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Background Mental health problems in children, adolescents and young adults are highly prevalent and cause a significant burden for both individuals and society, resulting in a high relevance to public health. Longitudinal studies are needed to provide profound population-based data on mental health and well-being. In the present study, first results of the 11-year follow-up of the German BELLA study are presented. These include age- and gender-specific courses of general health and well-being, long-term health outcomes of mental health problems, and the utilisation of mental health services. Methods The longitudinal BELLA study is the module on mental health and well-being within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The BELLA study has gathered data since 2003 at five measurement points using standardised measures. In the most recent 11-year follow-up, N = 3,492 young people aged 7 to 31 years participated. Individual growth modeling, linear regression and descriptive analyses were conducted. Results Self-reported general health and well-being were both better in younger than older and in male compared to female participants using data from all five measurement points. Mental health problems in childhood and adolescence (measured at baseline) were associated with adverse general, mental and physical health outcomes at 6-year and 11-year follow-ups. About 75 % of children and adolescents with a diagnosed mental disorder were under mental health treatment. Conclusions With its 11-year follow-up, the longitudinal BELLA study provides new data on mental health and well-being in German children, adolescents and young adults. Our findings are important for the development of targeted mental health promotion and early prevention strategies. Promising future analyses are planned. Key messages The BELLA study provides data on developmental trajectories of mental health from childhood to adulthood, on long-term health outcomes of mental health problems and on mental health care use. The findings of the present study are of great relevance for the development of targeted health promotion and prevention programs.

Background Depression is one of the most common mental disorders in adolescents and young adults worldwide, and causes severe impairments in psychological health, social functioning and employment. The identification of risk and resource factors for depression is an important research aim. The present study aims to investigate which individual, familial and social risk and resource factors in childhood and adolescence are associated with depressive symptoms five years later in a population-based cohort in Germany. Methods Analyses were performed using data from the longitudinal BELLA study. Data on risk and resource factors were collected among N = 632 children and adolescents aged 11 to 17 years. Depressive symptoms were measured five years later. The effects of risk and resource factors on depression were investigated using multivariate linear regression analyses. In subsequent models, we explored potential moderator effects of resource factors on the relationship between risk factors and depressive symptoms. Results A negative mother-child relationship was associated with stronger depressive symptoms in girls, while school stress was identified as a risk factor in boys. Peer competence was associated with fewer depressive symptoms in girls, and family cohesion served as a resource factor in boys. Moreover, self-efficacy moderated the association between negative mother-child relationship and depressive symptoms. Family cohesion acted as a moderator between peer problems and depressive symptoms. Conclusions Our findings provide evidence of gender-specific risk and resource factors for depressive symptoms. Individuals who are exposed to one of the identified risk factors must be monitored during the transition from childhood to adolescence and young adulthood. Gender-sensitive health promotion and early prevention programs are needed. Key messages Information concerning risk and resource factors for the development of depressive symptoms during adolescence and emerging adulthood are of high interest for public health, research and practice. The findings of the present study are of great relevance for the development of gender-sensitive health promotion and early prevention programs.

Introduction Adverse cardiac remodelling represents the most important risk factor for the development of heart failure (HF) after myocardial infarction (MI). Chymase is a protease that generates locally pro-fibrotic factors such as angiotensin II, TGFβ, and matrixmetallproteases that contribute to tissue remodelling. Purpose This phase IIa study examined the effects of the chymase inhibitor fulacimstat on functional parameters of adverse cardiac remodelling after acute MI. Methods A double-blind, multinational, randomized, placebo-controlled study was performed in patients after first STEMI who were treated with primary percutaneous coronary intervention within 24h of symptom onset. To enrich for patients at risk of adverse remodelling, main inclusion criteria were a left-ventricular ejection fraction (LVEF)≤45% and an infarct size>10% on day 5 to 9 post MI as measured by cardiac MRI. On day 6 to 12 post MI, patients were randomized to treatment with either 25 mg fulacimstat (n=54) or placebo (n=53) twice daily on top of standard of care. The changes in LVEF, LVEDVI, and LVESVI from baseline to 6 months of treatment were analyzed by a central blinded cardiac MRI core laboratory. Results Fulacimstat was safe and well tolerated, 64.8% of patients treated with fulacimstat and 75.5% of patients treated with placebo reported treatment emergent adverse events. Fulacimstat achieved exposures that were approximately 10-fold higher than those predicted to be required for minimal therapeutic activity. After six months of treatment, there were no effects of fulacimstat compared to placebo on the changes in LVEF, LVEDVI, and LVESVI (see Table). Analysis of primary efficacy parameters Parameter Placebo Fulacimstat p-value LVEF (%) baseline 37.2±6.1 39.1±5.5 0.15 6 months 41.2±8.4 42.6±8.4 0.45 delta 4.0±5.0 3.5±5.4 0.69 LVEDVI (mL/m2) baseline 80.0±17.1 77.4±18.2 0.51 6 months 85.1±19.1 84.7±23.4 0.94 delta 5.1±18.9 7.3±13.3 0.54 LVESVI (mL/m2) baseline 50.5±13.0 47.3±12.3 0.26 6 months 51.1±16.9 49.6±18.1 0.71 delta 0.6±14.8 2.3±11.2 0.56 Data are given as mean ± standard deviation. Conclusion Fulacimstat was safe and well tolerated in patients with left-ventricular dysfunction (LVD) after first STEMI but had no effect on adverse cardiac remodelling in the experimental setting of this study. Acknowledgement/Funding The study was funded by its sponsor BAYER AG