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The mental health module (BELLA study) within the German Health Interview and Examination Survey of Children and Adolescents (KiGGS): study design and methods.

Eur Child Adolesc Psychiatry. 2008 Dec;17 Suppl 1:10-21

Authors: Ravens-Sieberer U, Kurth BM, ,

The BELLA study on mental health and well-being in children and adolescents is the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The cross-sectional KiGGS survey collected comprehensive data on the health status of 17,641 children and adolescents, aged 0-17 years, living in Germany. The survey included physical examinations and tests, questionnaires filled in by parents and equivalent questionnaires for children aged 11 years or older. A computer-assisted personal interview was conducted by study physicians, and various laboratory tests, e.g. on blood and urine samples, were performed. The longitudinal BELLA study collected initial cross-sectional data from a representative KiGGS sub-sample of families with children aged 7-17 years. Of the 4,199 randomly selected families invited to participate in the BELLA study, 2,863 took part. A total of 48.5% of the participating children and adolescents were girls, 51.5% were boys. Within the BELLA study, trained interviewers conducted standardised telephone interviews with one parent and also the child, if it was at least 11 years old. Afterwards the families received additional questionnaires. The interviews and questionnaires included various standardised and ICD-10-oriented instruments examining overall mental health problems and associated burden, depression, anxiety, attention deficit-/hyperactivity and conduct disorders. Furthermore they covered a broad spectrum of aspects related to mental health and well-being, such as risk and protective factors and health-related quality of life. An analysis of the non-responders showed that the families who agreed to participate form a representative sample with respect to the German population. The sample deviated only slightly from the KiGGS sample structure regarding socioeconomic status and regarding parent-reported mental health problems. No such difference was observed for the children’s self-reported mental health. A weighting procedure was applied to correct for deviations from the sociodemographic and socioeconomic structure of the target population.

PMID: 19132300 [PubMed - indexed for MEDLINE]

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Prevalence of mental health problems among children and adolescents in Germany: results of the BELLA study within the National Health Interview and Examination Survey.

Eur Child Adolesc Psychiatry. 2008 Dec;17 Suppl 1:22-33

Authors: Ravens-Sieberer U, Wille N, Erhart M, Bettge S, Wittchen HU, Rothenberger A, Herpertz-Dahlmann B, Resch F, Hölling H, Bullinger M, Barkmann C, Schulte-Markwort M, Döpfner M,

BACKGROUND: Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany. OBJECTIVES: The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation. METHODS: The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7-17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/hyperactivity disorder (FBB-HKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined. RESULTS: Overall, 14.5% of the children and adolescents aged 7-17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed. CONCLUSIONS: The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

PMID: 19132301 [PubMed - indexed for MEDLINE]

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How impaired are children and adolescents by mental health problems? Results of the BELLA study.

Eur Child Adolesc Psychiatry. 2008 Dec;17 Suppl 1:42-51

Authors: Wille N, Bettge S, Wittchen HU, Ravens-Sieberer U,

BACKGROUND: The consideration of impairment plays a crucial role in detecting significant mental health problems in children whose symptoms do not meet diagnostic criteria. The assessment of impairment may be particularly relevant when only short screening instruments are applied in epidemiological surveys. Furthermore, differences between childrens’ and parents’ perceptions of present impairment and impairing symptoms are of interest with respect to treatment-seeking behaviour. OBJECTIVES: The objectives were to assess parent- and self-reported impairment due to mental health problems in a representative sample of children and adolescents; to describe the characteristics of highly impaired children with normal symptom scores; and to investigate the associations between symptoms in different problem areas and impairment. METHODS: The mental health module of the German Health Interview and Examination Survey for Children and Adolescents (the BELLA study) examined mental health in a representative sub-sample of 2,863 families with children aged 7-17. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children 11 years and older. RESULTS: Considerable levels of distress and functional impairment were found with 14.1% of the boys and 9.9% of the girls being severely impaired according to the parental reports. However, self-reported data shows a reversed gender-difference as well as lower levels of severe impairment (6.1% in boys; 10.0% in girls). Six percent of the sampled children suffer from pronounced impairment due to mental health problems but were not detected by screening for overall symptoms. Childrens’ and parents’ reports differed in regard to the association between reported symptom scores and associated impairment with children reporting higher impairment due to emotional problems. CONCLUSIONS: The assessment of impairment caused by mental health problems provides important information beyond the knowledge of symptoms and helps to identify an otherwise undetected high risk group. In the assessment of impairment, gender-specific issues have to be taken into account. Regarding the systematic differences between childrens’ and parents’ reports in the assessment of impairment, the child’s perspective should be given special attention.

PMID: 19132303 [PubMed - indexed for MEDLINE]

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Psychometric properties of two ADHD questionnaires: comparing the Conners’ scale and the FBB-HKS in the general population of German children and adolescents–results of the BELLA study.

Eur Child Adolesc Psychiatry. 2008 Dec;17 Suppl 1:106-15

Authors: Erhart M, Döpfner M, Ravens-Sieberer U,

BACKGROUND AND OBJECTIVE: To examine and compare the psychometric properties of two short screening instruments for children and adolescents suffering from attention deficit-/ hyperactivity disorder (ADHD). The Conners’ Hyperactivity Index consists of ten items that assess symptoms of hyperactivity through self-report and parents’ proxy. The German ADHD Rating scale (FBB-HKS/ADHS) consists of 20 items that assess the severity and perceived burden of inattention, hyperactivity, and impulsiveness as defined by the ICD-10 and DSM-IV. METHODS: Within the BELLA module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 2,863 children and adolescents rated the Conners’ Hyperactivity Index and the FBB-HKS. RESULTS: The internal consistency of item responses was assessed via Cronbach’s alpha and showed that both instrument scores were able to obtain a reliable measurement. The factorial validity of the FBB-HKS measurement model as well as the unidimensionality of the Conners’ scale was tested by means of exploratory and confirmatory factor analysis (EFA and CFA), indicating satisfactory goodness of fit for the FBB-HKS (RMSEA=0.06) and some deviation from the unidimensionality assumption of the Conners’ scale. Stability of results across age could be confirmed with few exceptions. Mean scores differences were found between both sexes, age groups, and different socioeconomic status groups (Winkler-Index) with males, younger respondents, and children with low socioeconomic status displaying more ADHD-related behaviour. Correlation coefficients between the two instruments’ scores and other scales assessing emotional and behavioural problems hinted at convergent validity. CONCLUSION: Both instruments’ scores showed reliability as well as factorial and convergent/discriminant validity. The pros and cons of the two instruments as well as for which purpose and under which circumstances one of the measures can be favoured must be considered prior to applying such a measure.

PMID: 19132310 [PubMed - indexed for MEDLINE]

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Maternal smoking in pregnancy and externalizing behavior in 18-month-old children: results from a population-based prospective study.

J Am Acad Child Adolesc Psychiatry. 2009 Mar;48(3):283-9

Authors: Stene-Larsen K, Borge AI, Vollrath ME

OBJECTIVE:: The relation between prenatal smoking and child behavioral problems has been investigated in children of school age and older, but prospective studies in younger children are lacking. Using the population-based prospective Norwegian Mother and Child Cohort Study, we examined the risk for externalizing behaviors among 18-month-old children after exposure to maternal smoking during pregnancy. METHOD:: Participants were 22,545 mothers and their 18-month-old children. Mothers reported their smoking habits at the 17th week of gestation and their child’s externalizing behavior at 18 months of age by means of standardized questionnaires. Data were analyzed using logistic regression, with scores of externalizing behavior above the 88.6th percentile as the dependent variable and self-reported smoking as the independent variable. We examined the child’s sex as a possible moderator. RESULTS:: We documented a threshold effect of smoking 10 cigarettes or more per day during pregnancy on subsequent externalizing behaviors among 18-month-old children, even after adjusting for relevant confounders (odds ratio 1.32, 95% confidence interval 1.03-1.70). The child’s sex did not moderate these effects (odds ratio 0.98, 95% confidence interval 0.83-1.16). CONCLUSIONS:: Maternal smoking during pregnancy increases offspring’s subsequent risk for externalizing behavior problems at 18 months of age. The pattern of risk does not differ between boys and girls. Our findings suggest a population attributable risk of 17.5% (i.e., the proportion of externalizing cases that could potentially be avoided if prenatal smoking was eliminated or reduced to fewer than 10 cigarettes per day).

PMID: 19242291 [PubMed - in process]

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The German version of the Centre for Epidemiological Studies Depression Scale for Children: psychometric evaluation in a population-based survey of 7 to 17 years old children and adolescents–results of the BELLA study.

Eur Child Adolesc Psychiatry. 2008 Dec;17 Suppl 1:116-24

Authors: Barkmann C, Erhart M, Schulte-Markwort M,

OBJECTIVES: To examine the psychometric properties and test the theoretical quality of the German version of the Centre for Epidemiological Studies depression scale for children (CES-DC), a 20-item screening instrument measuring the frequency of parent- and self-reported depressive symptoms in children and adolescents. METHODS: Using a population-based, representative sample of n=2,863 7 to 17-year-old German children and adolescents, factorial validity were determined by means of linear structural equation modelling. Cross-sectional coefficients of reliability, inter-rater agreement as well as descriptive statistics of the scales were calculated. RESULTS: In a population-based German sample, the four-factor version of the CES-DC following Radloff (Appl Psychol Meas 1:385-401, 1977) is considered to have good factorial validity and stability across age and informant versions. The main problems of the questionnaire are the high item difficulties, strong floor effects of the scales and low cross-sectional reliability, which are acceptable only for screening purposes. The low inter-rater agreement indicates that parental assessment can replace self-assessment only to a limited degree. CONCLUSION: The strengths and weaknesses of the CES-DC are discussed taking previous data and comparable tests into consideration. Particular advantages are the existence of the parent-report form and the adult version, as well as its multifactorial structure. Parental assessment should be supplemented by self-report data whenever possible.

PMID: 19132311 [PubMed - indexed for MEDLINE]

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Risk and protective factors for children’s and adolescents’ mental health: results of the BELLA study.

Eur Child Adolesc Psychiatry. 2008 Dec;17 Suppl 1:133-47

Authors: Wille N, Bettge S, Ravens-Sieberer U,

BACKGROUND: Since prevalence rates of mental health problems in children and adolescents are high and of considerable relevance to public health, determinants of mental health, such as risk and protective factors, are of special interest. OBJECTIVES: The present paper reports the frequencies and distributions of potential risk and protective factors and analyses their effects on children’s mental health. METHODS: The BELLA study is the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems and their assumed determinants are examined in a representative sub-sample of 2,863 families with children and adolescents aged 7-17. In order to identify mental health problems, the extended version of the Strengths and Difficulties Questionnaire was administered. Data on psychosocial risk factors as well as on protective factors in terms of personal, familial and social resources were collected by questioning the parents and, from the age of 11 years upwards, the children themselves. RESULTS: Adverse family climate stands out particularly as a negative contributor to children’s mental health. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Conversely, pronounced individual, family and social resources coincide with a reduced occurrence of mental health problems, especially in children with a limited number of risk factors. CONCLUSIONS: The results suggest that differential prevention strategies are needed depending on the risk level: in the low risk group, to which most children belong, effective prevention programmes should define strengthening resources as a key objective. In the smaller group of children with a high number of risk factors, more complex intervention designs are required, which must consider the reduction of risks as well as strengthening resources.

PMID: 19132313 [PubMed - indexed for MEDLINE]

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Health-related quality of life in children and adolescents in Germany: results of the BELLA study.

Eur Child Adolesc Psychiatry. 2008 Dec;17 Suppl 1:148-56

Authors: Ravens-Sieberer U, Erhart M, Wille N, Bullinger M,

BACKGROUND: The self-perceived health or health-related quality of life of children and adolescents is increasingly recognised as a relevant outcome in medical practice and public health research. Identifying children and adolescents with particularly low health-related quality of life allows for an early detection of hidden morbidity and health care needs. OBJECTIVES: The present study investigates health-related quality of life in children and adolescents in Germany. METHODS: In the Mental Health Module (BELLA study) of the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 2,863 children and adolescents aged 7-17 years, and 1,700 children and adolescents aged 11-17 years completed the KINDL-R quality of life questionnaire. RESULTS: The reliability (Cronbach’s alpha=0.86) and validity of the measurements using the parent-reported KINDL-R were confirmed. Means and percentiles were calculated for the total sample as well as for strata defined by age, sex, geographical region (east/west), migration status and socioeconomic status. Expected differences in health-related quality of life of children and adolescents from different social backgrounds and with different health statuses were demonstrated by differences in the KINDL-R scores (effect size d up to 1.29). CONCLUSION: This study provides representative, normative data (self-report and parent-report) on the test scores of health-related quality of life (KINDL-R) for the population of children and adolescents in Germany in general, as well as in sociodemographic and socioeconomic subpopulations.

PMID: 19132314 [PubMed - indexed for MEDLINE]

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[Development and Evaluation of a Group Therapy for Functional Memory and Attention Disorder.]

Psychother Psychosom Med Psychol. 2009 Feb 25;

Authors: Metternich B, Schmidtke K, Härter M, Dykierek P, Hüll M

OBJECTIVES: Functional Memory and Attention Disorder (FMD) is regularly seen in patients presenting in psychosomatic or memory clinics. The aim of this study was the evaluation of a novel group therapy for FMD in a randomized controlled trial. METHODS: 40 FMD patients were randomly assigned to either the experimental (EG) or the wait-list control group (CG). Out of these 35/31 were analysed (intent to treat vs. observed cases respectively). The intervention consisted of psychoeducation, cognitive restructuring, stress management, relaxation and mindfulness techniques. Data were collected at baseline, three months (post-intervention) and six months (follow-up). Primary outcome was the memory self-efficacy measure of the Metamemory in Adulthood Questionnaire (MSE). Secondary outcomes were the sum scores of the Perceived Stress Questionnaire (PSQ) and the SCL-90-R. RESULTS: The EG showed a significantly higher improvement on MSE at follow-up than the CG. No significant group differences emerged on PSQ or SCL-90-R. The CG showed stable MSE scores during the waiting period without intervention. However, after the CG received their therapy the same pattern on MSE scores as seen in the EG emerged. CONCLUSIONS: This study provides preliminary evidence for an improvement of memory self efficacy in FMD through a newly devised group therapy program consisting of different modules. This result ought to be replicated in larger studies.

PMID: 19242897 [PubMed - as supplied by publisher]

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Can transcendental meditation exercise a miraculous control over long-standing epilepsy?

Med Hypotheses. 2009 Jan;72(1):106

Authors: Jaseja H

PMID: 18805645 [PubMed - indexed for MEDLINE]

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