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Avoidance-based emotion regulation plays a central role in the development and maintenance of anxiety disorders across the life span. However, measures for children that account for different avoidance strategies, are scarce. Derived from Gross’ Process Model of Emotion Regulation, the Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) was developed to assess avoidance strategies (cognitive avoidance, behavioural avoidance, verbal reassurance, and social reassurance) and reappraisal in anticipatory anxious situations. In the present study, the BAER-C was administered to 129 school children aged 8 to 14 and 199 children with anxiety disorders aged 8 to 16 and their parents, along with established measures on anxiety, psychopathology, and emotion regulation. Factor structure, internal consistency, convergent, divergent and construct validity were analysed. Results of the anxious sample showed a satisfactory internal consistency (McDonald’s ω = .94) for all scales as well as positive correlations with anxiety symptoms (all rs > .17, all ps < .05). Factor analysis supported a five-factor model. This model was confirmed in the student sample. Children with an anxiety disorder scored higher on behavioural avoidance, verbal reassurance, and social reassurance than school children ( F (5,304) = 12.63, p = .003, η p 2 = .17). Results for construct validity were ambiguous. Our analyses suggest that the BAER-C is a promising theory-based new instrument to reliably assess different avoidance strategies in children. More research is needed to further analyse construct validity with other emotion regulation questionnaires.

General practitioners (GPs) play a significant role in depression care. Recognition of depression is crucial for adequate treatment but is impeded by a high portion of depressed patients only reporting physical symptoms to their GP. Among the many reasons for this phenomenon is mental health stigma. We investigated how patients with depression differed from patients without depression regarding the types and number of complaints presented to their GP, as well as their depression stigma. For the subgroup of patients with depression, potential associations between perceived depression stigma and number and types of presented complaints were investigated to see if these might reflect the patient's intention to conceal mental health symptoms due to fear of being stigmatized by others. Further, we investigated if perceived depression stigma is related to depression treatment. Data on depressive symptoms (assessed by the Depression Screening Questionnaire; DSQ), depression stigma (assessed by the Depressions Stigma Scale; DSS), type of complaints reported to the GP and treatment-related factors were collected from 3,563 unselected primary care patients of 253 GPs in a cross-sectional epidemiological study (\"VERA study\") in six different German regions. Data of a total of 3,069 patients was used for analysis on complaints reported to the GP (subsample of the VERA study), and for 2,682 out of 3,069 patients data on a stigma questionnaire was available. Nearly half of the primary care patients with depression (42.2%) reported only physical complaints to their GP. Compared to patients without a depression diagnosis, patients with depression reported twice as many complaints to their GP with a mean of 2.02 (1.33) vs. 1.2 (0.69), including a more frequent combination of physical and mental symptoms (28.8% vs. 3.5%). Patients with depression showed higher total stigma compared to patients without depression, Mdn = 48 (IQR 40-54) vs. Mdn = 46.3 (IQR 29-53), due to higher perceived stigma, Mdn = 27 (IQR 21-32) vs. Mdn = 25.9 (IQR 20-29). Perceived stigma was associated with male gender (beta -.14, p = .005) and a lack of pharmacological treatment (beta -.14, p = .021) in patients with a depression diagnosis. The number of complaints presented to the GP might function as a marker to actively explore depression in primary care patients, in particular when both physical and mental symptoms are reported. Perceived depression stigma should also be addressed especially in male patients. Further research should clarify the role of perceived stigma as a potential inhibitor of pharmacological treatment of depression in primary care.

Background Suicidal ideation and suicide attempts present a serious public health concern among adolescents and young adults. School-based suicide prevention programs are a key tool for addressing this problem. However, more research is necessary to assess their effectiveness, acceptability, and safety. In response, the HEYLiFE suicide prevention program was developed to enhance help-seeking, reduce stigma towards suicidal peers and diminish risk factors for suicidality. This article presents the evaluation findings of the HEYLiFE program in German secondary schools. Methods We conducted a randomized-controlled trial measuring short-term pre-post within-group effects in the intervention group only and mid-term effects at 6-months-follow-up compared to a waitlist-control group. Schools were assigned randomly to the intervention or control group (no blinding). We recruited students ≥12 years of age. Primary outcomes were knowledge about suicidality, attitudes towards suicidality, stigma towards a suicidal peer, help-seeking intentions and behaviours, risk factors for suicidality. The data was analysed with linear mixed models and generalized linear mixed models. Results A total of N = 745 students participated ( n = 353 intervention group, n = 392 control group). We observed favourable short-term effects on knowledge, attitudes towards suicidality and fear towards a suicidal peer. Unexpectedly, the program also led to an increase in desire for social distance and a decrease in prosocial emotions towards a suicidal peer. The mid-term effects of the program were exclusively favourable, resulting in enhanced attitudes towards help-seeking while protecting from a sharper rise in risk-factors for suicidality and from an increase in social distance. The program had more favourable effects on females and on students aged >13 years. The program was well-received by the students, and no serious adverse events were reported. Conclusions These findings demonstrate the effectiveness of the HEYLiFE universal suicide prevention program in addressing variables associated with suicidal ideation and suicide attempts among adolescents on the mid-term. The short-term negative effects on stigma and more negative effects on males should be addressed in the future. Future evaluation studies should examine its effects on suicidality and its effectiveness within populations at high risk. Trial registration The study was preregistered in the German Clinical Trials Register (registration number: DRKS00017045; registration date: 02/04/2019).

Background The association between mode of delivery (MOD) and parent-infant-bonding has only been studied in mothers and findings have been inconclusive. The aim of this study was to prospectively investigate how MOD relates to postpartum parent-infant-bonding in both mothers and fathers and whether these associations are mediated by birth experience. Methods This study is part of the prospective cohort study “Dresden Study on Parenting, Work, and Mental Health” (DREAM). Our sample comprised N  = 1,780 participants who completed quantitative questionnaires during pregnancy as well as 8 weeks and 14 months postpartum. MOD was dummy coded, contrasting spontaneous vaginal delivery against vaginal delivery induced by drugs, operative vaginal delivery, planned, and unplanned cesarean section. Parent-infant bonding and birth experience were assessed using validated scales. A moderated mediation analysis based on ordinary least square (OLS) regression and bootstrapped estimates was conducted, considering relevant confounding variables. Results Compared to spontaneous vaginal delivery, all categories of MOD predicted more negative birth experiences in both parents. A more positive birth experience predicted stronger parent-infant-bonding at 8 weeks, but not at 14 months postpartum. Mothers who delivered via cesarean section (planned or unplanned) reported stronger parent-infant-bonding at 8 weeks and 14 months postpartum. In fathers, only unplanned cesarean section was associated with stronger parent-infant-bonding at 8 weeks postpartum. At 8 weeks postpartum, birth experience mediated the association between a vaginal delivery induced by drugs and a planned cesarean section and mother-infant-bonding and between a vaginal delivery induced by drugs, an operative vaginal delivery, and planned cesarean section and father-infant-bonding. At 14 months postpartum, birth experience mediated the association between a vaginal delivery induced by drugs, operative vaginal delivery, and planned cesarean section and parent-infant-bonding in both parents. Conclusions The results emphasize the importance of the birth experience for parent-infant-bonding in both mothers and fathers. Further research should address the mechanisms by which parents with an unplanned cesarean section establish stronger parent-infant-bonding compared to parents whose baby was delivered via spontaneous vaginal delivery, despite their overall more negative birth experiences.

Improving Mental Health Literacy (MHL) is considered important to facilitate help‐seeking for mental health problems. However, it is crucial to ascertain the true significance of increasing mental health knowledge (the central component of MHL) for prevention efforts. This systematic review analyses the direction and effect size of the correlations between knowledge and different facets of stigma (personal, perceived, self) and help‐seeking (attitudes, intention, behavior), highlighting current research gaps. We conducted a PRISMA‐based systematic analysis of quantitative cross‐sectional and longitudinal data on the associations between mental health knowledge and mental health related stigma or help‐seeking in Western populations. Peer‐reviewed articles published since 1997 were retrieved via PubMed, PsycINFO and Web of Science, theses via DART‐EUROPE, EBSCO‐OpenDissertation and Google. The number of studies, types of outcomes, country, population, effect direction and size (median, range) are reported. We identified 47 studies on the association between knowledge and stigma, and 38 on its association with help‐seeking. Knowledge showed a medium‐sized association with personal stigma (Mdn r = −0.28; range = −0.54; −0.06) and attitudes towards help‐seeking (Mdn r = 0.29; range = 0.04; 0.58) and a small association with self‐stigma (Mdn r = −0.16; range = −0.39; −0.02), help‐seeking intention (Mdn r = 0.15; range = −0.07; 0.40) and help‐seeking behavior (Mdn r = 0.15; range = −0.04; 0.68). Knowledge was not consistently related to perceived stigma (Mdn r = −0.01; range = −0.29; 0.16). While the direction of the correlations meets our expectations, the only small to moderate effect sizes indicate that knowledge is relevant but not sufficient for reducing self‐stigma and improving help‐seeking. We identified several research gaps, such as a scarcity of studies with rigorous methodological standards and with older or clinical populations. We also propose including a broader range of potentially empowering variables in addition to knowledge in future studies.

Background Disruptive behavior and emotional problems are common in children and often reduce quality of life. This study aimed to screen for these problems and to examine the effectiveness of child-based indicated prevention. Methods N  = 3231 children`s disruptive behavior and emotional problems were screened using the Strengths and Difficulties Questionnaire (SDQ) during routine pediatric health check-ups for usually 5- to 10-year old’s. We examined the prevalences of disruptive behavior and emotional problems ( n  = 2825) and its association with quality of life (KINDL; n  = 1104). If indicated, children were recommended to participate in the prevention program “Baghira training” (nine 90 min group sessions and one parents’ evening) or “Tiger training” (two one-on-one and nine group sessions of 60 min each). To evaluate the training effectiveness of the two indicated prevention programs, SDQ and KINDL scores were followed-up for 6 and 12 months post screening and compared between the Training group (SDQ n  = 337; KINDL n  = 334; additionally divided into Baghira and Tiger), children not participating despite indication (NoTraining; SDQ n  = 595; KINDL n  = 146; additionally divided into NoBaghira and NoTiger), healthy children (SDQ n  = 1928; KINDL n  = 907), and children with clinical symptom levels (SDQ n  = 85; KINDL n  = 54) using mixed effect models. Results 37.0% of the children exhibited disruptive behavior or emotional problems, which were associated with impaired quality of life. The Training group perceived greater symptom reduction in emotional problems than NoTraining, and quality of life increases compared to decreases in NoTraining. The Tiger group showed improvement in symptomatology and quality of life compared to deterioration in NoTiger. The Baghira group also improved, though improvement was similar to NoBaghira apart from symptom reduction in emotional problems in Baghira compared to a symptom increase in NoBaghira. Effects sizes were predominantly small to medium. Conclusions Disruptive behavior and emotional problems in children are frequent and impair quality of life. Indicated prevention may improve symptomatology and quality of life. Specifically, the Tiger training is verifiably effective; for the Baghira training, effectiveness is implicated but needs further empirical evaluations.

Background Subclinical disruptive behavior problems often occur during childhood and are a risk factor for developing a mental disorder later in life. To prevent a manifestation of dysfunctional disruptive behavior, early intervention is critical. This study aimed to examine the effectiveness of an indicated prevention program in children with disruptive behavior problems. Methods Screening for disruptive behavior problems was conducted using the Strength and Difficulties Questionnaire during routine pediatric health check-ups. Depending on their risk status (normal vs. borderline vs. abnormal), children received a recommendation for no intervention, an indicated prevention program (i.a. “Baghira”) or further diagnostics. Questionnaires such as the Child Behavior Checklist and the Parent Rating Scale for Conduct Disorder (DISYPS Competence scale) were administered at three time points (T0: pre-intervention, T1: 6 months after screening/ post-intervention, T2: 6 months after T1). Children who participated in “Baghira” (BA n  = 171), a cognitive-behavioral group program for children with disruptive behaviors, were compared to children screened as normal (NOR n  = 881) or received a recommendation for “Baghira” but refused participation (NO BA n  = 46). Results Disruptive behavior problems decreased (BA: β = − 3.61, p <.001) and prosocial behavior increased (BA: β = 1.67, p <.001) in the BA compared to the NOR group from T0 to T1. These effects were maintained at T2 follow-up (BA: β = − 1.60; p =.035; β = 1.12; p =.019). However, the NO BA group also improved in prosocial behavior and from T0 to T1. Conclusion Although an improvement in disruptive behavior symptoms as well as an increase in prosocial behavior were observed, controlled studies using matched or stratified designs are needed to replicate the effectiveness of “Baghira” in a prevention context, apart from the Covid-19 pandemic, to improve children’s mental health.

Background Disruptive behavior and emotional problems – especially anxiety – are common in children and frequently co-occur. However, the role of co-occurring emotional problems in disruptive behavior intervention response is unclear. This study aimed to compare the effectiveness of an indicated prevention program in children with disruptive behavior problems with vs. without co-occurring emotional problems. Methods Children were screened for disruptive behavior and emotional problems during routine health check-ups and – if indicated – were offered a child-centered group prevention program. For children with disruptive behavior the “Baghira training” was administered. Training effectiveness was compared between participating children with vs. without emotional problems regarding disruptive behavior and emotional problems and anxiety in particular. Outcomes were measured before and after the training, and at six months follow-up using linear mixed effect model regression analyses. Results Overall, regarding disruptive behavior, children with and without co-occurring emotional problems profited equally from the Baghira training and training effectiveness was independent of the pre-training level of anxiety. However, there were few indications for greater disruptive behavior symptom reduction in children with co-occurring emotional problems. Overall, the Baghira training had little to no effect on the examined emotional problems/anxiety measures, except the Strengths and Difficulties Questionnaire emotional problems score strongly decreased in children with co-occurring emotional problems. Conclusions The effectiveness of the Baghira training is not negatively affected by co-occurring emotional problems/anxiety. However, as emotional problems/anxiety do not simultaneously improve, an additional training targeting these problems for respective children seems necessary.

The number of studies on fear conditioning in children and adolescents has increased in recent years. Most of these studies exclusively focus on data of completers while dropout rates, reasons for dropout, and specific characteristics of non-completers are underreported. This study systematically investigated data of 283 children and adolescents between 8 and 17 years (M = 11.10, SD = 2.14) undergoing a differential fear conditioning paradigm using a female scream as unconditioned stimulus (US). The sample included 230 children and adolescents with a current primary anxiety disorder (separation anxiety disorder, social anxiety disorder, and specific phobia) and 53 non-anxious controls. The dropout rate was 24.1%. The most common reason to discontinue was being afraid of the US (59.1%) followed by the startle probe being too loud (15.2%). Logistic regressions revealed that younger age and a present anxiety disorder predicted dropout. There seem to be distinct characteristics potentially predicting dropout from fear conditioning paradigms. Thus, interpretability and generalizability of those paradigms are limited when non-completers are not considered. Future research should conscientiously look at these data more closely and investigate paradigms that work independent of age and diagnostic status.

Although effective therapies exist, treatment rates of anxiety disorders (AD) are low, raising the question why affected individuals do not receive treatment. We provide data from the nationally representative German Health Interview and Examination Survey-2011 (DEGS1) on the help-seeking behavior and perceived treatment barriers of 650 subjects with Diagnostic and Statistical Manual of Mental Disorders’ (DSM-IV AD). Only 26% of all cases with AD in the community reported having had contact with mental health services because of their anxiety problems in their lifetime. 16% were currently receiving professional help, most frequently by psychotherapists (8%), psychiatrists (5%) and general practitioners (5%). 40% of all cases never even considered seeking help and 31% reported barriers to treatment, such as self-reliance (18%) or beliefs that treatments were ineffective (9%), unavailable (8%) or too stigmatizing (7%). Measures to increase treatment rates should thus target individual as well as public attitudes and health literacy to increase awareness of and access to evidence-based interventions.