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The COVID-19 pandemic has caused unprecedented changes in the lives of 1.6 billion children and adolescents. First non-representative studies from China, India, Brazil, the US, Spain, Italy, and Germany pointed to a negative mental health impact. The current study is the first nationwide representative study to investigate the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) and mental health of children and adolescents in Germany from the perspective of children themselves. A representative online survey was conducted among n = 1586 families with 7- to 17-year-old children and adolescents between May 26 and June 10. The survey included internationally established and validated instruments for measuring HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). Results were compared with data from the nationwide, longitudinal, representative BELLA cohort study (n = 1556) conducted in Germany before the pandemic. Two-thirds of the children and adolescents reported being highly burdened by the COVID-19 pandemic. They experienced significantly lower HRQoL (40.2% vs. 15.3%), more mental health problems (17.8% vs. 9.9%) and higher anxiety levels (24.1% vs. 14.9%) than before the pandemic. Children with low socioeconomic status, migration background and limited living space were affected significantly more. Health promotion and prevention strategies need to be implemented to maintain children's and adolescents' mental health, improve their HRQoL, and mitigate the burden caused by COVID-19, particularly for children who are most at risk. (Orig.).

Background: The COVID-19 pandemic has disrupted the lives of children and adolescents worldwide. The German COPSY study is among the first population-based longitudinal studies to examine the mental health impact of the pandemic. The objective of the study was to assess changes in health-related quality of life (HRQoL) and mental health in children and adolescents and to identify the associated risk and resource factors during the pandemic. Methods: A nationwide longitudinal survey was conducted with two waves during the pandemic (May/June 2020 and December 2020/January 2021). In total, n = 1923 children and adolescents aged 7 to 17 years and their parents participated (retention rate from wave 1 to wave 2: 85%). The self-report and parent-proxy surveys assessed HRQoL (KIDSCREEN-10), mental health problems (SDQ with the subscales emotional problems, conduct problems, hyperactivity, and peer problems), anxiety (SCARED), depressive symptoms (CES-DC, PHQ-2) and psychosomatic complaints (HBSC-SCL). Mixed model panel regression analyses were conducted to examine longitudinal changes in mental health and to identify risk and resource factors. Results: The HRQoL of children and adolescents decreased during the pandemic, and emotional problems, peer-related mental health problems, anxiety, depressive and psychosomatic symptoms increased over time, however the change in global mental health problems from wave 1 to wave 2 was not significant, and some changes were negligible. Socially disadvantaged children and children of mentally burdened parents were at particular risk of impaired mental health, while female gender and older age were associated with fewer mental health problems. A positive family climate and social support supported the mental health of children and adolescents during the pandemic. Discussion: Health promotion, prevention and intervention strategies could support children and adolescents in coping with the pandemic and protect and maintain their mental health.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood worldwide, and causes significant impairments in overall functioning. In order to develop effective prevention and intervention programs, knowledge of the determinants that have an impact on the onset and development of ADHD symptoms is essential. So far, little is known about factors affecting ADHD symptoms in children and adolescents over time. Therefore, this study investigates potential psychosocial risk and protective factors for ADHD symptoms based on cross-sectional and longitudinal data of a German population-based study. Data on children and adolescents (n = 1,384 aged 11 to 17 years) were collected at three measurement points (baseline, 1-year and 2-year follow-ups) covering a period of two years. We used latent growth modelling to investigate effects of parental mental health problems (risk factor) and self-efficacy, family climate and social support (protective factors) on symptoms of ADHD based on cross-sectional as well as longitudinal data. Sociodemographic factors, pre- and postnatal factors, and comorbid symptoms of internalizing and externalizing mental health problems were considered as covariates. At baseline, male gender, younger age, stronger aggressive behavior, and stronger parental mental health problems were related to more ADHD symptoms. Longitudinal analyses showed that female gender, migration status, increasing symptoms of generalized anxiety, increasing aggressive behavior and increasing parental mental health problems were associated with stronger increase of ADHD symptoms over time. However, improving family climate was related to decreasing ADHD symptoms over time. We further found moderator effects for social support. The findings of the study provide important information concerning risk and protective factors in the context of ADHD. Hence, the results may be integrated into the planning and implementation of future prevention and early intervention strategies that target affected children and adolescents.

The Strengths and Difficulties Questionnaire (SDQ) is a frequently used screening instrument for behavioral problems in children and adolescents. There is an ongoing controversy-not only in educational research-regarding the factor structure of the SDQ. Research results speak for a 3-factor as well as a 5-factor structure. The narrowband scales (5-factor structure) can be combined into broadband scales (3-factor structure). The question remains: Which factors (narrowband vs. broadband) are better predictors? With the prediction of child and adolescent outcomes (academic grades, well-being, and self-belief), we evaluated whether the broadband scales of internalizing and externalizing behavior (3-factor structure) or narrowband scales of behavior (5-factor structure) are better suited for predictive purposes in a cross-sectional study setting. The sample includes students in grades 5 to 9 (N = 4642) from the representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS study). The results of model comparisons (broadband scale vs. narrowband scales) did not support the superiority of the broadband scales with regard to the prediction of child and adolescent outcomes. There is no benefit from subsuming narrowband scales (5-factor structure) into broadband scales (3-factor structure). The application of narrowband scales, providing a more differentiated picture of students' academic and social situation, was more appropriate for predictive purposes. For the purpose of identifying students at risk of struggling in educational contexts, using the set of narrowband dimensions of behavior seems to be more suitable.

Mental health problems in children and adolescents are frequent, with a high risk of persistence into adulthood. Therefore, the investigation of determinants of onset and course of mental health problems is of high importance. The present paper investigates the impact of protective and risk factors on the development of depressive symptoms in children and adolescents. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KIGGS). Based on the first three measurement points of the BELLA study (covering a period of 2 years), the present analysis focused on children and adolescents aged 11–17 years at baseline ( n  = 1,643; 50.6 % female). A longitudinal growth modelling approach was used. Mental health problems in parents (parent-reports) predicted depressive symptoms in children and adolescents (self-reports) as well as the development of these symptoms over time. Further, child-reported protective factors of self-efficacy, positive family climate and social support were associated with less depressive symptoms at baseline. Additionally, positive changes in protective factors were associated with the development of less depressive symptoms over time. Finally, family climate and social support moderated the detrimental influence of parental psychopathology on child’s depressive symptoms. The addressed determinants for the development of depressive symptoms in children and adolescents are highly relevant for prevention and intervention strategies. Future research should investigate specific risk and protective factors focusing in detail on further mental health disorders and their development in children and adolescents.

Background As one of the most commonly diagnosed psychiatric disorders in children and adolescents, reliable prevalence data on attention-deficit/hyperactivity disorder (ADHD) is highly relevant to health policy and health care planning. However, routine data and parental diagnosis reports from surveys − as important data sources on child ADHD − often differ. This study investigates whether parental psychosocial factors are associated with parental diagnosis reporting in German parents whose child is registered with an administrative ADHD diagnosis (ICD-10 F90.0-9) with their statutory health insurance. We expected more parental burden to be associated with a lower likelihood of a parental diagnosis report. Methods Parents of 5,461 children and adolescents who presented with an administrative ADHD diagnosis in 2020 answered online questions about their child’s ADHD diagnosis and various psychosocial characteristics, including parental strain, parental psychological problems, parental ADHD diagnosis, family cohesion and parental health literacy. Chi-square tests and unadjusted linear regressions were used to analyze group differences in parental psychosocial characteristics between parents who reported the ADHD diagnosis and those who did not. Binary logistic regressions were conducted to predict the parental report of their child’s ADHD diagnosis in the survey. Results Group comparisons revealed that parents who reported their child’s ADHD diagnosis displayed significantly more parental strain, more psychological problems, higher rates of maternal and paternal ADHD, lower levels of family cohesion and lower health literacy than parents who did not report their child’s ADHD diagnosis. The results were partly confirmed in multivariate analysis, where maternal (OR = 3.18) and paternal ADHD (OR = 2.94) turned out to be the strongest predictor of a parental diagnosis report. Conclusions Contrary to our expectations, parental psychosocial burden, in particular parental ADHD diagnosis, increased the likelihood of a parental report of their child’s ADHD diagnosis, which may point to a greater sensitivity and awareness of affected parents towards their child’s ADHD. The findings suggest that differences in the diagnosis prevalence of child ADHD between routine and survey data may vary as a function of parental psychosocial factors.

Background Child maltreatment (CM) can have devastating and potentially lifelong effects for those affected and is a major contributor to mental health problems. To tackle public health problems it is crucial to have reliable data on CM. The aim of this study is to assess the prevalence and predictors of CM in a nationwide sample of the German population of young adults. Methods The study population (young adults aged 18 to 31 years) stems from the KiGGS Cohort study, the longitudinal branch of the German Health Interview and Examination Survey for children and adolescents. This sample meets the criteria of the United Nations Sustainable Development Goals (SDG) indicator 16.2.3. The data was collected between 2014 and 2017. CM were assessed with the Childhood Trauma Questionnaire (CTQ) in. In addition, socio-demographic variables and other known risk factors for CM were assessed. A total of 6433 (47.8% female) participants were included in the analyses. Binary logistic regression analyses were used to investigate predictors of maltreatment subtypes. Ordinal regression was used to examine their association with experience of multiple forms of CM. Results Overall, 18.4% (f: 20.9%, m: 16.1%) of the participants reported having experienced at least one type of CM; 6.7% (f: 8.8%, m: 4.8%) reported experiences of emotional abuse, 3.7% (f: 3.9%, m: 3.5%) physical abuse, 3.5% (f: 5.3%, m: 1.7%) sexual abuse, 9.0% (f: 9.9%, m: 8.2%) emotional neglect and 8.6% (f: 8.5%, m: 8.7%) physical neglect. Gender, subjective social status, education and household dysfunction (e.g. living with an individual who is using substances) emerged as significant predictors for different types of CM. Additionally, all these factors were significant risk factors for experiencing cumulative CM. Conclusions CM is common in the German population, with almost one in five people experiencing at least one type of CM. The results reveal important risk factors for the occurrence of CM. In particular, people with lower social status and those who grew up in dysfunctional households are at higher risk of CM. Greater support for this vulnerable population may reduce the prevalence of CM.

Background Antisocial behaviour is a common phenomenon in childhood and adolescence. Information on psychosocial risk and resource factors for antisocial behaviour are important for planning targeted prevention and early intervention programs. The current study explores risk and resource factors of antisocial behaviour in children and adolescents based on population-based longitudinal data. Methods We analysed longitudinal data from the German BELLA study ( n = 1145; 11 to 17 year-olds) measured at three measurement points covering two years. Latent growth analysis, linear regression models and structural equation modelling were used to explore cross-sectional and longitudinal data. Results Based on baseline data, we found that stronger self-efficacy and worse family climate were each related to stronger antisocial behaviour. Longitudinal data revealed that more severe parental mental health problems, worse family climate at baseline, deteriorating family climate over time, and more social support were each associated with increasing antisocial behaviour over time. We further found a moderating effect for family climate. Conclusions Our study provides important exploratory results on psychosocial risk, resource and protective factors in the context of antisocial behaviour in children and adolescents, which need confirmation by future research. Our exploratory results point in the direction that family-based interventions for antisocial behavior in children and adolescents may benefit from considering the family climate.

Converging evidence indicates an adolescent mental health crisis in Western societies that has developed and exacerbated over the past decade. The proposed driving factors of this trend include more screen time, physical inactivity, and social isolation, but their causal influence on mental health is insufficiently understood. The objective of this study is to test whether and based on which predictor variables the development of mental health in adolescents in the last decade can be predicted and to better understand the causal chain of factors at work. We implemented an interpretable machine learning pipeline based on gradient boosting regression with repeated cross-validation to assess the development of mental health throughout adolescence in members of 2 longitudinal cohort studies, the British Millenium cohort (MC; n=8599) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) cohort (n=1212). In total, 144 (MC) and 102 (KiGGS) predictors assessed at the age of around 13.8 years (MC) and 11.6 years (KiGGS) were used to assess mental health at the ages of around 16.7 years (MC) and 16.4 years (KiGGS). Based on these predictive models, we used permutation-based feature importance analyses to identify relevant predictors and predictor domains. Moreover, we performed partial dependence analyses in a causal inference framework to determine the direct effects of physical inactivity, screen time, and peer problems on the development of mental health. The average cross-validated Pearson correlation coefficient (r) between predicted and true mental health in late adolescence was 0.614 (MC) and 0.466 (KiGGS). Feature importance analyses indicated a strong impact of preexisting mental health and weaker impacts of sex (female as a risk factor), physical health (chronic disease as a risk factor), lifestyle, and socioeconomic and family factors (eg, low parental education, income, and mental health as risk factors). Causal inference analyses suggested a strong direct effect of peer relationships, but only a small direct effect of physical inactivity and a very small direct effect of screen time. Mental health development during adolescence can be assessed by a combination of variables from early adolescence. Peer problems represent an important direct cause of mental health development, and their deterioration may contribute to the current mental health crisis.

Background This paper aims to describe the study design, methodological approach, conduct, and sample characteristics of the data linkage project INTEGRATE-ADHD. The project was designed to evaluate the concordance and validity of administrative versus epidemiological and clinical ADHD diagnoses, thereby providing insights for health care and health care planning. The assessment of treatment satisfaction among families with children with ADHD, as well as the health economics of ADHD, is also part of the project. Methods A total of 24,880 parents of children and adolescents statutorily insured with DAK-Gesundheit, who had at least one confirmed administrative ADHD diagnosis in one quarter of the 2020 insurance year, were invited to complete an online survey. The survey included questions on ADHD diagnosis, disorder-specific and comorbid psychopathology, health care utilisation, and both the quality of and satisfaction with health care. A random sampling procedure was applied to select 202 participants for a guideline-based clinical online assessment. Administrative, survey, and clinical diagnostic data were subsequently linked at the individual level. Non-responder analyses and sample characteristics were examined with descriptive statistics. Group differences were tested with chi-square and t-tests. Sample representativeness was evaluated. Results A total of 5,461 parents of youths (mean age = 12.5 years; 25.4% girls) participated in the survey (response rate: 21.5%). A guideline-based clinical ADHD decision could be made for a subsample of 201 participants (mean age = 12.1 years; 27.9% girls). Non-responder analyses indicated only minor differences in sociodemographic and health care–related variables, parents of more severely affected children and adolescents were more likely to participate in the survey. Weighting factors were calculated to adjust for these deviations. Conclusion Non-responder analyses and comparisons with nationwide outpatient diagnostic data suggest that the results are broadly generalisable to German children and adolescents with an administrative ADHD diagnosis. By linking administrative, epidemiological, and clinical ADHD diagnostic data at the individual level, INTEGRATE-ADHD facilitates an individual-level evaluation of how administrative ADHD diagnoses relate to epidemiological and clinical assessments.