[Assessing Relationship Satisfaction with Four Items? Psychometric Evaluation of the Ultra-short German Version of the Dyadic Adjustment Scale (DAS-4)]

The quality of an individual's relationship plays a central role in their personal well-being as well as their mental and physical health. Despite its great importance, there are only a few ultra-short self-report measures for the assessment of relationship quality. An exception is the four-item version of the Dyadic Adjustment Scale (DAS-4), which is gaining increasing popularity internationally. In this study, the German version of the DAS-4 was evaluated for the first time with regard to its psychometric properties in a general population sample of individuals in a romantic relationship (N=1296). In addition to satisfactory item characteristics, the unidimensional measurement model showed sufficient goodness of fit and the internal consistency was satisfactory (ω=0.80). Measurement invariance was shown for men and women based on the latent construct of the DAS-4. In line with the hypothesis, associations of the DAS-4 with gender, general life satisfaction, psychopathology and attachment styles were found, which suggests construct validity. Despite the lack of application experiences and pending psychometric analyses of the DAS-4 in relevant target groups, such as individuals in couples counselling or therapy, the four-item version can be recommended for assessing relationship satisfaction.

Organized sexualized and ritual violence: Results from two representative German samples

BACKGROUND

Organized sexualized and ritual abuse (ORA), a contentious issue since the 1980s, remains a polarizing topic. Although there is much debate about the existence of this phenomenon, a differentiated perspective is lacking, and no representative study has yet addressed the frequency.

OBJECTIVE

This paper aims to investigate the frequency of ORA in Germany using two representative datasets.

PARTICIPANTS AND SETTING

Data were collected from representative samples of the German population (N = 2522, N = 2515). Participants aged 16 to 96 years (50 and 53 % female) were recruited. They were selected by a random route procedure and asked to fill out a paper-pencil-questionnaire.

METHODS

The four aspects of ORA (severe sexual violence, perpetrator networks, commercial exploitation, ideology) were assessed based on the definition provided by an expert group. Additionally, in the second survey, a direct yes/no question about the experience of ORA as well as details on perpetrators and offense characteristics were surveyed.

RESULTS

Frequency of ORA was low. The direct question on ORA was affirmed by 0.5 % (n = 13), while according to the criteria of the definition, only 0.2 % or less of individuals experienced organized sexualized abuse, and <0.1 % experienced ritual abuse.

CONCLUSION

Although ORA is discussed thoroughly, frequencies in the German population are low. This may be due to inconsistent terminology and operationalization of definitions with lack of precision. However, an intersection of conspiracy beliefs and the topic of ritual violence sheds another light on this issue that should receive more attention.

Running in the FAMILY: understanding and predicting the intergenerational transmission of mental illness

Over 50% of children with a parent with severe mental illness will develop mental illness by early adulthood. However, intergenerational transmission of risk for mental illness in one's children is insufficiently considered in clinical practice, nor is it sufficiently utilised into diagnostics and care for children of ill parents. This leads to delays in diagnosing young offspring and missed opportunities for protective actions and resilience strengthening. Prior twin, family, and adoption studies suggest that the aetiology of mental illness is governed by a complex interplay of genetic and environmental factors, potentially mediated by changes in epigenetic programming and brain development. However, how these factors ultimately materialise into mental disorders remains unclear. Here, we present the FAMILY consortium, an interdisciplinary, multimodal (e.g., (epi)genetics, neuroimaging, environment, behaviour), multilevel (e.g., individual-level, family-level), and multisite study funded by a European Union Horizon-Staying-Healthy-2021 grant. FAMILY focuses on understanding and prediction of intergenerational transmission of mental illness, using genetically informed causal inference, multimodal normative prediction, and animal modelling. Moreover, FAMILY applies methods from social sciences to map social and ethical consequences of risk prediction to prepare clinical practice for future implementation. FAMILY aims to deliver: (i) new discoveries clarifying the aetiology of mental illness and the process of resilience, thereby providing new targets for prevention and intervention studies; (ii) a risk prediction model within a normative modelling framework to predict who is at risk for developing mental illness; and (iii) insight into social and ethical issues related to risk prediction to inform clinical guidelines.

Victims of Technology-Assisted Child Sexual Abuse: A Scoping Review

Over the past two decades, technology-assisted child sexual abuse (TA-CSA) has become the focus of attention in politics, legislation, society, as well as research. However, the majority of literature and studies focus primarily on the offenders. This scoping review therefore aims to illustrate how victims of TA-CSA are represented in studies as primary participants. The databases Embase, PsychInfo, PSYNDEX, Cochrane Library, and Web of Science as well as reference lists were searched. Studies needed to be published between 2007 and 2021 and obtain data directly from and about victims to be included in this review. A total of 570 articles were identified from which 20 studies met inclusion criteria. The analysis showed that data can be obtained via different samples like adult and minor victims or other data such as legal documents or sexualized images. The studies researched different types of TA-CSA including exposure to pornographic material, online grooming leading to both online and offline sexual abuse, sexting and sexualized images, and the visual depiction of sexually explicit content. Consequences due to the abuse were of an emotional and psychological nature, medical or physical or impacted relationships, and the social environment. Even though the impact of the abuse on the victims appeared to be similar between different types of TA-CSA, much remains unknown. In order to gain further and more detailed insight into victims of TA-CSA, a universally accepted definition of TA-CSA as well as its different types and their distinctions needs to be established.

Long-term consequences of childhood emotional abuse in mothers on parental load and child mental health

BACKGROUND

Childhood emotional maltreatment can be associated with long-term consequences on mental health. In addition, transgenerational transmission of adverse childhood experiences to the next generation can occur and thus have an impact on the mental health of one's own children.

OBJECTIVE

The purpose of this study was to examine the role of stress on the association between childhood emotional maltreatment and parental load what is referred to in this study as limitations in parental functioning that affect the resources available to parents to cope with the demands of raising, caring for, and providing for their child. Furthermore the effect of parental load on the mental health of one's own children will be examined.

PARTICIPANTS AND SETTING

N = 237 mother-child dyads (age mother M = 33.76, SD = 4.07 years; age child M = 11.91 months, SD = 0.89 months) from a longitudinal cohort study were examined at two different measuring points.

METHODS

Emotional abuse, perceived stress, parental load and child mental health were assessed using self and external report questionnaires.

RESULTS

The calculation of a mediation showed that the association of emotional abuse and parental load was completely mediated by perceived stress (indirect effect ab = 0.44, 95 %-CI[0.17, 0.78]). In addition, effects of parental load on the child's mental health (β = 0.13, 95%CI [0.07;0.20]), mainly hyperactivity (β = 0.06, 95%CI [0.03;0.11]) and prosocial behavior (β = -0.04, 95%CI [-0.07; -0.01]), were evident.

CONCLUSIONS

The results of this study provide evidence that the mental health of children can be influenced in the long term by increased parental load.

Suicidal ideation in patients with diabetes and childhood abuse - The mediating role of personality functioning: Results of a German representative population-based study

AIMS

Suicidal ideation (SID) in patients with diabetes mellitus is increasingly acknowledged. Still, the underlying mechanisms are unclear. We examined SID prevalences in patients with diabetes, its association with different types of abuse, and a mediating effect of personality functioning.

METHODS

In a representative population sample (N = 2,515), diabetes, SID, abuse (ICAST-R), personality functioning (OPD-SQS), and depression/anxiety (PHQ-4) were assessed by self-report. Statistical analyses comprised Chi2-Tests, logistic regression and mediation analyses.

RESULTS

The prevalence of SID (21.8 %) was three fold higher in patients with diabetes compared to the general population. Abuse further increased the likelihood to report SID in diabetes patients (sexual: 48.1 % vs. 18.2 %; χ2(1) = 12.233, p <.001; emotional: 35.7 % vs. 15.7 %; χ2(1) = 10.892, p <.001). A dose-response relationship between the number of abuse experiences and SID was observed (one abuse experience: OR = 1.138, 95 %-CI [0.433, 2.990], p =.793, >2 abuse experiences: OR = 2.693, 95 %-CI [1.278, 5.675], p =.009). Impaired personality functioning had an indirect effect on the association between emotional abuse and SID (b = 0.25, 95 %-CI [0.037, 0.551]).

CONCLUSIONS

Diabetes patients experience increased SID prevalences, especially those with emotional or sexual abuse. In individuals with a history of emotional abuse, impaired personality functioning partly explained SID and should therefore be considered and addressed in this patient group.

Parental conscription and cumulative adverse experiences in war-affected children and adolescents and their impact on mental health: a comment following Russia's invasion of Ukraine in 2022

BACKGROUND

With Russia's invasion of the Ukraine on February 2022, Ukrainian children and adolescents have been exposed to several stressful life events. In addition to the confrontation with war, flight and parent-child separation due to flight and forced displacement, the majority underwent another challenge at the initial phase of the war: the fatherly separation due to conscription.

MAIN BODY

In the literature, the negative effects of exposure to war and flight/refuge, parent-child separation due to flight or forced displacement and parental deployment are well established. In the context of self-experienced war, the effects of parent-child separation caused by compulsory military service have not yet been sufficiently taken into account. However, the findings of the literature on the impact of these events on the mental health of children and adolescents show that they are at high risk for developing numerous psychological and behavioral problems.

CONCLUSION

As children's and adolescents' mental health might be severely affected by war and its consequences, interventional programs that address the special needs of those children and adolescents are crucial.

Abusive head trauma: The body of the iceberg - A population-based survey on prevalence and perpetrators

BACKGROUND

Research on abusive head trauma (AHT) is usually research on clinically identified cases, while population-based studies, having the potential to identify cases of shaking that did not end with hospital admission, are missing to date.

OBJECTIVE

Thus, we aimed to assess the prevalence of AHT and associated risk factors in a representative sample of the German population.

PARTICIPANTS AND SETTING

We conducted a cross-sectional, observational study in Germany from July to October 2021. Using different sampling steps including a random route procedure, a probability sample of the German population was generated. The final sample consisted of 2503 persons (50.2 % female, mean age: 49.5 years).

METHODS

Participants were asked about sociodemographic information in a face-to-face interview and whether they had been ever responsible for the care of an infant and whether they had ever performed potential harmful methods including shaking to calm it, intimate partner violence (IPV) and adverse childhood experiences (ACEs) using a questionnaire.

RESULTS

In total, 1.4 % of women (N = 18) and 1.1 % of men (N = 13) reported to have at least once shaken an infant to calm it. Ever having used a potential harmful parenting method in calming an infant was reported by 4.9 % of women (N = 61) and 3.1 % (N = 39) of men. No gender differences were seen. A low income, living with someone under 16 in the household and victimization and perpetration of IPV and ACEs are associated with increased risks of shaking and other potential harmful methods to calm an infant.

CONCLUSIONS

Our data suggest that despite better knowledge on the dangers of shaking, the percentage of women that shake infants might be higher than previously thought. Also, intimate partner violence and ACEs are key risk factor for shaking and harmful parenting behaviors in general. This has important implications for future prevention programs.

Scoping review on trauma and recovery in youth after natural disasters: what Europe can learn from natural disasters around the world

In the last decade, Europe has seen a rise in natural disasters. Due to climate change, an increase of such events is predicted for the future. While natural disasters have been a rare phenomenon in Europe so far, other regions of the world, such as Central and North America or Southeast Asia, have regularly been affected by Hurricanes and Tsunamis. The aim of the current study is to synthesize the literature on child development in immediate stress, prolonged reactions, trauma, and recovery after natural disasters with a special focus on trajectories of (mal-)adaptation. In a literature search using PubMed, Psychinfo and EBSCOhost, 15 studies reporting about 11 independent samples, including 11,519 participants aged 3-18 years, were identified. All studies identified resilience, recovery, and chronic trajectories. There was also evidence for delayed or relapsing trajectories. The proportions of participants within each trajectory varied across studies, but the more favorable trajectories such as resilient or recovering trajectory were the most prevalent. The results suggested a more dynamic development within the first 12 months post-disaster. Female gender, a higher trauma exposure, more life events, less social support, and negative coping emerged as risk factors. Based on the results, a stepped care approach seems useful for the treatment of victims of natural disasters. This may support victims in their recovery and strengthen their resilience. As mental health responses to disasters vary, a coordinated screening process is necessary, to plan interventions and to detect delayed or chronic trauma responses and initiate effective interventions.

A web-based psychological support program for caregivers of children with rare chronic diseases: a randomized controlled trial

BACKGROUND

Approximately 50% of rare diseases have symptom onset during childhood. A high level of nursing care and an often uncertain prognosis put caregivers of the affected children at high risk for psychological distress. At the same time, their caregivers have limited access to appropriate psychological care. The aim of this study was to evaluate a web-based psychological support program for caregivers of children with chronic rare diseases (WEP-CARE).

METHODS

German-speaking parents (recruited between May 2016 and March 2018) caring for children aged 0-25 years with a rare disease showing clinically relevant anxiety symptoms, were assigned to either the WEP-CARE (n = 38) or treatment as usual (n = 36) condition within a randomized controlled trial. The primary outcome measure was parental anxiety, assessed with the Generalized Anxiety Disorder Questionnaire (GAD-7). Secondary outcomes were fear of disease progression, depression, coping, quality of life and user satisfaction. The group differences were tested through repeated-measures analyses of variance. The WEP-CARE group was additionally followed up three months after the treatment.

RESULTS

A significant time-group interaction was found for anxiety (F (1,35) = 6.13, p = .016), fear of disease progression (F (1,331) = 18.23, p < .001), depression (F (1,74) = 10.79, p = .002) and coping (F (1,233) = 7.02, p = .010), suggesting superiority of the WEP-CARE group. Sustainability of the treatment gains regarding anxiety, fear of disease progression and coping was confirmed at the 6-month follow-up assessment (p < .01). A significant interaction effect could not be found for quality of life (F(1,2) = 0.016; p = .899). Both participating parents and therapists were satisfied with WEP-CARE.

CONCLUSIONS

Our results underline the efficacy and feasibility of WEP-CARE for parents of children with various rare diseases.

To trust or not to trust in the thrall of the COVID-19 pandemic: Conspiracy endorsement and the role of adverse childhood experiences, epistemic trust, and personality functioning

RATIONALE

Conspiracy endorsement is a public health challenge for the successful containment of the COVID-19 pandemic. While usually considered a societal phenomenon, little is known about the equally important developmental backdrops and personality characteristics like mistrust that render an individual prone to conspiracy endorsement. There is a growing body of evidence implying a detrimental role of adverse childhood experiences (ACEs) - a highly prevalent developmental burden - in the development of epistemic trust and personality functioning. This study aimed to investigate the association between ACEs and conspiracy endorsement in the general population, specifically questioning a mediating role of epistemic trust and personality functioning.

METHODS

Based on cross-sectional data from a representative German survey collected during the COVID-19 pandemic (N = 2501), we conducted structural equation modelling (SEM) where personality functioning (OPD-SQS) and epistemic trust (ETMCQ) were included as mediators of the association between ACEs and conspiracy endorsement. Bootstrapped confidence intervals (5000 samples, 95%-CI) are presented for all paths.

RESULTS

ACEs were significantly associated with conspiracy endorsement (β = 0.25, p < 0.001) and explained 6% of its variance. Adding epistemic trust and personality functioning as mediators increased the explained variance of conspiracy endorsement to 19% while the direct association between ACEs and conspiracy endorsement was diminished (β = 0.12, p < 0.001), indicating an indirect effect of personality functioning and epistemic trust in the association between ACEs and conspiracy endorsement. Fit indices confirmed good model fit.

CONCLUSIONS

Establishing an association between ACEs and conspiracy endorsement further increases the evidence for early childhood adversities' far-reaching and detrimental effects. By including epistemic trust and personality functioning, these findings contribute to a deeper understanding of the underlying mechanisms in the way that ACEs may be associated with conspiracy endorsement.

[Sexualized Violence Toward Children and Adolescents: The Visibility and Implementation of Safeguarding Concepts in Sports, Music, and Church]

Sexualized Violence Toward Children and Adolescents: The Visibility and Implementation of Safeguarding Concepts in Sports, Music, and Church Abstract: Objective: In 2010, the disclosure of sexualized violence in educational organizations led to a public debate and calls for safeguarding concepts against sexualized violence toward children and adolescents. However, there have been few efforts to systematically record the visibility, availability, and implementation of such concepts. We used a broad Google search and a telephone survey as an initial approach to close this research gap. Method: In a systematic Google search and a telephone survey (N = 50), we identified and examined safeguarding concepts against sexualized violence toward children and adolescents in the context of religious organizations, sports, and musical education regarding its visibility, availability, and implementation level. Results: The results of our systematic internet research show a low hit rate of identified safeguarding concepts in all contexts. The low number of search hits indicates that the issue of sexualized violence toward children and adolescents has been inadequately addressed in many institutions, and that protective measures have been neglected. The supplementary results of the telephone survey suggest a low implementation level within organizations and a low availability of existing safeguarding concepts.

[Emotional Maltreatment of Children and Adolescents - Definitions, Prevalences, Risk Factors and Psychological Consequences]

The aim of this article is to provide an introductory overview of the phenomenon of emotional maltreatment of children and adolescents by presenting national and international literature and, in particular, to illustrate the consequences for the mental health of those affected. First, relevant definitions are made and forms of appearance of emotional child maltreatment are presented. A comparison of national and global prevalences shows that emotional child maltreatment is one of the most prevalent forms of child maltreatment. There are different risk factors that can exist at the level of the parents as well as at the level of the children or the environment. The risk that children and adolescents who have experienced emotional violence will have experienced other forms of childmaltreatment is high.There aremultiple consequences for victims of emotional child maltreatment which can result in different, longterm participatory impairments. Especially the psychological and somatic consequences of emotional childmaltreatment can be compared to the consequences of child sexual abuse and physical child maltreatment. Nevertheless, the significance of emotional maltreatment for affected children and adolescents is still underestimated in practice. Often, the effects of emotionalmaltreatment on those affected are not visible. Froma child and adolescent psychiatric/ psychotherapeutic perspective, the psychological consequences must therefore be clearly stated. Finally, there is a need for a broader understanding of emotional child maltreatment that also includes peer and sibling violence.

Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.

Adverse childhood experiences increase the risk for low perceived social participation and health-related quality of life in a large-scale population-based study in Germany

BACKGROUND

Adverse childhood experiences (ACEs) are highly prevalent and increase the risk for long-term adverse health outcomes. Next to well-known ACE-associated risks for morbidity, recent research is increasingly invested in exploring pathways towards health, overall functioning, and partaking in society following early adversity.

OBJECTIVES

Thus, this study aims to assess the association between latent classes of ACEs with perceived social participation and health-related Quality of Life (QoL) in a large population-based sample and to explore potential moderators of these associations.

METHOD

A representative sample of the German population (N = 2531; Mage = 48.7; 51 % women) was cross-sectionally investigated for ACEs, social participation (KsT-5), and health-related QoL (EuroQol-5D-5L). Latent Class Analysis (LCA) was performed to derive groups with similar ACE patterns. Multiple regression analyses were used to investigate the association of latent classes of ACEs with social participation and health-related QoL and to explore potential moderators.

RESULTS

Four distinct latent classes of ACEs were identified; "no/low ACEs" (N = 1968, 77.8 %); "household-dysfunction" (N = 259, 10.2 %), "child abuse and neglect" (N = 188, 7.4 %), and "polyadversity" (N = 116, 4.6 %). Compared to participants in the no/low ACE class, those in the ACE-exposed classes showed overall lower levels of perceived social participation and health-related QoL. The polyadversity class showed lower levels of social participation compared to the two other ACE-exposed classes. Chronic stress, living with a partner, education, current job/educational involvement, and gender were found to moderate these associations in exploratory analyses.

CONCLUSIONS

This study shows people exposed to ACEs to have a higher risk for lower perceived social participation and lower health-related QoL - an increased risk, however, is not a deterministic uninventable fortune. Reduction of chronic stress, fostering of social support, and educational and vocational paths as interventional targets are discussed to enable those with precarious starting conditions to partake in society.

The negative association of the SARS-CoV-2 pandemic with the health of mother and child considering maternal childhood maltreatment

BACKGROUND

Social distancing strategies during the SARS-CoV-2 pandemic have left families facing a variety of different constraints. Especially in this stressful time, children need a stable parental home to prevent developmental consequences. Additional risk factors such as maternal childhood maltreatment (CM) may affect mother's psychosomatic health and children's physical well-being in this period.

OBJECTIVE

It was aimed to analyze the associations between maternal CM, mother's mental health, and children's physical complaints during the SARS-CoV-2-pandemic.

METHOD

Mothers of a well-documented birth cohort from a longitudinal study were included in this study. Psychosomatic health was assessed with the PHQ-D and children's physical health with the GBB-KJ during the pandemic. N = 159 mothers completed the online survey. To describe the maternal CM, data from a longitudinal survey were used.

RESULTS

The calculation of three mediation analyses demonstrate that maternal depression symptoms (c-path: β = 0.10, p = .02; c'-path: β = 0.07, p = .13), somatic symptoms (c-path: β = 0.10, p = .02; c'-path: β = 0.07, p = .13) and psychosomatic symptoms (c-path: β = 0.10, p = .02; c'-path: β = 0.06, p = .19) fully mediate the relationship between CM and children's physical health complaints.

CONCLUSIONS

Maternal CM experiences seem to be one relevant risk factor during the pandemic and seem to influence the way in which parents deal with stressful situations and increase the risk for depressive symptoms. The present results highlight the importance to provide individually adjusted assistance to help the families to get through the pandemic.

Therapeutic Drug Monitoring in Children and Adolescents: Findings on Fluoxetine from the TDM-VIGIL Trial

Fluoxetine is the recommended first-line antidepressant in many therapeutic guidelines for children and adolescents. However, little is known about the relationships between drug dose and serum level as well as the therapeutic serum reference range in this age group. Within a large naturalistic observational prospective multicenter clinical trial ("TDM-VIGIL"), a transdiagnostic sample of children and adolescents (n = 138; mean age, 15; range, 7-18 years; 24.6% males) was treated with fluoxetine (10-40 mg/day). Analyses of both the last timepoint and all timepoints (n = 292 observations), utilizing (multiple) linear regressions, linear mixed-effect models, and cumulative link (mixed) models, were used to test the associations between dose, serum concentration, outcome, and potential predictors. The receiver operating curve and first to third interquartile methods, respectively, were used to examine concentration cutoff and reference values for responders. A strong positive relationship was found between dose and serum concentration of fluoxetine and its metabolite. Higher body weight was associated with lower serum concentrations, and female sex was associated with lower therapeutic response. The preliminary reference ranges for the active moiety (fluoxetine+norfluoxetine) were 208-328 ng/mL (transdiagnostically) and 201.5-306 ng/mL (depression). Most patients showed marked (45.6%) or minimal (43.5%) improvements and reported no adverse effects (64.9%). This study demonstrated a clear linear dose-serum level relationship for fluoxetine in youth, with the identified reference range being within that established for adults.

Adverse childhood experiences and personality functioning interact substantially in predicting depression, anxiety, and somatization

Etiological theories on the development of psychopathology often incorporate adverse childhood experiences (ACE) as an important contributing factor. Recent studies suggest personality functioning (PF; i.e., stability of the self and interpersonal relationships) as an important transdiagnostic construct that could be useful in better understanding when persons with ACE do (not) develop psychopathological symptoms. A representative sample of N = 2363 was assessed by questionnaires on ACE, PF (Level of Personality Functioning Scale-Brief Form 2.0), and current symptoms of depression, anxiety, and somatization (Brief Symptom Inventory 18). The interaction between ACE and PF on symptoms was investigated using multiple group models and Bayesian structural equation modeling. ACE were positively associated with psychopathology and PF impairments. The interaction effect between ACE and PF explained incremental variance in current symptoms, ranging from 26% for somatization to 49% for depression with the complete model explaining up to 91% of the latent variance in psychopathology. Our findings indicate a diathesis-stress model with PF as a resource or resilience that may buffer against the development of symptoms in the face of adversity. Treatments of depression and anxiety targeting self and interpersonal functioning therefore may lead to improvements in resilience and relapse prevention. [Correction added on 15 March 2023, after first online publication: Level of Personality Functioning Scale-Brief Form has been replaced to Level of Personality Functioning Scale-Brief Form 2.0 ].

Supplementary data analyses for the associations of child maltreatment and diabetes in adulthood and the mediating effect of personality functioning

In this article, supplementary data analyses regarding the association between different types of child maltreatment (CM) and diabetes as well as mediation analyses examining the role of personality functioning are provided (original research article: 'Associations of different types of child maltreatment and diabetes in adulthood - the mediating effect of personality functioning: findings from a population-based representative German sample') (Zara et al., 2023). Analyses are based on a representative sample of the German population (N = 5,041). Data was acquired through a representative survey conducted by the independent research institute USUMA Berlin. CM, personality functioning, a diabetes diagnosis as well as symptoms of depression and anxiety were assessed using self-report questionnaires (CTQ, OPD-SQS, PHQ-4). Correlation analyses for all used variables were conducted. Independent t-tests were performed to examine whether symptoms of depression and anxiety are elevated in patients with diabetes and CM (compared to no CM). Regarding the odd ratios (ORs) calculated to examine the association between types of CM and diabetes as well as mediation analyses investigating the role of personality functioning in these associations, sensitivity analyses with persons ≥ 30 years are provided. The additional analyses are intended to add to the body of research showing that patients with diabetes experience symptoms of depression and anxiety more frequently compared to the general population (Kampling and Kruse, 2020; Chireh et al., 2019; Smith et al., 2018), examine the association between different types of CM and diabetes, and explore the role of personality functioning in the association between CM and diabetes.

The DNA methylation landscape of the human oxytocin receptor gene (OXTR): data-driven clusters and their relation to gene expression and childhood adversity

The oxytocin receptor gene (OXTR) is of interest when investigating the effects of early adversity on DNA methylation. However, there is heterogeneity regarding the selection of the most promising CpG sites to target for analyses. The goal of this study was to determine functionally relevant clusters of CpG sites within the OXTR CpG island in 113 mother-infant dyads, with 58 of the mothers reporting childhood maltreatment (CM). OXTR DNA methylation was analyzed in peripheral/umbilical blood mononuclear cells. Different complexity reduction approaches were used to reduce the 188 CpG sites into clusters of co-methylated sites. Furthermore, associations between OXTR DNA methylation (cluster- and site-specific level) and OXTR gene expression and CM were investigated in mothers. Results showed that, first, CpG sections differed strongly regarding their statistical utility for research of individual differences in DNA methylation. Second, cluster analyses and Partial Least Squares (PLS) suggested two clusters consisting of intron1/exon2 and the protein-coding region of exon3, respectively, as most strongly associated with outcome measures. Third, cross-validated PLS regression explained 7% of variance in CM, with low cross-validated variance explained for the prediction of gene expression. Fourth, substantial mother-child correspondence was observed in correlation patterns within the identified clusters, but only modest correspondence outside these clusters. This study makes an important contribution to the mapping of the DNA methylation landscape of the OXTR CpG island by highlighting clusters of CpG sites that show desirable statistical properties and predictive value. We provide a Companion Web Application to facilitate the choice of CpG sites.

Emotional problems in young children during the SARS-CoV-2-pandemic and child attachment

Background

Restrictions imposed by national governments during SARS-CoV-2-pandemic have impacted the mental health of children around the world. Studies have already proven the importance of secure attachment acting as a protective factor in child development. Therefore, children with secure attachment have a higher chance of developing and using appropriate coping mechanisms.

Objective

The goal of this study was to explore the possible connection between the pandemic, as well as child attachment, and young children's emotional health. The general hypothesis assumes a lower rate of emotional problems among children with secure attachment and a higher rate of emotional problems among children with insecure-disorganized attachment, as well as an increase of these problems during the pandemic.

Method

The analysis included N = 129 mothers (M = 39.98 years) and their children (M = 5.19 years). Via an online survey, which was held at different time points during the pandemic, information on the children's emotional problems was retrieved. The survey used the Strengths and Difficulties Questionnaire (SDQ). Data regarding the quality of attachment was collected via the Strange Situations Test (SST). At this point the participating children were approximately 12 months old.

Results

The calculation of a mixed ANCOVA showed, that attachment quality had a significant influence on children's emotional problems [F(2, 121) = 4.01, p = .021]. The interaction effect between time and child attachment reached significance [F(3.45, 208.42) = 3.58, p = .011]. The calculation of an additional mixed ANCOVA showed, that the reported emotional problems of girls were higher than those of boys F(1, 118) = 4.56, p = .035).

Conclusions

Our study shows that there is an association between attachment security and emotional problems and the impact of the SARS-CoV-2 pandemic on the mental health of preschool children in Germany. The emotional problems of all children increased, especially the disorganized attached children had been reported as emotionally stressed in the first lockdown. The results indicate the need for preventive services (for children and parents) to promote and maintain stress coping skills in order to maintain children's mental health in times of crisis.

Anxiety increased among children and adolescents during pandemic-related school closures in Europe: a systematic review and meta-analysis

BACKGROUND

Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies.

METHODS

A registration on the 'International Prospective Register of Systematic Reviews' (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the 'Risk of Bias in Non-randomized Studies of Exposure' [ROBINS-E]) and certainty of evidence (using the 'Grading of Recommendations Assessment, Development and Evaluation' [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement.

RESULTS

Of 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17-0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98-1.19). Increase in general anxiety symptoms was highest in the 11-15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30-0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23-0.65]) occurred.

CONCLUSION

General anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11-15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented. PROSPERO registration: CRD42022303714.

Long-term mental health consequences of female- versus male-perpetrated child sexual abuse

BACKGROUND

Research on child sexual abuse increasingly focuses on sexually offending females; however, there is a lack of research that focuses on the individuals being affected. Studies have suggested that the consequences for those affected by sexually offending males and females are comparable.

OBJECTIVE

The aim is to compare mental health consequences of sexual abuse perpetrated by women versus men in quantity and type.

PARTICIPANTS AND SETTING

Data was anonymously retrieved from the German-wide contact point "help line sexual abuse" from 2016 to 2021. Details of abuse cases, gender of the offending individuals, and reported mental disorders of the person affected were analyzed. The sample consisted of N = 3351 callers with experiences of child sexual abuse.

METHOD

The relationship between gender of the perpetrating person and mental disorders of the victimized person was computed using logistic regression models. To account for rare events data, Firth's logistics regression model was used.

RESULTS

The consequences were similar in quantity, albeit different in type. Callers with experiences of female-perpetrated abuse were more likely to report suicidality, non-suicidal self-injury behavior, personality disorders, dissociative identity disorders, alcohol/ drug addiction, and schizophrenia, while people with experiences of male-perpetrated abuse rather reported post-traumatic stress disorder, affective disorders, anxiety disorders, dissociative disorders, eating disorders, externalized disorders, and psychosomatic disorders.

CONCLUSIONS

The differences may be due to stigmatization leading to dysfunctional coping mechanisms. Societal gender stereotypes must be reduced, especially within the professional helping system to ensure support for people who have experienced sexual abuse, regardless of gender.

Epidemiology of intimate partner violence perpetration and victimisation in a representative sample

AIMS

Intimate partner violence (IPV) is a major global public health problem. Although IPV is known to be frequent and perpetration and victimisation often co-occur, large representative samples assessing both, male and female IPV perpetration and victimisation and overlaps are missing to date. Thus, we aimed to assess victimisation and perpetration and its overlap in physical, sexual, psychological and economic IPV in a representative sample of the German population.

METHODS

We conducted a cross-sectional, observational study in Germany from July to October 2021. Using different sampling steps including a random route procedure, a probability sample of the German population was generated. The final sample consisted of 2503 persons (50.2% female, mean age: 49.5 years). Participants were asked about socio-demographic information in a face-to-face interview and experience of physical, psychological, sexual and economic IPV using a questionnaire.

RESULTS

A significant proportion of persons in Germany reporting IPV are both perpetrator and victim for each IPV form. The biggest overlap between perpetration and victimisation was seen for psychological IPV. Major risk factors for IPV perpetration only were male gender and adverse childhood experiences (ACEs) while major risk factors for IPV victimisation only comprised of female gender, low household income and ACEs. In the perpetration and victimisation group, gender differences were less significant; older age and lower household income did increase the likelihood of combined perpetration and victimisation.

CONCLUSIONS

We have identified a significant overlap of perpetration and victimisation of IPV in the German population for men and women. However, men are at much higher risk to perpetrate IPV without being a victim. Further research and the development of adapted approaches for contexts of overlapping IPV are necessary.

Anxiety among children and adolescents during the COVID-19 pandemic in Europe: a systematic review protocol

BACKGROUND

A growing number of studies point to a high mental health burden among children and adolescents during the COVID-19 pandemic, particularly concerning anxiety. However, the study quality and effect direction are heterogeneous in the existing primary studies with a lacking overview for the European continent. Therefore, this systematic review aims to critically synthesise the evidence regarding the impact of the COVID-19 pandemic on anxiety among children and adolescents in Europe compared to a pre-pandemic baseline.

METHODS

A systematic literature search will be performed in six databases (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and WHO COVID-19 database) with a peer reviewed search strategy according to the evidence-based checklist Peer Review of Electronic Search Strategies (PRESS). Inclusion criteria are children and adolescents ≤ 19 years living in Europe and data report during the COVID-19 pandemic with an appropriate pre-pandemic baseline. Primary outcomes are general anxiety symptoms and clinically relevant anxiety rates. Risk of bias will be assessed using the 'Risk of Bias in Non-randomised Studies of Exposure' (ROBINS-E). Data extraction will systematically include information on study design, population characteristics, COVID-19 determinants, pre-pandemic baseline, diagnostic instruments and outcome. The certainty of evidence for each outcome will be evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach adapted to the use of non-randomised studies. All process steps will be performed independently by two reviewers; any discrepancies will be discussed and, if necessary, resolved by a third author. Also, subgroup analysis, sensitivity analysis, publication bias analysis, and meta-regression analysis, if applicable, will be performed. The systematic review was registered in the Prospective Register of Systematic Reviews (PROSPERO) and the protocol was prepared in accordance to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement.

DISCUSSION

This systematic review will address the lack of a critical and comprehensive summary of findings on the COVID-19 pandemic impact on anxiety among children and adolescents in Europe. In addition, it aims to identify pandemic-policy differences, such as the effect of school-closures, and identify particularly vulnerable risk groups.

SYSTEMATIC REVIEW REGISTRATION

CRD42022303714 (PROSPERO).

[Honors granted by the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) and its predecessors]

Honors granted by the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) and its predecessors Abstract. Abstracts: This research on the "honors" granted by the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) investigated all persons honored by the society from 1950 (following the postwar reestablishment of the society) up through 1990 (German reunification). We explored the adequacy of the honors regarding the professional ethics of the honorees during the NS-regime. Ethics violations included so-called T4-assessments (euthanasia) leading to death, working in "special units" where children were murdered using drugs, or any form of nontherapeutic experiments on humans. The Heinrich Hoffman Medal was first awarded in 1957, with honorary memberships being conferred from 1963 onward. From 1957 to 1990, the DGKJP awarded 19 honorary memberships and 9 Heinrich Hoffman Medal to 27 recipients (one person received both). Of those honored, three were detected as violators of professional ethics. After long internal discussions, the DGKJP had already distanced itself from Elisabeth Hecker (1895-1986), Hans-Alois Schmitz (1899-1973), and Werner Villinger (1887-1961). The ideology shared by these three was formulated by Villinger as the "ineducability" of their child victims because of an "inferiority paradigm." The rejection by the DGKJP went little noticed in public, and until 2021 was only briefly mentioned in the society's newsletter. Eleven honored persons were former members of the NSDAP without demonstrable ethical transgressions; the investigations are still ongoing for three others, whose ethical transgressions have neither been ruled out nor confirmed.

Widening epidemiological data on the prevalence of child maltreatment: Validation of the German ICAST-R in a student sample and national household survey

BACKGROUND

A number of instruments for measuring child maltreatment (CM) prevalence have repeatedly been used across different countries. Although they hold the potential for providing benchmarks to tackle the gap of lacking comparability of CM prevalence across countries, contextual information about the adverse experiences such as perpetrator, chronicity, frequency, or severity are rarely covered. The ISPCAN Child Abuse Screening Tool - Retrospective (ICAST-R) covers these important dimensions. The German version increases the number of available versions to 21 different languages. Spoken by about 120 million people, German is one of the 20 most prevalent languages around the world. Moreover, the ICAST-R is intended to be used with young adults. This study further aims at adding towards the gap of psychometrics in older age groups.

METHODS

Analyses are based on both a sample of German students (n = 333) and a nationally representative household survey (n = 2515). The validation process covered six steps: (1) Analyses of missing data on single items, (2) calculation of descriptive statistics to estimate the prevalence CM as well as subjective severity and main perpetrators. (3) Structural validity of the four conceptualized subtypes of CM (neglect, physical abuse, emotional abuse and sexual abuse) was tested using confirmatory factor analyses (CFA). Next (4), equivalence testing by multigroup confirmatory factor analyses (MGCFA) on age groups was conducted within the representative sample; (5) reliability was tested by determining internal consistencies for each subscale via the McDonald's Omega, Kuder-Richardson 20 (KR-20), and Cronbach's alpha. Lastly (6), criterion validity was tested in regression models comparing depressive/anxious symptomatology for single victimization and polyvictimization.

RESULTS

The German ICAST-R yielded low missing values items in both samples. 16 % of the participants in the national household survey reported neglect, 20.3 % physical abuse, 22.2 % emotional abuse, and 8.6 % sexual abuse. Polyvictimization was prevalent with 20.6 % of subjects reporting >2 types of CM. Students in the pilot-survey reported much higher prevalence estimates than participants in the nationally representative sample. The types of CM subjectively rated as most harmful were emotional abuse and sexual abuse. In both samples, structural validity was similarly confirmed as CFA was reproducing the four conceptualized subtypes of CM with adequate fit (household survey: CFI 0.919, TLI 0.907, RMSEA 0.017, SRMR 0.046). Internal consistency achieved acceptable and comparable values for all three types of coefficients; criterion validity was established with a significant dose-response effect of CM experiences on both anxiety and depressive symptoms/diagnoses. Age dependent analyses on structural validity (MGCFA) and reliability in the household survey revealed potential weaknesses of items.

CONCLUSION

The German version of the ICAST-R both widens the possibility of international CM prevalence comparison and provides novel epidemiological data for Germany on subjective severity of CM and CM perpetrators. Even in the presence of a marked selection bias, the ICAST-R had similarly good psychometric properties in the student and nationally representative household sample. Except for issues with two items, equivalence testing was comparable across age groups.

Parental stress and physical violence against children during the second year of the COVID-19 pandemic: results of a population-based survey in Germany

BACKGROUND

Parents and caregivers belonged to those with the highest burdens during the COVID-pandemic. Considering the close link between parental stress and child maltreatment, identifying families with high parental stress is of utmost importance to prevent violence against children. Within this study, we thus aimed to investigate the interplay of parental stress, changes in parental stress, and physical violence against children during the second year of the COVID-pandemic on an exploratory level.

METHODS

We conducted a cross-sectional, observational study in Germany from July to October 2021. By using different sampling steps, a representative probability sample of the German population was generated. A subsample of these participants with children under the age of 18 was included for analysis within this study (N = 453, 60.3% females, M_age = 40.08; SD = 8.53).

RESULTS

Higher parental stress levels were associated with more physical violence against children, higher levels of own experiences of child maltreatment, and mental health symptoms. An increase in parental stress during the pandemic was associated with female sex, the use of physical violence against children, and parental experience of child maltreatment. Parents who have ever used physical violence against their children have been characterized by higher parental stress levels, a stronger increase in parental stress during the pandemic, own experience of child maltreatment, mental health symptoms and sociodemographic characteristics. Higher parental stress levels, a stronger increase of parental stress during the pandemic, having pre-existing psychiatric disorders, and parental experience of child maltreatment predicted an increased use of physical violence against children during the pandemic.

CONCLUSIONS

Our results underscore the importance of parental stress for the risk of physical violence against children, more so in times of overall increased stress due to the pandemic and underline the need for low threshold support for families at risk in times of crises.

Associations of different types of child maltreatment and diabetes in adulthood - the mediating effect of personality functioning: Findings from a population-based representative German sample

PURPOSE

This study aimed to examine the role of personality functioning in the association between various types of child maltreatment (CM) (sexual, physical, and emotional abuse as well as physical and emotional neglect) and diabetes in adulthood.

METHODS

Analyses are based on representative data of the German population (N = 5,041) from 2016 to 2019. Self-report questionnaires assessed diagnosis of diabetes, child maltreatment (CTQ), personality functioning (OPD-SQS), and symptoms of depression/anxiety (PHQ-4). Odd ratios were calculated to examine the association between CM and diabetes, and mediation analyses including PHQ-4 as covariate were conducted to examine the role of personality functioning.

RESULTS

All CM types significantly elevated the odds of having diabetes in adulthood. Personality functioning mediated the association between abuse and diabetes (sexual: b = 0.012, 95% CI [.002, 0.022], P_M = 25.0%, physical: b = 0.009, 95% CI [.001, 0.017], P_M = 12.0%, and emotional: b = 0.013, 95% CI [.002, 0.024], P_M = 59.8%), but not between neglect and diabetes.

CONCLUSIONS

CM is associated with an increased risk of diabetes, with personality functioning being a relevant mediator for CM abuse types. Hence, by focusing on CM prevention and considering impaired personality functioning in diabetes treatment, diabetes self-management and health behavior could be improved.

SARS-CoV-2 pandemic as a catalyst? Development of emotional problems of preschool children of mothers with childhood maltreatment experiences in the course of the pandemic-a longitudinal analysis

Background

SARS-CoV-2 pandemic have posed great challenges for all families and children. Health risks and fears associated with SARS-CoV-2 negatively affect the parental mental health and perceived stress, which in turn influence parental coping and thereby impairs the mental health and well-being of their children. Additional risk factors within the parents, such as maternal childhood maltreatment (CM) experiences, may increase the risk of children to develop emotional problems during the pandemic.

Objective

The purpose of this longitudinal study is to determine whether preschool children of mothers with CM are at higher risk of developing emotional problems during the pandemic than preschool children of mothers without CM.

Method

74 mothers from a birth cohort examining pathways to resilience or vulnerability in the transgenerational transmission of CM, provided information on emotional problems of their children (aged 3-7 years) at two measurement time points (t1: May 2020, t2: March 2021) as part of an online "SARS-CoV-2 pandemic" survey. In addition, parents were asked for a retrospective assessment of their children's emotional problems before the pandemic at time t1. Children's emotional problems were assessed using the "emotional problems" scale of the German version of the Strengths and Difficulties Questionnaire (SDQ) and linked to previously collected data on mothers' childhood maltreatment experiences, which were collected using the German short version of the Trauma in Childhood Questionnaire (CTQ).

Results

Our analyses showed that children's emotional problems increased significantly over the SARS-CoV-2 pandemic [F(1.86, 116.88) = 3.72, p = 0.030 η ² = 0.06] and were rated significantly higher in the group of children of mothers with CM, than in the group of mothers without CM [F(1, 63) = 126.06, p < 0.001 η ²= 0.67]. Furthermore children's emotional problems of mothers with CM increased significantly more and reached a clinically significant value during the pandemic than for children of mothers without CM [F(1.86, 116.88) = 8.89, p < 0.001, η ²= 0.12].

Conclusions

Children of mothers with CM appear to be at increased risk of developing emotional problems during the pandemic. CM therefore needs to be considered as an additional risk factor in the impact of the pandemic on children.

Increase of depression among children and adolescents after the onset of the COVID-19 pandemic in Europe: a systematic review and meta-analysis

BACKGROUND

Research points to a high depression burden among youth during the COVID-19 pandemic; however, a lack of systematic evidence exists. We determine the change in depression symptoms among children and adolescents during COVID-19 compared to pre-pandemic baselines. By using country differences in pandemic-related restrictions and school closures in Europe as quasi-experimental design, we evaluate policy impacts on depression.

METHODS

In this systematic review and meta-analysis, following the PRISMA statement, we searched six databases (MEDLINE, EMBASE, PsycINFO, Cochrane Central, Web of Science, WHO COVID-19) using a peer-reviewed search string up until March 18, 2022 with citation tracking and grey literature searches. No limitations regarding language and effect measures existed. We included studies that compared (1) general depression symptoms or (2) clinically relevant depression rates in children and adolescents (≤ 19 years) before and during the COVID-19 pandemic in Europe. The validated Oxford Stringency Index was used as indicator for pandemic-related restrictions. Screening for eligibility, extracting data from published reports and from unpublished data requested directly from study authors, assessing the study risk of bias and grading certainty of evidence using the GRADE approach, were all done in duplicate. Data were pooled in a random-effects model.

PROSPERO

CRD42022303714.

RESULTS

Of 7,422 nonduplicate records, 22 studies with data from 868,634 participants pre-pandemic and 807,480 during pandemic, met full inclusion criteria. For the comparison of depression symptoms before and during the COVID-19 pandemic, moderate certainty of evidence was observed for general depression symptoms (standardized mean difference, 0.21 [95%CI, 0.12-0.30]; I² = 94%) and low certainty of evidence for clinically relevant depression rates (odds ratio, 1.36 [95%CI, 1.05-1.76]; I² = 95%) for total population. Increase in general depression symptoms was higher for male adolescents, whereas increase in clinically relevant depression rates was higher for females. Effect estimates were significantly higher when pandemic-related restrictions were more stringent or school closure occurred.

CONCLUSION

An increase in depression symptoms occurred in a pre-pandemic vs. during-pandemic comparison within the COVID-19 pandemic, whereby pandemic-related restrictions (such as school closures) resulted in a considerable effect increase. Ensuring adequate supply of mental health recovery services and long-term monitoring is of high public health relevance.

[Associations of Internal Migration and Somatoform Symptoms, Depression, and Anxiety in a German Representative Sample]

AIM

The aim of the present study was to determine, if internal German migration was associated with mental distress, somatoform symptoms, depression, and anxiety.

METHODS

Data from two representative studies from 2020 and 2021 were analysed (N=4922). Mental distress, including the dimensions somatoform symptoms, depression, and anxiety, was assessed with the short version of the Brief Symptom Inventory (BSI-18). Linear regression analyses were performed to examine associations between internal migration and mental distress while controlling for sociodemographic factors (gender, age, partner, household equivalised income, and education).

RESULTS

Internal migrants from East to West Germany reported more mental distress, somatoform symptoms, depression, and anxiety than those who grew up and stayed in the East. This finding remained after controlling for sociodemographic factors. No differences were found between internal migrants from West to East Germany and those who grew up and stayed in West Germany.

DISCUSSION

German internal migration should be taken into account when examining differences in mental health in East and West Germany. Our results suggest that particularly the group that had moved from the Eastern to the Western part of Germany reported significantly signs of mental distress.

Negative Posttraumatic Cognitions in 4- to 8-year-old Children following Maltreatment

PURPOSE

Research has shown that children and adolescents suffering from posttraumatic stress often have negative posttraumatic cognitions such as negative appraisals of the trauma sequel that increase mental health problems. However, little is known about posttraumatic cognitions in young children. The aim of this study was to investigate negative posttraumatic cognitions in 4- to 8-year-old children following maltreatment. We also examined their association with child age and well-being as well as caregiver psychopathology.

METHODS

The study includes N = 112 caregiver-child dyads with children's mean age of M = 6.2 (SD = 1.1) years. Children had experienced physical abuse, emotional abuse, neglect, sexual victimization, and/or domestic violence prior to participation. Posttraumatic cognitions were assessed using a short child interview including four items adapted from the Child Posttraumatic Cognitions Inventory (CPTCI; Meiser-Stedman et al in Journal of Child Psychology and Psychiatry, 50(4), 432-440, 2009).

RESULTS

Completion of the interview about posttraumatic cognitions was independent from child's age. Higher levels of negative posttraumatic cognitions were significantly associated with a higher cumulative maltreatment score (r = .35) and higher scores of posttraumatic stress symptoms (r = .39). There was no significant correlation with parent variables.

CONCLUSION

These findings indicate that posttraumatic cognitions might be an important diagnostic and treatment target for 4- to 8-year-old children.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40653-022-00455-4.

Condemn or Treat? The Influence of Adults' Stigmatizing Attitudes on Mental Health Service Use for Children

Stigmatizing attitudes towards mental disorders influence parents’ help-seeking behavior for their child’s mental health problems. As untreated mental disorders can cause morbidity and mortality, such parental attitudes are a serious barrier for public health promotion. Therefore, the help-seeking readiness in a distressed child’s broad social environment is essential. However, the role of stigma was unexplored in this context. This study empirically investigated the influence of adults’ stigmatizing attitudes towards mentally disabled people on their readiness to seek professional help for children’s mental health issues. Data from a representative German sample (N = 1906; 52% female) were collected between July and October 2021. A heteroscedastic ordered probit model was used for estimation. An empirical analysis provides evidence for a significant negative relationship between adults’ stigmatizing attitudes and their readiness to initiate mental health support for children (ß = −0.01; p < 0.001). Support acceptance seems to be independent of having children. To tackle stigmatizing attitudes and to promote public health, mental health literacy should be fostered through broad-based approaches. Awareness should be raised that children are also entitled to mental health care, just as they are in other health areas. Policy makers need to promote comprehensive information about mental illnesses and create incentives for acute and preventive service use.

Survey on Reporting of Child Abuse by Pediatricians: Intrapersonal Inconsistencies Influence Reporting Behavior More than Legislation

Background: Internationally, various laws govern reporting of child abuse to child protection services by medical professionals. Whether mandatory reporting laws are in place or not, medical professionals need internal thresholds for suspicion of abuse to even consider a report ("reasonable suspicion" in US law, "gewichtige Anhaltspunkte" in German law). Objective: To compare internal thresholds for suspicion of abuse among US and German pediatricians, i.e., from two countries with and without mandatory reporting laws. Participants and Setting: In Germany, 1581 pediatricians participated in a nationwide survey among child health professionals. In the US, a survey was mailed to all Pennsylvania pediatricians, and 1249 participated. Methods: Both samples were asked how high in their rank order of differential diagnoses child abuse would have to be when confronted with a child's injuries to qualify for reasonable suspicion/gewichtige Anhaltspunkte (differential diagnosis scale, DDS). In a second step, both had to mark a 10-point likelihood scale (0-100%) corresponding to reasonable suspicion/gewichtige Anhaltspunkte (estimated probability scale, EPS). Results: While for almost two-thirds of German pediatricians (62.4%), child abuse had to be among the top three differential diagnoses for gewichtige Anhaltspunkte, over half of the US respondents (48.1%) had a lower threshold for reasonable suspicion. On the estimated probability scale, over 65% in both samples indicated that the probability of abuse had to exceed 50% for reasonable suspicion/gewichtige Anhaltspunkte. There was great variability between the two countries. Conclusions: There are similar uncertainties in assessing cases of suspected child abuse in different legal systems. There is a need for debates on thresholds among medical professionals in both countries.

Is the end in the beginning? Child maltreatment increases the risk of non-suicidal self-injury and suicide attempts through impaired personality functioning

BACKGROUND

Child maltreatment is a risk factor for a range of mental disorders later in life, including dangerous self-harm and suicide attempts. A better understanding of the mechanisms underlying this association can inform prevention and intervention.

OBJECTIVE

To investigate personality functioning as a potential mediator of the association of childhood abuse and neglect and self-harm and suicide attempts in the general population.

PARTICIPANTS AND SETTING

Data were drawn from a representative German population sample (N = 2510).

METHODS

Participants filled out the Childhood Trauma Questionnaire (CTQ), OPD Structure Questionnaire (OPD-SQS), and items of the Self-Injurious Thoughts and Behaviors Interview (SITBI). In structural equation models, we operationalized impaired personality functioning as the mediator between childhood abuse and neglect and self-harm.

RESULTS

Individuals with a history of self-harm (combining suicide attempts, N = 47, and non-suicidal self-injury, N = 83) reported more childhood abuse and neglect (d = 1.39, p < .001) and greater impairments in personality functioning (d = 1.64, p < .001) than the rest of the population. The indirect effect via personality functioning accounted for 48.8 % of the total effect of childhood abuse and neglect on self-harm. In more differentiated analyses, emotional abuse showed the strongest association with self-harm. Only physical and sexual abuse had direct effects.

CONCLUSIONS

The results specify the relationship between child maltreatment and self-harm by demonstrating that it is partly mediated by basic functions of personality assessed using a dimensional measure. These abilities constitute modifiable risk factors that can be addressed by psychotherapy.

Zur Messqualität des Beck-Depressionsinventars (BDI-II) in unterschiedlichen klinischen Stichproben

Zusammenfassung. Theoretischer Hintergrund: Das BDI-II ist ein Selbstbeurteilungsinstrument zur Erfassung des Schweregrads einer Depression. Es liegen kaum Analysen mit Modellen aus der Item-Response-Theorie (IRT) vor. Fragestellung: Wie hoch ist die Messgenauigkeit des BDI-II über die unterschiedlichen Ausprägungen des latenten Traits (Depressivität) hinweg und sind die Kategorien der Items jeweils aufsteigend geordnet? Methode: Anhand von sechs großen Datensätzen aus verschiedenen klinischen Bereichen wurden psychometrische Analysen mit dem Graded Response Model durchgeführt. Ergebnisse: In allen Stichproben fand sich eine hohe interne Konsistenz. Die Schwellenwerte waren mit Ausnahme von Item 6 („Bestrafungsgefühle“) geordnet. Gemäß Testinformationsfunktion misst das BDI-II im mittleren bis hohen Depressionsbereich sehr gut (Reliabilität > .90) und im unteren Bereich gut. Schlussfolgerung: Für das BDI-II ergibt sich eine hohe und relativ gleichbleibende Messpräzision über einen weiten Bereich des latenten Traits, weshalb es insbesondere im klinischen, aber auch im nicht klinisch relevanten Wertebereich zur Erhebung des Schweregrades einer Depression gut geeignet ist.

Adverse childhood experiences growing up in East or West Germany or abroad

Background

Adverse childhood experiences (ACEs) are potentially traumatic events that occur before the age of 18. The term encompasses various adverse childhood experiences, e.g., physical, psychological, and sexual abuse, physical and psychological neglect, and family dysfunction. Prevalence estimates for a broad spectrum of ACEs against the background of where childhood and adolescence were spent are scarcely available in Germany. This study examines the frequencies of adverse childhood experiences, considering growing up in East or West Germany or abroad and interacting with different age cohorts and gender.

Methods

A total of 5,018 individuals (51.4% female) aged 14 years and older were retrospectively assessed on adverse childhood experiences using questionnaires "adverse childhood experiences" (ACE). Logistic regression models were used to analyze the association between birth cohort, gender, and where a person grew up. Descriptive statistics and univariate analyses were used to calculate frequencies, proportions, and unadjusted associations for each variable.

Results

37.4% (N = 1,878) of respondents reported experiencing at least one form of ACE. Individuals who grew up abroad report significantly more adverse childhood experiences than individuals in East or West Germany. Men and women who grew up in East Germany reported a lower rate of ACEs. We found significant effects for all predictors: Where childhood and adolescence were predominantly spent, year of birth, and gender. Significant differences in the prevalence of adverse childhood experiences within the gender groups were only found for sexual and physical abuse and substance dependence in the household.

Conclusion

The results suggest that the socio-political context plays an essential role in the experience of adverse childhood experiences, both in frequency and risk. Thus, child abuse and neglect studies should increasingly focus on societal risk and protection mechanisms.

Validation and standardization of the Childhood Trauma Screener (CTS) in the general population

BACKGROUND

A valid, quick and widely applicable retrospective screening tool for child maltreatment is of great importance to better adapt interventions and treatments. The Childhood Trauma Screener (CTS), derived from the Childhood Trauma Questionnaire (CTQ), is one such instrument that aims to increase the likelihood of detecting mental and physical disorders that have manifested in adulthood as a result of traumatic experiences and maltreatment in childhood and adolescence. The present study aimed to investigate the psychometric properties of the CTS and generate normative data.

METHODS

Data from two representative surveys were combined. Both surveys used identical methods. The CTS, consisting of five items, other self-report instruments, and demographic characteristics were used. Construct validity was examined using confirmatory factor analysis (CFA). A subsample was used to examine convergent validity with the Adverse Childhood Experiences Questionnaire (ACE). Normative data are reported for age groups and gender.

RESULTS

A total of 5039 study participants provided valid responses to the 5-items questionnaire (54.3% female, response rate = 78.9%). CFA showed good fit indices for a 2-factor solution. Convergent validity was generally supported by moderate intercorrelations with the ACE.

CONCLUSIONS

The results confirm the solid psychometric properties of the CTS as an easy-to-use, ultra-short retrospective measure of child maltreatment. The data can be used to compare sample or individual results with reference data provided.