit
und Lebensqualität. Körperliche Aktivität, Medienkonsum und Essverhalten veränderten sich kaum. Eine Gewichtsreduktion, verbunden
mit einer Verbesserung des kardiovaskulären Risikoprofils und Verhaltensänderungen sind langfristig möglich, wobei sich die
Einrichtungen deutlich in der Rate der nachuntersuchten PatientInnen und in der Reduktion des Übergewichtes unterscheiden.
Numerous forms of therapy exist for the increasing number of obese children and adolescents in Germany, but these are heterogeneous
and have not been evaluated. Access to health care, long- and short-term treatment outcome, as well as factors determining
success of therapy were examined for the first time using standardized instruments to measure somatic and psychosocial variables.
A total of 1,916 children aged 8–16years from 48 (5rehabilitation, 43outpatient) institutions were examined. Data were
collected for height, weight, blood pressure, and lipid status before treatment started (t0), at the end of treatment (t1),
and 1year after completion of treatment (t2). Furthermore, psychosocial variables were documented using questionnaires for
parents and children. The mean BMI-SDS (body mass index standard deviation score) reduction at t1 was −0.27 and 1year later
at t2 was −0.23 (per protocol analysis; intention to treat: t1=−0.24; t2=−0.06). Psychological health and quality of life,
which were markedly impaired at the beginning, improved. However, physical activity, media consumption, and nutrition remained
basically unchanged. A reduction in weight is associated with an improvement in cardiovascular risk profiles, and long-term
behavior changes are possible. However, the institutions differed considerably in the percentage of follow-up examinations
and in the weight reduction accomplished.
[show abstract][hide abstract] ABSTRACT: StudienzielTherapieangebote für adipöse Kinder und Jugendliche sollen nach folgenden Kriterien miteinander verglichen werden: ambulant/stationär,
mit/ohne AGA-Zertifizierung, gute/weniger gute Qualität.
Methodik1916 PatientInnen (acht bis 16,9Jahre) aus 48Therapieeinrichtungen wurden vor Therapie (t0), am Therapieende (t1) und mindestens
ein Jahr danach (t2/3) untersucht. Body-Mass-Index (BMI), Blutdruck, Lipide und psychosoziale Daten wurden erfasst.
ErgebnisseStationäre PatientInnen waren signifikant älter und adipöser. PatientInnen aus AGA-zertifizierten Zentren hatten einen höheren
Ausgangs-BMI, die Komorbiditätsdiagnostik war vollständiger, kurz- und langfristige BMI-Reduktion unterschieden sich nicht.
Nach der UKE-Studie 2004 als „gut“ eingestufte Einrichtungen unterschieden sich bezüglich der erzielten kurz- und langfristigen
BMI-SDS-Reduktion nicht von den „weniger guten“. Sie behandelten aber adipösere PatientInnen, die Komorbiditätsdiagnostik
war vollständiger. Drop-out und Loss to follow-up unterschieden sich nicht.
FazitInsgesamt zeigen sich nur wenige Unterschiede zwischen den untersuchten Gruppen. Deutlichere Unterschiede finden sich auf
Ebene der einzelnen Anbieter. Die Qualitätssicherung muss diesbezüglich weiter ausgebaut werden.
AimDifferent providers of obesity treatment in children and adolescents in Germany were compared using the following criteria:
outpatient/inpatient; with/without AGA certification; good/less good quality.
MethodsA total of 1,916patients (8–16.9years) from 48study centers were examined before (t0), after (t1), and at least 1year
after therapy (t2/3). Body mass index (BMI), blood pressure, blood lipids, and psychosocial data were measured.
ResultsPatients from inpatient rehabilitation centers were older and more obese. Patients from AGA-certified centers were more obese,
and the completeness of comorbidity screening was higher. There were no differences in short- or long-term BMI reduction.
“Good” treatment centers (classified after the UKE study 2004) did not differ from those centers not rated as “good” in weight
reduction. Patients treated in “good” centers were more obese, and screening for comorbidity was better. No differences in
drop out and loss to follow-up were found.
ConclusionThere were only small differences between the different groups. Pronounced differences were found between the individual treatment
centers. In order to improve therapy processes and outcomes, benchmarking and quality management have to be extended.
[show abstract][hide abstract] ABSTRACT: Although a higher prevalence of overweight/obesity was reported in clinical samples of patients with Attention-Deficit/Hyperactivity Disorder (ADHD), an association between overweight and ADHD has yet not been established in the general population in childhood. As both disorders are common and significantly affect psychosocial functioning, we investigated the prevalence of ADHD in overweight/obese youth and vice versa. In a cross-sectional nationally representative and community based survey 2,863 parents and their children aged 11-17 years rated symptoms on the Diagnostic and Statistical Manual of Mental Disorders-based German ADHD Rating scale. Weight and height were assessed by professionals. Body mass index was categorized according to national age and sex specific reference values. Overall, 4.2% of the respondents met criteria for ADHD. The prevalence of ADHD was significantly higher for overweight/obese (7%) than for normal weight (3.5%) and underweight (4.9%) children. In a logistic regression analysis controlling for age, gender, and socio-economic status, overweight/obese children were twice as likely to have an ADHD diagnosis (OR = 2.0). Vice versa, adjusting for all covariates, children with ADHD had an OR of 1.9 for overweight/obesity status. For all weight-status groups, children with ADHD more frequently reported eating problems as compared to their non-clinical counterparts. Overweight/obese respondents with ADHD displayed the highest level of health services utilization. A clinician should be aware of the significant risk for a child with ADHD to become overweight and for an overweight child to have ADHD. Longitudinal studies are needed to better understand the mechanisms underlying the association between ADHD and overweight/obesity.
[show abstract][hide abstract] ABSTRACT: Different providers of obesity treatment in children and adolescents in Germany were compared using the following criteria: outpatient/inpatient; with/without AGA certification; good/less good quality.
A total of 1,916 patients (8-16.9 years) from 48 study centers were examined before (t0), after (t1), and at least 1 year after therapy (t2/3). Body mass index (BMI), blood pressure, blood lipids, and psychosocial data were measured.
Patients from inpatient rehabilitation centers were older and more obese. Patients from AGA-certified centers were more obese, and the completeness of comorbidity screening was higher. There were no differences in short- or long-term BMI reduction. "Good" treatment centers (classified after the UKE study 2004) did not differ from those centers not rated as "good" in weight reduction. Patients treated in "good" centers were more obese, and screening for comorbidity was better. No differences in drop out and loss to follow-up were found.
There were only small differences between the different groups. Pronounced differences were found between the individual treatment centers. In order to improve therapy processes and outcomes, benchmarking and quality management have to be extended.
[show abstract][hide abstract] ABSTRACT: Numerous forms of therapy exist for the increasing number of obese children and adolescents in Germany, but these are heterogeneous and have not been evaluated. Access to health care, long- and short-term treatment outcome, as well as factors determining success of therapy were examined for the first time using standardized instruments to measure somatic and psychosocial variables. A total of 1,916 children aged 8-16 years from 48 (5 rehabilitation, 43 outpatient) institutions were examined. Data were collected for height, weight, blood pressure, and lipid status before treatment started (t0), at the end of treatment (t1), and 1 year after completion of treatment (t2). Furthermore, psychosocial variables were documented using questionnaires for parents and children. The mean BMI-SDS (body mass index standard deviation score) reduction at t1 was -0.27 and 1 year later at t2 was -0.23 (per protocol analysis; intention to treat: t1=-0.24; t2=-0.06). Psychological health and quality of life, which were markedly impaired at the beginning, improved. However, physical activity, media consumption, and nutrition remained basically unchanged. A reduction in weight is associated with an improvement in cardiovascular risk profiles, and long-term behavior changes are possible. However, the institutions differed considerably in the percentage of follow-up examinations and in the weight reduction accomplished.
[show abstract][hide abstract] ABSTRACT: To examine the feasibility, reliability, and validity of the newly developed EQ-5D-Y.
The EQ-5D-Y was administered in population samples of children and adolescents in Germany, Italy, South Africa, Spain, and Sweden. Percentages of missing values and reported problems were calculated. Test-retest reliability was determined. Spearman's rank correlation coefficients with other generic measures of HRQOL were calculated. Known groups' validity was examined by comparing groups with a priori expected differences in HRQOL.
Between 91 and 100% of the respondents provided valid scorings. Sweden had the lowest proportion of reported problems (1-24.9% across EQ-5D-Y dimensions), with the highest proportions in South Africa (2.8-47.3%) and Italy (4.3-39.0%). Percentages of agreement in test-retest reliability ranged between 69.8 and 99.7% in the EQ-5D-Y dimensions; Kappa coefficients were up to 0.67. Correlation coefficients with other measures of self-rated health indicated convergent validity (up to r = -0.56). Differences between groups classified according to presence of chronic conditions, self-rated overall health and psychological problems provided preliminary evidence of known groups' validity.
Results provide preliminary evidence of the instrument's feasibility, reliability and validity. Further study is required in clinical samples and for possible future applications in economic analyses.
Quality of Life Research 08/2010; 19(6):887-97. · 2.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: To develop a self-report version of the EQ-5D for younger respondents, named the EQ-5D-Y (Youth); to test its comprehensibility for children and adolescents and to compare results obtained using the standard adult EQ-5D and the EQ-5D-Y.
An international task force revised the content of EQ-5D and wording to ensure relevance and clarity for young respondents. Children's and adolescents' understanding of the EQ-5D-Y was tested in cognitive interviews after the instrument was translated into German, Italian, Spanish and Swedish. Differences between the EQ-5D and the EQ-5D-Y regarding frequencies of reported problems were investigated in Germany, Spain and South Africa.
The content of the EQ-5D dimensions proved to be appropriate for the measurement of HRQOL in young respondents. The wording of the questionnaire had to be adapted which led to small changes in the meaning of some items and answer options. The adapted EQ-5D-Y was satisfactorily understood by children and adolescents in different countries. It was better accepted and proved more feasible than the EQ-5D. The administration of the EQ-5D and of the EQ-5D-Y causes differences in frequencies of reported problems.
The newly developed EQ-5D-Y is a useful tool to measure HRQOL in young people in an age-appropriate manner.
Quality of Life Research 08/2010; 19(6):875-86. · 2.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: We examined treatment-seeking overweight and obese youths to better understand the gender, age, and treatment modality differences in generic and disease-specific health-related quality of life (HRQOL).
This multicenter study included 1,916 patients (mean = 12.6 years; 57% females; mean zBMI = 2.4) who started treatment for overweight and obesity in 48 treatment facilities between July 2005 and October 2006. The facilities offered either inpatient treatment or outpatient programs. Prior to treatment, all participants completed the generic KIDSCREEN-27 HRQOL-questionnaire, the self-perception subscale of the generic KIDSCREEN-52 and the disease-specific obesity module of the KINDLR.The patients' HRQOL was compared to the KIDSCREEN reference sample from the general population by one-way analyses of variance, adjusting for age, gender, and socioeconomic status. Independent t-tests were conducted to compare disease-specific HRQOL scores between patients by gender and age group. Significant mean differences in HRQOL between inpatients and outpatients were explored by one-way analyses of variance, adjusting for age, gender, and zBMI. Effect sizes 'd' were calculated employing the estimated marginal means and the pooled standard deviation (m(treatment) - m(norm)/SD(pooled)).
The patients' HRQOL scores were impaired relative to German norms, with effect sizes up to d = 1.12. The pattern of impairment was similar in boys and girls as well as in children and adolescents. In each of the analyses, at least three of six KIDSCREEN subscales were affected. Regardless of gender and age group, the highest impairments were found in self-perception and physical well-being. Because of the strong decrease in HRQOL in the general population during adolescence, compared to age-specific norms, adolescents were less impaired than were children. However, overweight and obese adolescents (especially females) reported the lowest absolute HRQOL scores. HRQOL varied with the intensity of treatment. Inpatients had significantly lower scores than did outpatients, even after adjusting for age, gender and zBMI.
The results suggest the presence of differences in HRQOL with regard to gender, age, and treatment modality in treatment-seeking overweight and obese youths. Research and clinical practice must consider the particular impairments of inpatients as well as the impairments of (especially female) adolescents.
Health and Quality of Life Outcomes 04/2010; 8:36. · 2.27 Impact Factor
[show abstract][hide abstract] ABSTRACT: The negative impact of overweight (including obesity) and related treatment on children's and adolescents' health-related quality of life (HRQoL) has been shown in few specific samples thus far. We examined HRQoL and emotional well-being in overweight children from an outpatient treatment sample as well as changes of these parameters during treatment.
In a cross-sectional design, self-reported HRQoL of 125 overweight (including obese) children who contacted a treatment facility, but had not yet receive treatment, were compared to 172 children from randomly selected schools using independent two-sample t-tests. Additionally, in a longitudinal design, the overweight children were retested by administering the same questionnaire at the end of the intervention (after one year). It included measures such as the body mass index (BMI), the general health item (GHI), the KINDLR, and the Child Dynamic Health Assessment Scale (ChildDynHA). Comparisons were based on dependent t-tests and the Wilcoxon signed-rank test.
Overweight children showed statistically significant impairment in the GHI (Cohen's d = 0.59) and emotional well-being (ChildDynha) (d = 0.33) compared to the school children. With respect to HRQoL, the friends dimension of the KINDLR was significantly impaired in the overweight group (d = 0.33). However, no impairment was found for the total HRQoL score or other KINDLR subdimensions. Regarding the longitudinal part of our study, most of the children improved their BMI, but the majority (87.5%) remained overweight. Nevertheless, the participants' perceived health, emotional well-being, and generic as well as disease-specific HRQoL improved during intervention.
The findings emphasize the importance of patient-reported outcomes such as HRQoL. Even though overweight and obesity might accompany most of the children throughout their lifetime, the impairment associated with this chronic condition can be considerably reduced. Opportunities of health promotion in overweight/obese children and adolescents are discussed.
BMC Public Health 01/2009; 8:421. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Scientific research on empowerment so far is nearly exclusively focused on the adult population. Nevertheless, it is possible to show a link between empowerment and a) the developmental psychology concepts of resilience, b) autogenetic concepts and c) concepts of risks and resources. This paper aims to study the role of personal, familial and other social resources as well as personal autonomy for subjective health-ratings.
A secondary analysis of the health data of 7,000 children and adolescents aged 10-17 years of the German health behaviour in school-aged children (HBSC) study as well as 1,700 children aged 11-17 years of the mental health module (BELLA Study) within the German health interview and examination survey for children and adolescents (KiGGS) was performed. Statistical analyses encompassed analyses of variance and linear regression.
Analyses of the HBSC study showed a protective effect for school-class climate as well as parental support, whereby school was associated with fewer self-reported health complaints. Analyses of the BELLA/KiGGS study showed personal, familial and other social resources as well as personal autonomy as unique predictors for a better health-related quality of life (KINDL-R). This was true even if psychological problems were observed.
The results confirm the importance of strengthening personal, familial and other social resources as well as the principal importance of personal autonomy for coping with health risks and health impairments. Future research explicitly focussed on empowerment could relate to the role of personal resources within children's and adolescents' contact with the medical and health care system. It can be expected that strengthening personal resources benefits and improves the communication and active participation of children and adolescents within treatment-decision and -evaluation.
Das Gesundheitswesen 01/2009; 70(12):721-9. · 0.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: The strengths and difficulties questionnaire (SDQ) is a brief screening instrument that addresses negative and positive behavioural attributes of children and adolescents in the age range of 4-16 years and can be completed by parents, teachers, and as a self-report. Furthermore, the impact supplement of the extended SDQ surveys for perceived problems, impact, and burden.
This paper aims to examine the psychometric properties of the parent form and to investigate differences in the SDQ scores for sociodemographic and socioeconomic subgroups. Patterns of association with other measures of mental health and descriptive comparison with the first normative sample are also reported.
Within the BELLA study module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a total of 2,406 children and adolescents aged 7-16 years as well as their parents answered the items of the SDQ and the additional impact supplement. The internal consistency of scale responses was assessed via Cronbach's alpha (alpha). Likert scale assumptions of sufficient and similar item-total correlation and item variance were investigated. The factorial validity of the SDQ measurement model was tested by means of exploratory and confirmatory factor analysis. Mean score differences between males and females, age groups (7-10 years vs. 11-16 years), and socioeconomic status groups (Winkler index) were examined via ANOVA.
Factor analysis provided an exact replication of the original five-factor SDQ subscale structure. All subscales were sufficiently homogeneous. The mean total difficulties and SDQ subscale scores of the BELLA sample did not differ from the first German normative data. Younger children were more impaired on various SDQ scales than older children, girls were more emotionally affected, and boys showed more externalising problems.
The present study confirmed the validity and reliability of the parent-reported SDQ scale structure. The SDQ was found to be a valid and helpful questionnaire for use in the framework of an epidemiological survey.
[show abstract][hide abstract] ABSTRACT: 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.
[show abstract][hide abstract] ABSTRACT: There is a lack of representative prevalence rates for attention deficit-/hyperactivity disorder (ADHD) according to DSM-IV criteria and hyperkinetic disorder (HD) according to ICD-10 criteria for German subjects.
To report the results of analyses of categorical data on the prevalence rates of the symptoms of ADHD/HD and additional diagnostic criteria, as well as of the diagnoses of ADHD and HD according to symptoms and other diagnostic criteria, according to the ICD-10 and DSM-IV. Further, to report administrative prevalence rates of the diagnosis and rates of co-existing behavioural and emotional problems.
Within the BELLA module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a representative sample of parents of 2,452 children and adolescents aged 7-17 years completed an ADHD symptom checklist (FBB-HKS/ADHS) and additional questionnaires for the assessment of coexisting behavioural and emotional problems.
The prevalence rates for the diagnoses of ADHD according to DSM-IV criteria were 5.0% and the rate for HD according to ICD-10 criteria was 1.0%. Higher prevalence rates were found in boys and in younger children. The addition of other diagnostic criteria (impairment, pervasiveness, onset, duration) resulted in a significant decrease of the prevalence rates of ADHD and HD to 2.2 and 0.6%, respectively. Higher prevalence rates were found in families of lower socioeconomic status and families from urban areas. The lifetime administrative prevalence rate was 6.5%. Children with ADHD had an increased risk for coexisting behavioural and emotional problems, especially for aggressive and antisocial behaviour problems, but also for anxiety and mood problems.
The results of the national sample are in line with community studies in other countries. The effects of the additional diagnostic criteria of impairment, situational pervasiveness, symptom onset and symptom duration on the prevalence rates have to be considered in other epidemiological studies.
[show abstract][hide abstract] ABSTRACT: Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany.
The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation.
The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7-17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/hyperactivity disorder (FBB-HKS, Conners' Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined.
Overall, 14.5% of the children and adolescents aged 7-17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed.
The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.
[show abstract][hide abstract] ABSTRACT: Since prevalence rates of mental health problems in children and adolescents are high and of considerable relevance to public health, determinants of mental health, such as risk and protective factors, are of special interest.
The present paper reports the frequencies and distributions of potential risk and protective factors and analyses their effects on children's mental health.
The BELLA study is the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems and their assumed determinants are examined in a representative sub-sample of 2,863 families with children and adolescents aged 7-17. In order to identify mental health problems, the extended version of the Strengths and Difficulties Questionnaire was administered. Data on psychosocial risk factors as well as on protective factors in terms of personal, familial and social resources were collected by questioning the parents and, from the age of 11 years upwards, the children themselves.
Adverse family climate stands out particularly as a negative contributor to children's mental health. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Conversely, pronounced individual, family and social resources coincide with a reduced occurrence of mental health problems, especially in children with a limited number of risk factors.
The results suggest that differential prevention strategies are needed depending on the risk level: in the low risk group, to which most children belong, effective prevention programmes should define strengthening resources as a key objective. In the smaller group of children with a high number of risk factors, more complex intervention designs are required, which must consider the reduction of risks as well as strengthening resources.
[show abstract][hide abstract] ABSTRACT: The self-perceived health or health-related quality of life of children and adolescents is increasingly recognised as a relevant outcome in medical practice and public health research. Identifying children and adolescents with particularly low health-related quality of life allows for an early detection of hidden morbidity and health care needs.
The present study investigates health-related quality of life in children and adolescents in Germany.
In the Mental Health Module (BELLA study) of the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 2,863 children and adolescents aged 7-17 years, and 1,700 children and adolescents aged 11-17 years completed the KINDL-R quality of life questionnaire.
The reliability (Cronbach's alpha=0.86) and validity of the measurements using the parent-reported KINDL-R were confirmed. Means and percentiles were calculated for the total sample as well as for strata defined by age, sex, geographical region (east/west), migration status and socioeconomic status. Expected differences in health-related quality of life of children and adolescents from different social backgrounds and with different health statuses were demonstrated by differences in the KINDL-R scores (effect size d up to 1.29).
This study provides representative, normative data (self-report and parent-report) on the test scores of health-related quality of life (KINDL-R) for the population of children and adolescents in Germany in general, as well as in sociodemographic and socioeconomic subpopulations.
[show abstract][hide abstract] ABSTRACT: To identify disordered eating behaviour and attitudes in a large representative population in order to determine the relationship with body weight status, and to assess associated psychopathology and health-related quality of life.
A total of 11-17 year-old adolescents (n=1,895) were randomly selected from the national representative sample of 17,641 families participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Weight and height were assessed by trained staff. Mental health problems and health-related quality of life were examined by means of a telephone interview and different questionnaires. Eating disordered behaviour and attitudes were identified by the SCOFF, an instrument consisting of five questions originally developed to screen for eating disorders in clinical settings.
About one third of the girls and 15% of the boys reported disordered eating behaviour and attitudes, which were most prevalent in overweight youth. There was a significant association between the presence of disordered eating behaviour and psychopathology, which was comprised of internalising and externalising behavioural problems. In addition, adolescents with disordered eating behaviour reported reduced quality of life.
The high prevalence of disordered eating in the general population of Germany is of great concern. Health professionals should not only be aware of disordered eating in underweight adolescents, but in all youth, especially overweight individuals. Disordered eating behaviour is associated with a wide range of psychopathological and psychosocial concerns. Thus, youngsters engaging in disordered eating behaviour should also be explored for other serious mental or social problems.
[show abstract][hide abstract] ABSTRACT: The consideration of impairment plays a crucial role in detecting significant mental health problems in children whose symptoms do not meet diagnostic criteria. The assessment of impairment may be particularly relevant when only short screening instruments are applied in epidemiological surveys. Furthermore, differences between childrens' and parents' perceptions of present impairment and impairing symptoms are of interest with respect to treatment-seeking behaviour.
The objectives were to assess parent- and self-reported impairment due to mental health problems in a representative sample of children and adolescents; to describe the characteristics of highly impaired children with normal symptom scores; and to investigate the associations between symptoms in different problem areas and impairment.
The mental health module of the German Health Interview and Examination Survey for Children and Adolescents (the BELLA study) examined mental health in a representative sub-sample of 2,863 families with children aged 7-17. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children 11 years and older.
Considerable levels of distress and functional impairment were found with 14.1% of the boys and 9.9% of the girls being severely impaired according to the parental reports. However, self-reported data shows a reversed gender-difference as well as lower levels of severe impairment (6.1% in boys; 10.0% in girls). Six percent of the sampled children suffer from pronounced impairment due to mental health problems but were not detected by screening for overall symptoms. Childrens' and parents' reports differed in regard to the association between reported symptom scores and associated impairment with children reporting higher impairment due to emotional problems.
The assessment of impairment caused by mental health problems provides important information beyond the knowledge of symptoms and helps to identify an otherwise undetected high risk group. In the assessment of impairment, gender-specific issues have to be taken into account. Regarding the systematic differences between childrens' and parents' reports in the assessment of impairment, the child's perspective should be given special attention.