Michael Schulte-Markwort

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

BackgroundOver 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.ObjectivesThe 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.MethodsThe 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.ResultsOverall, 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.ConclusionsThe 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.

Children of Somatically Ill Parents: A Methodological Review

The children of seriously ill parents are at risk for emotional disturbances. This review covers five former reviews, three theoretical articles, five case studies and 39 sample studies from the last 15 years. Methodological problems and shortcomings of previously published studies are discussed in detail. Based on former reviews and theoretical approaches, a developmental framework for children’s adaptation processes is elaborated. Empirical studies are analysed with a differentiation of how various results were correlated with the types of parental diseases and children’s age groups studied, as well as with various methodological designs and instruments applied. It appeared evident that children of seriously ill parents had higher scores on symptom scales than did controls, with a tendency towards internalizing symptomatology. In several studies, adolescent daughters of ill mothers appeared to be at highest risk for maladjustment. Ill parents’ subjective perception of their impairment predicted children’s symptoms better than the objective degree of severity of their disease. Although subgroups of children adjusted well, covariant protective mechanisms could not be clearly identified. In conclusion, suggestions for further research include ethical standards, a profound theoretical framework for any hypothesis to be tested, a combination of qualitative and quantitative methodology, the integration of the child’s subjective dimension by semi-structured or open interviews, and the consideration of coping as a process through longitudinal designs.

Posttraumatic syndromes in children and adolescents after road traffic accidents--a prospective cohort study

Background: The impact of road traffic accidents (RTAs) on the physical health of children is well recognized, but their psychological consequences have only recently become a topic of research. While other traumatic experiences in childhood are well studied, this kind of trauma has been poorly investigated to date. Sampling and Methods: A prospective cohort study was conducted of 8- to 18-year-old children and adolescents who were involved in RTAs in a large urban area during a 6-month period. The children and adolescents were interviewed within 1 week after the accident and, again, 3 months later. In total, 72 children and adolescents took part in the study. Symptoms of posttraumatic stress, depression and anxiety were assessed by a structured clinical interview and standardized questionnaires. Results: One week after the accident, 11% of the children met the diagnostic criteria for posttraumatic stress disorder (PTSD) according to ICD-10 and a further 13% met the criteria for ‘subsyndromal PTSD’. Complex syndromes consisting of subsyndromal posttraumatic stress, (separation) anxiety and depression were common among those children. Isolated cases of anxiety and depression symptoms were also observed but rarely reached an impairing level. Three months after the accident, 25% of the children reported persistence of the PTSD symptoms (measured by the Impact of Event Scale – Revised). The strongest predictor of the extent of posttraumatic stress after 3 months was proven to be the initial level of PTSD symptoms. This predictor alone accounted for 38% of its variance. Conclusions: Our results provide evidence that even after ‘everyday’ RTAs, psychological consequences are common. Special attention should be paid to the common occurrence of subsyndromal psychological disturbances and more complex syndromes. The results further indicate the limitations of the PTSD concept in the assessment of posttraumatic disturbances in childhood and adolescence.

Prevalence of emotional and behavioural disorders in German children and adolescents: a meta-analysis

Background This meta-analysis aimed to determine the overall prevalence of emotional and behavioural disorders among children and adolescents in Germany, the dependence of prevalence estimates upon the methods employed and potential secular trends. Methods Primary studies were subjected to meta-analytical analyses using a random effects model. Mean estimates of primary study effects were averaged using the precision-weighted method and were subsequently subjected to sensitivity analyses using hierarchical regression and (co-)variance analyses. Results The precision-weighted average primary study prevalence for the 33 studies included was M=17.6%. The effect size primarily depended on the case definition employed, with studies applying questionnaire criteria showing, on average, lower primary study effects. Moreover, a negative relationship was found between study validity and primary study effect. Conclusion Half a century of research efforts indicate that approximately every sixth child shows signs of emotional or behavioural disorders, and conclusions regarding period effects are not robust.

Emotional and behavioral problems of children and adolescents in Germany--an epidemiological screening.

BackgroundPrevious studies that were carried out to investigate the prevalence of mental health problems among children and adolescents in Germany are based on regional samples, limited age ranges or used ambiguous case definitions.MethodIn the Hamburg Health Survey, data on emotional and behavioral problems were collected by a parent and a child questionnaire on the basis of a nationwide representative sample of 1950 families with children and adolescents between the ages of 4 and 18. Besides study-specific items, the Child Behavior Checklist and the Youth Self-Report were used. The symptom and total prevalence rates of clinically significant cases as well as dimensional descriptive statistics and coefficients of agreement between parent- and self-report were calculated.ResultsThe results indicate that children and adolescents in Germany suffer from a variety of emotional and behavioral problems which require differentiated interpretations depending on their symptom, age and sex. In accordance with the respective case definition, between 10 % and 18% of the children and adolescents were considered to have a clinically relevant score requiring counseling, diagnostics or treatment. The agreement between parent- and self-report scores in the middle range using dimensional statistics and in the lower range for the case definitions.ConclusionThe results are discussed in comparison with German and international studies carried out so far. An increase of mental health problems over the past decades cannot be deduced from the data. Procedures which allow the standardization of future investigations are recommended and possibilities to improve current mental health care utilization are discussed.

Stabilization of juvenile metachromatic leukodystrophy after bone marrow transplantation: a 13-year follow-up.

A 29-year-old female patient with juvenile metachromatic leukodystrophy diagnosed at age 14 years received a bone marrow transplant at age 16 years. A report was published 6 years after bone marrow transplantation concluding that the disease had slowly progressed in the 2 years following bone marrow transplantation. We now report on a further 7-year follow-up, typified by a steady state of spastic paraplegia and mild dementia. Neurophysiological, neuroradiological, and psychological status also remained stable. In the patients leukocytes, the activity of arylsulfatase A, the enzyme deficient in untreated metachromatic leukodystrophy, was within the normal range whereas urinary sulfatides remained elevated. Data on the natural course of juvenile metachromatic leukodystrophy are rare, so in the present case it is difficult to establish whether the rather favorable course can be attributed with certainty to bone marrow transplantation. The long-term stabilization in this patient, however, suggested that bone marrow transplantation may halt the progression of juvenile metachromatic leukodystrophy.

A Prospective 12-Week Study of Quetiapine in Adolescents with Schizophrenia Spectrum Disorders

OBJECTIVE The aim of this study was to investigate the effectiveness, tolerability, and safety of quetiapine in adolescents with schizophrenia, schizophreniform, and schizoaffective disorders in a prospective open-label study. METHOD A total of 56 subjects (all-subjects-treated, AST), ages 12-17, received 200-800 mg of quetiapine per day (forced titration to 400 mg within week 1; median study dose 600 mg/day at week 6) in Germany, 2002 through 2004. Primary outcome measure was the change of Positive and Negative Syndrome Scale (PANSS) total score (based on the intent-to-treat (ITT) population, n = 52), secondary outcome measures were changes of PANSS subscales, severity of illness, subjective wellbeing, and safety/tolerability (the latter based on the AST population). Correlates of PANSS response (=50% reduction in PANSS total score) and discontinuation due to lack of effectiveness were analyzed by Cox regression analyses. RESULTS Twenty-seven subjects (48%) completed the study; 17 subjects (30%) were discontinued due to lack of effectiveness. A significant reduction of PANSS total score (last observation carried forward, LOCF; p < 0.0001; effect size = 0.92) and of secondary effectiveness outcomes were detected. In all, 34.6% fulfilled the PANSS response criterion, correlated with the degree of PANSS total change within week 1. Somnolence (21.4%) and fatigue (17.9%) were the most frequent adverse events. A significant mean weight gain (6.2 kg) and mean decrease in total serum thyroxine (2.5 ng/dl) were detected. CONCLUSIONS In this sample of mostly drug-naïve patients with early-onset schizophrenia spectrum disorders, significant reductions in PANSS total and positive scores were detected. Controlled studies are needed to confirm these findings. The significant weight gain with its potentially severe medical consequences must be weighed against quetiapines effectiveness.

Clowning as a supportive measure in paediatrics - a survey of clowns, parents and nursing staff

BackgroundHospital clowns, also known as clown doctors, can help paediatric patients with the stress of a hospitalization and to circumvent the accompanying feelings of fear, helplessness and sadness, thus supporting the healing process. The objectives of the present study were to clarify the structural and procedural conditions of paediatric clowning in Germany and to document the evaluations of hospital clowns, parents and hospital staff.MethodsA nationwide online survey of hospital clowns currently active in paediatric departments and an accompanying field evaluation in Hamburg hospitals with surveys of parents and hospital staff were conducted. In addition to items developed specifically for the study regarding general conditions, procedures, assessments of effects and attitudes, the Work Satisfaction Scale was used. The sample included n = 87 hospital clowns, 37 parents and 43 hospital staff members.ResultsThe online survey showed that the hospital clowns are well-trained, motivated and generally satisfied with their work. By their own estimate, they primarily boost morale and promote imagination in the patients. However, hospital clowns also desire better interdisciplinary collaboration and financial security as well as more recognition of their work. The Hamburg field study confirmed the positive results of the clown survey. According to the data, a clown intervention boosts morale and reduces stress in the patients. Moreover, there are practically no side effects. Both parents and hospital staff stated that the patients as well as they themselves benefited from the intervention.ConclusionsThe results match those of previous studies and give a very positive picture of hospital clowning, so that its routine use and expansion thereof can be recommended. Furthermore, the intervention should be subject to the rules of evidence-based medicine like other medical treatments.

Peritraumatic Dissociation Predicts Posttraumatic Stress in Children and Adolescents Following Road Traffic Accidents.

ABSTRACT To date, only few studies have examined the predictive value of dissociative symptoms in the context of acute, single-event traumatic experiences in children. In a short-term follow-up study, we examined the relationship between peritraumatic dissociation and levels of posttraumatic stress in forty-five child and adolescent victims of road traffic accidents at one week and at three months after the event. Peritraumatic dissociative experiences were common, with 62% of children endorsing at least one symptom. In a final regression model, peritraumatic derealization accounted for thirty-three percent of variance of posttraumatic stress symptoms three months after the accident. The results suggest that peritraumatic dissociative experiences could also be valuable in identifying children and adolescents at risk for later symptomatology.

Very low birth-weight as a risk factor for postpartum depression four to six weeks postbirth in mothers and fathers: Cross-sectional results from a controlled multicentre cohort study

BACKGROUND Preterm birth and survival rates of very low birth-weight (VLBW: <1.500g) infants have increased. Although new parents are frequently affected by depressive symptoms, little is known about prevalence, risk, and predictors of parental postpartum depression (PPD) following VLBW birth. Furthermore, most studies assessing PPD in parents of preterm children relied on self-report only. METHODS As part of the HaFEn cohort-study, data from the index groups of parents with VLBW infants and the control group of parents with term infants were cross-sectionally analysed. Families were recruited at the three largest centres of perinatal medical care in Hamburg, Germany. PPD was evaluated one month postpartum using standardized questionnaires and clinical interviews. Socioeconomic status, social support, risks during pregnancy, and psychiatric lifetime diagnoses were also assessed. A multiple random coefficient model was used to examine predictors of PPD in both parents simultaneously. RESULTS 230 mothers and 173 fathers were included. Depending on the measure, the risk of being postnatally depressed was 4 to 18 times higher in mothers and 3 to 9 times higher in fathers from the index group. The most relevant risk factor for PPD was the birth of a VLBW infant, followed by female sex, lifetime psychiatric disorder, and low social support. LIMITATIONS Results presented here, are based on cross sectional data. Therefore no temporal relationships can be established. CONCLUSIONS Our findings highlight the importance of early screening for PPD in both parents of VLBW infants. Factors contributing to developing depression should also be considered in neonatal care.