Search

Objectives: Despite high demand, culturally adapted therapies for Arabic speaking refugee patients with depression are rare. Aim of the study was to culturally adapt and evaluate the group treatment Metacognitive Training for Depression (D-MCT) for them., Methods: The cultural adaptation of the D-MCT included translation and surface adaptation as well as an expert discussion. The comprehensibility, acceptance and feasibility of the outpatient culturally adapted D-MCT (CA-D-MCT) were then tested in an uncontrolled pilot study with n=11 refugee patients., Results: The experts rated 83% of the translations and 78% of the illustrations as unproblematic in terms of equivalence. The acceptability and feasibility of the eight modules were predominantly positive., Conclusions: From the patients' perspective, the adapted training shows a high acceptance and comprehensibility for culturally sensitive, interpreter-supported implementation., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Although the experiences of discrimination have become part of everyday lives for many children and adolescents in Germany, there is a lack of empirical data to explore its consequences on the well-being and other aspects of life. The limited data can be attributed to the lack of age-appropriate survey methods and instruments. Thus, the authors focus on the possibilities and challenges for an age-appropriate, standardised assessment of discrimination experiences among children and adolescents in Germany. An electronic database search was conducted to identify published instruments worldwide. Three Englishlanguage questionnaires developed for children aged nine years and onwards in the USA were found.These instruments have been used to collect data in samples with a large proportion of minor African Americans. The authors tested for the comprehensibility of the Child Perceived Discrimination Questionnaire (CPDQ; LaFont et al., 2018) in a sample of n = 21 schoolchildren aged between 6 and 14 years using cognitive interviews.The results highlight age differences in the item comprehensibility and demonstrate the topic's relevance even for preschool children. The authors discuss the importance of findings on discrimination experiences of minors for therapeutic and pedagogical practice and illustrate starting points for closing the research gap identified.

Background: Psychosocial stress can have detrimental effects on the mother's health and the development of the child. The aim of the family intervention "Babylotse ambulant" in gynecologic practices is the systematic and early identification of psychosocially distressed families as well as consulting and connecting them to the regional health and social care system., Objectives: The effectiveness of the family intervention in six gynecologic practices was investigated through a pre-post control group design using perceived self-efficacy as outcome. It was assumed that participation in the intervention would result in increased maternal self-efficacy as a measurement of faith in one's own abilities to solve problems., Methods: Self-efficacy of n=202 psychosocially distressed and n=262 non-distressed patients, who were screened in one of the six gynaecologic practices, was assessed using the Self-Efficacy Scale during the first trimester (T0) and one year after birth (T1)., Results: Psychosocially distressed mothers, who all received counselling from social workers, showed a significantly higher self-efficacy at T1 compared to T0. After the intervention, no significant differences were found between distressed patients and the control group of non-distressed patients who received no intervention., Discussion: Increased self-efficacy in distressed mothers after giving birth and thus, more faith in their own problem-solving capabilities points to the positive effects of the intervention during pregnancy in an outpatient gynecologic setting., Conclusion: Addressing psychosocial distress and strengthening self-efficacy is relevant in clinical interventions. As interface management, a pilot-based intervention like "Babylotse ambulant" can provide relief in the care of distressed patients during pregnancy and birth., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim of the Study: Many people with an African migration background in Europe are affected by discrimination and racism because of their skin color and culture and have a below-average socioeconomic status and quality of life (QoL). The aim of this study was to find starting points for improving the integration and QoL of people with a migration background from Sub-Saharan Africa (SSA) living in Germany., Method: For the first time, a sample of 518 people from SSA (19-56 years) living in Germany was interviewed via an online survey in three languages about the psychological QoL and their locus of control as an indicator of their adjustment performance., Results and Conclusion: The results of the nationwide survey pointed to a significant strong positive association between locus of control and psychological QoL among people from SSA in Germany (p<.010; r=.49). Here, age, length of residence in Germany, occupational group, and educational attainment were significantly related to locus of control beliefs and mental QoL. A multiple regression model showed that, among the socioeconomic and sociodemographic factors, educational attainment was a significant predictor for the relationship between psychological QoL and locus of control. About 24% of the variance in mental health was explained by locus of control beliefs and educational attainment. Education is a starting point for interventions to promote integration and mental health of migrants from SSA at different stages of life., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Paternal Risk and Protective Factors for Endangerment of Child Well-Being and their Consideration in the Risk Inventories Used Throughout Germany In view of the current family and role models, paternal risk and protective factors can have a significant impact on the risk of violence within a family and should therefore - in addition to the factors on the part of the mother, the child and the closer or other family systems - be taken into consideration when estimating the endangerment of child well-being. In this article we explore which empirical findings on paternal risk and protective factors for abuse, neglect and sexual abuse (sexual violence) in childhood and adolescence were published in international research literature from 1980 to 2019. Seventeen risk factors and four protective factors could be identified, which in 33 quantitative original studies showed a risk-increasing or a buffering influence on violence experiences in families on the part of the father. In addition, the risk inventories used in practice in Germany were analyzed with regard to the paternal risk and protective factors, in order to be able to illustrate the application of the empirically identified factors in early intervention, youth welfare and health care. The article used results from a benchmark survey on risk inventories from 2009. These results were compared with current findings from 2018 as part of a research update. In 2009, 67 % of the instruments "often" contained items on the father, while this was found for 12 % of the instruments in 2018. At the same time, in 2018, 53 % of the risk inventories were "often" asked about custodians, parents or main caregivers. The article thus reflects developments in research and practice in risk assessment for child well-being, in which especially the fathers, who unlike the mothers are often not explicitly addressed during screenings and interventions for families with psychosocial problems, are taken into consideration. The knowledge about the influence of the fathers can feed into the preventive interventions in early interventions and complement them meaningfully.

Background: There are indications that during the lockdown and the measures of social distancing due to the coronavirus disease 2019 (COVID-19) pandemic, physical and sexual child abuse and neglect may have increased. Additionally, decreased social control may have led to a lower detection rate of child protection cases., Objective: This study aimed to better understand the impact of the lockdown in Germany on the frequency and severity of child abuse and neglect. To do so the quantity and quality of cases of suspected child abuse and neglect in German pediatric departments and outpatient departments for medical child protection were examined., Methods: In May 2020 a total of 343 institutions of medical child protection were invited to fill in a questionnaire with items describing their institution and items depicting cases of child protection in March and April 2019 and 2020 regarding age, form and severity of abuse as well as items to describe particular remarks and ideas for child protection during the pandemic., Results: Out of the 343 pediatric departments and outpatient departments of medical child protection invited, the participation rate was 46%. In this study 81 institutions reported the total cases of suspected child abuse or neglect for both March and April 2019 and 2020. The number of cases dropped from 454 to 387 (-15%) in outpatient child abuse clinics and from 307 to 246 (-20%) in pediatric inpatient departments. Regarding the age of affected children and the form of abuse no significant differences were found., Conclusion: The study found a decrease in reported cases of suspected child abuse and neglect during the lockdown in March and April 2020 compared to 2019. While the results do not show an increase of total child abuse and neglect, as suspected by many professionals, the decrease in reported cases may be explained by a steep increase in unreported cases due to reduced social control., (© The Author(s) 2021.)

In Germany, deaf patients undergoing psychotherapy have the right to have the costs of a sign language interpreter covered by the insurance since 2001. The effectiveness of interpreter-aided psychotherapy worldwide is disputed. A systematic literature review was conducted on sign language interpreter-aided psychotherapy. Six scientific databases were searched. Two independent raters conducted a 2-step rating process. Out of 1,184 identified publications, 10 studies in German and English language were included. These 10 studies examined between 1 and 85 deaf patients (7-60 years) in different psychotherapeutic settings (8 ambulatory, 4 family therapy). Nine studies reported therapy success. Relevant knowledge (e. g. about culture of deaf people), attitudes (e. g. openness), abilities (e. g. sign language) and general conditions (e. g. declaration for professional secrecy, light conditions) were recommended for psychotherapists with normal hearing and sign language interpreters. Empirical data on psychotherapy with sign language interpreters is low and methodologically limited. The present study can be considered as a starting point for further research., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenskonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Developmental trauma disorder (DTD) in children and adolescents - results from a patient population at the special consultation hour for traumatized children and adolescents Abstract. Objective: Children and adolescents who have experienced interpersonal Type-II-trauma often develop symptoms going far beyond the Post-Traumatic Stress Disorder (PTSD). Van der Kolk (2009) suggested the Developmental Trauma Disorder (DTD) to define the extensive symptomatology; however, research on DTD is limited. Method: Frequency and group differences of DTD were examined based on physicians' letters of n = 161 patients between one and 18 years (61 % female) from an out-patient unit for traumatized patients at a paediatric and adolescent psychiatry. Physicians' letters were rated and analysed using an adapted DTD algorithm. Results: In total, 77 % of the patients experienced interpersonal Type-II-trauma, 6 % met the criteria for the adapted DTD diagnosis. DTD criteria were found more frequently in interpersonal Type-II-trauma victims than in patients with accidental or Type-I-trauma, but group differences only reached statistical significance for the DTD criteria B (affective and physiological dysregulation) and G (impairments) at the adjusted 0,2 % significance level. No statistically significant differences for age or gender were found. The posttraumatic symptoms of children younger than seven years were analysed descriptively. Conclusions: The results show that, although many children and adolescents have developed symptoms beyond the PTSD, only a small proportion have met the DTD diagnosis. In view of the partially unspecific and contradictory findings, further studies on DTD considering larger samples, the complete DTD criteria, and diagnosis-specific instruments seem to be reasonable and necessary.

Background: The nationwide prevention program "Parent Guide - Growing up Healthy" aims to improve parental health knowledge in Germany. At the birth of their first child, parents of any socioeconomic status (SES) are provided with written educational material that includes relevant health knowledge as well as basic information about routine health checkups for children., Objectives: This study aimed at evaluating the program regarding 1) the effects on parental health knowledge and parental satisfaction with routine child health checkups, 2) the sensitivity of the effects on SES, and 3) parental acceptance of the written educational material., Materials and Methods: A longitudinal randomized controlled trial (RCT) was carried out with 1318 young parents recruited from 14 hospitals with maternity clinics in Germany. Parents of the intervention group received educational material whereas controls didn't receive material. Respondents completed interviews at the child's birth (T0) and first birthday (T1)., Results: Parental health knowledge at T1 was significantly higher (p = 0.005; partial eta 2  = 0.006) in the intervention group but with a small effect size. The influence of the educational material was not moderated by SES (p = 0.456). Satisfaction with routine child health checkups did not differ significantly between the groups (p = 0.606). Parents showed high acceptance of the parent guide regardless of SES., Conclusions: Written educational material is an effective approach in increasing parental health knowledge and has the potential to reach all parents regardless of SES. A higher satisfaction with routine child health checkups could not be achieved by educational material.

Complex Trauma-related Disorders in Research and Practice Frequent traumata in childhood and adolescence are long-term or repeated interpersonal traumata caused by perpetrators in the close environment of the minors. For the description of the extensive symptoms after interpersonal Type II traumata, the complex trauma-related disorders Complex Posttraumatic Stress Disorder (CPTSD) or Disorder of Extreme Stress Not Otherwise Specified (DESNOS) and the Developmental Trauma Disorder (DTD) are being discussed for inclusion in the classification systems for mental disorders. Scientific knowledge and practical experiences regarding CPTSD, DESNOS and DTD in children and adolescents up to 18 years were examined by 1) a Systematic Review of 1,070 publications identified by database research and additional search strategies, and 2) a nationwide online survey of 374 psychotherapists and psychiatrists for children and adolescents in Germany. Of 13 included empirical studies (8 CPTSD or DESNOS, 5 DTD), 9 were conducted in the USA, 4 based on file coding and 3 on secondary data analysis and only 7 reported diagnosis rates (range: 0-78 %). Of the interviewed therapists, 100 % considered the CPTSD as being met with at least one patient with interpersonal traumata up to 18 years of age in 2014 and 99 % gave this estimate for the DTD. Two thirds of therapists rated the diagnostic option CPTSD and DTD as "very often" or "often" helpful for their therapeutic work with children and adolescents. While empirical data available is to be considered insufficient and characterized by methodological limitations, the relevance of complex trauma-related disorders is perceived as high by practitioners.

Objective The aim of the present study was to assess the health care situation and barriers to support minor children of mentally ill parents from the perspective of adult psychiatry in Germany. Methods Based on the German Hospital Register mental health practitioners of all psychiatric clinics in Germany were asked to answer a 37-item questionnaire. Overall, 441 practitioners of 239 psychiatric clinics participated in the cross sectional study. Results Most important barriers were high workload, scarce resources, patient-focused treatment, missing expertise as well as insufficient awareness. Conclusions More resources, training, clear declaration of competence and coordination of services are necessary to implement family sensitive services in psychiatric clinics., Competing Interests: Interessenkonflikt: Die Autorinnen geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

In Germany, since 2010 the debate regarding sexual assault victims, additionally due to extensive activities of the independent commissioner for questions regarding sexual abuse of children (Unabhängiger Beauftragter für Fragen des sexuellen Kindesmissbrauchs, UBSKM), has received increased attention from the public and the healthcare system. Sexual violence is a burdening experience regardless of age and can have a lasting impact on the physical, psychological and/or social life of victims. Empirically, it has been found that more than half of the adult population suffering from mental disorders have experienced sexual abuse in childhood and adolescence. In some of the affected the impact of the trauma experienced, which is often accompanied by neglect and physical violence, can negatively influence the course of disease. Early counseling and therapeutic support for affected children and adolescents should be taken more into account and focus on optimizing treatment for this patient group. This article discusses the prevalence of sexual violence, possible health and social consequences and the treatment situation of affected children, adolescents and adults in various areas of the help/aid system. In doing so, a discrepancy between scientific findings, recommendations from statutory health insurance companies (GKV), the current healthcare situation and the real needs of the affected are made clear.

Background: Due to their high social acceptance gynecologists provide ideal conditions for approaching families. Psychosocial stress (PSS), e. g. in the context of partnership conflicts, poverty or social isolation can be identified and support can be initiated., Objectives: The aim of the study was to capture attitudes and engagement of gynecologists dealing with patients with PSS in gynecological practices in Germany., Methods: Out of 3000 randomly selected gynecologists in private practices, 1034 (response rate: 35%) took part in a Germany-wide questionnaire study on gynecologists' sense of responsibility, procedures and barriers when dealing with women with PSS., Results: Ninety-six percent of the surveyed gynecologists felt responsible for patients with PSS. On average, gynecologists assumed PSS in 23% of their patients. Most of the gynecologists counseled patients with PSS and referral into the regional help system often occurred. When asked about the German early intervention system, 74% responded that they could imagine their own practice participating in this system. A need for improvement was observed in networking and financing. Significant differences in screening and interventions were found mainly in terms of professional experience, old vs. new federal states as well as between single and joint practices., Conclusions: Surprisingly, openness and engagement for patients with PSS were found in gynecological practices. The majority of gynecologists already offered psychosocial interventions. It may be deduced from these results that gynecologists in practices would contribute to the psychosocial aid network if key basic conditions including the financing were fulfilled.

Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.

Background: Germany is one of the most important host countries for minor refugees and asylum seekers in Europe. The number of children who leave their home country has significantly risen worldwide in recent years; a further rise is to be expected due to the increasing number of crisis zones. A literature review demonstrates the state of research on traumatization, post-traumatic stress disorders and psychotherapy in minor refugees and asylum seekers., Exposure to Violence and Post-Traumatic Stress Disorders: Many minor refugees and asylum seekers have made mainly interpersonal traumatic experiences within their home country or during their flight and develop simple or complex post-traumatic stress disorders. Left untreated, there is a risk of chronification., Health Care Situation: The psychotherapeutic treatment of minor refugees and asylum seekers in Germany takes place primarily in specialized psychosocial treatment centers. For an involvement of therapists in private practices, a reduction of organizational barriers as well as evidence-based treatment methods for interpreter-aided psychotherapy of minor refugees and asylum seekers that also consider their developmental state, are still lacking., Conclusion: In research, as well as in practice, there is further need for an early and systematic identification and treatment of minor refugees and asylum seekers with post-traumatic stress disorders or high risk of disease in Germany.

Aggressive and violent behaviour in children and adolescents can be associated with physical and psychological health effects continuing into adulthood. Early programs for violence prevention in childhood and adolescence are intended to prevent or reduce aggressive behaviour in order to decrease the risk for short- and long-term developmental impairments. In a literature review, research findings on prevalence, typical courses of development, and predictors of violent behavior in childhood are first summarized and compared with findings on the frequency, developmental course, and consequences of youth violence. International and German programs for violence prevention in children and adolescents are presented in the context of various settings (family, school, community), target groups (primary vs. secondary prevention) as well as target variables (universal vs. specific). Empirical findings on efficacy testing of violence prevention programs are described and discussed. The presented findings stress the relevance and potential of services for violence prevention for children and adolescents, but also demonstrate the challenges and gaps.

Introduction: Since 1971 routine child health check-ups allow the routine identification of dis-eases in children and adolescents. Paediatricians play a central role in health prevention in childhood and adolescence and are - on account of their acceptance and admission requirements - important actors in child protection. Thus, paediatric practitioners were actively involved in the invitation and reporting system for the routine child health check-ups (U6 and U7), which was introduced to increase participation rates and improve child protection in Hamburg., Method: By means of a questionnaire survey, all paediatric practitioners practicing in Hamburg were asked a year after introduction of the invitation and reporting system to report on their practical experience, and to share their assessment and criticism of the system (response rate 73%)., Results: Out of 110 participating pediatricians (M=19.5 years practical experience), 81% evaluated the invitation and reporting system as very useful, useful or rather useful; 83% supported an expansion of the system for routine child health check-ups, and about 18% observed an increased utilisation of routine child health check-ups especially from families with a migrant background and by socially-disadvantaged families. Criticism was made concerning ineffective procedures., Conclusion: The invitation and reporting system for routine child health check-ups in Hamburg shows how pediatricians can be integrated into the network of prevention and child welfare. It also shows their support of this system. Paying more systematic attention and an interdisciplinary network connecting paediatricians may contribute to a more comprehensive prevention and child protection., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Families with migrant backgrounds (MB) are exposed to several psychosocial risk factors that increase the likelihood of impaired child development, in particular., Questions: We investigated whether families with MB differ from families without MB regarding their psychosocial stressors in the period of pregnancy and birth., Method: As part of a social early warning system in an obstetrics clinic in Germany n=502 families with MB were compared with n=349 families without MB with respect to the degree of stress and stress factors on the basis of an initial screening of risk factors for child maltreatment by a midwife or physician and a subsequent structured clearing interview by social education workers during the mothers' inpatient hospitalisation., Results: For families without MB, a significantly higher total score was found in the risk screening (M=3,9 points vs. M=2,9 points) in comparison to families with MB. While families with MB compared to families without MB were faced more frequently by social stressors, e. g., financial problems or a difficult housing situation (81 vs. 37%), they were less frequently impacted by mental strain (27 vs. 48%), young fathers (2 vs. 10%) and maternal psychiatric diseases (3 vs. 17%), according to the risk screening. Socio-economic determinants such as social inclusion and living environment were found to be important factors influencing the psychosocial stress level of families., Conclusion: Explanations and implications for research and practice are discussed., (© Georg Thieme Verlag KG Stuttgart · New York.)

Representatives of the statutory health insurance (n=46) and policy makers at the local, federal and state level (n=136) were interviewed in 2 nationwide online surveys about the significance and degree of implementation of prevention. The group comparison between the decision-makers shows significant differences in terms of attitudes towards health prevention. The political leaders are demanding an improvement of the GKV-benefit package and the obstacles require the cooperation of urgent attention., (© Georg Thieme Verlag KG Stuttgart · New York.)