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Background The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including—but not restricted to—child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. Conclusion There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.

Background Child maltreatment and its consequences are considered a major public health problem. So far, there is only one study from Germany reporting prevalence rates on different types of maltreatment. Methods A representative sample of the German general population was examined for experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ) between September and November 2016. A total of 2510 (53.3% female) participants between 14 and 94 years (M = 48.8 years) were enrolled. Besides the CTQ, a range of sociodemographic information was collected. The interrelatedness of different types of maltreatment was examined using configuration analysis and predictors for maltreatment were identified by performing binary logistic regression analyses. Results Overall, 2.6% (f: 3.9%, m: 1.2%) of all participants reported severe emotional abuse, 3.3% (f: 3.4%, m: 3.3%) severe physical abuse, 2.3% (f: 3.7%, m: 0.7%) severe sexual abuse, 7.1% (f: 8.1%, m: 5.9%) severe emotional neglect and 9% (f: 9.2%, m: 8.9%) severe physical neglect. Women were more likely to report at least moderate sexual and emotional abuse than men. The largest difference between age groups was reported for physical neglect, with participants aged over 70 years reporting the highest rates. Participants who reported childhood maltreatment were more likely to be unemployed or have lower educational outcomes. The most common combination of maltreatment types were physical and emotional neglect, all five types of maltreatment combined and physical and emotional neglect and physical abuse combined. Conclusions Child maltreatment, especially physical neglect is common in the German population. Women seem to be at greater risk for sexual and emotional abuse than men. Knowledge about different types of maltreatment based on the Childhood Trauma Questionnaire (CTQ) can help to put findings of future studies into an epidemiological and societal context.

Background Research points to a high depression burden among youth during the COVID-19 pandemic; however, a lack of systematic evidence exists. We determine the change in depression symptoms among children and adolescents during COVID-19 compared to pre-pandemic baselines. By using country differences in pandemic-related restrictions and school closures in Europe as quasi-experimental design, we evaluate policy impacts on depression. Methods In this systematic review and meta-analysis, following the PRISMA statement, we searched six databases (MEDLINE, EMBASE, PsycINFO, Cochrane Central, Web of Science, WHO COVID-19) using a peer-reviewed search string up until March 18, 2022 with citation tracking and grey literature searches. No limitations regarding language and effect measures existed. We included studies that compared (1) general depression symptoms or (2) clinically relevant depression rates in children and adolescents (≤ 19 years) before and during the COVID-19 pandemic in Europe. The validated Oxford Stringency Index was used as indicator for pandemic-related restrictions. Screening for eligibility, extracting data from published reports and from unpublished data requested directly from study authors, assessing the study risk of bias and grading certainty of evidence using the GRADE approach, were all done in duplicate. Data were pooled in a random-effects model. PROSPERO: CRD42022303714. Results Of 7,422 nonduplicate records, 22 studies with data from 868,634 participants pre-pandemic and 807,480 during pandemic, met full inclusion criteria. For the comparison of depression symptoms before and during the COVID-19 pandemic, moderate certainty of evidence was observed for general depression symptoms (standardized mean difference, 0.21 [95%CI, 0.12–0.30]; I 2  = 94%) and low certainty of evidence for clinically relevant depression rates (odds ratio, 1.36 [95%CI, 1.05–1.76]; I 2  = 95%) for total population. Increase in general depression symptoms was higher for male adolescents, whereas increase in clinically relevant depression rates was higher for females. Effect estimates were significantly higher when pandemic-related restrictions were more stringent or school closure occurred. Conclusion An increase in depression symptoms occurred in a pre-pandemic vs. during-pandemic comparison within the COVID-19 pandemic, whereby pandemic-related restrictions (such as school closures) resulted in a considerable effect increase. Ensuring adequate supply of mental health recovery services and long-term monitoring is of high public health relevance.

Research on child maltreatment epidemiology has primarily been focused on population surveys with adult respondents. Far less attention has been paid to analyzing reported incidents of alleged child maltreatment and corresponding agency responses. This type of research is however indispensable to know how well a child protection system works and if the most vulnerable are identified and served. Notable findings of child maltreatment epidemiological research are summarized and directions for future studies discussed.

Background Discrimination, stalking, sexual harassment and sexual violence (DSHV) remain pervasive problems at universities. However, systemic investigations from German universities are lacking. This study aimed to assess the prevalence of DSHV using an integrative approach with all forms of DSHV to identify pattern-based subcategories with distinct DSHV-profiles and predictive factors for cluster affiliation for students and staff. Methods A total of 2,128 participants (1,358 students; 14% response rate; 753 employees; 42% response rate) completed the online survey between April and July in 2023 for the DSHV-investigation. Hierarchical cluster analysis was applied to find pattern-based subcategories (clusters) and multinomial logistic regression models were used to examine factors influencing cluster affiliation. Results Three pattern-based clusters emerged for both students and staff, each with significantly distinct DSHV-profiles: There is an unaffected group, a group with limited DSHV-experiences and a group with extensive DSHV-experiences, especially sexual harassment and sexual violence. Being female, perceiving stronger hierarchical structures at workplace or study field, working or studying for a longer time at the university and studying medicine or natural sciences are associated with an increased risk of belonging to the affected clusters. Conclusion This study, including a high number of both, data from students and employees, highlights the prevalence and co-occurrence of different forms of DSHV in academic settings and demonstrates that experience of one type of DSHV often correlates with vulnerability to others. Greater attention should be given to female students in the natural sciences. As DSHV is group-specific, measures should include both global and in particular targeted components based on a risk analysis, and might be helpful for students and staff.

Background Russia’s full-scale military invasion of Ukraine on February 24, 2022 led to an increase of anxiety and depressive states, psychosomatic manifestations, and a tendency to abuse alcohol and psychoactive substances in the population. The aim of this paper is to examine the mental health burden among university students twenty months after war and to identify risk and protective factors for mental health problems. Methods A cross-sectional study was conducted among Ukrainian students in October 2023 ( n  = 1398). The online survey included sociodemographic data collection, evaluation of psychological well-being and measured depression, anxiety, PTSD symptoms and insomnia. Normality of included variables was verified by Kolmogorov–Smirnov test. An independent-samples t-test, Mann–Whitney U-test, χ2 test and analysis of variance were used to compare the data. Differences in PHQ-9 and GAD-7 levels based on sociodemographic characteristics were analyzed using ANOVA. Correlation between variables was calculated with Pearson correlation, adjusted with Benjamini-Hochberg procedure. To develop the predictive model the XGBoost algorithm was employed, additionally, the SHAP algorithm was utilized. Results Symptoms of PTSD, as well as moderate and severe symptoms of anxiety, depression, and insomnia, were reported by 48.1%, 34.1%, 33.6%, and 19.3% of students, respectively. The severity of these symptoms varied based on factors such as sex, age, prior trauma experiences, and living conditions. Additionally, the type of relocation (within Ukraine or abroad) significantly influenced mental health outcomes. A majority of participants (68.5%) reported the experience of war-related traumatic events. Factors linked to higher depression symptom scores included lower initial well-being, greater social media use, female gender, exposure to multiple traumatic events, experiences of assault or sexual violence, the loss of a loved one, pre-existing and ongoing mental health treatment during the war, and the use of psychotropic medications. Conclusions Ukrainian university students face a significant mental health burden due to the ongoing war, with high rates of reported PTSD, anxiety, depression, and insomnia symptoms. These findings highlight the importance of tailored mental health interventions through different stakeholders that take into account individual needs, past experiences, burdens and social media usage.

Background Non-suicidal self-injury (NSSI) is a proposed new “condition for further study” in the DSM-5. To date no prevalence data has been available on this diagnostic entity from a representative sample of the general population. Methods A representative sample of the German population ( N  = 2509, mean age = 48.8 years, SD = 18.1, female 55.4 %) completed the NSSI section of the German version of the Self-Injurious Thoughts and Behaviors Interview (SITBI-G). Results A history of NSSI at least once during lifetime was reported by 3.1 % of all participants, with higher lifetime prevalence rates in younger age groups. DSM-5 NSSI disorder criteria were met by 0.3 %. The most common function of NSSI was automatic negative reinforcement (e.g. to alleviate negative feelings). Conclusions To the best of our knowledge, this is the first study reporting rates for the proposed NSSI category in DSM-5 from a representative sample of the general population. In comparison to findings from community samples of adolescents, adults seem to have lower lifetime prevalence rates of NSSI, thus making it necessary to emphasize prevention and treatment efforts in younger age groups.

Background Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies. Methods A registration on the ‘International Prospective Register of Systematic Reviews’ (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the ‘Risk of Bias in Non-randomized Studies of Exposure’ [ROBINS-E]) and certainty of evidence (using the ‘Grading of Recommendations Assessment, Development and Evaluation’ [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Results Of 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17–0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98–1.19). Increase in general anxiety symptoms was highest in the 11–15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30–0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23–0.65]) occurred. Conclusion General anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11–15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented. PROSPERO registration: CRD42022303714.

Background Violence against children and adolescents, including physical, emotional, and sexual maltreatment as well as neglect, is a global issue that has long-term consequences. This violence can occur in various institutions, including children and youth clubs (CACs), where proximity to children may be exploited. Although some studies have documented violence in CACs (VCAC), its full extent often remains unrecognized. Despite ongoing prevention efforts, data on the successful implementation of those efforts are lacking. Since protection of VCAC and support of those affected is crucial, this study aimed to determine VCAC prevalence rates, the frequency of measures for protecting children and adolescents from VCAC as well as supporting them, and their relationship to feelings of safety in a German sample. Methods From October 2023 to March 2024, a representative sample of 2,513 people aged 16 years and older in Germany was surveyed. The survey collected sociodemographic information and details on voluntary activities in CACs, focusing on experiences with VCAC and safeguarding measures. Descriptive statistics were used to analyze the sample and VCAC prevalence, regressions were used to examine perceptions of protective measures and subjective well-being. The study adhered to ethical guidelines and was approved by the University of Leipzig’s Ethics Committee. Results Among 954 respondents which were active in CACs 819 were looked after as child/adolescent, of those 8.42% experienced VCAC − 6.22% emotional, 5.74% physical, and 1.10% sexual violence. The most common protective measures included discussions about violence (42.49%) and complaint procedures (29.06%). Experience with VCAC were negative associated with perceived protective measures and subjective well-being. Subjective well-being was positive associated with VCAC taken seriously in the CACs. Conclusions These findings highlight the importance of CACs for the development of children and adolescents. However, 7% of people involved in CACs experience at least one form of VCAC, which indicates that there is still room for improvement in the protection of children and adolescents. Furthermore, existing prevention measures are often still insufficiently known, which points to a communication gap. This finding highlights the importance of mandatory safeguarding measures and better training for volunteers to effectively safeguard children and adolescents in CACs.

Background Child maltreatment, due to its high prevalence and often long-lasting (health and/or psycho-social) consequences, is one of the main reasons for global health inequalities. The medical field offers many opportunities to support affected children. This gives physicians and other health professionals the opportunity to provide protective measures and therapies to affected children at an early stage. However, the level of training concerning child protection is often too low among health professionals. This can affect the quality of care as well as providing the appropriate treatment and thus, the long-term (health) burden. The present work aims to survey the state of knowledge and capacities of health professionals regarding child protection in medicine and elicit health professionals' perspectives who absolved a child protection online course on a potential need for action in Germany. Methods From June 2016 until February 2021, 3,360 health professionals were interviewed. Using quantitative and qualitative items, the questionnaire assessed demographic and professional background information as well as assessments regarding the awareness of child protection, abilities in child protection among health professionals and training offers in medicine. Results The analysis indicates that the topic of child protection in medicine is not as present as the high prevalence of child maltreatment would imply. The majority (94.0%; n  = 3.159) of the health professionals stated that they need more knowledge and capacities regarding child protection in medicine. More than half of the health professionals assessed the importance of the issue of child protection as low among health professionals. The reasons cited included child protection as an uncomfortable topic, an unwillingness among managers, and a lack of training on the topic. Conclusions There is too little awareness and importance regarding child protection in the medical field in Germany. Hence, it is difficult to ensure adequate care for those affected. Child protection topics should be mandatory in the training curricula of all health professionals, and quality standards for prevention and intervention should be implemented in medical institutions. Furthermore, networking in child protection has to be improved, and medical campaigns should address the topic to sensitize health professionals and society to the issue and to destigmatize the topic.