Nora Wille

Development of the EQ-5D-Y: a child-friendly version of the EQ-5D

PurposeTo develop a self-report version of the EQ-5D for younger respondents, named the EQ-5D-Y (Youth); to test its comprehensibility for children and adolescents and to compare results obtained using the standard adult EQ-5D and the EQ-5D-Y.MethodsAn international task force revised the content of EQ-5D and wording to ensure relevance and clarity for young respondents. Children’s and adolescents’ understanding of the EQ-5D-Y was tested in cognitive interviews after the instrument was translated into German, Italian, Spanish and Swedish. Differences between the EQ-5D and the EQ-5D-Y regarding frequencies of reported problems were investigated in Germany, Spain and South Africa.ResultsThe content of the EQ-5D dimensions proved to be appropriate for the measurement of HRQOL in young respondents. The wording of the questionnaire had to be adapted which led to small changes in the meaning of some items and answer options. The adapted EQ-5D-Y was satisfactorily understood by children and adolescents in different countries. It was better accepted and proved more feasible than the EQ-5D. The administration of the EQ-5D and of the EQ-5D-Y causes differences in frequencies of reported problems.ConclusionsThe newly developed EQ-5D-Y is a useful tool to measure HRQOL in young people in an age-appropriate manner.

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.

Mental health of children and adolescents in Germany. Results from the BELLA study within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

ZusammenfassungIn der BELLA-Studie, dem Modul „Psychische Gesundheit“ des deutschen Kinder- und Jugendgesundheitssurveys (KiGGS), wurde eine repräsentative Unterstichprobe im Umfang von 2863 Familien mit Kindern im Alter von 7–17 Jahren vertiefend zum seelischen Wohlbefinden und Verhalten befragt. Die Auftretenshäufigkeit psychischer Auffälligkeiten wurde anhand der Angaben über Symptome und Belastung im Strengths and Difficulties Questionnaire (SDQ) und weiterer standardisierter Screening-Verfahren ermittelt. Insgesamt zeigen 21,9 % (95 % KI: 19,9–24,0) aller Kinder und Jugendlichen Hinweise auf psychische Auffälligkeiten. Als spezifische psychische Auffälligkeiten treten Ängste bei 10,0 % (95 % KI: 8,7– 11,6), Störungen des Sozialverhaltens bei 7,6 % (95 % KI: 6,5–8,7) und Depressionen bei 5,4 % (95 % KI: 4,3–6,6) der Kinder und Jugendlichen auf. Unter den untersuchten Risikofaktoren erweisen sich vor allem ein ungünstiges Familienklima sowie ein niedriger sozioökonomischer Status als bedeutsam. Bei kumuliertem Auftreten mehrerer Risikofaktoren steigt die Häufigkeit psychischer Auffälligkeiten stark an. Personale, familiäre und soziale Ressourcen sind hingegen bei psychisch unauffälligen Kindern und Jugendlichen stärker ausgeprägt. Die gesundheitsbezogene Lebensqualität psychisch auffälliger Kinder und Jugendlicher ist deutlich eingeschränkt. Längst nicht alle betroffenen Kinder und Jugendlichen werden behandelt. Bei der Identifikation von Risikogruppen sollten nicht nur Risikofaktoren für die psychische und subjektive Gesundheit einbezogen, sondern auch die vorhandenen Ressourcen berücksichtigt werden. Die Stärkung dieser Ressourcen sollte wesentliches Ziel von Prävention und Intervention sein.AbstractThe Mental Health Module (BELLA study) examines emotional well-being and behaviour in a representative sub-sample of 2,863 families with children aged 7 to 17 from the National Health Interview and Examination Survey for Children and Adolescents (KiGGS). The prevalence of mental health problems was determined using the Strengths and Difficulties Questionnaire (SDQ) and additional standardised screening measures. Of children and adolescents, 21.9 % (95 %CI: 19.9–24.0) showed signs of mental health problems. The psychiatric disorders observed included anxiety (10.0 %; 95 % CI: 8.7–11.6), conduct disorder (7.6 %; 95 % CI: 6.5–8.7) and depression (5.4 %; 95 % CI: 4.3–6.6). Of the risk factors examined, adverse family climate and low socioeconomic status stand out particularly as negative contributors. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Conversely, positive individual, family and social resources coincide with an absence of mental health problems. Children and adolescents with mental health problems display distinctly impaired health-related quality of life, and far from all of them are receiving treatment. Identifying high risk groups therefore requires the assessment of available resources in addition to the usual risk factors for mental and subjective health. Strengthening these resources should be a key objective, both in prevention and in interventions.

Die Messung der subjektiven Gesundheit: Stand der Forschung und Herausforderungen

Die Bedeutung der individuellen Gesundheit wie auch der gesundheitlichen Situation von Bevolkerungsgruppen ist vor dem Hintergrund knapper werdender Ressourcen fur Gesundheitsdienstleistungen in den letzten Jahren immer starker in den Blickpunkt der Offentlichkeit, der Medien und der politischen Entscheidungstrager geruckt. Epidemiologische Studien zur gesundheitlichen Situation der Bevolkerung bzw. einzelner Bevolkerungsgruppen konnen durch die Erfassung gesundheitlicher Unterschiede der Identifikation von Risikogruppen und Risikofaktoren aber auch der Bestimmung des Behandlungs- oder Versorgungsbedarf dienen und z.B. eine Unterversorgung aufdecken. Die Erfassung der Mortalitat und Morbiditat im Rahmen statistischer Routinedaten etwa ermoglicht es, die Bedeutung sozialer Ungleichheit fur den Gesundheitszustand der Bevolkerung abzuschatzen. Wiederholte Erhebungen konnen Gesundheitstrends erkennen lassen, die beispielsweise mit Veranderungen der sozialen Lage von Bevolkerungsgruppen verbunden sind.

Risk behaviour and health-related quality of life among European adolescents

Risikoverhalten und Lebensqualitat von Jugendlichen in Europa Fragestellung: Das Zusammenspiel von soziookonomischem Status (SES), Alkohol- und Tabakkonsum sowie subjektiver Lebensqualitat und psychischer Gesundheit bei europaischen Jugendlichen wurde untersucht. Methodik: Eine Stichprobe von 12.494 Jugendlichen (12–18 Jahre) wurde mit Hilfe von logistischen Regressionsanalysen, Varianzanalysen und linearen Strukturgleichungsmodellen analysiert. Ergebnisse: Regelmasig rauchende Jugendliche sowie regelmasig Alkohol trinkende Madchen berichten haufiger psychische Probleme und eine geringere Lebensqualitat (Effektstarke d Schlussfolgerung:

The Parent Version of the Preschool Social Skills Rating System: Psychometric Analysis and Adaptation with a German Preschool Sample

The Social Skills Rating System (SSRS) developed by Gresham and Elliott (1990) is a multirater, norm-referenced instrument measuring social skills and adaptive behavior in preschool children. The aims of the present study were (a) to test the factorial structure of the Parent Form of the SSRS for the first time with a German preschool sample (391 children) and (b) to present a modified version appropriate for 3- to 6-year-olds in German preschools. The sample consisted of 391 children (187 males, 204 females) from German preschools and their parents. Confirmatory factor analyses (CFAs) revealed a poor overall fit testing the original version. For the extended age range (3-6 years) a revised version of the SSRS with a reduced and newly composed item pool is proposed based on explorative factor analyses. Results are discussed with respect to practicability and revision of SSRS for German preschool populations.

Wohlbefinden und gesundheitsbezogene Lebensqualität aus einer bevölkerungsbezogenen Perspektive

Zusammenfassung. Bevolkerungsbezogene Untersuchungen des Wohlbefindens von Kindern und Jugendlichen ermoglichen die Identifikation von Risikofaktoren und Risikogruppen fur ein beeintrachtigtes Wohlbefinden und gesundheitliche Belastungen. In dieser Arbeit wird am Beispiel dreier internationaler bzw. nationaler bevolkerungsbezogener Studien aufgezeigt, wie sich die komplexen Beziehungen zwischen Wohlbefinden und fur das Wohlbefinden relevanten Aspekten unter Verwendung komplexer statistischer Modellierungsansatze untersuchen lassen. Die im Modul „Seelisches Wohlbefinden und Verhalten” des Kinder- und Jugendgesundheitssurveys (BELLA-Studie; n = 1700), der Health Behaviour in School-aged Children (HBSC; n = 7000) und der KIDSCREEN Studie (n = 8000) an 11 bis 18jahrigen Kindern und Jugendlichen erhobenen Daten zu ihrem Wohlbefinden, psychischen Problemen, personalen familiaren und sozialen Ressourcen, schulischer Umgebung sowie Tabak- und Alkoholkonsum werden dazu ausgewertet. Uber die Daten jeder der drei St...

Sensitivity analysis of weight reduction results of an observational cohort study in overweight and obese children and adolescents in Germany: the EvAKuJ Study

In the German EvAKuJ observational cohort study, changes in the body mass index standard deviation score (BMI–SDS) of overweight and obese children and adolescents as primary outcome of multimodal (short, inpatient or long, outpatient) weight-loss interventions are difficult to interpret. Published intention-to-treat (ITT) and per protocol data obtained at the end of the intervention (T1), one year (T2), and two years (T3) after its end were used for sensitivity analysis of treatment success rates. The odds ratio and the number needed to treat (NNT) for BMI–SDS reduction of at least −0.2 (successful treatment) and at least −0.5 (good treatment success) were related to spontaneous BMI-SDS reduction rates in a hypothetical control group (control event rate, CER). At T1, treatment seems to be effective up to a CER of 10% in inpatients and of 5% in outpatients. ITT analysis, compromised by a loss to follow-up of 81 to 90% (inpatients) and 57 to 66% (outpatients), indicated that treatment may become less effective at a CER above 1% in inpatients (e.g., successful treatment at T2: NNT=106, at T3: NNT=51), and above 5% in outpatients (successful treatment at T2: NNT=7, at T3: NNT=8; good treatment success at T2 and T3: NNT=25). Positive short-term effects of inpatient treatment of overweight and obese children and adolescents may not be maintained in the long term. Long-term effectiveness of outpatient treatment may depend on age and the degree of overweight.

How to Assess Resilience: Reflections on a Measurement Model

During the past century the health of children and adolescents has improved radically in Western industrialised countries due to improvements in nutrition and infection control. Today, however, children and adolescents in Western industrialised countries are more likely to suffer from problems related to mental health concerns such as social, emotional and behavioural difficulties. The chapter will describe the importance of mental health promotion in children and adolescents against the background of the new morbidity. With respect to current knowledge regarding relevant health determinants, the importance of taking health assets into account will be pointed out. Important concepts regarding the interaction of risks and resources in the context of mental health and resilience will also be introduced. In a next step the potential of population-based studies will be outlined and ways to operationalise risks and – most important – assets will be described. To end, an example from our own study will clarify how the theoretical concept of assets and their protective effects can be supported by empirical evidence in order to develop effective public health initiatives that address not only the individual child and its health problems but also its family and the community in which it lives.