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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    • "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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    • "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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