Skip to main content

Advertisement

Log in

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

  • ORIGINAL CONTRIBUTION
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Background

Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany.

Objectives

The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation.

Methods

The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7–17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/hyperactivity disorder (FBB-HKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined.

Results

Overall, 14.5% of the children and adolescents aged 7–17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed.

Conclusions

The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Arbeitsgruppe Deutsche Child Behavior Checklist (1998) Elternfragebogen über das Verhalten von Kindern und Jugendlichen; deutsche Bearbeitung der Child Behavior Checklist (CBCL/4-18). Einführung und Anleitung zur Handauswertung, 2. Auflage mit deutschen Normen. Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik, Köln

  2. Achenbach TM (1991) Manual for the Child Behavior Checklist/4–18 and 1991 Profile. University of Vermont, Department of Psychiatry, Burlington

    Google Scholar 

  3. Achenbach TM (1991) Manual for the Youth Self-Report and 1991 Profile. University of Vermont, Department of Psychiatry, Burlington

    Google Scholar 

  4. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders–DSM-IV-TR, 4th edn. APA, Washington, DC

    Google Scholar 

  5. Antonovsky A (1987) Unraveling the mystery of health. Bass, San Francisco

    Google Scholar 

  6. Bastine R (1998) Klinische Psychologie. Band 1. Grundlegung der Allgemeinen Klinischen Psychologie, Kohlhammer, Stuttgart

    Google Scholar 

  7. Barkmann C, Schulte-Markwort M (2002) Wie gesund sind die Seelen unserer Kinder? Zur Epidemiologie von Erlebens- und Verhaltenssauffälli- gkeiten bei 4–18-jährigen in Deutschland. XXVII. Kongress der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie und Psychotherapie, 3–6 April, Berlin

  8. Barkmann C, Schulte-Markwort M (2004) Prävalenz psychischer Auffälligkeiten bei Kindern und Jugendlichen in Deutschland - ein systematischer Literaturüberblick. Psychiatr Prax 31: 1–10

    Article  Google Scholar 

  9. Belfer ML (2008) Child and adolescent mental disorders: the magnitude of the problem across the globe. J Child Psychol Psychiatry 49:226–236

    Article  PubMed  Google Scholar 

  10. Bethell C, Read D, Stein RE, Blumberg SJ, Wells N, Newacheck PW (2002) Identifying children with special health care needs: development and evaluation of a short screening instrument. Ambul Pediatr 2:38–48

    Article  PubMed  Google Scholar 

  11. Bettge S, Ravens-Sieberer U, Wietzker A, Hölling H (2002) Ein Methodenvergleich der Child Behavior Checklist und des Strengths and Difficulties Questionnaire. Gesundheitswesen 64:119–124

    Article  Google Scholar 

  12. Bettge S, Ravens-Sieberer U (2003) Schutzfaktoren für die psychische Gesundheit von Kindern und Jugendlichen–empirische Ergebnisse zur Validierung eines Konzepts. Gesundheitswesen 65:167–172

    Article  CAS  PubMed  Google Scholar 

  13. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M (1999) psychometric properties of the screen for child anxiety related emotional disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 38:1230–1236

    Article  CAS  PubMed  Google Scholar 

  14. Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, Neer SM (1997) The screen for child anxiety related emotional disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36:545–553

    Article  CAS  PubMed  Google Scholar 

  15. Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Erlbaum Associates, Inc, Hillsdale

    Google Scholar 

  16. Conners CK (1973) Rating scales for use in drug studies with children. Pharmacotherapy of children [Special issue]. Psychopharmacol Bull 9:24–29

    Google Scholar 

  17. Costello EJ, Egger H, Angold A (2005) 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. J Am Acad Child Adolesc Psychiatry 44:972–986

    Article  PubMed  Google Scholar 

  18. Döpfner M, Plück J, Berner W, Fegert JM, Huss M, Lenz K, Schmeck K, Lehmkuhl U, Poustka F, Lehmkuhl G (1997) Psychische Auffälligkeiten von Kindern und Jugendlichen in Deutschland–Ergebnisse einer repräsentativen Studie: Methodik, Alters-, Geschlechts- und Beurteilereffekte. Z Kinder Jugendpsychiatr Psychother 25:218–233

    PubMed  Google Scholar 

  19. Döpfner M, Lehmkuhl G (2000) Diagnostik-System für psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV (DISYPS-KJ), 2nd edn. Verlag Hans Huber, Bern

    Google Scholar 

  20. Döpfner M, Steinhausen H-C, Coghill D, Dalsgaard S, Poole L, Ralston SJ, Rothenberger A, the ADORE study group (2006) Cross-cultural reliability and validity of ADHD assessed by the ADHD Rating Scale in a pan-European study. Eur Child Adolesc Psychiatry 15(Suppl1):46–55

    Article  Google Scholar 

  21. Faulstich ME, Carey MP, Ruggiero L, Enyart P, Gresham F (1986) Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CESDC). Am J Psychiatry 143:1024–1027

    CAS  PubMed  Google Scholar 

  22. Fendrich M, Weissman MM, Warner V (1990) Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. Am J Epidemiol 131:538–551

    CAS  PubMed  Google Scholar 

  23. Ford T, Goodman R, Meltzer H (2003) The British child and adolescent mental health survey 1999: The prevalence of DSM-IV isorders. J Am Acad Child Adolesc Psychiatry 42(10):1203–1211

    Article  PubMed  Google Scholar 

  24. Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586

    Article  CAS  PubMed  Google Scholar 

  25. Goodman R (1999) The extended version of the strengths and difficulties questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 40:791–799

    Article  CAS  PubMed  Google Scholar 

  26. Goodman R, Ford T, Simmons H, Gatward R, Meltzer H (2000) Using the strengths and difficulties questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry 177:534–539

    Article  CAS  PubMed  Google Scholar 

  27. Goodman R, Renfrew D, Mullick M (2000) Predicting type of psychiatric disorder from strengths and difficulties questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry 9:129–134

    Article  CAS  PubMed  Google Scholar 

  28. Hölling H, Erhart M, Ravens-Sieberer U, Schlack R (2007) Verhaltensauffälligkeiten bei Kindern und Jugendlichen. Erste Ergebnisse aus dem Kinder- und Jugendgesundheitssurvey (KiGGS). [Behavioural problems in children and adolescents. First results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsbl Gesundheits- forsch Gesundheitsschutz 50:784–793

    Article  Google Scholar 

  29. Ihle W, Esser G (2002) Epidemiologie psychischer Störungen im Kindes- und Jugendalter. Prävalenz, Verlauf, Komorbidität und Geschlechtsunterschiede. Psychol Rundsch 53:159–169

    Article  Google Scholar 

  30. Kamtsiuris P, Lange M, Schaffrath Rosario A (2007) Der Kinder- und Jugendgesundheitssurvey (KiGGS): Stichprobendesign, Response und Nonresponse- Analyse. Bundesgesundheitsbl – Gesundheitsforsch - Gesundheitsschutz 50:547–555

    Article  CAS  Google Scholar 

  31. Masten AS, Hubbard JJ, Gest SD, Tellegen A, Garmezy N, Ramirez M (1999) Competence in the context of adversity: Pathways to resilience and maladaptation from childhood to late adolescence. Dev Psychopathol 11:143–169

    Article  CAS  PubMed  Google Scholar 

  32. Meltzer H, Gatward R, Goodman R, Ford T (2000) Mental health of children and adolescents in Great Britain. Stationary Office, London

    Google Scholar 

  33. Palfrey JS, Tonniges TF, Green M, Richmond J (2005) Introduction: addressing the millennial morbidity—the context of community. Pediatrics 115:1121–1123

    Article  PubMed  Google Scholar 

  34. Patel V, Flisher AJ, Hetrick S, McGorry P (2007) Mental health of young people: a global public-health challenge. Lancet 369:1302–1313

    Article  PubMed  Google Scholar 

  35. Ravens-Sieberer U (2003) Der Kindl-R Fragebogen zur Erfassung der gesundheitsbezogenen Lebensqualität bei Kindern und Jugendlichen - Revidierte Form. In: Schumacher JKA, Brähler E (eds) Diagnostische Verfahren zu Lebensqualität und Wohlbefinden. Göttingen, Hogrefe, pp 184–188

    Google Scholar 

  36. Ravens-Sieberer U, Kurth B-M, KiGGS study group, BELLA study group (2008) The mental health module (BELLA study) within the German Health Interview and Examination Survey of Children and Adolescents (KiGGS): study design and methods. Eur Child Adolesc Psychiatry 17(Suppl1):10–21

    Google Scholar 

  37. Ravens-Sieberer U, Wille N, Bettge S, Erhart M (2007) Psychische Gesundheit von Kindern und Jugendlichen in Deutschland. Ergebnisse aus der BELLA-Studie im Kinder- und Jugendgesundheitssurvey (KiGGS). [Mental health of children and adolescents in Germany. Results from the BELLA study within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 50:871–878

    Article  CAS  Google Scholar 

  38. Roberts RE, Attkisson CC, Rosenblatt A (1998) Prevalence of psychopathology among children and adolescents. Am J Psychiatry 155:715–725

    CAS  PubMed  Google Scholar 

  39. Weissman MM, Orvaschel H, Padian N (1980) Children’s symptom and social functioning self-report scales. Comparison of mothers’ and children’s reports. J Nerv Ment Dis 168:736–740

    Article  CAS  PubMed  Google Scholar 

  40. Winkler J, Stolzenberg H (1999) Der Sozialschichtindex im Bundes-Gesundheitssurvey. Gesundheitswesen 61(Sonderheft 2):S178–S183

    PubMed  Google Scholar 

  41. World Health Organization (1993) The ICD–10 classification of mental and behavioural disorders: multiaxial presentation. WHO, Geneva

    Google Scholar 

  42. World Health Organization (2001) International classification of functioning, disability and health (ICF). WHO, Geneva

    Google Scholar 

  43. World Health Organization (2001) The World health report. Mental health: new understanding, new hope. Geneva, WHO. Available at: http://www. who.int/whr/2001/en/whr01_en.pdf Accessed August 2008

Download references

Conflict of interest

All authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Ulrike Ravens-Sieberer MPH.

Additional information

Members of the BELLA study group: Ulrike Ravens-Sieberer (Principal Investigator), Claus Barkmann, Susanne Bettge, Monika Bullinger, Manfred Döpfner, Michael Erhart, Beate Herpertz-Dahlmann, Heike Hölling, Franz Resch, Aribert Rothenberger, Michael Schulte-Markwort, Nora Wille, Hans-Ulrich Wittchen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ravens-Sieberer, U., Wille, N., Erhart, M. et al. Prevalence of mental health problems among children and adolescents in Germany: results of the BELLA study within the National Health Interview and Examination Survey. Eur Child Adolesc Psychiatry 17 (Suppl 1), 22–33 (2008). https://doi.org/10.1007/s00787-008-1003-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-008-1003-2

Keywords

Navigation