Religious Identity and its Relation to Health-Related Quality of Life and COVID-Related Stress of Refugee Children and Adolescents in Germany

Research shows that religious identity is associated with health. The aim of this study was to understand the role of religious identity for refugee minors' health in greater detail. Middle Eastern refugee minors resettled in Germany and aged 8-18 years completed questionnaires at baseline (T1, n = 246) and follow-up (T2, n = 122) measurement between 2019 and 2022. Religious identity was assessed with a 4-item measure (Cronbach's α = .89). Associations of religious identity at T1 with health-related quality of life (HRQoL) at T1, change in HRQoL from T1 to T2, and perceived COVID-related stress at T2, as well as the mediating role of resources were examined. The results showed a positive association between religious identity and HRQoL, which was partially mediated by integration into peer group, but not by ethnic identity, sense of coherence or religious practice. No significant associations between religious identity and change in HRQoL or COVID-related stress occurred. Therefore, cross-sectional analyses support the beneficial role of religious identity for HRQoL and the crucial mediating role of integration into peer group, suggesting the promotion of religious identity or peer group integration. However, the absence of significant effects on change in HRQoL from T1 to T2 and COVID-related stress at T2 do not allow drawing any long-term conclusions.

Reasons for non-participation of children and adolescents in a large-scale school-based mental health project

Background

Non-participation in mental health studies is an under-explored but very important topic. Investigating reasons for non-participation holds promise for the planning of future study designs and recruitment strategies. This study aimed at investigating reasons for children and adolescents (C&A) not participating in a school-based mental health research project.

Methods

Data collection took place within the school-based recruitment of a large-scale multi-site project ("ProHEAD-Promoting Help-seeking using E-technology for Adolescents") in Germany. Participants were N = 534 C&A aged ≥ 12 years attending secondary schools. The present cross-sectional study analyzed anonymous survey data of C&A who themselves or whose parents, respectively, did not provide written consent to participate in the mental health research project. The questionnaire consisted of 14 items covering potential reasons for non-participation, and four free text fields. Besides descriptive statistics, free text field answers were analyzed using qualitative content analysis.

Results

Students indicated an average of M = 2.94 (SD = 1.75) reasons for their non-participation in the project. In the descriptive analysis of indicated items, the three most frequently reported reasons for non-participation included students reporting to not be concerned by the topic "mental health" (n = 290, 54.3%), not having returned the consent form to the teacher (n = 175, 32.8%), and not having time for participation (n = 149, 27.9%). In the qualitative content analysis, the most frequently assigned categories were organizational reasons (n = 216, 57.1%), general disinterest in study participation (n = 139, 36.8%), and personal attitudes toward the topic "mental health" (n = 84, 22.2%), such as not being concerned with the topic "mental health" (n = 23, 6.1%) or being too concerned with the topic "mental health" (n = 16, 4.2%).

Conclusion

The study provides unique insights into reasons for C&A and their caregivers not participating in a large federally funded mental health research project. The results suggest that in order to increase participation rates, stigma should be reduced, parents as well as teachers should be involved where possible, and the use of incentives might be helpful. The study highlights the importance of assessing reasons for non-participation, especially in online intervention studies on mental health.

Gender role attitudes and well-being of German and refugee adolescents-same or different?

BACKGROUND

Assumed differences in gender role attitudes (GRAs) of German adolescents and refugee adolescents from the Middle East are often discussed, but rarely investigated. Presumed differences in GRAs across cultures and genders are assumed to be involved in emerging gender differences in well-being and mental health symptoms. Overall, appropriate measurements for investigating GRAs of adolescents with different cultural backgrounds are scarce.

METHODS

Hence, the present study exemplarily investigates (1) the measurement invariance (MI) of a German translation of the Social Role Questionnaire (SRQ) for German (n = 114) and German-speaking Middle Eastern refugee adolescents from Syria, Afghanistan, or Iraq (n = 115), using a Multiple Indicator Multiple Cause (MIMIC) model to account for age and gender. Moreover, (2) differences between GRAs of both groups, (3) relationships of GRAs with different facets of affective well-being, as well as (4) differences in these relationships between German and refugee adolescents are examined by extending the MIMIC-model to a full structural equation model (SEM).

RESULTS

Results indicate (1) that scalar MI for the SRQ can be assumed. Furthermore, (2) German adolescents show less traditional gender-linked GRAs than refugee adolescents, but no further differences in GRAs. Furthermore, no differences between the relationships of GRAs with well-being and mental health symptoms were found between the groups (4). Also, (3) GRAs showed no relation with any of the outcomes, but gender and age predicted mental health symptoms.

CONCLUSION

The findings show that the SRQ is a useful measurement for investigating the GRAs of adolescents living in Germany and could be used in further cross-cultural research.

Help-seeking attitudes and behaviours for mental health problems in adolescents before and during the first COVID-19 school closures in Germany

AIM

Comparing measures of psychological wellbeing and help-seeking in youths before and within the first school closures due to the coronavirus disease 2019 (COVID-19) pandemic enables a better understanding of the effects the pandemic has for those seeking professional help for mental health problems.

METHODS

Data were obtained from the Germany-based ProHEAD school study. Pre-lockdown and lockdown samples (n = 648) were compared regarding pupils' psychological wellbeing, help-seeking attitudes and help-seeking behaviour.

RESULTS

Participants from the lockdown sample showed greater positive attitudes towards seeking professional help, whereas psychological wellbeing and help-seeking behaviour remained stable.

CONCLUSIONS

Possible explanations may include an increased public discourse on mental health or self-selection bias for participation during lockdown.

The reciprocal interplay of physical activity and health‐related quality of life in children and adolescents: Evidence for both upward and downward spirals

OBJECTIVE

This study examines the bidirectional effect between physical activity (PA) and health-related quality of life in children and adolescents, focusing on within-person effects.

METHODS

PA and health-related quality of life were assessed in children and adolescents (N = 685, age: M = 10.29 years, SD = 1.35, range = 8-14), via self-report across four waves, each 6 months apart, and a random-intercept cross-lagged panel model with time-invariant cross-lagged effects was calculated.

RESULTS

Positive cross-lagged effects between prior PA and health-related quality of life 6 months later ( γ y  = 0.536, 95% CI [0.016, 1.055], p = .043, d = 0.11) and vice versa ( γ x  = 0.015, 95% CI [0.001, 0.030], p = .039, d = 0.12) were found. Furthermore, the random intercept correlation was significant ( T xy  = 3.622, 95% CI [2.204, 5.041], p < .001, d = 0.27).

CONCLUSIONS

The findings confirm known correlations between PA and health-related quality of life and extends them by indicating both an upward and downward spiral of PA and health-related quality of life in children and adolescents.

Moderators of pre-post changes in school-based mental health promotion: Psychological stress symptom decrease for adolescents with mental health problems, knowledge increase for all

Background

School-based mental health promotion aims to strengthen mental health and reduce stress. Results on the effectiveness of such programs are heterogeneous. This study realized a school-based mental health promotion program (StresSOS) for all students and aimed to identify moderators (mental health status, gender, grade level) of pre- to post-changes in stress symptoms and knowledge.

Methods

Participants were N = 510 adolescents (from 29 classes; 46.7% female) aged 12-18 years (M = 13.88, SD = 1.00; grade levels 7-10). They were without mental health problems (65.9%), at risk for mental health problems (21.6%), or with mental health problems (12.5%) and participated in a 90 min per week face-to-face training with 8 sessions in class at school. Demographic variables, mental health status, stress symptoms, and knowledge about stress and mental health were collected at baseline. Program acceptance, stress symptoms, and knowledge were collected post-intervention. Multilevel mixed effects models were conducted with the fixed effects time (within factor), mental health status, gender, and grade level (between factors). Random effects for students within classes were included.

Results

In the pre-post comparison, mental health status moderated the changes on psychological stress symptoms (p < 0.05). In adolescents with mental health problems the largest reduction in stress symptoms was observed between pre- and post-assessment. Gender and grade level were less relevant. For all adolescents knowledge gains were revealed (p < 0.001). Program acceptance was moderated by mental health status and grade level (p < 0.01). Mentally healthy adolescents and within the group of adolescents at-risk or with mental health problems, especially younger students (7th/8th grade), rated program acceptance higher.

Conclusion

Psychological stress symptoms decreased among adolescents with mental health problems and not among adolescents at risk for or without mental health problems. Mental health-related knowledge increased for all adolescents. The results add to knowledge on school-based mental health intervention research and practice. Its implications for different prevention strategies (universal, selective or a combination of both) are discussed.

Coping of Young Refugees in Germany

Abstract. Background: Coping is considered to have an important influence on well-being, especially in adolescent refugees dealing with a high amount of stress. In addition, gender differences in coping are a common topic for research and are often attributed to differences in socialization between boys and girls. Aims: The study aims at clarifying the gender differences in coping strategies used by non-Western adolescents. Additionally, associations with aspects of socialization, in particular Gender Role Attitudes (GRA), on gender differences are investigated. Method: Refugees from Syria, Iraq, and Afghanistan ( N = 106, 55% male) aged 11–18 years completed questionnaires in schools or housing facilities. Associations between gender, GRA, coping strategies, and well-being were investigated using moderation and regression analyses. Results: Gender differences found in previous literature could, in part be replicated. Refugee girls reported more anger-related emotion regulation than boys did. However, GRA did not show any connections to coping strategies. Limitations: Most limitations result from low reliabilities and possible biases due to the use of self-reports. Conclusion: The more frequent use of anger-related emotion regulation as the only gender difference replicated in this study highlights the importance of research with refugee samples to prevent over-generalization of previous results from Western cultures.

Well-Being and Resources of Minors With Refugee Background in Comparison to Minors With Migration or Native Background

Abstract. Background: Studies on the health of minors with refugee background (RM) often focus on symptoms and risks. In contrast to these deficit-oriented approaches, the present study examined well-being and resources of RM. Aims: The aim was to get an overview of the extent to which RM differ from both minors with migration (MM) as well as native (NM) background regarding well-being and resources. In addition, the study sought to identify resources of RM that are significant for well-being. General personal and social resources, religious identity and practice as well as multicultural resources (bilingualism, ethnic identity) were examined. Method: The study was conducted in Germany with minors aged 8–16 years. RM ( n = 209), MM ( n = 535) and NM ( n = 858) completed questionnaires. Comparative analyses and multiple regression analyses were computed. Results: RM showed lower well-being and fewer social resources than MM and NM. For personal resources, the group differences were less consistent. Personal and social resources predicted the well-being of minors. While multicultural resources were not significant, especially the resources sense of coherence, integration into peer group, and religious identity positively predicted the well-being of RM. Limitations: The group of MM is very heterogeneous. Further studies should differentiate the group of MM more precisely. Conclusion: The differences in well-being among RM, MM and NM can largely be explained by differences in resources. Religious identity is an important available resource for RM. Sense of coherence and integration into peer groups should be given special attention in health promotion for RM.

Stresserleben und Stresssymptomatik bei Kindern und Jugendlichen

Zusammenfassung. Diese Studie untersucht, ob sich das Ausmaß des Stresserlebens und der physischen Stresssymptomatik bei Kindern und Jugendlichen in den vergangenen 20 Jahren verändert hat. Grundlage bilden die Daten von 4450 Schülerinnen und Schülern der dritten bis sechsten Klassenstufe (Altersbereich: 6 bis 14 Jahre), die im Rahmen der Normierung des Fragebogens zur Erhebung von Stress und Stressbewältigung im Kindes- und Jugendalter (SSKJ) in den Jahren 1996 (Kohorte 1, n = 960, 49 % männlich), 2006 (Kohorte 2, n = 1324, 49 % männlich) und 2018 (Kohorte 3, n = 2166, 50 % männlich) erfasst wurden. Die Überprüfung der Messinvarianz anhand konfirmatorischer Faktorenmodelle zeigte für beide Skalen partielle skalare Invarianz, wonach die Voraussetzung für die Durchführung latenter Mittelwertvergleiche erfüllt ist. Die Vergleiche weisen bei beiden Skalen nicht auf eine bedeutsame Veränderung über die Zeit hinweg hin. Gleichzeitig lassen die Invarianzanalysen erkennen, dass die Struktur der erhobenen Konstrukte über die Zeit stabil war.

Polytraumatization in young male refugees from the Middle East and its association with internalizing and externalizing symptoms

BACKGROUND

Young Middle Eastern male refugees are currently among the most vulnerable groups in Europe. Most of them have experienced potentially traumatic events (PTEs) such as rape, torture, or violent assaults. Compared to their peers, young refugees suffer more from internalizing and externalizing symptoms, especially when unaccompanied. Little is known about the cumulative impact of experiencing different types of PTEs on mental health outcomes (polytraumatization) of young male refugees from the Middle East. We investigated (1) whether there is a dose-response relationship between multiple PTE types experienced and mental health outcomes, (2) whether individual types of PTEs are particularly important, and (3) to what extent these are differentially associated with mental health outcomes among unaccompanied or accompanied peers.

METHODS

In total, 151 young Middle Eastern male refugees in Germany (M_age = 16.81 years, SD_age = 2.01) answered questionnaires on PTEs, mental health, and post-migration stress.

RESULTS

Hierarchical regression analyses revealed, while controlling for age, duration of stay, unaccompanied status, and post-migration stress, (1) a dose-effect between PTE types on both internalizing and externalizing symptoms. Moreover, (2) regarding internalizing symptoms, violent family separation and experiencing life-threatening medical problems were particularly crucial. The latter was driven by unaccompanied refugees, who also reported higher levels of substance use.

CONCLUSIONS

The results extend findings from the literature and suggest that not only may greater polytraumatization be related to greater depression among refugees, but also to a range of other mental health outcomes from the internalizing and externalizing symptom domains. Furthermore, the results highlight the mental health risks that unaccompanied and accompanied refugee adolescents face after exposure to PTEs, and provide information for practitioners as well as researchers about event types that may be particularly relevant.

Stress-symptoms and well-being in children and adolescents: factor structure, measurement invariance, and validity of English, French, German, Russian, Spanish, and Ukrainian language versions of the SSKJ scales

Objective

The present cross-cultural study examined the factor structure, measurement invariance, and convergent validity of the Stress-Symptom and Well-Being Scales from the Stress and Coping Questionnaire for Children and Adolescents (SSKJ), originally in German, across gender and for five newly developed language versions: English, French, Russian, Spanish, and Ukrainian.

Design

Children and adolescents (N = 5,227) from Germany, France, Russia, the Dominican Republic, Ukraine, and several English-speaking countries participated in the survey study.

Main outcome measures

The SSKJ Stress-Symptom and Well-Being Scales capture stress symptomatology and well-being with five subscales: Somatic Symptoms, Anger, Sadness, Anxiety, and Well-Being. The Strengths and Difficulties Questionnaire (SDQ) was used for validation.

Results

The factorial structure (five factors) was confirmed. In multi-group comparisons, confirmatory factor analyses showed partial metric invariance across the different languages. Regarding gender, results showed scalar invariance for all languages, except for Spanish. Gender differences were shown with girls scoring higher on somatic symptoms, sadness, anxiety (German-, French-, Russian-speaking samples), anger (French), and well-being (German, Ukrainian). Correlations with indicators of mental health and behavioral problems demonstrated convergent validity.

Conclusion

The SSKJ Stress-Symptom and Well-Being Scales showed psychometric evidence for equivalence across the different languages and gender. Thus, this instrument is a useful tool for cross-cultural research in children and adolescents.

Editorial Perspective: A plea for the sustained implementation of digital interventions for young people with mental health problems in the light of the COVID-19 pandemic

The coronavirus disease 2019 pandemic and the consequent global lockdown posed a particular challenge for youths with mental health problems. Crucial interference with their everyday lives likely increased psychological distress while accessibility of conventional mental health care was limited. Ongoing online trials offer a unique opportunity to analyse mental health status and help-seeking behaviour of adolescents during the pandemic. The ProHEAD-online trial aims at improving help-seeking behaviour of children and adolescents with significant psychological impairment. From January to May 2020, 1,042 students had access to the ProHEAD-online platform providing information on mental illness, monitoring, peer support and professional counselling. In the week from 11 March, when schools were closed in Germany, a drastic (more than 2 standard deviations) but time-limited increase in utilization of the ProHEAD-online services became apparent. This may indicate a worsened mental health status and an increased help seeking via digital services during the lockdown. Although this finding is purely observational, it speaks to the importance of evidence-based online service in the field of mental health within the current crisis and beyond.

Angst und Freude in schulischen Kontexten

Zusammenfassung. Mit den Schulmodulen des „Mehrdimensionalen Angstinventars für Kinder und Jugendliche“ (MAI-KJ) können Angst und Freude spezifisch für schulische Leistungs- und Interaktionssituationen erfasst werden. Die vorliegende Studie überprüft die Faktorenstruktur, die psychometrischen Eigenschaften und die Validität. Für drei schulbezogene Situationen (eine Klassenarbeit schreiben, Zusammensein mit anderen im Pausenhof, etwas vor anderen präsentieren) werden Angst (mit Subskalen zu Aufgeregtheit und Besorgnis) und Freude erfasst. Die Analysen basieren vorwiegend auf zwei Stichproben von Kindern und Jugendlichen im Alter von 8 bis 19 Jahren der Klassenstufen 3 bis 10 (Stichprobe 1: N = 2594, Stichprobe 2: N = 7339). Die angenommene Faktorenstruktur konnte anhand explorativer und konfirmatorischer Faktorenanalysen bestätigt werden. Struktur und Messeigenschaften waren invariant gegenüber Geschlecht und Altersgruppe der Kinder. Die Reliabilitäten der Skalen fielen zufriedenstellend bis gut aus (Cronbachs α = .79 bis .93). Die Stabilitäten variierten für einen Zeitraum von im Mittel 3 Wochen zwischen r tt = .65 und .76. Hinweise auf die Validität konnten durch Korrelationen mit Fragebogenverfahren zur Diagnostik von Angst (z.B. Prüfungsangst, soziale Angst) wie auch Schulleistung ermittelt werden.

The Coping Scales From the German Stress and Coping Questionnaire for Children and Adolescents

Abstract. The coping scales from the Stress and Coping Questionnaire for Children and Adolescents (SSKJ 3–8; Lohaus, Eschenbeck, Kohlmann, & Klein-Heßling, 2018 ) are subscales of a theoretically based and empirically validated self-report instrument for assessing, originally in the German language, the five strategies of seeking social support, problem solving, avoidant coping, palliative emotion regulation, and anger-related emotion regulation. The present study examined factorial structure, measurement invariance, and internal consistency across five different language versions: English, French, Russian, Spanish, and Ukrainian. The original German version was compared to each language version separately. Participants were 5,271 children and adolescents recruited from primary and secondary schools from Germany ( n = 3,177), France ( n = 329), Russia ( n = 378), the Dominican Republic ( n = 243), Ukraine ( n = 437), and several English-speaking countries such as Australia, Great Britain, Ireland, and the USA (English-speaking sample: n = 707). For the five different language versions of the SSKJ 3–8 coping questionnaire, confirmatory factor analyses showed configural as well as metric and partial scalar invariance (French) or partial metric invariance (English, Russian, Spanish, Ukrainian). Internal consistency coefficients of the coping scales were also acceptable to good. Significance of the results was discussed with special emphasis on cross-cultural research on individual differences in coping.

Die Diagnostik von Angst und Depression mit dem Mehrdimensionalen Angstinventar für Kinder und Jugendliche (MAI-KJ)

Zusammenfassung. Das allgemeine Modul des „Mehrdimensionalen Angstinventars für Kinder und Jugendliche“ (MAI-KJ) dient der Messung von dispositioneller Angst (indiziert durch Aufgeregtheit und Besorgnis) und Depression (indiziert durch hohe Traurigkeit und niedrige Freude). Der Aufbau des Fragebogens wird vorgestellt. Überprüft werden Faktorenstruktur, psychometrische Eigenschaften und Validität des Verfahrens. Die Analysen basieren vorwiegend auf 2 Stichproben von Kindern und Jugendlichen der Klassenstufen 3 bis 10 (Stichprobe 1: N = 2 594, Stichprobe 2: N = 7 339). Die angenommene Struktur konnte mittels explorativer und konfirmatorischer Faktorenanalysen bestätigt werden. Struktur und Messeigenschaften des MAI-KJ waren weitgehend invariant gegenüber Geschlecht und Alter der Kinder. Die Reliabilitäten der Skalen fielen zufriedenstellend bis gut aus (Cronbachs α zwischen .70 und .88). Die Stabilitäten erwiesen sich als hoch (Korrelationen zwischen .61 und .76, Zeitabstand: 2 bis 4 Wochen). Zahlreiche Hinweise auf die Validität konnten durch Korrelationen mit Fragebogenverfahren zur Diagnostik von Angst und Depression gewonnen werden.

Promoting Help-seeking using E-technology for ADolescents with mental health problems: study protocol for a randomized controlled trial within the ProHEAD Consortium

BACKGROUND

The highest incidence and prevalence of mental health problems across the lifespan as well as the first onset of most long-term mental health conditions are reported for youths between 14 and 25 years of age. At the same time, only 25% of adolescents with mental health problems receive professional treatment. One explanation for poor treatment access in youths is their low help-seeking behavior. Barriers that can keep children and adolescents (C&A) from seeking professional help include a lack of perceived need, structural barriers, or stigma. Interventions based on e-technology might present an effective approach, overcoming these barriers by reducing stigma and providing low-threshold access with enhanced reach, ultimately facilitating help-seeking for mental health problems among youths.

METHODS

The study is designed as a multi-center, randomized controlled trial. In total, an estimated number of n = 1,500 C&A with mental health problems, drawn from a school-based sample of n = 15,000 pupils attending school grades 6 to 13 (≥ 12 years of age), recruited in five regions of Germany, will be randomized either to an intervention (ProHEAD online) or a control condition. C&A in the intervention group will receive online access to tailored information and individual advice on where to seek professional help for their specific needs close to their place of living, case reports of and interaction with peers, as well as the opportunity for online and telephone counseling. C&A in the control intervention will receive a recommendation to seek help and online information on where to find professional help. All participants will be asked to complete questionnaires concerning their help-seeking behavior at baseline, during the intervention (monitoring), and also at a 1 and 2 year follow-up. The primary endpoint is the number of C&A seeking conventional face-to-face professional help in the real-world setting within 1 year after their initial screening.

DISCUSSION

The trial will investigate if an Internet-based intervention can increase professional help-seeking in C&A with mental health problems. With its randomized controlled design and large-scale school-based sampling, the study aims to overcome the shortages of previous research. The intervention has the potential to narrow the treatment gap in C&A and to ultimately improve the mental health care system.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00014685 . Registered on 7 July, 2018.

Effectiveness of a web-based screening and brief intervention with weekly text-message-initiated individualised prompts for reducing risky alcohol use among teenagers: study protocol of a randomised controlled trial within the ProHEAD consortium

BACKGROUND

Early and excessive alcohol use is a significant threat to healthy development. Evidence supports the effectiveness of electronic alcohol interventions for young drinkers. However, effects are typically small and studies targeting under 18-year-olds are scarce. This trial is the first to evaluate the effectiveness of a single-session, brief, motivational, web-based intervention (ProWISE) plus weekly text-message-initiated individualised prompts (TIPs) in reducing alcohol consumption and alcohol-related harm among children and adolescents aged ≥ 12 years. TIPs are designed to decrease risky alcohol use by reaching youth in the contexts of their everyday lives and by providing individualised feedback on drinking intentions, actual drinking and succession in achieving personal goals for low-risk drinking or abstinence.

METHODS/DESIGN

The trial is part of the multicentre consortium ProHEAD testing e-interventions for mental health problems in children and adolescents. Participants in grades 6-13 aged ≥ 12 years will be recruited in schools which participate in ProHEAD (target N = 15,000). Main criterion for inclusion in the ProWISE-TIP trial is a positive screening for at-risk alcohol use in the CRAFFT-d questionnaire (target n = 1076). In a multicentre, four-arm, randomised controlled design the following groups will be compared: (A) web-based intervention plus TIPs for 12 weeks; (B) web-based intervention plus text-message-initiated assessment of alcohol consumption for 12 weeks; (C) web-based intervention only; and (D) alcohol-related psychoeducation. TIPs will be delivered shortly before and after high-risk situations for excessive alcohol use and will be tailored to age, gender, drinking motives and alcohol consumption. Study participants will be followed up at three, six and nine months in the ProWISE-TIP trial and at one and two years in the ProHEAD consortium. Primary outcome is alcohol use in the past 30 days at nine months after enrolment. Secondary outcomes are alcohol-related problems, co-occurring substance use, health service utilisation, mental health problems and quality of life.

DISCUSSION

Trial results will generate important evidence on how to enhance effectiveness of single-session, web-based alcohol interventions for youth. The ProWISE-TIP intervention, if effective, can be used as a stand-alone alcohol intervention or as an add-on to school-based or community-based alcohol prevention programs.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00014606 Registered on 20 April 2018.

School-based mental health promotion in children and adolescents with StresSOS using online or face-to-face interventions: study protocol for a randomized controlled trial within the ProHEAD Consortium

BACKGROUND

Schools are an ideal setting in which to promote health. However, empirical data on the effectiveness of school-based mental health promotion programs are rare, and research on universal Internet-based prevention in schools is almost non-existent. Following the life skills approach, stress management training is an important component of health promotion. Mental health literacy is also associated with mental health status, and it facilitates formal help-seeking by children and adolescents (C&A). The main objectives of this study are (1) the development and evaluation of an Internet-based version of a universal school-based health promotion program called StresSOS and (2) demonstrating non-inferiority of the online setting compared to the face-to-face setting. StresSOS aims to improve stress management and mental health literacy in C&A.

METHODS/DESIGN

A school-based sample of 15,000 C&A (grades 6-13 and older than 12 years) will be recruited in five regions of Germany within the ProHEAD Consortium. Those with a screening result at baseline indicating no mental health problems will be invited to participate in a randomized controlled trial comparing StresSOS online to an active online control condition (Study A). In addition, 420 adolescents recruited as a separate school-based sample will participate in the StresSOS face-to-face intervention. Participants in both intervention groups (online or face-to-face) will receive the same eight treatment modules to allow for the comparison of both methods of delivery (Study B). The primary outcome is the number of C&A with symptoms of mental health problems at a 12 months follow-up. Secondary outcomes are related to stress/coping (i.e., knowledge, symptoms of stress, coping resources), mental health literacy (knowledge and attitudes toward mental disorders and help-seeking), program usage patterns, cost-effectiveness, and acceptability of the intervention.

DISCUSSION

This study represents the first adequately powered non-inferiority trial in the area of school-based mental health promotion. If online StresSOS proves efficacious and non-inferior to face-to-face delivery, this offers great potential for health promotion in youths, both in and outside the school environment.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00014693 . Registered on 14 May 2018.

Efficacy and cost-effectiveness of two online interventions for children and adolescents at risk for depression (E.motion trial): study protocol for a randomized controlled trial within the ProHEAD consortium

BACKGROUND

Depression is a serious mental health problem and is common in children and adolescents. Online interventions are promising in overcoming the widespread undertreatment of depression and in improving the help-seeking behavior in children and adolescents.

METHODS

The multicentre, randomized controlled E.motion trial is part of the German ProHEAD consortium (Promoting Help-seeking using E-technology for ADolescents). The objective of the trial is to investigate the efficacy and cost-effectiveness of two online interventions to reduce depressive symptomatology in high-risk children and adolescents with subsyndromal symptoms of depression in comparison to an active control group. Participants will be randomized to one of three conditions: (1) Intervention 1, a clinician-guided self-management program (iFightDepression®); (2) Intervention 2, a clinician-guided group chat intervention; and (3) Control intervention, a psycho-educational website on depressive symptoms. Interventions last six weeks. In total, N = 363 children and adolescents aged ≥ 12 years with Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) scores in the range of 5-9 will be recruited at five study sites across Germany. Online questionnaires will be administered before onset of the intervention, at the end of the intervention, and at the six-month follow-up. Further, children and adolescents will participate in the baseline screening and the one- and two-year school-based follow-up assessments integrated in the ProHEAD consortium. The primary endpoint is depression symptomatology at the end of intervention as measured by the PHQ-A score. Secondary outcomes include depression symptomatology at all follow-ups, help-seeking attitudes, and actual face-to-face help-seeking, adherence to and satisfaction with the interventions, depression stigma, and utilization and cost of interventions.

DISCUSSION

This study represents the first randomized controlled trial (RCT) investigating efficacy and cost-effectiveness of two online interventions in children and adolescents aged ≥ 12 years at risk for depression. It aims to provide a better understanding of the help-seeking behavior of children and adolescents, potential benefits of E-mental health interventions for this age group, and new insights into so far understudied aspects of E-mental health programs, such as potential negative effects of online interventions. This knowledge will be used to tailor and improve future help offers and programs for children and adolescents and ways of treatment allocation.

TRIAL REGISTRATION

German Register for Clinical Trials (DRKS), DRKS00014668 . Registered on 4 May 2018. International trial registration took place through the "international clinical trials registry platform" with the secondary ID S-086/2018.

Fear of Being Laughed at in Children and Adolescents: Exploring the Importance of Overweight, Underweight, and Teasing

Weight bias toward obese youths is often accompanied by the experience of psychological stress in those affected. Therefore, the fear of being laughed at (i.e., gelotophobia) in overweight children and adolescents can be rather serious. In four explorative studies, the importance of relative weight, self-awareness of weight (incl. satisfaction with weight), experiences of teasing and ridicule, as well as the role of social-evaluative situations in school were analyzed with regard to gelotophobia. In two online interviews of adults with pronounced gelotophobia (Study I: 102 English-speaking participants, Study II: 22 German-speaking participants) relating to reasons they assumed for their development of gelotophobia, there was evidence of injurious appearance-related experiences during childhood and adolescence. In Study III (75 Swiss adolescents) associations between the experience of weight-related teasing and mockery with overweight, self-perceptions of weight, and gelotophobia were analyzed. Especially in girls, overweight was associated with the experience of weight-related teasing and ridicule, which in turn was accompanied by gelotophobia. Study IV included 178 German adolescents who were asked to report their body image (“Do you think you are… too thin, just the right weight, or too fat?”). In addition, gelotophobia, teasing, BMI based on self-reports, and joy at school were measured. In particular, girls who felt too fat and boys who felt too thin reported teasing. Teasing was related to diminished joy at school and to gelotophobia. Among boys, underweight mediated by weight-related teasing contributed to gelotophobia. The results suggest that more research should be devoted to gelotophobia and the experience of weight-related teasing and mocking to better understand factors contributing to the well-being of children and adolescents with weight problems.

Development of Coping Strategies From Childhood to Adolescence

Abstract. Extensive research exists on coping in children and adolescents. However, developmental issues have only recently started to receive more attention. The present study examined age differences and developmental changes in six coping strategies (social support seeking, problem solving, avoidant coping, palliative emotion regulation, anger-related emotion regulation, and media use) assessed by a coping questionnaire (German Stress and Coping Questionnaire for Children and Adolescents, SSKJ 3–8; Lohaus, Eschenbeck, Kohlmann, & Klein-Heßling, 2006 ) in middle/late childhood and early adolescence. At the initial assessment, 917 children from grades 3 to 7 (age range 8–15 years) were included (cross-sectional sample). Three cohorts (grades 3–5 at baseline) were traced longitudinally over 1½ years with four assessments (longitudinal sample: n = 388). The cross-sectional coping data showed significant effects for grade level in four coping strategies. Older children scored higher in problem solving and media use, and lower in avoidant coping. Seventh graders scored lower than fourth and fifth graders in social support seeking. Longitudinal data confirmed time effects and cohort effects indicating developmental changes. Increases over time were found for problem solving and media use; decreases were found for avoidant coping and anger-related emotion regulation. For social support seeking, an increase within the youngest cohort (grades 3–5) was found. Developmental trends (in cross-sectional and longitudinal data), with especially strong increases for problem solving or declines in avoidant coping in the youngest cohort, differed for the two studied stressful situations (social, academic) but were independent of the child’s gender. To conclude, particularly in the age range of 9–11 years relevant developmental changes toward a more active coping seem to appear.

Bullying im Klassenverband

Zusammenfassung. In Anlehnung an den Participant-Role-Ansatz ( Salmivalli, Lagerspetz, Björkqvist, Österman & Kaukiainen, 1996 ) wurde Bullying als Gruppenphänomen untersucht. Mittels Peer-Nominierung wurden an einer Stichprobe von 5 083 Sechst- und Neuntklässler_innen folgende Rollen identifiziert: Pro-Bullying-Akteure, Opfer, Verteidiger, Außenstehende und Bully-Opfer. Rund 55 % der Schülerinnen und Schüler konnte eine dieser Rollen zugeordnet werden. Es zeigt sich, dass der Anteil der Pro-Bullying-Akteure in den 9. Klassen geringer als in den 6. Klassen ist, nicht aber der Anteil der Opfer. Auch Verteidiger sind in Stufe 9 seltener zu finden. Die Gruppe der Pro-Bullying-Akteure besteht größtenteils aus Jungen, wohingegen die Verteidiger überwiegend weiblich sind. Pro-Bullying-Akteure zeichnen sich des Weiteren durch einen kontroversen Status im Klassenverband und schlechte Schulleistungen aus. Opfer haben einen geringen sozialen Status und durchschnittliche Zeugnisnoten. Verteidiger erweisen sich als äußerst beliebt und leistungsstark.

Daily Stress, Hearing-Specific Stress and Coping: Self-reports from Deaf or Hard of Hearing Children and Children With Auditory Processing Disorder

This study evaluated stressors and coping strategies in 70 children who are deaf or hard of hearing (D/HH) or with auditory processing disorder (APD) attending Grades 5 and 6 of a school for deaf and hard-of-hearing children. Everyday general stressors and more hearing-specific stressors were examined in a hearing-specific modified stress and coping questionnaire. Reports were compared with normative data for hearing children. Regarding everyday general stressors, stress levels for children who are D/HH or with APD did not differ from those of hearing children. Within children with hearing problems, everyday stressors were experienced as more stressful than hearing-specific stressors. For coping strategies, differences between children with hearing problems (D/HH, APD) and hearing children were shown (i.e., problem solving, anger-related emotion regulation). Girls scored higher in seeking social support whereas boys reported higher amounts of media use as a way of coping. Differences regarding stress and coping between children who are D/HH and children with APD were minor; D/HH children reported more social support seeking. Implications for assessment and resource promotion are discussed.

Self-regulation of healthy nutrition: automatic and controlled processes

Background

Self-regulatory behaviour refers to both controlled and automatic processes. When people are distracted, automatic over controlled processes prevail. This was analysed with regard to nutritional behaviour (food choices, beverage intake) in situations of low or high distraction.

Methods

A self-concept Implicit Association Test (IAT) was adapted to assess the implicit associations of self (vs. other) with healthy (vs. unhealthy) food. Explicit preferences for healthy and unhealthy food and the diet’s healthiness were measured by self-report. Both implicit and explicit measures were used as predictors of nutritional behaviour. Among 90 undergraduates, the choice of fruit versus snack in a food choice task (low distraction) and the amount of mineral water and soft drinks consumed in a taste comparison task to cover liquid intake (high distraction) were observed.

Results

In the low distraction situation, food choice was predicted solely by explicit measures. Fruits were chosen less, when unhealthy foods were explicitly liked. In the high distraction situation, mineral water intake was predicted solely by the IAT. Participants implicitly associating themselves with healthy foods drank more mineral water than those implicitly associating themselves with unhealthy foods.

Conclusions

Nutritional behaviour is influenced by both automatic and controlled processes depending on the available capacity for self-regulation.

A Turkish Adaptation of the Coping Scales From the German Stress and Coping Questionnaire for Children and Adolescents

The present study develops and validates a Turkish adaptation of the coping scales from the German Stress and Coping Questionnaire for Children and Adolescents (SSKJ 3–8; Lohaus, Eschenbeck, Kohlmann, & Klein-Heßling, 2006 ). In a Turkish sample of 473 children and adolescents from grades 4 to 8 (220 girls, 253 boys, age range: 9–15 years), the factor structure of the original German version was confirmed for the six subscales: seeking social support, problem solving, avoidant coping, palliative emotion regulation, anger-related emotion regulation, and media use. All six subscales showed good internal consistency. Correlations between these subscales and indicators of psychological adjustment as well as replication of gender differences for the subscales also demonstrated high correspondence between the original German version of the SSKJ 3–8 coping scales and the Turkish adaptation.

Perception makes the difference: the association of actual and perceived weight status with self-reported and parent-reported personal resources and well-being in adolescents

The study analyzed associations between actual weight status and weight perceptions with personal resources, physical and psychological health, as well as physical performance among adolescents (N = 5,518; age: 11-17 years). Analyses are based on data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Self-report measures, parental reports, as well as objective test data were considered. Results indicate that weight perceptions, rather than actual weight status, were associated with personal resources, health, and perceived physical performance. Comparing groups, we found that adolescents who felt they had "just the right weight" achieved more favourable results than those who perceived themselves as "too fat", regardless of their actual weight status. However, actual physical performance was predicted better by actual weight status. Furthermore, weight perceptions were found to mediate the link between actual weight status and all the assessed outcomes (personal resources, health, and physical performance). With respect to self-reports, the mediational effect was consistently stronger for girls, whereas the reverse was true regarding physical performance. Parental reports were not moderated by sex. Findings provide further evidence that among overweight adolescents there are subgroups that differ significantly with regard to risks and resources. Implications for practice are discussed.

Mediennutzung als Bewältigungsstrategie von Kindern und Jugendlichen

Zusammenfassung. In dem Beitrag wird über die Erweiterung des Fragebogens zur Erhebung von Stress und Stressbewältigung im Kindes- und Jugendalter (SSKJ 3-8; Lohaus, Eschenbeck, Kohlmann & Klein-Heßling, 2006 ) um die Bewältigungsskala Mediennutzung berichtet. An einer Schülerstichprobe (N = 1086, 50% Mädchen, Klassenstufen 2–8) wurden die fünf Skalen zur Erhebung des Bewältigungsverhaltens (Suche nach sozialer Unterstützung, problemorientierte Bewältigung, vermeidende Bewältigung, konstruktiv-palliative Emotionsregulation und destruktiv-ärgerbezogene Emotionsregulation) sowie zusätzlich Mediennutzung als Bewältigungsstrategie erfasst. Mithilfe von Hauptkomponentenanalysen und konfirmatorischen Faktorenanalysen konnte die sechsfaktorielle Skalenstruktur bestätigt werden. Korrelationen mit den Variablen Alter, Medienkonsum und Stresssymptomatik liefern Hinweise auf die Validität der neuen Subskala Mediennutzung.

Bewältigung alltäglicher Stresssituationen von Kindern und Jugendlichen

Zusammenfassung. Dieser Artikel liefert einen Überblick über Befunde zu situativen und personalen Einflussfaktoren auf die Bewältigung alltäglicher Anforderungen von klinisch unauffälligen Kindern und Jugendlichen. Hierzu wurden insgesamt 28 Studien aufgenommen. Mit dem Ziel einer ersten Bestandsaufnahme wird die Frage beantwortet, welchen Einfluss die Faktoren Belastungssituation, Alter und Geschlecht auf das Bewältigungsverhalten der Kinder und Jungendlichen zeigen. Ausgehend vom dargestellten Forschungsstand werden Empfehlungen für zukünftige Studien abgeleitet und Perspektiven für die Gesundheitspsychologie aufgezeigt.

Physician-diagnosed obesity in German 6- to 14-year-olds. Prevalence and comorbidity of internalising disorders, externalising disorders, and sleep disorders

OBJECTIVE

This study analyses whether children with obesity have an increased risk of internalising disorders, externalising disorders, and sleep disorders compared to children without physician-diagnosed obesity.

METHOD

The study included 156,948 children aged between 6 and 14 years. We analysed data of a German national health insurance company concerning the rates of the physician-diagnosed ICD-10 disorders of obesity and psychiatric disorders.

RESULTS

Greater odds for externalising disorders (odds ratio (OR) = 1.64), internalising disorders (OR = 2.00), sleep disorders (OR = 1.87), and a stay in hospital (OR = 1.44) were found among children with physician-diagnosed obesity compared to children without physician-diagnosed obesity. The increased ORs were higher in girls with obesity compared to boys with obesity for externalising disorders (OR = 1.91 vs. 1.52) and internalising disorders (especially anxiety, OR = 2.15 vs. 1.43). According to age group, the increased OR was highest in young adolescents (12- to 14-year-olds) with obesity compared to younger children with obesity for internalising disorders (especially anxiety, OR = 2.32 vs. 1.59 and 1.43).

CONCLUSION

For obesity prevention and obesity intervention, it is important to understand comorbid health problems as well as potential interindividual influence factors (such as gender or age), both of which should be a focus in respective programmes.

Stress, Stressbewältigung und Blutzuckereinstellung von Jugendlichen mit Typ-1-Diabetes mellitus

Zusammenfassung. Untersucht wurden Stresssituationen, Strategien der Bewältigung und Blutzuckereinstellung von 53 Jugendlichen mit Typ-1-Diabetes mellitus (Alter 12-17 Jahre). Dabei wurden sowohl krankheitsspezifische Situationen als auch Alltagsstressoren betrachtet. Die erkrankten Jugendlichen bearbeiteten eine diabetesspezifisch erweiterte Version des “Fragebogen zur Erhebung von Stress und Stressbewältigung im Kindes- und Jugendalter“ (SSKJ 3-8; Lohaus, Eschenbeck, Kohlmann & Klein-Heßling, 2006 ). Die Diabetessituationen wurden nicht per se belastender erlebt als die Alltagsstressoren. Mädchen berichteten häufiger über Suche nach sozialer Unterstützung sowie problemorientierte Bewältigung, Jungen dagegen über vermeidende Bewältigung. Eine diabetesbezogene vermeidende Bewältigung war bei Mädchen mit ungünstigeren mittleren Blutzuckerwerten der letzten drei Monate (HbA1c) assoziiert. Die Ergebnisse werden im Hinblick auf diagnostische sowie gesundheitspsychologische Implikationen diskutiert.

Gender Differences in Coping Strategies in Children and Adolescents

Abstract. The present study focuses on gender effects and interactions between gender, type of stressful situation, and age-group in coping strategies in childhood and adolescence. The sample consisted of N = 1990 children and adolescents (957 boys, 1033 girls; grade levels 3-8). Participants responded to a coping questionnaire (Fragebogen zur Erhebung von Stress und Stressbewältigung im Kindes- und Jugendalter, SSKJ 3-8; Lohaus, Eschenbeck, Kohlmann, & Klein-Heßling, 2006 ) with the five subscales: seeking social support, problem solving, avoidant coping, palliative emotion regulation, and anger-related emotion regulation. Repeated measures ANOVAs with Gender and Grade Level as the between-subject factors and Situation (social, academic) as the within-subject factor were performed separately for each of the subscales. In general, girls scored higher in seeking social support and problem solving, whereas boys scored higher in avoidant coping. These three main effects were further modified by significant Gender × Situation interactions and for both seeking social support and avoidant coping by significant Gender × Situation × Grade Level interactions. Compared to the academic situation (homework), gender differences were more pronounced for the social situation (argument with a friend), especially in adolescence. The results are discussed with respect to a gender-specific development of coping strategies.

Attentional biases for threatening faces in children: vigilant and avoidant processes

The authors examined the processing of threat-related information in childhood anxiety with the emotional Stroop task and the dot probe task. In study 1, a nonclinical sample of 112 pupils (mean age = 9 years) performed pictorial versions of both tasks. For each task, an index indicating a bias for threat processing was computed. Positive correlations were found between these indices and anxiety. When compared with the original emotional Stroop index, the absolute value of the emotional Stroop index was a better predictor of anxiety. It was possible to replicate this result in study 2 with 80 pupils (mean age = 8.6 years). Results are discussed with regard to vigilance and avoidance as basic mechanisms underlying performance on the tasks.

Die Diagnostik von Stressbewältigung mit dem “Fragebogen zur Erhebung von Stress und Stressbewältigung im Kindes- und Jugendalter“ (SSKJ 3-8)

Zusammenfassung. In diesem Beitrag wird über die faktorielle und psychometrische Prüfung eines revidierten Fragebogens (SSKJ 3-8) zur Erfassung von Stressbewältigung im Kindes- und Jugendalter berichtet. Aspekte der Stressbewältigung werden mit fünf Subskalen erfasst (Suche nach sozialer Unterstützung, problemorientierte Bewältigung, vermeidende Bewältigung, konstruktiv-palliative Emotionsregulation und destruktiv-ärgerbezogene Emotionsregulation). Die Studien beruhen auf einer Gesamtstichprobe von insgesamt 1991 Kindern und Jugendlichen der Klassenstufen 3 bis 8. Die Ergebnisse zeigen gute bis befriedigende Reliabilitäten (interne Konsistenzen, Retest). Die Skalenstruktur konnte mit Hilfe von exploratorischen und konfirmatorischen Faktorenanalysen bestätigt werden. Zahlreiche Hinweise auf die Validität konnten durch Korrelationen mit Außenkriterien (Stressbewältigungs-, Persönlichkeits-, gesundheitsbezogene Lebensqualitätsvariablen) ermittelt werden.

Ernährungsverhalten von Grundschulkindern:

Zusammenfassung. Untersucht wurde die Bedeutung der Einflussfaktoren Geschlechtszugehörigkeit und problemorientierte Stressbewältigung für das Ernährungsverhalten von Grundschulkindern. Dabei wurde das Ernährungsverhalten multimethodal mit Selbsteinschätzung, Verhaltensbeobachtung und Ernährungsprotokoll erhoben. 196 Kinder der Klassenstufen 3 und 4 im Alter zwischen 7 und 12 Jahren nahmen an der Studie teil. Die Ergebnisse zeigten deutliche Zusammenhänge sowohl zwischen der Geschlechtszugehörigkeit und den Gesundheitsverhaltensweisen als auch zwischen einer problemorientierten Stressbewältigung und gesundheitsbezogenem Verhalten: Mädchen zeigten verglichen mit Jungen das günstigere gesundheitsbezogene Verhalten. Eine problemorientierte Bewältigung ging mit einem gesünderen Verhalten einher. Dabei blieb dieser Zusammenhang auch nach Kontrolle potentieller Einflussparameter (z.B. Geschlecht, Klassenstufe, selbstberichtetes Gesundheitsverhalten) substantiell.

Geschlechtsunterschiede in der Stressbewältigung von Grundschulkindern

Zusammenfassung. Untersucht wurden Geschlechtsunterschiede in der Stressbewältigung von Grundschulkindern. 132 Kinder der Klassenstufen 2 bis 4 (Alter 7-12 Jahre) bearbeiteten den Teil Stressbewältigung des “Fragebogens zur Erhebung von Stresserleben und Stressbewältigung im Kindesalter“ (SSK; Lohaus, Fleer, Freytag & Klein-Heßling, 1996 ) mit den Skalen Suche nach sozialer Unterstützung, problemlösendes Handeln und emotionsregulierende Aktivitäten. Varianzanalysen wurden sowohl auf Skalenebene mit den Faktoren Geschlecht, Klassenstufe, Situation (Streit mit Freund, Hausaufgaben) und der Kovariate Alter als auch auf der Ebene der zugrundeliegenden Substrategien mit den Faktoren Geschlecht, Klassenstufe und Substrategien (8 Stufen) und der Kovariate Alter durchgeführt. Auf Skalenebene berichteten bereits ab der zweiten Klasse Mädchen häufiger als Jungen über Suche nach sozialer Unterstützung sowie problemlösendes Handeln. Für emotionsregulierende Aktivitäten zeigten sich keine Effekte. Auf der Ebene der Substrategien ergaben sich jedoch auch für diese Skala bedeutsame Geschlechtsunterschiede: Mädchen berichteten häufiger über “traurig werden und weinen“, Jungen dagegen über “wütend werden und etwas kaputt machen“ sowie “laut vor sich hinfluchen“. Die Ergebnisse werden vor dem Hintergrund der Skaleneigenschaften sowie gesundheitspsychologischer Implikationen diskutiert.