Abstract
The high prevalence of mental health problems (MHP) in childhood and adolescence is a global health challenge of the 21st century. Information about age of onset, persistence and development of MHP in young people is necessary to implement effective prevention and intervention strategies. We describe the design and methods of the longitudinal BELLA study, which investigates developmental trajectories of MHP from childhood into adulthood, their determinants, and the utilisation of mental health services. First results on the developmental course of MHP in children and adolescents are reported over a 6-year period. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KiGGS). BELLA examines the mental health and well-being of children and adolescents aged 7–17 years (a representative subsample of KiGGS, n = 2,863 at baseline). Standardised screening measures served to identify MHP at baseline and at follow-ups (1, 2, and 6 years later). Among children and adolescents participating at all measurement points (n = 1,255), 10 % showed clinically significant MHP at baseline (n = 130). Over the 6-year period, 74.3 % showed no signs of MHP (n = 933), 15.5 % had remitted (n = 194), 2.9 % showed persistent (n = 36) and 7.3 % acute or recurrent MHP (n = 92). Overall, MHP were more likely to occur between the age of 7 and 12 and after the age of 19 years. Regarding mental health service use, 33 % of the participants with acute or recurrent MHP (n = 30) and 63.9 % with persistent MHP used mental health services (n = 23). Mental health problems in children and adolescents have a high risk to persist into adulthood. In children and adolescents a low rate of mental health service use was observed, even among those with mental health problems.
Similar content being viewed by others
Notes
Other analyses of the BELLA data within this ECAP special issue used various procedures to deal with missing data, so that robustness of the findings can easily be assessed.
Both of these aspects are covered in two additional papers in this ECAP special issue offering corresponding analyses based on BELLA data.
References
World Health Organization (2005) Atlas: child and adolescent mental health resources: global concerns, implications for the future. World Health Organization. http://www.who.int/mental_health/resources/Child_ado_atlas.pdf. Accessed 31 March 2014
Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jonsson B, Olesen J et al (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(9):655–679. doi:10.1016/j.euroneuro.2011.07.018
Belfer ML (2008) Child and adolescent mental disorders: the magnitude of the problem across the globe. J Child Psychol Psychiatry 49(3):226–236. doi:10.1111/j.1469-7610.2007.01855.x
Barkmann C, Schulte-Markwort M (2012) Prevalence of emotional and behavioural disorders in German children and adolescents: a meta-analysis. J Epidemiol Community Health 66(3):194–203. doi:10.1136/jech.2009.102467
Ormel J, Oldehinkel AJ, Sijtsema J, van Oort F, Raven D, Veenstra R, Vollebergh WA et al (2012) The TRacking Adolescents’ Individual Lives Survey (TRAILS): design, current status, and selected findings. J Am Acad Child Adolesc Psychiatry 51(10):1020–1036. doi:10.1016/j.jaac.2012.08.004
Posserud MB, Lundervold AJ (2013) Mental health services use predicted by number of mental health problems and gender in a total population study. Sci World J 2013:247283. doi:10.1155/2013/247283
Kessler RC, Avenevoli S, Costello EJ, Georgiades K, Green JG, Gruber MJ, He JP et al (2012) Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 69(4):372–380. doi:10.1001/archgenpsychiatry.2011.160
Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R (2003) Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry 60(7):709–717. doi:10.1001/archpsyc.60.7.709
Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, Wang P et al (2005) Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 352(24):2515–2523. doi:10.1056/NEJMsa043266
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841–850. doi:10.1016/S0140-6736(07)61414-7
Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jonsson B (2012) The economic cost of brain disorders in Europe. Eur J Neurol 19(1):155–162. doi:10.1111/j.1468-1331.2011.03590.x
Ravens-Sieberer U, Kurth BM (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(Suppl. 1):10–21. doi:10.1007/s00787-008-1002-3
Kamtsiuris P, Lange M, Schaffrath Rosario A (2007) Der Kinder- und Jugendgesundheitssurvey (KiGGS): Stichprobendesign, Response und Nonresponse-Analyse (The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): sample design, response and nonresponse analysis). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50(5–6):547–556. doi:10.1007/s00103-007-0215-9
Kurth BM, Kamtsiuris P, Holling H, Schlaud M, Dolle R, Ellert U, Kahl H et al (2008) The challenge of comprehensively mapping children’s health in a nation-wide health survey: design of the German KiGGS-Study. BMC Public Health 8(1):196
Ravens-Sieberer U, Wille N, Erhart M, Bettge S, Wittchen HU, Rothenberger A, Herpertz-Dahlmann B et al (2008) 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. doi:10.1007/s00787-008-1003-2
Lange M, Butschalowsky HG, Jentsch F, Kuhnert R, Schaffrath Rosario A, Schlaud M, Kamtsiuris P et al (2014) The first KiGGS follow-up (KiGGS Wave 1): study conduct, sample design, and response. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 57(7):747–761. doi:10.1007/s00103-014-1973-9
Goodman R (1997) The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 38(5):581–586
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(5):791–799. doi:10.1017/S0021963099004096
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(10):1230–1236. doi:10.1097/00004583-199910000-00011
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(4):545–553. doi:10.1097/00004583-199704000-00018
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401. doi:10.1177/014662167700100306
Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH (2009) The PHQ-8 as a measure of current depression in the general population. J Affect Disord 114(1–3):163–173. doi:10.1016/j.jad.2008.06.026
Kroenke K, Spitzer RL (2002) The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 32(9):509–515
Achenbach TM (1991) Manual for the Child Behavior Checklist/4–18 and 1991 Profile. University of Vermont, Department of Psychiatry, Burlington, VT
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, 2nd edn. Hogrefe, Köln
Conners CK (1997) Conners’ rating scale—revised (CRS-R): technical manual. Multi-Health Systems Inc, New York
Conners CK, Sitarenios G, Parker JD, Epstein JN (1998) The revised Conners’ Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. J Abnorm Child Psychol 26(4):257–268
Schneider S, Margraf J (eds) (2011) Diagnostisches Interview bei psychischen Störungen, 4th edn. Springer, Heidelberg
Unnewehr S, Schneider S, Margraf J (2009) Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS), 2nd edn. Springer, Heidelberg
Winkler J, Stolzenberg H (1999) Social class index in the Federal Health Survey. Gesundheitswesen 61 Spec No:S178–183
Lange M, Kamtsiuris P, Lange C, Schaffrath Rosario A, Stolzenberg H, Lampert T (2007) Messung soziodemographischer Merkmale im Kinder- und Jugendgesundheitssurvey (KiGGS) und ihre Bedeutung am Beispiel der Einschatzung des allgemeinen Gesundheitszustands (Sociodemographic characteristics in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)—operationalisation and public health significance, taking as an example the assessment of general state of health). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50(5–6):578–589. doi:10.1007/s00103-007-0219-5
Schenk L, Ellert U, Neuhauser H (2007) Children and adolescents in Germany with a migration background. Methodical aspects in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50(5–6):590–599. doi:10.1007/s00103-007-0220-z
Little RJA, Rubin DB (2002) Statistical analysis with missing data, 2nd edn. Wiley, Hoboken, NJ
Meltzer HGR, Goodman R, Ford T (2000) Mental health of children and adolescents in Great Britain. Stationary Office, London
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(12):736–740
Rowe KS, Rowe KJ (1997) Norms for parental ratings on Conners’ Abbreviated Parent-Teacher Questionnaire: implications for the design of behavioral rating inventories and analyses of data derived from them. J Abnorm Child Psychol 25(6):425–451
Löwe B, Spitzer RL, Zipfel S, Herzog W (2002) PHQ-D: Gesundheitsfragebogen für Patienten. Manual Komplettversion und Kurzform. http://www.klinikum.uni-heidelberg.de/fileadmin/Psychosomatische_Klinik/download/PHQ_Manual1.pdf. Accessed 20 March 2014
Gräfe K, Zipfel S, Herzog W, Löwe B (2004) Screening psychischer Störungen mit dem “Gesundheitsfragebogen für Patienten (PHQ-D)”. Diagnostica 50(4):171–181. doi:10.1026/0012-1924.50.4.171
Akaike H (1974) A new look at the statistical model identification. IEEE T Automat Contr 19(6):716–723
Bates D, Maechler M, Bolker B, Walker S (2014) lme4 package (version 1.1-5). http://CRAN.R-project.org/package=lme4. Accessed 31 March 2014
Bird HR (1996) Epidemiology of childhood disorders in a cross-cultural context. J Child Psychol Psychiatry 37(1):35–49
Ihle W, Esser G, Schmidt MH, Blanz B (2000) Prävalenz, Komorbidität und Geschlechtsunterschiede psychischer Störungen vom Grundschul- bis ins frühe Erwachsenenalter. Z Klin Psychol Psychiatr Psychother 29(4):263–275. doi:10.1026//0084-5345.29.4.263
Ihle W, Esser G (2002) Epidemiologie psychischer Störungen im Kindes- und Jugendalter: Prävalenz, Verlauf, Komorbidität und Geschlechtsunterschiede (Epidemiology of mental disorders in childhood and adolescence: prevalence, course, comorbidity and gender differences). Psychol Rundsch 53(4):159–169. doi:10.1026//0033-3042.53.4.159
Patton GC, Viner R (2007) Pubertal transitions in health. Lancet 369(9567):1130–1139. doi:10.1016/S0140-6736(07)60366-3
Wittchen HU, Nelson CB, Lachner G (1998) Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med 28(1):109–126
Costello EJ, Copeland W, Angold A (2011) Trends in psychopathology across the adolescent years: what changes when children become adolescents, and when adolescents become adults? J Child Psychol Psychiatry 52(10):1015–1025. doi:10.1111/j.1469-7610.2011.02446.x
Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60(8):837–844. doi:10.1001/archpsyc.60.8.837
Wölfle S, Jost D, Oades R, Schlack R, Hölling H, Hebebrand J (2014) Somatic and mental health service use of children and adolescents in Germany (KiGGS-study). Eur Child Adolesc Psychiatry 9:753–764
Lambert M, Bock T, Naber D, Löwe B, Schulte-Markwort M, Schäfer I, Gumz A et al (2013) Die psychische Gesundheit von Kindern, Jugendlichen und jungen Erwachsenen—Teil 1: Häufigkeit, Störungspersistenz, Belastungsfaktoren, Service-Inanspruchnahme und Behandlungsverzögerung mit Konsequenzen (Mental Health of Children, Adolescents and Young Adults—Part 1: Prevalence, Illness Persistence, Adversities, Service use, Treatment Delay and Consequences). Fortschr Neurol Psychiatr 81(11):614–627. doi:10.1055/s-0033-1355843
Hintzpeter B, Klasen F, Schön G, Voss C, Hölling H, Ravens-Sieberer U, The BELLA study group (2014) Mental health care use among children and adolescents in Germany: results of the longitudinal BELLA study. Euro Child Adoles Psych (submitted)
Klasen F, Otto C, Kriston L, Patalay P, Schlack R, Ravens-Sieberer U, The BELLA study group (2014) Risk and protective factors for the development of depressive symptoms in children and adolescents: results of the longitudinal BELLA study. Euro Child Adoles Psych. doi:10.1007/s00787-014-0637-5
Acknowledgments
The authors thank all children, adolescents, their parents and young adults who participated in this research for their time and involvement. We are very grateful to all the researchers and students who worked on this project and made it possible, especially to: Dr. Nora Wille, Dr. Birte Hintzpeter, Franziska Reiss, Anne-Catherine Haller, Helen Bichmann, Catharina Voss, Julia Pranicka, Ann‐Katrin Meyrose and Praveetha Patalay; we are also grateful to all the researchers working with us on this ECAP special issue, especially to: PD Dr. Astrid Dempfle, Dr. Anja Görtz‐Dorten, PD Dr. Christopher Hautmann and Dr. Andreas Becker. We would like to thank the Robert Koch Institute for their ongoing support and co-operation. The BELLA study has been financially supported by various grants: Baseline, 1-year follow-up and 2-year follow-up of the BELLA study were financed by the German Science Foundation. The 6-year follow-up was funded by the German Federal Ministry of Health (BMG).
Conflict of interest
None of the authors has a conflict of interest to disclose.
Author information
Authors and Affiliations
Consortia
Corresponding author
Additional information
Members of the BELLA study group are: Ulrike Ravens-Sieberer and Fionna Klasen, Hamburg (Principal Investigators); Claus Barkmann, Hamburg; Monika Bullinger, Hamburg; Manfred Döpfner, Köln; Beate Herpertz-Dahlmann, Aachen; Heike Hölling, Berlin; Franz Resch, Heidelberg; Aribert Rothenberger, Göttingen; Sylvia Schneider, Bochum; Michael Schulte-Markwort, Hamburg; Robert Schlack, Berlin; Frank Verhulst, Rotterdam; Hans-Ulrich Wittchen, Dresden.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Ravens-Sieberer, U., Otto, C., Kriston, L. et al. The longitudinal BELLA study: design, methods and first results on the course of mental health problems. Eur Child Adolesc Psychiatry 24, 651–663 (2015). https://doi.org/10.1007/s00787-014-0638-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00787-014-0638-4