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Baldofski S, Scheider J, Kohls E, Klemm SL, Koenig J, Bauer S, Moessner M, Kaess M, Eschenbeck H, Lehner L, Becker K, Krämer J, Diestelkamp S, Thomasius R, Rummel-Kluge C. Intentions and barriers to help-seeking in adolescents and young adults differing in depression severity: cross-sectional results from a school-based mental health project. Child Adolesc Psychiatry Ment Health 2024; 18:84. [PMID: 39010111 PMCID: PMC11251315 DOI: 10.1186/s13034-024-00775-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Mental health problems, such as depression, have a high prevalence in young people. However, the majority of youths suffering from depression do not seek professional help. This study aimed to compare help-seeking behavior, intentions and perceived barriers between youthswith different levels of depressive symptoms. METHODS This cross-sectional study is part of a large-scale, multi-center project. Participants were n = 9509 youths who were recruited in German schools and completed a baseline screening questionnaire. Based on their depressive symptoms, youths were allocated to the following three subgroups: (a) without depressive symptoms, (b) with subclinical symptoms, (c) with clinical symptoms (measured by PHQ-A). Quantitative analyses compared previous help-seeking behavior, help-seeking intentions and perceived barriers (Barriers questionnaire) between these subgroups. An additional exploratory qualitative content analysis examined text answers on other perceived barriers to help-seeking. RESULTS Participants were mostly female (n = 5575, 58.6%) and 12 to 24 years old (M = 15.09, SD 2.37). Participants with different levels of depressive symptoms differed significantly in help-seeking behavior, intentions and perceived barriers. Specifically, participants with clinical depressive symptoms reported more previous help-seeking, but lower intentions to seek help compared to participants without symptoms (all p < 0.05). Participants with subclinical depressive symptoms reported a similar frequency of previous help-seeking, but higher intentions to seek help compared to participants without symptoms (all p < 0.05). Perception of barriers was different across subgroups: participants with clinical and subclinical depressive symptoms perceived the majority of barriers such as stigma, difficulties in accessibility, and family-related barriers as more relevant than participants without depressive symptoms. Across all subgroups, participants frequently mentioned intrapersonal reasons, a high need for autonomy, and a lack of mental health literacy as barriers to help-seeking. CONCLUSIONS Youths with higher levels of depressive symptoms are more reluctant to seek professional help and perceive higher barriers. This underlines the need for effective and low-threshold interventions to tackle barriers, increase help-seeking, and lower depressive symptoms in adolescents and young adults differing in depression severity. TRIAL REGISTRATION DRKS00014685.
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Affiliation(s)
- Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Jelena Scheider
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig University, Leipzig, Germany
| | - Sarah-Lena Klemm
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Bauer
- Centre for Psychosocial Medicine, Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim/Heidelberg/Ulm, Mannheim, Germany
| | - Markus Moessner
- Centre for Psychosocial Medicine, Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Heike Eschenbeck
- Department of Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Laya Lehner
- Department of Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Jennifer Krämer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the Philipps-University Marburg, Marburg, Germany
| | - Silke Diestelkamp
- German Center for Addiction Research in Childhood and Adolescence, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Thomasius
- German Center for Addiction Research in Childhood and Adolescence, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany.
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig University, Leipzig, Germany.
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Reich H, Niermann HCM, Voss C, Venz J, Pieper L, Beesdo-Baum K. Sociodemographic, psychological, and clinical characteristics associated with health service (non-)use for mental disorders in adolescents and young adults from the general population. Eur Child Adolesc Psychiatry 2024; 33:391-400. [PMID: 36807526 PMCID: PMC10869368 DOI: 10.1007/s00787-023-02146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/19/2023] [Indexed: 02/21/2023]
Abstract
Most adolescents and young adults who experience psychological distress do not seek professional help. This study aims to enhance the understanding of sociodemographic, psychological, and clinical characteristics associated with the underuse of health services by adolescents and young adults with mental disorders. Data from a cross-sectional, epidemiological study with a population-based sample (N = 1180 participants, 14-21 years old) were used. Participants completed a fully standardized, computer-assisted diagnostic interview (DIA-X-5/D-CIDI) administered by trained clinical interviewers to assess lifetime mental disorders according to DSM-5 as well as lifetime health service use for mental health problems, and completed self-report questionnaires to assess various psychological variables (e.g., stigma). Predictors of health service use were examined using univariate and multiple logistic regression analyses, data were weighted for age and sex to improve representativeness Of n = 597 participants with any lifetime mental disorder, 32.4% [95% CI 28.4; 36.7] had ever used any health services because of a mental health, psychosomatic, or substance use problem. Even less had received psychotherapeutic or pharmacological treatment (Cognitive Behavioral Therapy: 12.1% [9.5; 15.2]; other psychotherapy: 10.7% [8.4; 13.7]; medication: 5.4% [3.7; 7.8]). High education was associated with less health service use (low/ middle/ other vs. high education: 53.8% vs. 26.9%; OR = 0.26, p < .001). In the multiple regression model, stigma toward mental disorders was the single psychological variable associated with a reduced likelihood of using health services (OR = 0.69 [0.52; 0.90], p < .01). These findings draw attention to the treatment gap for mental disorders during adolescence and highlight related factors to be addressed in public health contexts.
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Affiliation(s)
- H Reich
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Depression Research Centre of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, Frankfurt am Main, 60528, Frankfurt, Germany
| | - H C M Niermann
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - C Voss
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - J Venz
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - L Pieper
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - K Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
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Panagi L, White SR, Howdle C, Bennett S, Heyman I, Shafran R, Ford T. Predictors of contact with services for mental health problems among children with comorbid long-term physical health conditions: a follow-up study. Eur Child Adolesc Psychiatry 2024; 33:21-31. [PMID: 36357554 PMCID: PMC10807016 DOI: 10.1007/s00787-022-02105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
Children with long-term physical health conditions (pLTCs) are at increased risk of developing mental health comorbidities, although most do not access services for their mental health. No previous studies have examined the determinants of contact with services for mental health concerns among this group of children. This 3-year longitudinal study involved a population-based sample of children aged 5-16 years from the British Child and Adolescent Mental Health Surveys conducted in 1999 and 2004. In children with comorbid pLTCs and mental health disorders at baseline (N = 397), we examined associations between several child-, family- and service-related factors and (a) contact with primary health care, (b) contact with paediatrics and (c) contact with child and adolescent mental health services over 3-year follow-up (2002 and 2007). Separate multivariable binary logistic regressions were conducted for each service. The impact of mental health difficulties on the child and contact with the teacher predicted contact with all three services. Adolescent age, female gender, larger family size, some or marked academic difficulties, and having parents with educational qualification(s) were specific predictors of contact with primary health care. Male gender, stressful life events, and contact with primary health care were specific predictors of contact with child and adolescent mental health services. No other factors predicted contact with paediatrics. Our findings highlight the role of child-, family-, and service-related factors in accessing mental health care in children with comorbid pLTCs and mental health disorders which could inform planning and provision of services to reduce unmet mental health needs.
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Affiliation(s)
- Laura Panagi
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK.
| | - Simon R White
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
| | - Charlotte Howdle
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
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Naumann W, Grosselli L, Herzog K, Knappe S. [How good are teachers at recognising mental health issues and assistance needs in adolescents? A vignette-based study]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:116-124. [PMID: 37208275 DOI: 10.1016/j.zefq.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Teachers can help identify mental health issues in adolescents and act as gateway-providers by referring adolescents at risk to a mental health professional. Studies have so far investigated awareness concerning mental health issues among primary school teachers in the USA. The present study uses case vignettes to examine whether secondary school teachers in Germany can detect and assess the presence and severity of mental disorders in adolescents, and which factors predict referral to professional support services. METHODS N=136 secondary school teachers completed an online questionnaire with case vignettes depicting students with moderate or severe internalizing and externalizing disorders. We assessed the ability to recognize mental health issues and evaluate the level of severity, worry and perceived prevalence of the problem as well as the helping behaviour among teachers. RESULTS 66 and 75% of the teachers were able to identify mental health issues in case vignettes of externalizing and internalizing disorders, respectively. 60% and 61%, respectively, designated the mental disorder correctly as externalizing or internalizing, and the true positive rates did not differ between externalizing vs. internalizing disorders. However, moderate and externalizing disorders were identified with less precision, and recommendations to seek professional mental help were more seldom made for these disorders. DISCUSSION The results indicate that teachers can validly and probably intuitively identify (at least severe cases of) mental disorders in their students. Given the uncertainty expressed and the substantial interest of teachers, further education and training on mental health conditions disorders in adolescents is recommended.
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Affiliation(s)
- Wibke Naumann
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Deutschland
| | - Luna Grosselli
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Deutschland
| | - Kristina Herzog
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Deutschland; Selbstständige Abteilung für Pädiatrische Onkologie, Hämatologie und Hämostaseologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland; Klinik und Poliklinik für Psychiatrie und Psychotherapie, Fakultät für Medizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Susanne Knappe
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Deutschland; Evangelische Hochschule Dresden (ehs), University of Applied Sciences for Social Work, Education and Nursing Dresden, Dresden, Deutschland.
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Loidl V, Hamacher K, Lang M, Laub O, Schwettmann L, Grill E. Impact of a pediatric primary care health-coaching program on change in health-related quality of life in children with mental health problems: results of the PrimA-QuO cohort study. BMC PRIMARY CARE 2023; 24:182. [PMID: 37684633 PMCID: PMC10486116 DOI: 10.1186/s12875-023-02119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/31/2023] [Indexed: 09/10/2023]
Abstract
Mental health problems (MHP) have a considerable negative impact on health-related quality of life (HRQoL) in children and their families. A low threshold Health Coaching (HC) program has been introduced to bring MH services to primary care and strengthen the role of pediatricians. It comprised training concepts as a hands-on approach for pediatricians, standardization of diagnosis and treatment, and extended consultations. The aim of this study was to evaluate the potential effects of the HC on HRQoL in children with MHP and their parents.We used data from the PrimA-QuO cohort study conducted in Bavaria, Germany from November 2018 until November 2019, with two assessments one year apart. We included children aged 17 years or younger with developmental disorder of speech and language, non-organic enuresis, head and abdominal pain, and conduct disorder. All included children were already part of the Starke Kids (SK) program, a more general preventive care program, which includes additional developmental check-ups for children enrolled in the program. In addition, treatment according to the HC guidelines can be offered to children and adolescents with mental health problems, who are already enrolled in the SK program. These children form the intervention group; while all others (members of BKK and SK but not HC) served as controls. HRQoL in children was assessed using the KINDL questionnaire. Parental HRQoL was measured by the visual analogue scale. To analyze the effects of the intervention on children´s HRQoL over the 1-year follow-up period, we used linear mixed effects models.We compared 342 children receiving HC with 767 control patients. We could not detect any effects of the HC on HRQoL in children and their parents. This may be attributed to the relatively high levels of children´s HRQoL at baseline, or because of highly motivated pediatricians for the controls because of the selection of only participant within the Starke Kids program. Generally, HRQoL was lower in older children (-0.42 points; 95% CI [-0.73; -0.11]) and in boys (-1.73 points; 95% CI [-3.11; -0.36]) when reported by proxy. Parental HRQoL improved significantly over time (2.59 points; 95% CI [1.29; 3.88]).Although this study was not able to quantitatively verify the positive impact of this HC that had been reported by a qualitative study with parents and other stakeholders, and a cost-effectiveness study, the approach of the HC may still be valid and improve health care of children with MHP and should be evaluated in a more general population.
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Affiliation(s)
- Verena Loidl
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany.
- Pettenkofer School of Public Health, Munich, Germany.
| | | | - Martin Lang
- PaedNetz Bayern e.V., Munich, Germany
- Berufsverband der Kinder- und Jugendärzte (BVKJ) e.V., Cologne, Germany
| | - Otto Laub
- Berufsverband der Kinder- und Jugendärzte (BVKJ) e.V., Cologne, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management (IGM), Neuherberg, Germany
- Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- German Centre for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
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Lunkenheimer F, Eckert AJ, Hilgard D, Köth D, Kulzer B, Lück U, Lüdecke B, Müller A, Baumeister H, Holl RW. Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes. Sci Rep 2023; 13:1556. [PMID: 36707607 PMCID: PMC9883226 DOI: 10.1038/s41598-023-28373-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
Mental comorbidities in patients with type 1 diabetes mellitus (T1D) are common, and can have a negative impact on acute blood glucose levels and long-term metabolic control. Information on the association of T1D and comorbid posttraumatic stress disorder (PTSD) with diabetes-related outcomes is limited. The aim was to examine the associations between a clinical diagnosis of PTSD and diabetes-related outcomes in patients with T1D. Patients with T1D and comorbid documented PTSD from the DPV database (n = 179) were compared to a group with T1D without PTSD (n = 895), and compared to a group with T1D without comorbid mental disorder (n = 895) by matching demographics (age, gender, duration of diabetes, therapy and migration background) 1:5. Clinical diabetes-related outcomes {body mass index (BMI), hemoglobin A1c (hbA1c), daily insulin dose, diabetic ketoacidosis (DKA), hypoglycemia, number of hospital admissions, number of hospital days} were analyzed, stratified by age groups (≤ 25 years vs. > 25 years). Patients with comorbid PTSD aged ≤ 25 years compared with patients without PTSD or patients without mental disorders had significantly higher HbA1c (8.71 vs. 8.30 or 8.24%), higher number of hospital admissions (0.94 vs. 0.44 or 0.32 per year) and higher rates of DKA (0.10 vs. 0.02 or 0.01 events/year). Patients with comorbid PTSD aged ≤ 25 years compared with patients without PTSD had significantly higher BMI (0.85 vs. 0.59) and longer hospital stays (15.89 vs.11.58 days) than patients without PTSD. Patients with PTSD > 25 years compared with patients without PTSD or without any mental comorbidities had significantly fewer hospital admissions (0.49 vs. 0.77 or 0.69), but a longer hospital length of stay (20.35 vs. 11.58 or 1.09 days). We found that PTSD in younger patients with T1D is significantly related to diabetes outcome. In adult patients with T1D, comorbid PTSD is associated with fewer, but longer hospitalizations. Awareness of PTSD in the care of patients with T1D should be raised and psychological intervention should be provided when necessary.
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Affiliation(s)
- Frederike Lunkenheimer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany.
| | - Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany
| | - Dörte Hilgard
- Pediatric Endocrinology and Diabetology, Primary Psychosomatic Care, Bahnhofstraße 54, Witten, Germany
| | - Daniel Köth
- Department of Endocrinology and Diabetology, Hospital Sachsenhausen, Schulstraße 31, Frankfurt, Germany
| | - Bernhard Kulzer
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany
- Research Institute of the Diabetes-Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Straße 12, Bad Mergentheim, Germany
| | - Ursula Lück
- Department of Pediatrics and Adolescent Medicine, Regional Hospital Mödling, Sr. M. Restituta-Gasse 12, Mödling, Austria
| | - Blanca Lüdecke
- Diabetes Centre, Alexianer St. Hedwig Hospital, Große Hambuger Straße 5-11, Berlin, Germany
| | - Antonia Müller
- Clinic Group Dr. Guth GmbH & Co. KG, Clinical Center Karlsburg, Greifswalder Straße 11, Karlsburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany
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Sarmiento C, Reid GJ. Accessing and re-accessing mental health walk-in clinics for children and families. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231200617. [PMID: 37786838 PMCID: PMC10541731 DOI: 10.1177/27550834231200617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/22/2023] [Indexed: 10/04/2023]
Abstract
Background Many child and youth mental health (CYMH) agencies across Canada and in Ontario are using mental health walk-in clinics (MHWCs). Objectives (1) Explore how MHWCs are used by families (e.g. mean, mode, and median number of visits), and (2) document how often and how soon families returned for a second MHWC visit and identify correlates of time to a second MHWC visit. Design Administrative data from two CYMH agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. Methods In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared to MHWC use exclusively. Results About a third of children and families using MHWCs had two or more visits. Child age, guardianship, and disposition at discharge emerged as correlates of time to a second MHWC visit. Conclusion MHWCs can save families' time, and both agencies' time and money by eliminating the need to complete a detailed assessment prior to treatment for cases that would go on to have a single visit within this service.
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Affiliation(s)
- Catalina Sarmiento
- Department of Psychology, The University of Western Ontario, London, ON, Canada
| | - Graham J. Reid
- Departments of Psychology, Family Medicine, and Paediatrics, The University of Western Ontario, London, ON, Canada
- Children’s Health Research Institute, London, ON, Canada
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Sevecke K, Wenter A, Haid-Stecher N, Fuchs M, Böge I. [A three-country comparison of mental health and treatment options of children and adolescents with mental health problems in times after the COVID-19 pandemic]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:192-201. [PMID: 36352338 PMCID: PMC9645753 DOI: 10.1007/s40211-022-00438-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND RESEARCH QUESTION The Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP) is publishing a series of articles in a special issue of Neuropsychiatrie dealing with the current provision of care in child and adolescent psychiatry. Aim of this article is to give an overview of provision of care for children and adolescents with mental health problems in Austria, Germany, and Switzerland and then draw conclusions for the Austrian child and adolescent psychiatric care landscape. METHOD First, epidemiologic data as well as different traditions and treatment philosophies and their effect for provision of care in child and adolescent psychiatry in Austria, Germany and Switzerland are presented. Subsequently, data of provided child and adolescent psychiatric care in Austria and Germany are presented and related to each other. RESULTS AND CONCLUSIONS On the basis of the data presented, the current deterioration of mental health in children and adolescents due to the pandemic as well as the deficit of available inpatient beds (0.03-0.09) there is an urgent need for action in Austrian provision of child and adolescent psychiatric care. An improvement of the structural deficits in the child and adolescent psychiatric research and care landscape, a significant increase of capacities for inpatient treatment, day-care as well as outpatient treatment with establishment of modern treatment options such as home treatment is necessary.
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Affiliation(s)
- Kathrin Sevecke
- Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Tirol Kliniken, Milser Straße 10, 6060, Hall i. T., Österreich.
- Medizinische Universität Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Österreich.
| | - Anna Wenter
- Medizinische Universität Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Österreich
| | - Nina Haid-Stecher
- Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Tirol Kliniken, Milser Straße 10, 6060, Hall i. T., Österreich
| | - Martin Fuchs
- Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Tirol Kliniken, Milser Straße 10, 6060, Hall i. T., Österreich
- Medizinische Universität Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Österreich
| | - Isabel Böge
- Universitätsklinikum Graz, Auenbruggerplatz 1, 8036, Graz, Österreich
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Podar MD, Freţian AM, Demir Z, Razum O, Namer Y. How schools in Germany shape and impact the lives of adolescent refugees in terms of mental health and social mobility. SSM Popul Health 2022; 19:101169. [PMID: 35935280 PMCID: PMC9352960 DOI: 10.1016/j.ssmph.2022.101169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/03/2022] Open
Abstract
Schools are relevant settings for supporting refugee adolescents' mental health. As education and migration are important social determinants of health, we aim to integrate the qualitative findings of our mixed-methods study into a broader discussion regarding the role of schools and the potential effects on refugee adolescents' lives and mental health, as well as the impact of the COVID-19 pandemic. In this article, we present the findings of school-based actors' (i.e., teachers and school psychologists) perception of refugee adolescents' access to mental health care. The interviews highlight the importance of schools and social activities as main stabilizers and sources of support for refugee adolescents’ mental health and the role trusting school-parent relationships play in mental health care help-seeking. Our data indicate that schools lack the resources to properly address these needs. However, these structural gaps are rooted into historical segregation and discrimination in the German educational system and left unaddressed, can increase stigma and intergenerational social inequalities, especially in connection to the COVID-19 pandemic. We conclude our article with a set of recommendations that could be relevant and implemented across different contexts to strengthen the role of the school setting in promoting the mental health and well-being of refugee adolescents. Schools have the potential be sites of support for refugee minors' mental health. Yet, German schools have historically been sites of segregation and discrimination. Social activities are main stabilizers for mental health, but schools lack resources. School closings during the COVID19 pandemic in Germany exacerbated these challenges. We recommend anti-racist education practices and inclusionary strategies in schools.
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Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study. BMC PRIMARY CARE 2022; 23:211. [PMID: 35996092 PMCID: PMC9396915 DOI: 10.1186/s12875-022-01780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022]
Abstract
Background In Germany, 19.1% of boys and 14.5% of girls are affected by mental health problems (MHP). Paediatricians are usually the first in line to be contacted but they often do not feel adequately trained to diagnose and treat MHP in primary care. A major statutory health insurance fund introduced a health coaching (HC) programme to strengthen primary care consultation for MHP. The HC includes a training concept for paediatricians, standardised guidelines for actions and additional payments. The aim of this study was to investigate the potential effects of the HC programme on the change of MHP in children and adolescents. Methods A prospective cohort study was conducted in Bavaria, Germany, in 2018 and 2019. Data were collected at 2 points 1 year apart using an online questionnaire. Parents of patients with developmental disorder of speech and language, head/abdominal pain, conduct disorder or non-organic enuresis were approached by their health insurance. Families treated according to the HC programme form the intervention group while all others serve as controls. MHP was assessed using the Strengths and Difficulties Questionnaire (SDQ) as a child self-assessment (SDQ-S)/or external assessment by parents (SDQ-P). Determinants of SDQ total score were analysed using linear mixed effects models. Results Cross-sectional (n = 1090) and longitudinal analyses (n = 599) were performed. At baseline, a total of 23.5% had an SDQ total score “at risk” (SDQ-S > 15/SDQ-P > 13). There were no significant differences between intervention and controls. After full adjustment for all potential confounders, higher SDQ scores indicating more problems were significantly associated with male sex (2.000, p < 0.001) whereas a high parental education level was significantly associated with decreased SDQ scores (-2.127, p =0.034). There was a significant improvement in the control group over time (-0.814, p = 0.001) while the SDQ scores in the intervention group remained stable (-0.012, p = 0.020). Conclusion This evaluation of the HC programme could not prove a clinically relevant intervention’s effect on the MHP developmental course. Nevertheless, (HC) paediatricians have crucial potential to improve the care of MHP patients. Targeting families with less access to support measures might help reduce the burden of MHP and be a step towards continuous improvement of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01780-1.
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Geirhos A, Domhardt M, Lunkenheimer F, Temming S, Holl RW, Minden K, Warschburger P, Meissner T, Mueller-Stierlin AS, Baumeister H. Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACH CD): a randomized controlled pilot trial. BMC Pediatr 2022; 22:69. [PMID: 35093047 PMCID: PMC8800235 DOI: 10.1186/s12887-022-03134-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/11/2022] [Indexed: 01/20/2023] Open
Abstract
Background Adolescents and young adults (AYA) with a chronic medical condition show an increased risk for developing mental comorbidities compared to their healthy peers. Internet- and mobile-based cognitive behavioral therapy (iCBT) might be a low-threshold treatment to support affected AYA. In this randomized controlled pilot trial, the feasibility and potential efficacy of youthCOACHCD, an iCBT targeting symptoms of anxiety and depression in AYA with chronic medical conditions, was evaluated. Methods A total of 30 AYA (Mage 16.13; SD= 2.34; 73% female), aged 12-21 years either suffering from cystic fibrosis, juvenile idiopathic arthritis or type 1 diabetes, were randomly assigned to either a guided version of the iCBT youthCOACHCD (IG, n=15) or to a waitlist control group (CG, n=15), receiving an unguided version of the iCBT six months post-randomization. Participants of the IG and the CG were assessed before (t0), twelve weeks after (t1) and six months after (t2) randomization. Primary outcome was the feasibility of the iCBT. Different parameters of feasibility e.g. acceptance, client satisfaction or potential side effects were evaluated. First indications of the possible efficacy with regard to the primary efficacy outcome, the Patient Health Questionnaire Anxiety and Depression Scale, and further outcome variables were evaluated using linear regression models, adjusting for baseline values. Results Regarding feasibility, intervention completion was 60%; intervention satisfaction (M = 25.42, SD = 5.85) and perceived therapeutic alliance (M = 2.83, SD = 1.25) were moderate and comparable to other iCBTs. No patterns emerged regarding subjective and objective negative side effects due to participation in youthCOACHCD. Estimates of potential efficacy showed between group differences, with a potential medium-term benefit of youthCOACHCD (β = -0.55, 95%CI: -1.17; 0.07), but probably not short-term (β = 0.20, 95%CI: -0.47; 0.88). Conclusions Our results point to the feasibility of youthCOACHCD and the implementation of a future definitive randomized controlled trial addressing its effectiveness and cost-effectiveness. Due to the small sample size, conclusions are premature, however, further strategies to foster treatment adherence should be considered. Trial registration The trial was registered at the WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (ID: DRKS00016714, 25/03/2019). Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03134-3.
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Affiliation(s)
- A Geirhos
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany. .,Faculty of Engineering, Computer Science and Psychology Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Lise-Meitner-Straße 16, 89081, Ulm, Germany.
| | - M Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - F Lunkenheimer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - S Temming
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - R W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - K Minden
- Charité University Medicine Berlin, Berlin, Germany.,German Rheumatism Research Centre, Berlin, Germany
| | - P Warschburger
- Department of Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - T Meissner
- Department of General, Paediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - A S Mueller-Stierlin
- Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ulm University, Günzburg, Germany
| | - H Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Meißner C, Meyrose AK, Kaman A, Michalkiewicz M, Ravens-Sieberer U. Associations Between Mental Health Problems in Adolescence and Educational Attainment in Early Adulthood: Results of the German Longitudinal BELLA Study. Front Pediatr 2022; 10:828085. [PMID: 35281228 PMCID: PMC8914221 DOI: 10.3389/fped.2022.828085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Mental health problems (MHP) in adolescence are a major public health concern of the 21st century. Global prevalence estimates range between 10 and 20%. Most MHP manifest by adolescence and persistence rates are high, often accumulating further impairment in early adulthood and beyond. We analyzed data of N = 433 participants from the German longitudinal BELLA study to examine whether MHP in adolescence negatively affect educational attainment in early adulthood. Externalizing and internalizing MHP among adolescents aged 11-17 years were assessed at baseline using the Strengths and Difficulties Questionnaire. Educational attainment was assessed at the 6-year follow-up based on level of education, failure to attain the expected level of education, and dropout from vocational or academic training. Findings from logistic regression analyses suggest that more pronounced externalizing MHP in adolescence predict a lower level of education in early adulthood. We did not find a corresponding effect for internalizing MHP. Adolescents with higher-educated parents were less likely to attain a lower level of education themselves and less likely to fail in attaining their expected level of education. Our findings support that educational attainment presents a central channel for intergenerational reproduction of education and forms an important pathway for upward, but also downward social mobility. The current study emphasizes school as a central setting to implement measures to prevent onset and persistence of MHP and to foster equal opportunities in education.
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Affiliation(s)
- Carina Meißner
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Ann-Katrin Meyrose
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Anne Kaman
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martha Michalkiewicz
- Institute for Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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MacLeod L, Suruliraj B, Gall D, Bessenyei K, Hamm S, Romkey I, Bagnell A, Mattheisen M, Muthukumaraswamy V, Orji R, Meier S. A Mobile Sensing App to Monitor Youth Mental Health: Observational Pilot Study. JMIR Mhealth Uhealth 2021; 9:e20638. [PMID: 34698650 PMCID: PMC8579216 DOI: 10.2196/20638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/02/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
Background Internalizing disorders are the most common psychiatric problems observed among youth in Canada. Sadly, youth with internalizing disorders often avoid seeking clinical help and rarely receive adequate treatment. Current methods of assessing internalizing disorders usually rely on subjective symptom ratings, but internalizing symptoms are frequently underreported, which creates a barrier to the accurate assessment of these symptoms in youth. Therefore, novel assessment tools that use objective data need to be developed to meet the highest standards of reliability, feasibility, scalability, and affordability. Mobile sensing technologies, which unobtrusively record aspects of youth behaviors in their daily lives with the potential to make inferences about their mental health states, offer a possible method of addressing this assessment barrier. Objective This study aims to explore whether passively collected smartphone sensor data can be used to predict internalizing symptoms among youth in Canada. Methods In this study, the youth participants (N=122) completed self-report assessments of symptoms of anxiety, depression, and attention-deficit hyperactivity disorder. Next, the participants installed an app, which passively collected data about their mobility, screen time, sleep, and social interactions over 2 weeks. Then, we tested whether these passive sensor data could be used to predict internalizing symptoms among these youth participants. Results More severe depressive symptoms correlated with more time spent stationary (r=0.293; P=.003), less mobility (r=0.271; P=.006), higher light intensity during the night (r=0.227; P=.02), and fewer outgoing calls (r=−0.244; P=.03). In contrast, more severe anxiety symptoms correlated with less time spent stationary (r=−0.249; P=.01) and greater mobility (r=0.234; P=.02). In addition, youths with higher anxiety scores spent more time on the screen (r=0.203; P=.049). Finally, adding passively collected smartphone sensor data to the prediction models of internalizing symptoms significantly improved their fit. Conclusions Passively collected smartphone sensor data provide a useful way to monitor internalizing symptoms among youth. Although the results replicated findings from adult populations, to ensure clinical utility, they still need to be replicated in larger samples of youth. The work also highlights intervention opportunities via mobile technology to reduce the burden of internalizing symptoms early on.
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Affiliation(s)
- Lucy MacLeod
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Dominik Gall
- Department of Psychology, University of Würzburg, Würzburg, Germany
| | - Kitti Bessenyei
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Sara Hamm
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Isaac Romkey
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | | | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Reinauer C, Platzbecker AL, Viermann R, Domhardt M, Baumeister H, Foertsch K, Linderskamp H, Krassuski L, Staab D, Minden K, Kilian R, Holl RW, Warschburger P, Meißner T. Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions: A Cluster Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2127622. [PMID: 34596672 PMCID: PMC8486984 DOI: 10.1001/jamanetworkopen.2021.27622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Despite the high prevalence of anxiety and depression in youths with chronic medical conditions (CMCs), physicians encounter substantial barriers in motivating these patients to access mental health care services. OBJECTIVE To determine the efficacy of motivational interviewing (MI) training for pediatricians in increasing youths' use of mental health care. DESIGN, SETTING, AND PARTICIPANTS The COACH-MI (Chronic Conditions in Adolescents: Implementation and Evaluation of Patient-Centered Collaborative Healthcare-Motivational Interviewing) study was a single-center cluster randomized clinical trial at the University Children's Hospital specialized outpatient clinics in Düsseldorf, Germany. Treating pediatricians were cluster randomized to a 2-day MI workshop or treatment as usual (TAU). Patient recruitment and MI conversations occurred between April 2018 and May 2020 with 6-month follow-up and 1-year rescreening. Participants were youths aged 12 to 20 years with CMCs and comorbid symptoms of anxiety and depression; they were advised by their MI-trained or untrained physicians to access psychological counseling services. Statistical analysis was performed from October 2020 to April 2021. INTERVENTIONS MI physicians were trained through a 2-day, certified MI training course; they recommended use of mental health care services during routine clinical appointments. MAIN OUTCOMES AND MEASURES The primary outcome of uptake of mental health care services within the 6-month follow-up was analyzed using a logistic mixed model, adjusted for the data's cluster structure. Uptake of mental health services was defined as making at least 1 appointment by the 6-month follow-up. RESULTS Among 164 youths with CMCs and conspicuous anxiety or depression screening, 97 (59%) were female, 94 (57%) had MI, and 70 (43%) had TAU; the mean (SD) age was 15.2 (1.9) years. Compared with patients receiving TAU, the difference in mental health care use at 6 months among patients whose physicians had undergone MI training was not statistically significant (odds ratio [OR], 1.96; 95% CI, 0.98-3.92; P = .06). The effect was moderated by the subjective burden of disease (F2,158 = 3.42; P = .04). Counseling with an MI-trained physician also led to lower anxiety symptom scores at 1-year rescreening (F1,130 = 4.11; P = .045). MI training was associated with longer conversations between patients and physicians (30.3 [16.7] minutes vs 16.8 [12.5] minutes; P < .001), and conversation length significantly influenced uptake rates across conditions (OR, 1.03; 95% CI, 1.01-1.06; P = .005). CONCLUSIONS AND RELEVANCE In this study, use of MI in specialized pediatric consultations did not increase the use of mental health care services among youths with CMCs but did lead to longer patient-physician conversations and lower anxiety scores at 1 year. Additional research is required to determine whether varying scope and duration of MI training for physicians could encourage youths with CMCs to seek counseling and thus improve integrated care models. TRIAL REGISTRATION German Trials Registry: DRKS00014043.
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Affiliation(s)
- Christina Reinauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Lena Platzbecker
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rabea Viermann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Katharina Foertsch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hannah Linderskamp
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lisa Krassuski
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin, and Charité, University Medicine, Berlin, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, University of Ulm and BKH Günzburg, Günzburg, Germany
| | - Reinhard W. Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Petra Warschburger
- Department of Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - Thomas Meißner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
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Jaite C, Hoffmann F, Seidel A, Mattejat F, Bachmann C. [Outpatient Psychological Therapies in Children and Adolescents in Germany: Status Quo and Time Trends, 2009-2018]. PSYCHIATRISCHE PRAXIS 2021; 49:304-312. [PMID: 34352894 DOI: 10.1055/a-1540-4958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the prevalence of outpatient psychological therapies (PT) in youths with statutory health insurance in Germany. METHODS Based on statutory health insurance funds data for 2009-2018, the prevalence of outpatient PT was assessed, stratified by sex, age, and federal state. Psychotherapeutic specialty, coded psychiatric diagnoses, and type of PT were also analysed. RESULTS In 2018, 7.3 % received any form of PT (2009: 7.1 %). Of these, 18.4 % (2009: 12.8 %) received therapy according to the directives for psychotherapy (dPT), with CBT (since 2012) being most frequently used. PT prevalence was highest in 15- to 19-year olds, and only marginally differed by sex. Child psychiatrists delivered the majority of PTs. Main diagnoses were anxiety/emotional disorders, ADHD, and adjustment disorders. CONCLUSION During the studied period, PT prevalence has not changed markedly. Yet, the share of dPT has increased, with CBT ranking top.
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Affiliation(s)
- Charlotte Jaite
- Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters
| | - Falk Hoffmann
- Carl von Ossietzky Universität Oldenburg, Abteilung Ambulante Versorgung und Pharmakoepidemiologie
| | - Anja Seidel
- Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Fachbereich Versorgungsforschung, Systemanalyse und Data Science
| | | | - Christian Bachmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
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Szota K, Schulte KL, Christiansen H. Kompetenzerleben von Psychotherapeut_innen im Umgang mit Kindern und Jugendlichen mit Gewalterfahrungen und Traumafolgestörungen. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die psychotherapeutische Versorgung von Kindern und Jugendlichen mit psychischen Störungen nach Gewalterfahrungen ist ungenügend. Zu ihrer Verbesserung wird eine routinemäßige Exploration von Gewalterfahrungen und Traumafolgestörungen und eine evidenzbasierte Behandlung empfohlen. Behandelnde berichten jedoch Unsicherheiten und Befürchtungen dahingehend. Fragestellung: Beeinflusst das therapeutische Kompetenzerleben das konfrontative Vorgehen, den Einbezug von Bezugspersonen, die berufliche Belastung und das Interesse an Weiterbildungen? Methode: 323 Psychotherapeut_innen nahmen an der Online-Umfrage teil. Zur Beantwortung der Fragestellung wurde ein Strukturgleichungsmodell spezifiziert und geprüft. Ergebnisse: Ein höheres Kompetenzerleben ist mit einem konfrontativeren Vorgehen, einem häufigeren Einbezug von Bezugspersonen und einer geringeren beruflichen Belastung assoziiert, nicht jedoch mit einem geringeren Weiterbildungsinteresse. Organisatorische Aspekte werden als häufigste Gründe gegen Weiterbildungen genannt. Diskussion und Schlussfolgerung: Es ergeben sich praktische Implikationen für die inhaltliche und organisatorische Gestaltung von Weiterbildungen und Supervisionen.
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Supke M, Ferling C, Hahlweg K, Schulz W. Persistence and course of mental health problems from childhood into adolescence: results of a 10-year longitudinal study. BMC Psychol 2021; 9:38. [PMID: 33640034 PMCID: PMC7912888 DOI: 10.1186/s40359-021-00535-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health problems (MHP) in children and adolescents (CA) are common. This longitudinal study analyzed the prevalence, course, and persistence of MHP over 10 years from childhood into adolescence based on a sample from the Future Family project (N = 230). METHODS At the pre-assessment point the children were on average 5 (SE = 1) and the mothers 35 (SE = 5) years old. Descriptive methods, Chi2-tests, binary logistic regression, and different analytical approaches (number chains, transition probability) were used. RESULTS Approximately 24% of the CA suffered from borderline clinical or clinically relevant MHP. The largest proportion of the sample was stable healthy (70%), whereas 15% of the CA showed chronic mentally ill, 8% transient, 4% negative and 4% positive courses. The mental health of the mother proved to be a decisive predictor for chronic mentally ill courses. Short-term persistence rates ranged between 60 and 70% from one assessment point to the next one. On the other hand, long-term persistence rates (from childhood into adolescence) were lower (51-59%). CONCLUSION One in seven children in this sample suffered from chronic MHP, while only one third of the CA in Germany with clinically relevant MHP take advantage of psychological or psychiatric care. Prevention programs should be considered as an effective and economic approach to reduce childhood suffering in Germany.
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Affiliation(s)
- Max Supke
- Institute for Psychology, Technical University Brunswick, Humboldtstr. 33, 38106, Braunschweig, Germany.
| | - Caterina Ferling
- Institute for Psychology, Technical University Brunswick, Humboldtstr. 33, 38106, Braunschweig, Germany
| | - Kurt Hahlweg
- Institute for Psychology, Technical University Brunswick, Humboldtstr. 33, 38106, Braunschweig, Germany
| | - Wolfgang Schulz
- Institute for Psychology, Technical University Brunswick, Humboldtstr. 33, 38106, Braunschweig, Germany
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Decke S, Deckert K, Lang M, Laub O, Loidl V, Schwettmann L, Grill E. "We're in good hands there." - Acceptance, barriers and facilitators of a primary care-based health coaching programme for children and adolescents with mental health problems: a qualitative study (PrimA-QuO). BMC FAMILY PRACTICE 2020; 21:273. [PMID: 33341115 PMCID: PMC7749989 DOI: 10.1186/s12875-020-01344-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
Background 11.5 % of girls and 17.8 % of boys are affected by a mental health problem (MHP). The most prevalent problem areas are behavioural problems (girls/boys in %: 11.9/17.9), emotional problems (9.7/8.6) and hyperactivity problems (4.8/10.8). Primary care paediatricians are the first in line to be contacted. Nevertheless, even for less severely affected patients, referral rates to specialised care are constantly high. Therefore, a major statutory health insurance fund introduced a Health Coaching (HC) programme, including a training concept for paediatricians, standardised guidelines for actions and additional payments to strengthen primary care consultation for MHP and to decrease referrals to specialised care. The aim of this study was to examine how the HC is perceived and implemented in daily practice to indicate potential strengths and challenges. Methods During a one-year period starting in November 2017, a series of guideline-based interviews were conducted by phone with HC-developers, HC-qualified paediatricians, parents and patients (≥14 years) treated according to the HC programme. Paediatricians were selected from a Bavarian practice network with a total of 577 HC qualified paediatricians. Parents of patients with the four most common MHP diagnoses were approached by their health insurance: [World Health Organization, 2013] developmental disorder of speech and language [Wille N, et al., 2008] head/abdominal pain (somatoform) [Holling H, et al., 2003-2006 and 2009-2012] conduct disorder [Plass-Christl A, et al., 2018] non-organic enuresis. 23 paediatricians, 314 parents and 10 adolescents consented to be interviewed. Potential participants were selected based on purposeful sampling, according to principles of maximum variance. All interviews were recorded and transcribed verbatim. Two researchers analysed the transcripts independently of each other. Structuring content analysis derived from Mayring was used for analysis. Results 11 paediatricians, 3 co-developers, 22 parents and 4 adolescents were included. Families were generally satisfied with paediatric care received in the programme’s context. The HC supported paediatricians’ essential role as consultants and improved their diagnostic skills. Lack of time, financial restrictions and patients’ challenging family structures were reported as major barriers to success. Conclusion The HC programme is perceived as a facilitator for more patient-centred care. However, structural barriers remain. Starting points for improvement are further options to strengthen families’ resources and expanded interdisciplinary networking. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01344-1.
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Affiliation(s)
- Siona Decke
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany. .,Pettenkofer School of Public Health, Munich, Germany.
| | | | - Martin Lang
- Berufsverband der Kinder- und Jugendärzte (BVKJ) e.V., Cologne, Germany.,PaedNetz Bayern e.V., Munich, Germany
| | - Otto Laub
- PaedNetz Bayern e.V., Munich, Germany
| | - Verena Loidl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management (IGM), Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany. .,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.
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Abstract
A substantial number of children experience persistent or recurrent problems and may need more than one episode of care. However, there is a paucity of research on recurrent service use. The present study examined the rates and predictors of re-accessing community-based care. Secondary data analyses were conducted on administrative data from 5 mental health agencies in Ontario (N = 1802). Approximately a third (29.6%) of children who had an episode of care re-accessed services again within 4 years; the median time to re-access was 386 days or 12.68 months. Social content (e.g., age, parental marital status) and treatment system (e.g., spacing of visits) variables predicted re-accessing services, although predictors varied based on how services were re-accessed. A better understanding of the factors that influence recurrent service use may help mental health agencies better prepare for and facilitate this process for families.
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Geirhos A, Domhardt M, Galler A, Reinauer C, Warschburger P, Müller-Stierlin AS, Minden K, Temming S, Holl RW, Baumeister H. Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1264-6590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungJugendliche und junge Erwachsene mit Typ-1-Diabetes sind häufig von komorbiden psychischen Störungen betroffen. Dabei zeigt die Studienlage zur Verbreitung ein heterogenes und inkonsistentes Bild. Diagnose und Behandlung der somatopsychischen Begleiterkrankungen beeinflussen den Behandlungs- und Krankheitsverlauf sowie die Lebensqualität der Betroffenen. Trotzdem wird dies in der klinischen Praxis selten frühzeitig berücksichtigt. Das multizentrische Verbundprojekt COACH verfolgt das Ziel, die Erkennung und Behandlung psychischer Komorbidität für diese Zielgruppe in der bundesweiten Routineversorgung zu optimieren.
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Affiliation(s)
- Agnes Geirhos
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Matthias Domhardt
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Pädiatrische Endokrinologie und Diabetologie, Berlin, Germany
| | - Christina Reinauer
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Annabel S. Müller-Stierlin
- Sektion Gesundheitsökonomie und Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Germany
| | - Kirsten Minden
- Klinik für Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, kooperatives Mitglied der Freien Universität Berlin, der Humboldt-Universität zu Berlin und des Berliner Instituts für Gesundheitsforschung, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie, Germany
| | - Svenja Temming
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Reinhard W. Holl
- ZIBMT, Institut für Epidemiologie und medizinische Biometrie, Universität Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherburg, Germany
| | - Harald Baumeister
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
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Lunkenheimer F, Domhardt M, Geirhos A, Kilian R, Mueller-Stierlin AS, Holl RW, Meissner T, Minden K, Moshagen M, Ranz R, Sachser C, Staab D, Warschburger P, Baumeister H. Effectiveness and cost-effectiveness of guided Internet- and mobile-based CBT for adolescents and young adults with chronic somatic conditions and comorbid depression and anxiety symptoms (youthCOACH CD): study protocol for a multicentre randomized controlled trial. Trials 2020; 21:253. [PMID: 32164723 PMCID: PMC7069009 DOI: 10.1186/s13063-019-4041-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adolescents and young adults (AYA) with chronic somatic conditions have an increased risk of comorbid depression and anxiety symptoms. Internet- and mobile-based cognitive behavioural therapy (iCBT) might be one possibility to extend the access to evidence-based treatments. Studies suggest that guided iCBT can reduce anxiety and depression symptoms in AYA. However, little is known about the effectiveness of iCBT for AYA with chronic somatic conditions and comorbid symptoms of anxiety and/or depression in routine care. Evidence on the (cost-)effectiveness of iCBT is essential for its implementation in health care. OBJECTIVES AND METHODS This multicentre two-armed randomized controlled trial (RCT) aims to evaluate the (cost-) effectiveness of guided iCBT (youthCOACHCD) in addition to treatment as usual (TAU) compared to enhanced treatment as usual (TAU+) in AYA aged 12-21 years with one of three chronic somatic conditions (type 1 diabetes, cystic fibrosis, or juvenile idiopathic arthritis). AYA with one of the chronic somatic conditions and elevated symptoms of anxiety or depression (Patient Health Questionnaire [PHQ-9] and/or Generalized Anxiety Disorder [GAD-7] Screener score ≥ 7) will be eligible for inclusion. We will recruit 212 patients (2 × n = 106) in routine care through three German patient registries. Assessments will take place at baseline and at 6 weeks, 3 months, 6 months, and 12 months post-randomization. The primary outcome will be combined depression and anxiety symptom severity as measured with the PHQ Anxiety and Depression Scale. Secondary outcomes will include health-related quality of life, coping strategies, self-efficacy, stress-related personal growth, social support, behavioural activation, adjustment and trauma-related symptoms, automatic thoughts, intervention satisfaction, working alliance, and Internet usage. The cost-effectiveness will be determined, and potential moderators and mediators of intervention effects will be explored. DISCUSSION iCBT might implicate novel ways to increase the access to evidence-based interventions in this specific population. The distinct focus on effectiveness and cost-effectiveness of youthCOACHCD in patients with chronic somatic conditions, as well as intervention safety, will most likely provide important new insights in the field of paediatric e-mental health. A particular strength of the present study is its implementation directly into routine collaborative health care. As such, this study will provide important insights for health care policy and stakeholders and indicate how iCBT can be integrated into existing health care systems. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00017161. Registered on 17 September 2019.
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Affiliation(s)
- Frederike Lunkenheimer
- Department of Clinical Psychology and Psychotherapy, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany
| | - Agnes Geirhos
- Department of Clinical Psychology and Psychotherapy, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ulm University, Günzburg, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University of Düsseldorf, Düsseldorf, Germany
| | - Kirsten Minden
- Charité University Medicine Berlin, Berlin, Germany
- German Rheumatism Research Centre, Berlin, Germany
| | - Morten Moshagen
- Department of Psychological Research Methods, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Ramona Ranz
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - Cedric Sachser
- Clinic of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Doris Staab
- Charité University Medicine Berlin, Berlin, Germany
| | - Petra Warschburger
- Department Psychology, Counselling Psychology, University of Potsdam, Potsdam, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany.
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Adolescents' Views on Seeking Help for Emotional and Behavioral Problems: A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010191. [PMID: 31892118 PMCID: PMC6981849 DOI: 10.3390/ijerph17010191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 11/25/2022]
Abstract
This study aimed to get insight into adolescents’ views on help-seeking for emotional and behavioral problems. Fourteen focus groups were conducted. Two vignettes, depicting one healthy adolescent with few issues and one adolescent with severe psychosocial problems, were used to structure the focus groups. The focus groups were framed within a youth help-seeking model. Adolescents (mean age of 15.0 years) generally reported seeking help from friends or the internet for mild issues and from a person they trust like a parent or school mentor, for more severe problems. Adolescents correctly recognized the issues in vignette one as surmountable and the problems in vignette two as severe. A bond of trust with a help source was regarded as the main facilitator for the decision to seek help. Adolescents reported a preference for help sources who clearly displayed their expertise for the issue at hand and for informal help-sources, particularly friends.
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Meyrose AK, Wüstner A, Otto C, Lampert T, Ravens-Sieberer U. [Associations of maternal educational background with health and health behavior in infants]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1067-1076. [PMID: 31440768 DOI: 10.1007/s00103-019-02998-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The basis for healthy development is established during the first years of one's life. In this early phase, parents can significantly influence the health conditions under which their child grows up. Parental education can play a key role in this regard. This study examines the association of maternal education with health and health behavior in infants. METHODS A subsample of the representative German KiGGS study (Wave 1, 2009-2012) on the health of children and adolescents was investigated. Data from 1727 mothers who reported on health-specific characteristics of their infants (0 to 2 years), on their own educational background, and on characteristics of the family were analyzed. The influence of maternal education on indices of health and health behavior in infants was investigated by means of logistic regression; additional predictors were considered in regression models. RESULTS Higher maternal education was associated with better health behavior, but not with overall infant health. The impact of maternal education on health behavior remained significant when considering other predictors (financial worries, low maternal age at childbirth, premature birth/low birth weight). Overall, low maternal education was accompanied by an accumulation of additional risks. CONCLUSIONS Higher maternal education can help infants have a good start in their lives. The impact of poor health behavior on infant health may not become apparent until later in their lives. For prevention and intervention, it is important to identify sensitive stages of development during childhood and the underlying mechanisms of the relationship between maternal education and infant health behavior.
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Affiliation(s)
- Ann-Katrin Meyrose
- Zentrum für Psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Anne Wüstner
- Zentrum für Psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Christiane Otto
- Zentrum für Psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Thomas Lampert
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Soziale Determinanten der Gesundheit, Robert Koch-Institut, Berlin, Deutschland
| | - Ulrike Ravens-Sieberer
- Zentrum für Psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
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Daeem R, Mansbach-Kleinfeld I, Farbstein I, Apter A, Elias R, Ifrah A, Chodick G, Fennig S. Barriers to help-seeking in Israeli Arab minority adolescents with mental health problems: results from the Galilee study. Isr J Health Policy Res 2019; 8:45. [PMID: 31122285 PMCID: PMC6532130 DOI: 10.1186/s13584-019-0315-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Galilee Study assessed mental health service needs among Israeli Muslim and Druze adolescents and their mothers. Studies show that mothers of adolescents belonging to the Arab minority have much lower help-seeking rates than Jewish mothers. This paper examines mothers' structural and cultural barriers to help-seeking. METHODS All 9th grade students living in 5 towns representative of Muslim and Druze localities in northern Israel, were eligible for the study and 1639 (69.3%) obtained parental agreement and participated. Emotional or behavioral problem were assessed in the classroom using the Strengths and Difficulties Questionnaire. A total of 704 adolescent-mother dyads participated in the follow-up, and were interviewed at home, using the Development and Well Being Assessment inventory, the Composite Barriers to Help-Seeking Questionnaire, the General Health Questionnaire - 12, the Subjective Feelings of Discrimination Index and socio-demographic questions. Pearson χ2 test and multivariate binary logistic regressions were performed to analyze mothers' consultation rates by risk factors. Exploratory factor analysis was performed to identify underlying factors and assess construct validity of the Composite Barriers to Help-Seeking Questionnaire, and also mean scores and standard deviations for the distinct scales were calculated. RESULTS More mothers of adolescents with a mental disorder than those without a mental disorder consulted a professional or school source (39.7% vs. 20.5%; χ2 = 45.636; p = < 0.001). The most important barriers to help-seeking were those related to "Accessibility", followed by barriers related to the belief that "Treatment is detrimental" and to the possibility of "Reprisal by authorities". Barriers related to "Stigma" and "Distrust of professionals" had the lowest means scores. Differences by ethnicity/religion were found. CONCLUSIONS Structural barriers related to lack of access, were considered the main obstacle to help-seeking in this Israeli Arab minority population. Cultural barriers such as stigma were considered of secondary importance. Structural barriers could be reduced by increasing the number of accessible public mental health clinics in the minority localities, a responsibility of the Ministry of Health and the HMOs. Information campaigns and psychoeducation for parents would help reduce other barriers to mental health treatment.
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Affiliation(s)
- Raida Daeem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100 Zefat, Israel
| | - Ivonne Mansbach-Kleinfeld
- The Feinberg Child Study Center, Schneider Medical Center for Children in Israel, 49202 Petach Tikvah, Israel
| | - Ilana Farbstein
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100 Zefat, Israel
| | - Alan Apter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Psychiatry, Schneider Children’s Medical Center of Israel, 49202 Petach Tikva, Israel
- Ruppin Academic Center, Netanya, Israel
- Inter-Disciplinary Center, Herzliya, Israel
| | - Rasha Elias
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100 Zefat, Israel
| | - Anneke Ifrah
- Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, 5265601 Tel Hashomer, Israel
| | - Gabriel Chodick
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
- Epidemiology and Data Base, MaccabiTech, Tel Aviv, Israel
| | - Silvana Fennig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Psychiatry, Schneider Children’s Medical Center of Israel, 49202 Petach Tikva, Israel
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Heradstveit O, Skogen JC, Hetland J, Stewart R, Hysing M. Psychiatric Diagnoses Differ Considerably in Their Associations With Alcohol/Drug-Related Problems Among Adolescents. A Norwegian Population-Based Survey Linked With National Patient Registry Data. Front Psychol 2019; 10:1003. [PMID: 31133937 PMCID: PMC6517475 DOI: 10.3389/fpsyg.2019.01003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/15/2019] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to examine alcohol/drug use and problems across psychiatric diagnoses and to what extent associations between each psychiatric diagnosis and alcohol/drug use and problems were independent from the potential confounding effects of psychiatric comorbidity, socioeconomic status, sex and age. We used a dataset comprising a linkage between a large population-based and cross-sectional study among Norwegian adolescents (the youth@hordaland conducted in 2012) and national registry-based data on specialist mental health care use during the 4 years prior to the survey (2008 to 2011). The study sample included 16 to 19 year olds who participated in the youth@hordaland survey and consented to the linkage with patient registry data (n = 9,408). Among these, 853 (9%) had received specialist mental health care and comprised the clinical group, while the rest (n = 8,555) comprised the comparison group. The main outcome variables were several self-reported indicators for alcohol/drug use, including any alcohol use, frequent alcohol intoxication, high-level alcohol consumption, and lifetime illicit drug use, as well as one indicator for potential alcohol/drug-related problems: a positive CRAFFT-score. Adolescents receiving specialist mental health care (n = 853) reported more frequently alcohol/drug use and problems compared to adolescents not receiving these services (Cohens d's ranging from 0.09 to 0.29, all p ≤ 0.01). Anxiety, depression, conduct disorders, eating disorders, ADHD, and trauma-related disorders were all associated with single measures of alcohol/drug use and problems, with odds ratios (ORs) ranging from 1.58 to 4.63, all p < 0.05) in unadjusted models. Trauma-related disorders, depression and conduct disorders were also positively associated with higher scores on a combined indicator of alcohol/drug use and problems (ORs ranging from 1.89 to 3.15, all p < 0.01), even after the full adjustment from psychiatric comorbidity and sociodemographic variables (adjusted odds ratios ranging from 1.61 to 2.79, p < 0.05). These results suggest that alcohol/drug use and problems were slightly more common among adolescents who received specialist mental health care during the past 4 years compared with the general adolescent population, and adolescents with trauma-related disorders, depression and conduct disorders were high-risk groups for alcohol/drug use and problems.
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Affiliation(s)
- Ove Heradstveit
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Centre, Bergen, Norway
| | - Jens Christoffer Skogen
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Jørn Hetland
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mari Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Centre, Bergen, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
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Canals-Sans J, Hernández-Martínez C, Sáez-Carles M, Arija-Val V. Prevalence of DSM-5 depressive disorders and comorbidity in Spanish early adolescents: Has there been an increase in the last 20 years? Psychiatry Res 2018; 268:328-334. [PMID: 30096661 DOI: 10.1016/j.psychres.2018.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/31/2018] [Accepted: 07/13/2018] [Indexed: 12/21/2022]
Abstract
The aim of the study was to investigate the current prevalence of DSM-5 Depressive Disorders (DD) among Spanish school children and compare it with data obtained 20 years ago from the same place. We assessed comorbidity, severity and sociodemographic related factors. With a double-phase design, a sample of 1514 students participated in the 1st phase and 562 students (175 at risk of depression) were assessed in the 2nd phase with the Mini-International Neuropsychiatric Interview for Kids. The estimated current prevalence of Major Depressive Disorder (MDD) was 1.6%, similar to the 1.5% found 20 years ago. A total of 3.4% were diagnosed with some form of DD (MDD or Persistent Depressive Disorder (PDD)). No significant differences between genders were found in either of the two periods studied. The rate of depressive symptoms (11.6%) was not significantly different from that of previous data (9.4%). 80% and 71.9% of the children diagnosed with MDD and PDD respectively also had an anxiety disorder. In conclusion, we have not found an increase in depression among Spanish early adolescents. However, the data on the prevalence of DD, the comorbidity, and the impairment all highlight the need to design and implement appropriate preventive interventions in schools.
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Affiliation(s)
- Josefa Canals-Sans
- Department of Psychology, Research Center for Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, Ctra. Valls S/N, 43007 Tarragona, Spain.
| | - Carmen Hernández-Martínez
- Department of Psychology, Research Center for Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, Ctra. Valls S/N, 43007 Tarragona, Spain.
| | - Mercè Sáez-Carles
- Department of Psychology, Research Center for Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, Ctra. Valls S/N, 43007 Tarragona, Spain.
| | - Victoria Arija-Val
- Unit of Preventive Medicine and Public Health, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, C/Sant Llorenç, 21, 43201 Reus, Spain.
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Predictive value of dysregulation profile trajectories in childhood for symptoms of ADHD, anxiety and depression in late adolescence. Eur Child Adolesc Psychiatry 2018; 27:767-774. [PMID: 29071438 DOI: 10.1007/s00787-017-1059-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/25/2017] [Indexed: 01/10/2023]
Abstract
We examined whether there are certain dysregulation profile trajectories in childhood that may predict an elevated risk for mental disorders in later adolescence. Participants (N = 554) were drawn from a representative community sample of German children, 7-11 years old, who were followed over four measurement points (baseline, 1, 2 and 6 years later). Dysregulation profile, derived from the parent report of the Strengths and Difficulties Questionnaire, was measured at the first three measurement points, while symptoms of attention deficit hyperactivity disorder (ADHD), anxiety and depression were assessed at the fourth measurement point. We used latent class growth analysis to investigate developmental trajectories in the development of the dysregulation profile. The predictive value of dysregulation profile trajectories for later ADHD, anxiety and depression was examined by linear regression. For descriptive comparison, the predictive value of a single measurement (baseline) was calculated. Dysregulation profile was a stable trait during childhood. Boys and girls had similar levels of dysregulation profile over time. Two developmental subgroups were identified, namely the low dysregulation profile and the high dysregulation profile trajectory. The group membership in the high dysregulation profile trajectory (n = 102) was best predictive of later ADHD, regardless of an individual's gender and age. It explained 11% of the behavioural variance. For anxiety this was 8.7% and for depression 5.6%, including some gender effects. The single-point measurement was less predictive. An enduring high dysregulation profile in childhood showed some predictive value for psychological functioning 4 years later. Hence, it might be helpful in the preventive monitoring of children at risk.
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Wagner G, Zeiler M, Waldherr K, Philipp J, Truttmann S, Dür W, Treasure JL, Karwautz AFK. Mental health problems in Austrian adolescents: a nationwide, two-stage epidemiological study applying DSM-5 criteria. Eur Child Adolesc Psychiatry 2017; 26:1483-1499. [PMID: 28540609 PMCID: PMC5701961 DOI: 10.1007/s00787-017-0999-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/08/2017] [Indexed: 01/01/2023]
Abstract
This is a nationwide epidemiological study using DSM-5 criteria to assess the prevalence of mental disorders in a large sample of Austrian adolescents between 10 and 18 years including hard-to-reach samples. A sample of 3615 adolescents from four cohorts (school grades 5, 7, 9, 11; age range 10-18 years) was recruited from 261 schools, samples of unemployed adolescents (n = 39) and adolescents from mental health institutions (n = 137) were added. The Youth Self-Report and SCOFF were used to screen for mental health problems. In a second phase, the Childrens' Diagnostic Interview for Mental Disorders was used to make point and lifetime psychiatric diagnoses. Mental health service use was also assessed. Point prevalence and lifetime prevalence rates for at least one psychiatric disorder were 23.9% and 35.8%. The highest lifetime prevalence rates were found for anxiety disorders (15.6%), neurodevelopmental disorders (9.3%; ADHD 5.2%) and depressive disorders (6.2%). Forty-seven percent of adolescents with a lifetime psychiatric disorder had a second diagnosis. Internalising disorders were more prevalent in girls, while neurodevelopmental disorders and disruptive, impulse control and conduct disorders were more prevalent in boys. Of those with a lifetime psychiatric disorder, 47.5% had contacted mental health services. Of the residual 52.5% who had not contacted mental health services, 18.1% expressed an interest in treatment. DSM-5 mental health disorders are highly prevalent among Austrian adolescents. Over 50% had or were interested in accessing treatment. Early access to effective interventions for these problems is needed to reduce burden due to mental health disorders.
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Affiliation(s)
- Gudrun Wagner
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Michael Zeiler
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Health Promotion Research, Untere Donaustraße 47/3, 1020, Vienna, Austria
| | - Karin Waldherr
- Ludwig Boltzmann Institute Health Promotion Research, Untere Donaustraße 47/3, 1020, Vienna, Austria
- FernFH Distance - Learning University of Applied Sciences, Zulingergasse 4, 3200, Wiener Neustadt, Austria
| | - Julia Philipp
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefanie Truttmann
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Wolfgang Dür
- Ludwig Boltzmann Institute Health Promotion Research, Untere Donaustraße 47/3, 1020, Vienna, Austria
| | - Janet L Treasure
- Institute of Psychiatry, Psychology and Neuroscience, Kings College University, London, UK
| | - Andreas F K Karwautz
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Mental Health Care Use in Children of Parents with Mental Health Problems: Results of the BELLA Study. Child Psychiatry Hum Dev 2017; 48:983-992. [PMID: 28421318 DOI: 10.1007/s10578-017-0721-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Whether parental mental health problems facilitate or hinder the use of mental health care of the parents´ children is still unclear. The present cross sectional study examined mental health care use and potential predictors in a population based sample. Children of parents with mental health problems (CPM) were nearly 5 times more likely to use mental health care compared to children of parents without mental health problems. A multiple regression analysis revealed that the most important predictors of mental health care use for CPM were active family life (OR = 2.67) and children´s own mental health problems (OR = 1.18 self-report, 1.17 parent-report). Additionally, parental strain showed a tendency to predict mental health care use (OR = 2.45). This study demonstrates that parental mental health problems are associated with mental health care use in their children and that improving certain family factors may support children´s mental health care use.
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Münzer A, Rosner R, Ganser HG, Naumann A, Plener PL, Witt A, Goldbeck L. Usual Care for Maltreatment-Related Pediatric Posttraumatic Stress Disorder in Germany. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 46:135-141. [PMID: 29035141 DOI: 10.1024/1422-4917/a000548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Child maltreatment represents a major risk factor for the development of emotional and behavioral problems, especially posttraumatic stress disorder (PTSD). While effective trauma-focused treatments are available, little is known about the usual mental healthcare for abused youths in Germany. The present study compared the utilization of mental healthcare in abused youths who had developed a PTSD (N = 95) with a group presenting other mental disorders (N = 146). Semistructured interviews were used to assess maltreatment histories, current mental health, and healthcare utilization. In addition, potential child factors associated with access to mental healthcare (age and level of functioning) were examined. Results showed that 65 % of both diagnostic groups currently fail to use any mental healthcare service. Of the participants with PTSD, 43 (45 %) had never received any mental healthcare intervention. Investigations on potential barriers are necessary to close the huge gap between clinical services and evidence-based, trauma-focused interventions.
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Affiliation(s)
- Annika Münzer
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Rita Rosner
- 2 Department of Psychology, Catholic University Eichstätt-Ingolstadt, Germany
| | - Helene Gertrud Ganser
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Alexander Naumann
- 3 Department of Child and Adolescent Psychiatry/Psychotherapy, Lüneburg Psychiatric Hospital, Lüneburg, Germany
| | - Paul L. Plener
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Andreas Witt
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Lutz Goldbeck
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
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Abbas S, Ihle P, Adler JB, Engel S, Günster C, Holtmann M, Kortevoss A, Linder R, Maier W, Lehmkuhl G, Schubert I. Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders. Eur Child Adolesc Psychiatry 2017; 26:433-444. [PMID: 27628527 DOI: 10.1007/s00787-016-0900-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
Children and adolescents with mental health problems need effective and safe therapies to support their emotional and social development and to avoid functional impairment and progress of social deficits. Though psychotropic drugs seem to be the preferential treatment, psychotherapy and psychosocial interventions are essential in mental health care. For Germany, current data on the utilization of psychotherapy and psychosocial interventions in children with mental health problems is lacking. To analyse why certain children and adolescents with mental or behavioural disorders do and others do not receive non-drug treatment, we assessed predictors associated with specific non-drug psychiatric/psychotherapeutic treatment including psychosocial interventions, psychotherapy and other non-drug treatments. The study is based on data of two large German health insurance funds, AOK and TK, comprising 30 % of the German child and adolescent population. Predictors of non-drug psychiatric/psychotherapeutic treatment were analysed for 23,795 cases and two controls for every case of the same age and sex in children aged 0-17 years following a new diagnosis of mental or behavioural disorder in 2010. Predictors were divided according to Andersen's behavioural model into predisposing, need and enabling factors. The most prominent and significant predictors positively associated with non-drug psychiatric/psychotherapeutic treatment were the residential region as predisposing factor; specific, both ex- and internalizing, mental and behavioural disorders, psychiatric co-morbidity and psychotropic drug use as need factors; and low area deprivation and high accessibility to outpatient physicians and inpatient institutions with non-drug psychiatric/psychotherapeutic department as enabling factors. In conclusion, the present study suggests that the residential region as proxy for supply of therapist and socioeconomic situation is an influencing factor for the use of psychotherapy. The analysis sheds further light on predisposing, need and enabling factors as predictors of non-drug psychotherapeutic/psychiatric treatment in children and adolescents with mental or behavioural health disorders in Germany. More research is needed to further understand the factors promoting the gap between the need and utilization of mental health care.
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Affiliation(s)
- Sascha Abbas
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany
| | - Peter Ihle
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany
| | | | - Susanne Engel
- Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | | | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Axel Kortevoss
- GeoMed Research Forschungsgesellschaft mbH, Bad Honnef, Germany
| | - Roland Linder
- Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | - Werner Maier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Gerd Lehmkuhl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany.
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[Children and adolescents after child abuse and neglect: Do they receive appropriate treatment?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:803-10. [PMID: 27215625 DOI: 10.1007/s00103-016-2351-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Child abuse and neglect (CAN) is a risk factor for the development of psychiatric disorders. Untreated, disorders can sustain into adulthood. OBJECTIVES This study compares rates of psychiatric disorders to mental health care utilization in victims of CAN. METHODS From three regions in Germany, 322 children and adolescents aged between 4 and 17 and a non-abusive caregiver were assessed for the child's history of CAN, mental health and mental health care utilization via semi-structured interviews. RESULTS Approximately two thirds of the participants (present state 64.29 %; lifetime 69.57 %) suffered from a psychiatric disorder classifiable with ICD-10. Posttraumatic stress disorder (25.16 %), conduct disorders (21.34 %) and attention and hyperactivity disorders (16.15 %) were most frequently diagnosed. Merely 19.88 % were using mental health care at the time of the assessment. CONCLUSIONS The provision of mental health care for victims of CAN is insufficient. To improve access to appropriate services for this vulnerable clientele, cooperation between psychiatrists and psychotherapists and the child welfare system is essential. The implementation and dissemination of evidence-based diagnostic methods and treatments must be further advanced.
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Klein J, von dem Knesebeck O. [Social disparities in outpatient and inpatient care: An overview of current findings in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:238-44. [PMID: 26631009 DOI: 10.1007/s00103-015-2283-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
There is controversy about social disparities in healthcare services in Germany, but a differentiated analysis regarding various dimensions of healthcare is lacking. This narrative review intends to summarize conceptually the current state of research and draw subsequent conclusions. Separated into access, utilization and quality, the findings of social inequality in outpatient and inpatient care in Germany are summarized. Besides the common individual indicators of socioeconomic status (SES), regional deprivation and health insurance status are also included. Despite methodical diversity, the results show that healthcare inequalities due to SES exist, but not universally. Furthermore, there is a differentiated pattern respecting separate dimensions of healthcare. Concerning access (e.g. waiting times, co-payments) lower status groups and patients covered by statutory health insurance are deprived. Higher utilization becomes apparent among higher status groups and privately insured patients in terms of specialist consultations and prevention services. The findings regarding quality of process and outcome differ depending on quality indicator and disease. In different dimensions of medical healthcare, social disparities still exist, though the impact on health remains unclear for some types of healthcare inequalities. Moreover, it is often difficult to conclude from unequal outcome quality the inequalities of healthcare. Depending on access, utilization and quality, separate interventions for reducing these disparities are to be introduced.
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Affiliation(s)
- Jens Klein
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20146, Hamburg, Deutschland.
| | - Olaf von dem Knesebeck
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20146, Hamburg, Deutschland
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Prinz N, Bächle C, Becker M, Berger G, Galler A, Haberland H, Meusers M, Mirza J, Plener PL, von Sengbusch S, Thienelt M, Holl RW. Insulin Pumps in Type 1 Diabetes with Mental Disorders: Real-Life Clinical Data Indicate Discrepancies to Recommendations. Diabetes Technol Ther 2016; 18:34-8. [PMID: 26451621 DOI: 10.1089/dia.2015.0180] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The latest American Association of Clinical Endocrinologists/American College of Endocrinologists consensus statement published in 2014 does not recommend continuous subcutaneous insulin infusion (CSII) in patients with mental health problems. This study investigated the use and discontinuation of CSII in daily routine care of type 1 diabetes (T1D) patients with or without comorbid mental disorders. MATERIALS AND METHODS Insulin-treated T1D patients (n = 48,700) between 5 and 30 years of age (median [interquartile range], 15.6 [12.0-17.7] years) from the German/Austrian diabetes patient follow-up registry (DPV) were studied. A comorbid diagnosis and/or specific treatment of mental disorder was documented in 3,158 (6.5%) patients: attention-deficit hyperactivity disorder (ADHD), n = 1,352; depression, n = 692; eating disorders, n = 395; needle phobia, n = 319; anxiety/obsessive compulsive disorder (OCD), n = 231; and psychosis and/or neuroleptic medication, n = 169. Multivariable logistic regression with age, sex, diabetes duration, and migration background as independent variables was used to compare groups. RESULTS After adjustment for confounders, use of CSII was more common in patients with depression (41.5%), anxiety/OCD (41.4%), or needle phobia (75.8%) compared with patients without mental disorders (34.6%) (each P < 0.05). By contrast, psychotic patients (26.2%, P < 0.05) used CSII less often, and patients with ADHD (36.3%) or eating disorders (33.9%) used it with a similar frequency. Compared with patients without mental disorders (5.1%), the rate of CSII discontinuation was higher in patients with ADHD (9.7%), depression (8.2%), or eating disorders (10.0%) (P < 0.05, respectively) but similar in patients with anxiety/OCD (6.0%), psychosis (4.2%), or needle phobia (5.3%). CONCLUSIONS In routine diabetes care, CSII use and discontinuation vary widely among T1D patients with mental disorders and indicate clear differences from the latest recommendations.
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Affiliation(s)
- Nicole Prinz
- 1 Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm , Ulm, Germany . *
| | - Christina Bächle
- 2 Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany . *
| | - Marianne Becker
- 3 Clinic for Children and Adolescents, Dr. Horst-Schmidt-Kliniken GmbH , Wiesbaden, Germany
| | - Gabriele Berger
- 4 Department of Pediatric and Adolescent Medicine, Medical University Vienna , Vienna, Austria
| | - Angela Galler
- 5 Pediatric Endocrinology and Diabetology, University Hospital for Children and Adolescents , Campus Virchow, Charité-University Hospital Berlin , Berlin, Germany
| | - Holger Haberland
- 6 Hospital for Children and Adolescents, Sana Hospital Berlin Lindenhof , Berlin, Germany
| | - Michael Meusers
- 7 Department of Child and Adolescent Psychiatry and Neurology, Community Hospital , Herdecke, Germany
| | - Joaquina Mirza
- 8 Children's Hospital, Hospitals of the City of Cologne , Cologne, Germany
| | - Paul L Plener
- 9 Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm , Ulm, Germany
| | - Simone von Sengbusch
- 10 Clinic for Child and Adolescent Medicine, University Hospital Schleswig-Holstein , Campus Lübeck, Lübeck, Germany
| | - Michaela Thienelt
- 11 Clinic for Children and Adolescents, St. Vincenz Hospital , Christophorus Clinics, Coesfeld, Germany
| | - Reinhard W Holl
- 1 Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm , Ulm, Germany . *
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Klasen F, Otto C, Kriston L, Patalay P, Schlack R, Ravens-Sieberer U. Risk and protective factors for the development of depressive symptoms in children and adolescents: results of the longitudinal BELLA study. Eur Child Adolesc Psychiatry 2015; 24:695-703. [PMID: 25432629 DOI: 10.1007/s00787-014-0637-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Fionna Klasen
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany,
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The longitudinal BELLA study: design, methods and first results on the course of mental health problems. Eur Child Adolesc Psychiatry 2015; 24:651-63. [PMID: 25428179 DOI: 10.1007/s00787-014-0638-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
The high prevalence of mental health problems (MHP) in childhood and adolescence is a global health challenge of the 21st century. Information about age of onset, persistence and development of MHP in young people is necessary to implement effective prevention and intervention strategies. We describe the design and methods of the longitudinal BELLA study, which investigates developmental trajectories of MHP from childhood into adulthood, their determinants, and the utilisation of mental health services. First results on the developmental course of MHP in children and adolescents are reported over a 6-year period. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KiGGS). BELLA examines the mental health and well-being of children and adolescents aged 7-17 years (a representative subsample of KiGGS, n = 2,863 at baseline). Standardised screening measures served to identify MHP at baseline and at follow-ups (1, 2, and 6 years later). Among children and adolescents participating at all measurement points (n = 1,255), 10 % showed clinically significant MHP at baseline (n = 130). Over the 6-year period, 74.3 % showed no signs of MHP (n = 933), 15.5 % had remitted (n = 194), 2.9 % showed persistent (n = 36) and 7.3 % acute or recurrent MHP (n = 92). Overall, MHP were more likely to occur between the age of 7 and 12 and after the age of 19 years. Regarding mental health service use, 33 % of the participants with acute or recurrent MHP (n = 30) and 63.9 % with persistent MHP used mental health services (n = 23). Mental health problems in children and adolescents have a high risk to persist into adulthood. In children and adolescents a low rate of mental health service use was observed, even among those with mental health problems.
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