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Journal of Health Monitoring 2021 6(4)
Mental health issues in childhood and adolescence, psychosocial resources and socioeconomic statusJournal of Health Monitoring
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Mental health issues in childhood and adolescence, psychosocial
resources and socioeconomic status – An analysis of the KiGGS
Wave 2 data
Abstract
Mental health burdens are among the most common health issues in childhood and adolescence. Psychosocial resources
can act as protective factors and can help in preventing the development and reduce the symptoms of mental health
issues. This article discusses this relationship and the availability of these resources within the three dierent social
status groups among 11- to 17-year-olds. The database is the second wave of the German Health Interview and Examination
Survey for Children and Adolescents (KiGGS Wave 2, 2014–2017). Mental health issues were assessed via the Strengths
and Diculties Questionnaires; psychosocial resources via self-reported personal, family and social resources; social
status was ascertained through a multidimensional index based on the information provided by parents on education,
occupational status and income. The analyses show that 11- to 17-year-olds who have psychosocial resources are less
likely to show mental health issues (independent of their social status) and that, compared to high social status, mental
health issues are more frequently associated with low social status. Children from (socially) worse-o families have less
access to resources. The results consequently highlight the importance of prevention and health promotion measures
directed at strengthening resources. Focusing such measures on the needs of disadvantaged population groups should
contribute to health equity.
MENTAL HEALTH BURDENS · PSYCHOSOCIAL RESOURCES · KIGGS WAVE · SOCIAL SITUATIONBASED HEALTH PROMOTION
1. Introduction
The course of a person’s future health is set very early on in
life. From a life-course-epidemiology perspective, mental
health issues in childhood and adolescence play an impor-
tant role for health in later life. The risk of issues manifest-
ing as a disorder, becoming chronic and of various comor-
bidities developing is great [1, 2, 3]. A pronounced social
gradient is observed in the occurrence of mental health
issues, with an increased risk for children and adolescents
from the low-status groups [4, 5].
Psychosocial resources in terms of personal, family and
social resources, are of particular importance, as they act
as protective factors and are capable of positively influenc-
ing mental health. This protection can help in preventing
the development of mental health issues or otherwise
ensure that children and adolescents with mental health
issues nevertheless develop into mentally healthy adults [6].
Journal of Health Monitoring · ()
DOI ./
Robert Koch Institute, Berlin
Claudia Schmidtke , Raimund Geene ,
Heike Hölling , Thomas Lampert †
Robert Koch Institute, Berlin
Department of Epidemiology and
Health Monitoring
Berlin School of Public Health,
Alice Salomon Hochschule, Berlin
Submitted: ..
Accepted: ..
Published: ..
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Mental health issues in childhood and adolescence, psychosocial resources and socioeconomic statusJournal of Health Monitoring
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However, children and adolescents from socially disad
-
vantaged backgrounds are demonstrably less likely to
count on these resources than those from socially bet-
ter-o families.
Also with regard to health equity, the ties between men-
tal health issues, psychosocial resources and social status
are key to strengthening health promotion and prevention.
Important references here are the target anchored in Ger-
many’s Prevention Act [7, 8] of ‘reducing socially rooted
and gender-related inequalities in health opportunities’,
the health goal ‘Growing up healthy: life skills, exercise,
nutrition’ [8, 9, 10], which is also mentioned in the Preven-
tion Act, as well as the Cooperation Network on Equal
Health Opportunities [11].
The German Health Interview and Examination Survey
for Children and Adolescents (KiGGS) provides data on
the physical and mental health of children and adoles-
cents, which are also comprehensively analysed for their
relationship with social status [4, 5, 12, 13]. As a supple-
mentary evaluation, this paper intends to examine the
relationship between social status, mental health issues
and personal, social and family resources, in particular
the extent to which children from socially disadvantaged
families benefit from corresponding resources. Against
this backdrop, we will examine three questions: (1) what
is the significance of psychosocial resources for the risk
of mental health issues in 11- to 17-year-old children and
adolescents?; (2) are there social status-specific dier-
ences in the availability of psychosocial resources?; and,
(3) how does social status aect the relationship between
resources and mental health issues?
2. Methodology
2.1 Data basis
The analyses presented here build on data collected between
2014 and 2017 for the second wave of the German Health
Interview and Examination Survey for Children and Ado-
lescents (KiGGS Wave 2). The KiGGS survey has been con-
ducted as a part of health monitoring at the Robert Koch
Institute (RKI) since 2003. It also comprises repeated
cross-sectional surveys of 0- to 17-year-old children and
adolescents representative for Germany. Like the KiGGS
baseline survey (2003–2006), KiGGS Wave 2 was conduct-
ed as a combined examination and interview survey. KiGGS
Wave 1 (2009–2012) was designed and conducted as a
telephone interview survey.
The population for the cross-sectional data of KiGGS
Wave 2 consists of the group of 0- to 17-year-old children
and adolescents with a permanent residence in Germany.
Sampling was carried out via residency registration oces
and the subsequent invitation of randomly selected chil-
dren and adolescents from the 167 cities and municipali-
ties of the KiGGS baseline survey. A total of 15,023 study
subjects (7,538 girls, 7,485 boys) participated in the cross-
sectional KiGGS Wave 2 survey. The participation rate was
40.1%. In addition, 3,567 children and adolescents partici-
pated in the screening programme (1,801 girls, 1,766 boys;
participation rate: 41.5%) [14]. For the present study, 3,423
girls and 3,176 boys aged 11 to 17 years were included in
the analyses.
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Coherence Scale (e.g. ‘my daily activities give me pleasure
and are fun’) [19]. These questions measure personality
traits such as a respondent’s sense of coherence (the feel-
ing of being understandable, manageable and meaningful)
or dispositional optimism (general confidence that things
will develop positively, regardless of previous experiences).
Another characteristic taken into account is general self-
ecacy, i.e. the general conviction that one has the neces-
sary skills to deal with challenges [20].
A modified version of the family health climate scale
according to Schneewind et al. [21] was applied to assess
family resources. This was summarised into nine items
and four answers for each item. Of particular importance
here are aspects of family climate, such as family cohesion
and the parenting behaviour of parents (e.g. ‘we all really
get along well with each other’ or ‘in our family everyone
responds to the worries and needs of the others’) [20].
Social resources were assessed using a German trans-
lation of the Social Support Scale [22] with eight items. The
five-stage response categories were coded with values from
1 to 5. The items ask about the social support respondents
experience or that is available to them from peers and
adults in the form of listening and aection, about support
and help to solve problems in life as well as opportunities
to do things together [20].
Overall, the item values were coded in such a way that
a higher value reflects a greater resource availability. The
figures were added up and transformed into values
between 0 and 100. Based on an assessment of the item
contents, cut-o values were determined that take into
account the response distributions established in the
KiGGS sample. The scale values were then divided into
2.2 Study variables
KiGGS Wave 2 recorded mental health issues based on
parental responses to the Strengths and Diculties Ques-
tionnaire (SDQ), a symptoms questionnaire comprising a
total of 25 items. These refer to five subscales with five
items each, namely the four problem scales Emotional Dif-
ficulties, Behavioural Issues, Hyperactivity Problems, Prob-
lems with Peers and the strength dimension Prosocial
Behaviour. In this paper, however, only the four problem
dimensions of the questionnaire were considered. Parents
were asked to rate a total of 20 statements regarding their
children. A score was calculated from the answers Not true
at all (0), True to a certain extent (1) or Very true (2). Chil-
dren and adolescents with a total score of up to 12 points
across all areas are classified as psychologically normal,
those with a score between 13 and 16 as borderline and
those with a score of 16+ as presenting mental health issues
[3, 12, 15]. Based on SDQ scores, respondents in the bor-
derline and mental health issues groups were grouped
together as being at risk of mental health issues [12].
Psychosocial resources were surveyed using various
items and can be divided into personal, family and social
resources [13, 16]. The corresponding data and results are
based exclusively on self-reported data from the 11- to
17-year-old children and adolescents.
Personal resources were assessed based on a five-item
scale and four possible responses for each item. These
items are based on Schwarzer and Jerusalem’s self-ecacy
scale (e.g. ‘for every problem I can find a solution’) [17], the
Bern Questionnaire on Well-Being’ optimism scale (e.g.
‘my future looks bright’) [18] and the Children’s Sense of
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the distribution of mental health issues with consideration
of social status was examined for 11- to 17-year-old children
and adolescents. Subsequently, the distribution of psycho-
social resources was examined, also segregated by social
status. Psychosocial resources were always dierentiated
as personal, family and social resources. The third step
consisted in assessing the significance of psychosocial
resources for the occurrence of mental health issues. In
the final fourth step, whether and, if yes, the extent to which
social status aects the relationship between resources
and mental health issues was examined. The analyses were
carried out with the statistics programme STATA 14.2.
Preva lences are presented with 95% confidence intervals.
In addition, binary logistic regressions were calculated and
odds ratios with 95% confidence intervals are reported. The
odds ratios express the factor by which the statistical
chance that the respective outcome is present is increased
in a determined group in relation to a defined reference
group. All calculations were carried out with a weighting
factor that corrects for deviations of the sample from the
general population structure with regard to age in years,
gender, federal state, German nationality and parental dis-
tribution of education [24].
3. Results
Based on the KiGGS Wave 2 data, 15.6% of 11- to 17-year-
olds in Germany present mental health issues. Thereby,
clear dierences can be observed with regard to social sta-
tus. Overall, 19.4% of 11 to 17-year-olds from the low status
group present mental health issues compared to 15.9%
from the medium and 9.9% from the high-status group. The
the categories of ‘inconspicuous or normal’, ‘below aver-
age or borderline’ and ‘significant deficits’ [13, 20]. Dum-
mies were created for the binary logistic regressions (see
2.3 Statistical analyses). The categories ‘inconspicuous
or normal’ and ‘below average or borderline’ were com-
bined and labelled ‘medium/high’. ‘Significant deficits’
were labelled as ‘low’.
KiGGS Wave 2 records socioeconomic status (SES)
based on a multidimensional index by calculating a point
total score from the information provided by parents on
education (school achievement and professional qualifica-
tions) and occupational status, as well as on needs-weighted
net household income (net equivalent income) [23].
For each individual dimension, point values ranging
from one to seven are assigned according to a fixed scheme.
Information on education and occupational status is col-
lected from the mother and father and the higher point
values taken into account. In the case of single parents, the
single value is used. Based on distribution, three groups
are distinguished, with 20% of children and adolescents
in the low-status group (1st quintile), 60% in the medium
status group (2nd to 4th quintile) and 20% in the high-sta-
tus group (5th quintile) [23].
A detailed description of KiGGS Wave 2 can be found
in the S3/2017 issue of the Journal of Health Monitoring
[16]. A more detailed description of SES is found in issue
1/2018 [23].
2.3 Statistical analyses
To analyse the questions described at the beginning of this
article, a four-step procedure was adopted. In a first step,
Psychosocial resources
can positively influence
mental health.
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more frequently than their peers from the medium and
high-status groups (18.4% and 13.3% respectively). When
segregated by gender, the high proportion of girls from
the low status group who have few personal resources
(36.3%) is particularly striking. In the medium and high-
status groups, this proportion is only about half as high.
For boys, the dierences are less pronounced, but still
clear, at least when comparing the low to the high-status
group (Figure 2).
Slightly smaller dierences are observed for family
resources. 42.0% of children and adolescents from the low
status group have few family resources compared to 38.5%
from the medium and 31.0% from the high-status group.
When segregated by gender, the analyses show a somewhat
more pronounced social gradient for girls than for boys. In
addition, regarding the share of those with few family
social gradient is clearly evident for all genders, but is some-
what more pronounced in girls than in boys (Figure 1).
Figure 2, Figure 3 and Figure 4 show the distribution of
psychosocial resources among 11- to 17-year-old girls and
boys in the dierent social status groups.
The results indicate that children and adolescents from
the low-status group (27.3%) have few personal resources
Figure
Mental health issues among - to -year-old
girls and boys by socioeconomic status
Source: KiGGS Wave (–)
Figure (left)
Lack of personal resources for - to -year-old
girls and boys by socioeconomic status
Source: KiGGS Wave (–)
Figure (right)
Lack of family resources among - to -year-old
girls and boys by socioeconomic status
Source: KiGGS Wave (–)
Social status:
5
10
15
20
25
Girls Boys Total
MediumLow High
Proportion (%)
5
10
15
20
25
30
35
Girls Boys Total
40
45
Proportion (%)
Social status: MediumLow High
5
10
15
20
25
30
35
Girls Boys Total
40
45
50
Proportion (%)
Social status: MediumLow High
According to KiGGS Wave 2
around 16% of 11- to 17-year
olds in Germany are aected
by mental health issues.
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gradient is evident for both girls and boys. Unlike for per-
sonal resources, boys score lower in social resources than
girls and more often have less resources (Figure 4).
To examine the influence of psychosocial resources on
mental health issues, we will first look at mental health
issues in relation to the availability of resources among 11-
to 17-year-old girls and boys. KiGGS Wave 2 data indicate
that children and adolescents show lower levels of mental
health issues overall if they have more resources at their
disposal. This eect is most pronounced regarding per-
sonal resources. Here, 31.7% of the children and adoles-
cents who have few resources evidence issues with mental
health, but only 11.7% of their peers with medium/many
resources. The corresponding dierences in social and
family resources are somewhat smaller. Of those with few
social resources, 26.8% present mental health issues; of
those with medium/many resources the figure is 12.6%.
21.8% of children and adolescents with few family resources
have mental health issues, compared to 11.6% of those
with medium/many family resources.
resources, the dierences by gender are minimal and this
applies to all status groups (Figure 3).
The gradient for the distribution of social resources
among 11- to 17-year-olds is somewhat more pronounced
(28.5% in the low-status group compared to 19.2% in the
medium and 15.9% in the high-status group). This social
Figure
Lack of social resources among - to -year-
old girls and boys by socioeconomic status
Source: KiGGS Wave (–)
5
10
15
20
25
30
35
Girls Boys Total
40
45
Proportion (%)
Social status: MediumLow High
Girls Boys Total
% (% CI) OR (% CI) % (% CI) OR (% CI) % (% CI) OR (% CI)
Personal Resources
Little . (.–.) . (.–.) . (.–.) . (.–.) . (.–.) . (.–.)
Medium/Many . (.–.) Ref. . (.–.) Ref. . (.–.) Ref.
Family Resources
Little . (.–.) . (.–.) . (.–.) . (.–.) . (.–.) . (.–.)
Medium/Many . (.–.) Ref. . (.–.) Ref. . (.–.) Ref.
Social Resources
Little . (.–.) . (.–.) . (.–.) . (.–.) . (.–.) . (.–.)
Medium/Many . (.–.) Ref. . (.–.) Ref. . (.–.) Ref.
OR = Odds Ratio, CI = Confidence Interval, Ref. = Reference
Table
Mental health issues in - to -year-old girls
and boys by resources (Odds Ratios calculated
using binary logistic regressions)
Source: KiGGS Wave (–)
Access to psychosocial
resources in society is clearly
skewed, i.e. girls from the
low social status group have
fewer personal resources.
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The dierences between the status groups in this regard
are somewhat less pronounced than for personal resources.
When segregated by gender, a clear connection between
resources and mental health issues is found for girls and
boys across all status groups. Some specific aspects how-
ever do stand out. For girls, the connection between social
resources and mental health issues is strongest in the
high-status group. Among boys, the connection between
personal resources and mental health issues is even more
pronounced in the medium status group than in the low or
high status group.
4. Discussion
For 11- to 17-year-old girls and boys, the KiGGS Wave 2 results
indicate that the availability of psychosocial resources
reduces the risk of mental health issues. This protective
eect was visible in the analyses of personal, family and
also social resources and for children and adolescents from
all social status groups. At the same time, the results high-
light that children and adolescents from families with low
An analysis by gender shows that the connection
between the availability of resources and mental health
issues is evident as much for girls as also for boys. For per-
sonal resources, the connection is somewhat stronger for
boys than for girls. For social resources, the figure for girls
are somewhat greater than for boys. For family resources,
the relationship is similar for girls and boys (Table 1).
Table 2 shows the relationship between psychosocial
resources and mental health issues in 11- to 17-year-olds by
social status. For all three resources, children and adoles-
cents with medium/many resources are significantly less
likely to present mental health issues than those with few
resources. This can be observed across all three social sta-
tus groups. When controlling for age and gender, children
and adolescents in the low-social status group with low
levels of personal resources have a 4.2-fold increased risk
of presenting mental health issues compared to those with
medium/many resources.
For family and social resources, too, children and ado-
lescents with few resources more often present mental
health issues than those with medium/many resources.
Social status: Low Social status: Medium Social status: High
% (% CI) OR (% CI) % (% CI) OR (% CI) % (% CI) OR (% CI)
Personal Resources
Little . (.–.) . (.–.) . (.–.) . (.–.) . (.–.) . (.–.)
Medium/Many . (.–.) Ref. . (.–.) Ref. . (.–.) Ref.
Family Resources
Little . (.–.) . (.–.) . (.–.) . (.–.) . (.–.) . (.–.)
Medium/Many . (.–.) Ref. . (.–.) Ref. . (.–.) Ref.
Social Resources
Little . (.–.) . (.–.) . (.–.) . (.–.) . (.–.) . (.–.)
Medium/Many . (.–.) Ref. . (.–.) Ref. . (.–.) Ref.
OR = Odds Ratio, CI = Confidence Interval, Ref. = Reference
Table
Eects of personal, family and social resources
on mental health issues in - to -year-olds
by social status (Odds Ratios adjusted
for age and gender)
Source: KiGGS Wave (–)
The results highlight
the protective function
of personal, family and
social resources, which
calls attention to fields
of action for health
promotion and prevention.
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hood and adolescence, such as growing up in unstable
family relationships, and impacts on health later in life.
Hughes et al. [27] published a systematic review on this
question, whereby 11,621 references were compiled to
examine the eects of negative childhood experiences on
adult health. A total of 37 studies were identified that
described risk factors for 23 outcomes, such as obesity,
smoking, substance abuse or mental illness. Negative
childhood experiences can be a risk factor for various health
outcomes later in life. Against this backdrop, the authors
emphasise the importance of resilience-building and pre-
venting negative experiences.
In their review study, Egle et al. [28] evaluate the inter-
national body of studies on the perpetuation of childhood
stress experiences as well as the neurobiological and devel-
opmental psychological mechanisms that mediate these
long-term consequences. They emphatically advocate for
family-related prevention measures that protect parents,
children and adolescents from stress and enable experi-
ences of self-ecacy.
A number of American studies from the 1970s and
1990s are also worth referencing. In the Rochester Longi-
tudinal Study, Samero et al. [29] accompanied psycholog-
ically stressed women and their children as well as an
unstressed control group up to 12th grade. The Adverse
Childhood Experience (ACE) study [30] was conducted by
the Centres for Disease Control and Prevention towards
the end of the 1990s. In two survey waves, children were
examined with regard to health risks later in life as a result
of negative psychological experiences in childhood. The
results yielded clear evidence for a strong connection
between such experiences and lifelong health consequences
social status have fewer resources at their disposal than
their peers from higher status groups and more frequent-
ly suer mental health issues. Furthermore, a number of
gender-related dierences are apparent. For girls, the tie
between social resources and mental health issues is some-
what stronger than for boys. On the other hand, the con-
nection between personal resources and mental health
issues is somewhat more pronounced in boys than it is in
girls. However, the key finding that the psychosocial
resources of children and adolescents of all status groups
are associated to a reduced risk for mental health issues,
applies to both girls and boys.
The results presented here are largely in line with previ-
ous research. This applies, on the one hand, to the finding
of a protective eect of resources on mental health and, on
the other hand, to the status-specific dierences with
regard to available resources and the risk of suering men-
tal health issues [25]. Particular reference should be made
to the results of the mental health module of the KiGGS
survey [26], the BELLA study (BEfragung zum seeLischen
WohLbefinden und VerhAlten), which shows that children
and adolescents from families with low social status more
often face mental health issues and have fewer psychoso-
cial resources at their disposal. In addition, the BELLA study
showed that making use of resources reduces the risk of
suering mental health issues. Whether this applies equally
to children and adolescents from all social status groups,
however, has, to our knowledge, not been demonstrated
in detail, neither by the BELLA study nor by other German
studies [26].
In addition, international literature contains numerous
studies on the links between negative experiences in child-
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naire (SDQ) to record mental health issues. However, SDQ
is only a screening procedure and not a psycho-diagnostic
instrument. The set age range of 11 to 17 years is large and
does not take into account age group specific psychosocial
health dierences and the importance of personal, family
and social resources. It should also be noted that the anal-
yses were conducted based on the cross-sectional data
from KiGGS Wave 2. Cross-sectionally collected data only
allow statements on the relationships between the varia-
bles examined, however, not on causal relationships. Thus,
for example, the question of whether the availability of
resources actually reduces the risk of mental health issues,
as assumed in the paper, or conversely, whether it is men-
tal health issues that impact a person’s resources, cannot
be answered conclusively. In a next step, the longitudinal
data from KiGGS, which are now available, could possibly
be used to answer this question [33]. It should also be
pointed out that the KiGGS study uses a multidimensional
index to record social status. Although this index includes
data on parental levels of education and occupational sta-
tus as well as on household income, other important
aspects of the living situation of adolescents and their fam-
ilies, such as parent employment status or household com-
position, are not taken into account. Finally, quantitative
surveys have fundamental limitations in terms of the depth
of their explanations, because – unlike qualitative studies –
they do not allow for a deeper understanding of individual
constellations of status-related stress factors, existing
resources and mental health issues.
Despite the limitations mentioned, the results point to
the importance of strengthening resources as a fundamen-
tal aspect of prevention and health promotion. The results
with eects on well-being. Compared to individuals who
did not suer adverse childhood experiences, those who
suered multiple childhood adversities (four or more ACEs)
had a twice as high risk of coronary heart disease, an 1.9
times higher risk of any type of cancer, a 2.4 times higher
risk of stroke, a 3.9 times higher risk of chronic lung dis-
ease and an 1.6 times higher risk of diabetes [30].
In 2019, the results of the ‘AWO-ISS Study on the long-
term life course consequences of poverty’ were presented.
The study focussed on the material, personal, family and
social resources of children growing up in poverty in Ger-
many. There were three survey waves with a total of 20 years
of follow-up. For Germany, too, the study proves a high cor-
relation between low social status and a limited availability
of resources in childhood and adolescence with depression
symptoms, low life satisfaction and need for support with
drug and alcohol abuse among the now 25-year-old young
adults [31]. Settings-based preventive approaches that
address the overall conditions in which children grow up
are listed as protective factors, for example through set-
tings-based approaches in day-care centres and schools
that aim to reduce stressors (such as bullying or situations
that produce stress and pressure), strengthening resources
and promoting healthier relationships between people
within a respective setting. Overarching strategies to com-
bat the consequences of poverty are identified as measures
that promote health, especially in the transition between
institutions and stages of socialisation (transitions), for
example through municipal prevention chains [31, 32].
Various limitations must be pointed out regarding the
underlying data basis and the analyses carried out. The
KiGGS study uses the Strengths and Diculties Question-
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Overall, there has been a clear increase in mental health
issues, especially among young people [38]. In particular
in times of crisis, however, youth outreach structures
should be secured and further developed.
Preventive measures are also of great importance for
example during transitions between institutions such as
switching from one school to another or when people leave
school (transitions), as they can counteract a spiral of
resource losses and use these stations along the life course
to build up psychosocial resources [36].
Overall, the relevance of personal, family and social
resources described here indicates that youth outreach is
an important setting for health promotion and prevention,
which should be used and expanded especially to reduce
socially conditioned and gender-related inequalities in
health opportunities.
Corresponding author
Claudia Schmidtke
Robert Koch Institute
Department of Epidemiology and Health Monitoring
General-Pape-Str. 62–66
12101 Berlin, Germany
E-mail: SchmidtkeC@rki.de
Please cite this publication as
Schmidtke C, Geene R, Hölling H, Lampert T (2021)
Mental health issues in childhood and adolescence,
psychosocial resources and socioeconomic status –
An analysis of the KiGGS Wave 2 data.
Journal of Health Monitoring 6(4): 20–33.
DOI 10.25646/8865
The German version of the article is available at:
www.rki.de/journalhealthmonitoring
in this paper show that all children and adolescents can
benefit from psychosocial resources. If resources are avail-
able, then they have a protective eect regardless of social
status. However, the availability of resources is not distrib-
uted evenly across all social status groups. For this reason,
measures should be identified that contribute to both
reducing stress and strengthening resources in children
and adolescents of all social status groups. Nonetheless,
assurances would have to be made that those from socially
disadvantaged families are also reached, as they will still
have fewer resources. The focus should be on preventive
interventions to reduce socially unequal health opportuni-
ties, for example by combating poverty, improving educa-
tional opportunities and ensuring needs-based, low-thresh-
old counselling and support services for families under
stress. In the sense of the ‘Health in All Policies’ approach,
the framework conditions for children, adolescents and
families could therefore be more strongly orientated
towards promoting health [34, 35].
As children grow older, the importance of institutions
of tertiary socialisation such as recreational child and youth
facilities, sports clubs and street or school social work
grows. Particularly for socially stressed young people, they
oer many opportunities to strengthen resources, for exam-
ple through participation, conflict resolution or other meth-
ods to promote self-ecacy. However, there are often only
limited human and financial resources available for tertiary
socialisation programmes. In many cases, the programmes
have little conceptual, structural and financial support;
accordingly, they often find it hard to retain young people
[36]. In addition, in the context of the COVID-19 pandemic,
maintaining such services became increasingly dicult [37].
Journal of Health Monitoring 2021 6(4)
Mental health issues in childhood and adolescence, psychosocial resources and socioeconomic statusJournal of Health Monitoring
FOCUS
4. Robert Koch-Institut (Ed) (2010) Gesundheitliche Ungleichheit
bei Kindern und Jugendlichen in Deutschland. Beiträge zur
Gesundheitsberichterstattung des Bundes. RKI, Berlin.
https://www.rki.de/DE/Content/Gesundheitsmonitoring/
Gesund heitsberichterstattung/GBEDownloadsB/soz_ungleich-
heit_kinder.pdf?__blob=publicationFile (As at 17.06.2021)
5. Kuntz B, Rattay P, Poethko-Müller C et al. (2018) Social inequali-
ties in health of children and adolescents in Germany. Results of
the cross-sectional KiGGS Wave 2 study. Journal of Health
Monitoring 3(3):17–33.
https://edoc.rki.de/handle/176904/5773 (As at 17.05.2021)
6. Baumgarten F, Klipker K, Göbel K et al. (2018) The developmen-
tal course of mental health problems among children and adoles-
cents. Results of the KiGGS cohort. Journal of Health Monitoring
3(1):57–61.
https://edoc.rki.de/handle/176904/5633 (As at 17.06.2021)
7. Sozialgesetzbuch (2015) Fünftes Buch (V) §20 Absatz 1.
http://www.gesetze-im-internet.de/sgb_5/ (As at 17.06.2021)
8. Präventionsgesetz – PrävG (2015) Gesetz zur Stärkung der
Gesundheitsförderung und der Prävention. Bundesgesetzblatt
Jahrgang 2015 Teil I Nr 31, ausgegeben zu Bonn am 24 Juli
2015:1368–1379.
http://www.bgbl.de/xaver/bgbl/start.xav?startbk=Bundesanzei-
ger_BGBl&jumpTo=bgbl115s1368.pdf (As at 18.06.2021)
9. Sozialgesetzbuch (2015) Fünftes Buch (V) §20 Absatz 3.
http://www.gesetze-im-internet.de/sgb_5/ (As at 17.06.2021)
10. Bundesministerium für Gesundheit (2010) Nationales Gesund-
heitsziel Gesund aufwachsen: Lebenskompetenz, Bewegung,
Ernährung. BMG, Berlin
11. Kooperationsverbund Gesundheitliche Chancengleichheit (2018)
Gesundheitsförderung bei sozial benachteiligten Kindern und
Jugendlichen.
http://www.gesundheitliche-chancengleichheit.de/gesundheits-
foerderung-bei-kindern-und-jugendlichen/ (As at 05.07.2020)
12. Hölling H, Schlack R, Petermann F et al. (2014) Psychische
Auälligkeiten und psychosoziale Beeinträchtigungen bei
Kindern und Jugendlichen im Alter von 3 bis 17 Jahren in
Deutschland – Prävalenz und zeitliche Trends zu 2 Erhebungs-
zeitpunkten (2003–2006 und 2009–2012). Bundesgesundheitsbl
57(7):807–819.
https://edoc.rki.de/handle/176904/1894 (As at 18.06.2021)
Data protection and ethics
The KiGGS Wave 2 is subject to strict compliance with the
data protection provisions set out in the EU General Data
Protection Regulation (GDPR) and the Federal Data Protec-
tion Act (BDSG). Hannover Medical School’s ethics com-
mittee assessed KiGGS Wave 2 (No. 2275-2014) and pro-
vided its approval. Participation in the study was voluntary.
The participants and/or their parents/legal guardians were
also informed about the aims and contents of the study,
and about data protection. Informed consent was obtained
in writing.
Funding
KiGGS is funded by the Federal Ministry of Health and the
Robert Koch Institute.
Conflicts of interest
The authors declared no conflicts of interest.
References
1. Dragano N, Siegrist J (2006) Die Lebenslaufperspektive gesund-
heitlicher Ungleichheit: Konzepte und Forschungsergebnisse. In:
Richter M, Hurrelmann K (Eds) Gesundheitliche Ungleichheit.
VS Verlag für Sozialwissenschaften, Wiesbaden, P. 171–184
2. Erhart M, Wille N, Ravens-Sieberer U (2008) In die Wiege gelegt?
Gesundheit im Kindes- und Jugendalter als Beginn einer
lebenslangen Problematik. In: Bauer U, Bittlingmayer U, Richter M
(Eds) Health inequalities: Determinanten und Mechanismen
gesundheitlicher Ungleichheit. VS Verlag für Sozialwissenschaf-
ten, Wiesbaden, P. 331–358
3. Klipker K, Baumgarten F, Göbel K et al. (2018) Mental health
problems in children and adolescents in Germany. Results of the
cross-sectional KiGGS Wave 2 study and trends. Journal of
Health Monitoring 3(3):34–41.
https://edoc.rki.de/handle/176904/5774 (As at 17.05.2021)
Journal of Health Monitoring 2021 6(4)
Mental health issues in childhood and adolescence, psychosocial resources and socioeconomic statusJournal of Health Monitoring
FOCUS
24. Forschungsdatenzentren der Statistischen Ämter des Bundes
und der Länder (2017) Mikrozensus, 2013.
http://www.forschungsdatenzentrum.de/bestand/mikrozensus/
(As at 20.08.2019)
25. Lampert T, Hoebel J, Kuntz B et al. (2019) Soziale Ungleichheit
und Gesundheit. In: Haring R (Ed) Gesundheitswissenschaften.
Springer Reference Pflege – Therapie – Gesundheit. Springer,
Berlin, Heidelberg, New York
26. Klasen F, Reiß F, Otto C et al. (2017) The BELLA study – the
mental health module of KiGGS Wave 2. Journal of Health
Monitoring 2(S3):52–62.
https://edoc.rki.de/handle/176904/2816 (As at 17.05.2021)
27. Hughes K, Bellis MA, Hardcastle KA et al. (2017) The eect of
multiple adverse childhood experiences on health: a systematic
review and meta-analysis. The Lancet Public Health 2(8):356–366
28. Egle UT, Franz M, Joraschky P et al. (2016) Gesundheitliche
Langzeitfolgen psychosozialer Belastungen in der Kindheit –
ein Update.Bundesgesundheitsbl59(10):1247–1254.
https://doi.org/10.1007/s00103-016-2421-9 (As at 18.06.2021)
29. Samero A, Gutman LM, Peck SC (2003) Adaptation among
youth facing multiple risks: Prospective research findings. In:
Luthar SS (Ed) Resilience and vulnerability: Adaptation in the
context of childhood adversities, 1. Cambridge University Press,
Cambridge, P. 364–391
30. Felitti VJ, Anda RF, Nordenberg D et al. (2019) Relationship of
childhood abuse and household dysfunction to many of the
leading causes of death in adults: The Adverse Childhood
Experiences (ACE) Study. American Journal of Preventive
Medicine 56(6):774–786
31. Volf I, Laubstein C, Sthamer E (2019) Wenn Kinderarmut
erwachsen wird… AWO-ISS-Langzeitstudie zu (Langzeit-)Folgen
von Armut im Lebensverlauf. ISS, Frankfurt am Main
32. Geene R, Thyen U, Quilling E et al. (2016) Familiäre Gesundheits-
förderung.Prävention und Gesundheitsförderung11(4):222–229
33. Lange M, Homann R, Mauz E et al. (2018) KiGGS Wave 2
longitudinal component – data collection design and develop-
ments in the numbers of participants in the KiGGS cohort.
Journal of Health Monitoring 3(1): 92–107.
https://edoc.rki.de/handle/176904/5638 (As at 17.06.2021)
34. Thyen U, Geene R (2020) Priorisierung von Kindergesundheit
im Kontext von HiAP. In:Public Health Forum. De Gruyter
28(3):169–175
13. Hölling H, Schlack R, Dippelhofer A et al. (2008) Personale,
familiäre und soziale Schutzfaktoren und gesundheitsbezogene
Lebensqualität chronisch kranker Kinder und Jugendlicher.
Bundesgesundheitsbl 51(6):606–620.
https://edoc.rki.de/handle/176904/462 (As at 18.06.2021)
14. Homann R, Lange M, Butschalowsky H et al. (2018) KiGGS
Wave 2 cross-sectional study – participant acquisition, response
rates and representativeness. Journal of Health Monitoring
3(1):78–91.
https://edoc.rki.de/handle/176904/5637 (As at 17.06.2021)
15. Woerner W, Becker A, Friedrich C et al. (2002) Normierung und
Evaluation der deutschen Elternversion des Strengths and
Diculties Questionnaire (SDQ): Ergebnisse einer repräsentati-
ven Felderhebung. Zeitschrift für Kinder- und Jugendpsychiatrie
und Psychotherapie 30(2):105–112
16. Mauz E, Gößwald A, Kamtsiuris P et al. (2017) New data for
action. Data collection for KiGGS Wave 2 has been completed.
Journal of Health Monitoring 2(S3):2–27.
https://edoc.rki.de/handle/176904/2812 (As at 17.06.2021)
17. Schwarzer R, Jerusalem M (1999) Skalen zur Erfassung von
Lehrer- und Schülermerkmalen. Dokumentation der psychomet-
rischen Verfahren im Rahmen der Wissenschaftlichen Begleitung
des Modellversuchs Selbstwirksame Schulen, Berlin
18. Grob A, Lüthi R, Kaiser FG et al. (1991) Berner Fragebogen zum
Wohlbefinden Jugendlicher (BFW). Diagnostica 37(1):66–75
19. Kern R, Rasky E, Noack RH (1995) Indikatoren für Gesundheits-
förderung in der Volksschule. Karl-Franzens-Universität Graz
20. Erhart M, Hölling H, Bettge S et al. (2007) Der Kinder- und
Jugendgesundheitssurvey (KiGGS): Risiken und Ressourcen für
die psychische Entwicklung von Kindern und Jugendlichen.
Bundesgesundheitsbl 50(5/6):800–809.
21. Schneewind K, Beckmann M, Hecht-Jackl A (1985) Familienkli-
ma-Skalen Bericht 8.1 und 8.2., Institut für Psychologie-Persön-
lichkeitspsychologie und Psychodiagnostik, Ludwig-Maximilians-
Universität, München
22. Donald CA, Ware JE (1984) The measurement of social support.
Research in Community & Mental Health, 4, P. 325–370
23. Lampert T, Hoebel J, Kuntz B et al. (2018) Socioeconomic status
and subjective social status measurement in KiGGS Wave 2.
Journal of Health Monitoring 3(1):108–128.
https://edoc.rki.de/handle/176904/5639 (As at 17.06.2021)
Journal of Health Monitoring 2021 6(4)
Mental health issues in childhood and adolescence, psychosocial resources and socioeconomic statusJournal of Health Monitoring
FOCUS
35. Pinheiro P, Bauer U (2020) Verringerung ungleicher Gesundheits-
chancen als vorrangiges nationales Gesundheitsziel: Rückblick
und Ausblick. In: Liel K, Rademaker AL (Eds) Gesundheitsförde-
rung und Prävention – Quo vadis Kinder- und Jugendhilfe?
Juventa, Weinheim, S. 283–297
36. Geene R (2018) Familiäre Gesundheitsförderung. Ein nutzerori-
entierter Ansatz zur Ausrichtung kommunaler Gesundheitsförde-
rung bei Kindern und Familien.Bundesgesundheits-
bl61(10):1289–1299.
https://doi.org/10.1007/s00103-018-2814-z (As at 17.06.2021)
37. Voigts G (2020) Vom „Jugend vergessen“ zum „Jugend ermög-
lichen“: Bewegungs, Beteiligungs- und Freiräume für junge
Menschen in Corona-Zeiten. Forum Kind Jugend Sport 1:93–99.
https://doi.org/10.1007/s43594-020-00022-5 (As at 18.06.2021)
38. Ravens-Sieberer U, Kaman A, Otto C et al. (2021) Seelische
Gesundheit und psychische Belastungen von Kindern und
Jugendlichen in der ersten Welle der COVID-19-Pandemie –
Ergebnisse der COPSY-Studie. Bundesgesundheitsbl.
https://doi.org/10.1007/s00103-021-03291-3 (As at 18.06.2021)
Journal of Health Monitoring 2021 6(4)
Mental health issues in childhood and adolescence, psychosocial resources and socioeconomic statusJournal of Health Monitoring
FOCUS
Imprint
Journal of Health Monitoring
Publisher
Robert Koch Institute
Nordufer 20
13353 Berlin, Germany
Editors
Johanna Gutsche, Dr Birte Hintzpeter, Dr Franziska Prütz,
Dr Martina Rabenberg, Dr Alexander Rommel, Dr Livia Ryl,
Dr Anke-Christine Saß, Stefanie Seeling, Dr Thomas Ziese
Robert Koch Institute
Department of Epidemiology and Health Monitoring
Unit: Health Reporting
General-Pape-Str. 62–66
12101 Berlin, Germany
Phone: +49 (0)30-18 754-3400
E-mail: healthmonitoring@rki.de
www.rki.de/journalhealthmonitoring-en
Typesetting
Kerstin Möllerke, Alexander Krönke
Translation
Simon Phillips/Tim Jack
ISSN 2511-2708
Note
External contributions do not necessarily reflect the opinions of the
Robert Koch Institute.
The Robert Koch Institute is a Federal Institute within
the portfolio of the German Federal Ministry of Health
This work is licensed under a
Creative Commons Attribution .
International License.
