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Rebecca C Brown,1,* Paul L Plener,1,2,* Elmar Braehler,3,4 Joerg M Fegert,1 Markus Huber-Lang5 1Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany; 2Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; 3Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University of Mainz, Mainz, Germany; 4University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany; 5Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany *These authors contributed equally to this work Background: Chronic pain is a frequent burden in the general population. Child maltreatment and bullying are risk factors for the development of chronic pain. Aim of this cross-sectional study was to investigate the association of child maltreatment and bullying and pain experiences in a representative sample of the general population.Materials and methods: A total of N=2,491 people from the general population of Germany participated in the study (Mage=48.3 years [SD=18.2], 53.2 % female). Child maltreatment was assessed with the Childhood Trauma Questionnaire (CTQ), pain was rated with the Polytrauma Outcome (POLO)-physical state domain, depression scores were assessed with the Patient Health Questionnaire, and anxiety scores via the General Anxiety Disorder Questionnaire. Regression analyses were calculated to investigate the effect of bullying and child maltreatment, as well as depression, anxiety, and gender on pain experiences.Results: A significant correlation between increasing pain levels and number of adverse childhood experiences was found. With regard to specific types of maltreatment, largest effect sizes were found for emotional abuse. Bullying was significantly, but overall rather moderately, related to pain suffering. In women, all forms of maltreatment were associated with pain, while in men only sexual and physical abuse revealed significant effects. Although depression and anxiety scores were significantly associated with the experience of current pain, they did not change the effect of child maltreatment on pain significantly.Conclusion: In this sample of the general population, adverse childhood experiences were significantly associated with pain and showed cumulative effects, over and above depressive and anxiety symptoms. Keywords: child maltreatment, adulthood, depression, anxiety

Background: Child maltreatment is a significant problem in Germany. Hospital data on child maltreatment serve as a crucial foundation for planning effective prevention measures. These data enable an assessment of the extent to which at-risk children and adolescents are identified, supported, and protected. A systematic evaluation and classification of all hospital data relevant to child maltreatment in Germany is still lacking. Therefore, the aim of this article is to gain an overview of the data in this field and thus bridge the gap., Methods: Descriptive analyses of (partially) inpatient data on child abuse and neglect (secondary diagnosis in ICD-10: T74.0, T74.1, T74.2, T74.3, T74.8, T74.9) + (procedure OPS: 1‑945.0, 1‑945.1) from the 2019-2023 data collection period. The variables age, gender, and main diagnoses relevant to maltreatment are considered in each case. The data were analyzed via the publicly accessible data browser of the Institute for the Hospital Remuneration System (InEK)., Results: The number of diagnosed cases of child maltreatment of (partially) inpatients is detached from prevalence rates in the population; in consequence, there is a significant underreporting of all forms of maltreatment, with boys and girls being recognized differently for different forms of maltreatment. In addition, the frequent lack of a link between child maltreatment-related diagnoses and procedures performed becomes apparent., Conclusion: In addition to raising awareness, training, and further education of healthcare professionals, there is also a need for investment in political change., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: J.M. Fegert ist Mitglied des Beirats der Unabhängigen Beauftragten für Fragen des sexuellen Kindesmissbrauchs (UBSKM) und Mitglied des Nationalen Rats gegen sexuelle Gewalt an Kindern und Jugendlichen. A. Jud ist Mitglied des Nationalen Rats gegen sexuelle Gewalt an Kindern und Jugendlichen. T. Walter gibt an, dass kein Interessenkonflikt besteht. Die Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie des Universitätsklinikums Ulm erhält verschiedene Drittmittel aus der öffentlichen und privaten Hand. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2025. The Author(s).)

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; M Age-Baseline = 16.1 years; M Age-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.

Importance: Associations between child maltreatment (CM) and health have been studied broadly, but most studies focus on multiplicity (number of experienced subtypes of CM). Studies assessing multiple CM characteristics are scarce, partly due to methodological challenges, and were mostly conducted in patient samples., Objective: To determine the importance of CM characteristics in association with physical multimorbidity in adulthood for women and men in a German representative sample., Design, Setting, and Participants: This survey study used data from a representative sample of the German population between July and October 2021. Households were randomly selected within regional areas by a German demographic consultation company, and the Kish-Grid method was applied to ensure random participation. Reasons for nonparticipation were refusal of the selected household or target person to participate and failure to contact a household after 4 visits. Analyses took place between June 2023 and July 2024., Exposure: Characteristics of CM, including subtypes of CM, multiplicity, age at time of maltreatment (timing), number of years of experienced maltreatment (duration), frequency, and subjective severity (measured with the ISPCAN Child Abuse Screening Tools Retrospective version questionnaire)., Main Outcomes and Measures: The main outcome was physical multimorbidity, defined as the sum score of lifetime leading morbidity and mortality causes in Western countries (obesity, diabetes, cancer, hypertension, myocardial infarction, chronic obstructive pulmonary disease, and incident stroke). Conditioned random forest regression analyses (a machine learning regression technique) were conducted to examine what characteristics of CM were most importantly associated with physical multimorbidity in adulthood while considering all other variables in the model., Results: Of 5908 individuals invited, the study sample included 2514 participants (response rate, 42.6%), with 1297 (51.6%) women (mean [SD] age, 50.6 [17.9] years) and 1217 (48.4%) men (mean [SD] age, 49.5 [18.2] years). Duration of CM was the most important factor for physical multimorbidity in adulthood for both women (importance = 0.595; 95% CI, 0.599-0.601) and men (importance = 1.389; 95% CI, 1.386-1.394). Duration and timing variables were more importantly associated with outcomes than multiplicity in women and men. For women, severity and experiencing CM at age 4 years was significantly associated with physical multimorbidity in adulthood. For men, experiencing CM at age 11 years was most importantly associated with physical multimorbidity in adulthood., Conclusions and Relevance: In this survey study, conditioned random forest regression analyses were applied to provide insights in the importance of duration and timing of CM for physical health in addition to the frequently studied multiplicity. These findings suggest that CM assessments should be considered in diagnostics of individuals with physical health conditions and may also inform strategies to mitigate the risk.

Background: A growing body of evidence explored symptom burden of somatic symptom disorder (SSD) and its complex etiology involving psychosocial aspects. Child abuse has been linked to numerous psychopathologies including somatic symptoms as well as impaired personality functioning and disruptions in epistemic trust. This work aims to investigate personality functioning and epistemic trust in the association between child abuse and somatic symptom burden., Methods: We conducted structural equation modelling (SEM) using representative data of the German population (N = 2436). Personality functioning (OPD-SQS) was applied as a mediator between retrospectively recalled child abuse (ICAST-R) and somatic symptom burden (SSS-8, SSD-12, 6 month time criterion), while epistemic trust was added as a predictor of personality functioning., Results: 6.8 % (n = 166) of participants self-reported SSD. Prevalence of child abuse (53.6 % vs. 31.7 %; χ 2  = 33.44, p < .001) was significantly higher among those with SSD. Child abuse was significantly associated with somatic symptom burden (criterion A: β = 0.23, 95 %-CI: 0.19-0.27, p < .001; criterion B (β = 0.24, 95 %-CI: 0.20-0.28, p < .001) and explained 6 % and 5 % of its variance respectively. Adding personality functioning as a mediator increased the explained variance to 28 % for both somatic symptom burden criterion A and B. Including epistemic trust further increased the explained variance of personality functioning (from 15 to 36 %)., Limitations: All assessments and results are based on self-report and cross-sectional data., Conclusions: Impairments in personality functioning and disruptions in epistemic trust might play an important role in experiencing symptoms of SSD. Both domains thus present new avenues for treatment improvement and further research in patients with SSD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: The Patient Health Questionnaire (PHQ-9) is a popular tool for assessing depressive symptoms in both general and clinical populations. The present study used a large representative sample of the German adult population to confirm desired psychometric functioning and to provide updated population norms., Methods: The following psychometric properties were assessed: (i) Item characteristics (item means, standard deviations and inter-item correlations), (ii) Construct validity (correlations of the PHQ-9 sum-score with scores obtained from instruments assessing depression, anxiety and somatization (GAD-7, BSI-18), (iii) Internal consistency (coefficient omega), (iv) Factorial validity (via confirmatory factor analysis of the assumed one factorial model) as well as (v) Measurement invariance (via multi-group confirmatory factor analyses across gender, age, income and education)., Results: The study found that the PHQ-9 had sound psychometric properties in terms of internal consistency and construct validity, and that measurements obtained with the tool could be compared across gender and age., Limitations: Despite using a representative sample, the response rate was only 42.6%. Furthermore, diagnostic efficiency cannot be assessed as there were no clinical interviews conducted. Conclusion: The updated population based norms, which are presented for the total sample as well as separated by gender and various age-groups, provide a useful reference for clinical practice and epidemiological research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kliem, Sachser, Lohmann, Baier, Brähler, Gündel and Fegert.)

Background: The COVID-19 pandemic and the associated measures have had a significant impact on millions of individuals and families worldwide. Although cross-sectional studies have demonstrated the considerable burden placed on families during the pandemic, trends over different phases of the pandemic including later stages and using population-based samples is scarce., Objective: In this study, we aimed to assess trends in family functioning across four population-based surveys between December 2020 and March 2023 using a repeated cross-sectional design. The surveys were conducted using a similar sampling strategy and measures. We included individuals residing in a household with at least one minor below the age of 16., Results: The most notable changes across surveys over time were related to quality of life. While 54.3% of respondents reported a decline in quality of life during the winter of 20/21 compared to pre-pandemic levels, this was observed in only 22.6% of participants during the spring of 23. The proportion of respondents who indicated a deterioration in their relations with their children also decreased during the pandemic. While 9.9% of respondents reported a deterioration in their relationship with their children during the winter of 20/21 in comparison to the initial phase of the pandemic, this was reported by only 5.2% in the spring 23. The relationship with one's partner and health status exhibited minimal fluctuations. Mental health problems were associated with a decline in quality of life, health status and relationships with children and partners compared to pre-pandemic levels at all time points. Moreover, lower income levels were associated with poorer relationship quality with the partner in the most recent wave., Conclusions: Our findings demonstrate significant improvements in family functioning since the onset of the pandemic, indicating that individuals and families in our sample were generally adapting well. However, a subgroup of the population still reports suboptimal family functioning compared to before the pandemic. Psychosocial care and social policy support for families are needed., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the Medical Department of the University of Leipzig (Protocol Number: 298/21-ek; Date of Approval: 12.7.2021). Informed consent was obtained from all individual participants included in the study. In the case of minors, participants gave informed assent with informed consent being provided by their caregivers. Consent for publication: Not applicable. Competing interests: AG, DB, EB and VC declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. JMF has received research funding from EU, BMG, BMBF, BMFSFJ, DFG, G-BA Innovation Fund, State Ministries of Baden-Württemberg and Saarland, Landesstiftung Baden-Württemberg, Porticus Stiftung, Evangelische Landeskirche Baden-Württemberg, travel grants, speakers’ fees, event and training sponsorship from APK, Adenauer and Ebert Foundations, Deutschlandfunk, DFG, DJI, DKSB, Infectopharm, med update, UNICEF, professional associations, universities and federal and state ministries. JMF is consultant for APK, federal and state ministries. JMF has no industry-sponsored lecture series, no shareholdings, no participation in pharmaceutical companies., (© 2024. The Author(s).)

Epistemological Misunderstandings of the German Federal Court of Justice in Criminal Cases Regarding the Null Hypothesis: Verification in the Credibility Assessment Abstract: Background: The article deals with the decision of the German Federal Court of Justice (Bundesgerichtshof, BGH) in criminal matters regarding credibility assessment dated 30 July 1999 (1 StR 618/98, BGHSt 45, 164). Regarding criminal matters, the BGH formulated specific requirements for credibility assessments based on two published scientific expert reports. Method: We analyzed conflicting postulates of scientific theory in the expert reports and the reception of these principles in the BGH judgment by examining the original quotes. Results: Given the central importance of this BGH decision, we analyzed the original expert reports for their epistemological content. The BGH formulated the scientific approach of starting from the assumption that the statement is untrue - the so-called "null hypothesis". In doing so, it referred to Popper's deductivism, albeit without addressing the rules of hypothesis testing. Based on the second expert report, which argues for inductive.

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., Competing Interests: Declarations. Ethical approval: All studies included in the FAMILY framework have been approved by the respective local human research ethics committees and/or committees of animal experiments. All procedures performed in studies involving human participants are conducted in accordance with the ethical standards of the institutional and/or national research ethics committee and with the WMA Declaration of Helsinki and its latest amendments or comparable ethical standards. All animal experiments are conducted in full compliance with national/European Union directives on the protection of animals used for scientific purposes. Competing interests: BE is part of the Advisory Board of Eli Lilly Denmark A/S, Janssen-Cilag, Lundbeck Pharma A/S, and Takeda Pharmaceutical Company Ltd; and has received lecture fees from Bristol-Myers Squibb, Boehringer Ingelheim, Otsuka Pharma Scandinavia AB, Eli Lilly Company, and Lundbeck Pharma A/S. CM has received honoraria as a consultant and/or advisor and/or for lectures from Angelini, Compass, Esteve, Exeltis Janssen, Lundbeck, Neuraxpharm, Nuvelution, Otsuka, Pfizer, Servier and Sunovion. outside the submitted work. CFB is founder and shareholder of SBGneuro Ltd. Other authors have no competing interests to declare., (© 2024. The Author(s).)

Background: The background to this article is a polarized media debate about ritual violence against children in German speaking countries. Two opposing positions have formed, which are unable to engage in a reasonable exchange with each other., Objective: The article therefore aims to contribute to bridging the differences and argues, above all in the interests of patient well-being, for positioning oneself beyond polarization and to reflect on an evidence-base in treatment as well as in scientific discourse., Material and Methods: The article is based on a critical examination of exemplary scientific literature, public investigation reports and diverse media coverage., Results: In certain psychotraumatology circles and in the media (especially on social media, such as telegram), there is a conspiracy narrative about a large network of perpetrators who inflict the most serious sexual violence on children in a ritual context. An uncritical belief in this has already led to mistreatment of patients and also to a fundamental mistrust of their statements. This threatens these already vulnerable patients with further harm, which contradicts the basic principles of medical ethics., (© 2024. The Author(s).)

Background: Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents and young adults worldwide. It is linked to a broad variety of mental disorders and an increased suicide risk. Despite its high prevalence, research on the underlying mechanisms and on potential risk and resilience factors for maintaining or quitting NSSI remains scarce. This manuscript presents an overview of the "Self-injury: Treatment-Assessment-Recovery" (STAR) collaboration, which aimed to address these gaps., Methods: We investigated the natural course of NSSI as well as its social, psychological, and neurobiological predictors (observational study; OS). OS data collection occurred at four timepoints (baseline [T0], 4 [post, T1], 12 [follow-up (FU), T2], and 18 [FU, T3] months after baseline) for the NSSI group, which was compared to a healthy control (HC) group at T0 only. Online self-report was used at all timepoints, while semi-structured interviews (face-to-face (f2f)) were conducted at T0 and T3. At T0 only, we conducted ecological momentary assessment and neurobiological investigations. Here, we present the general methodology and sample characteristics of the completed OS including the f2f subprojects, while other subprojects are not within the scope of this paper., Sample Description: The OS sample consists of 343 participants at T0 (180 NSSI, 163 HC). Mean age in the NSSI group (T0) was 18.1 years (SD = 2.09, range: 15-25), gender-related data is available for 166: 156 = female, 7 = male, 3 = transgender, 10 = not disclosed). In the HC group, mean age (T0) was 19.1 years (SD = 2.35, range: 15-25) (142 = female, 21 = male). At T1, 128 (71.11%) of the NSSI participants completed the questionnaires, at T2 125 (69.44%) and at T3 104 (57.78%). In the fMRI subproject, 126 adolescents participated (NSSI = 66, HC = 60, 100% female; mean age (T0): NSSI = 18.10 years, SD = 2.21; HC = 19.08, SD = 2.36)., Conclusion: Understanding predictors is of utmost importance for adequate diagnosis and intervention for NSSI. Our OS applied a multimodal investigation of social, psychological, and neurobiological parameters and is the largest sample of adolescents with NSSI to date including follow-up assessments. As health care providers require specific knowledge to develop new treatments, we believe that our in-depth assessments can potentially enhance care for youths engaging in NSSI., (© 2024. The Author(s).)

Background: Adolescents face many challenges when coping with out-of-home placement, and life story work can be helpful in this context. Typically conducted in individual settings, life story work's high resource requirements pose a challenge for implementation in the standard care of youth welfare institutions. To address this issue, the ANKOMMEN intervention was developed as a manualized group program for adolescents in residential care focusing on processing and coping with experiences associated with their out-of-home placement., Method: The intervention was evaluated in a single-arm pilot study with questionnaires administered at three time points (pre-intervention, post-intervention, and 3-month follow-up). The primary outcome was self-efficacy, while secondary outcomes included self-esteem, depressive symptoms, posttraumatic stress symptoms, and behavioral problems. A total of 31 intervention groups with 115 adolescents (M = 14.91 years; SD = 1.45; 52.2% male) were conducted between October 2020 and September 2022 in Germany. Data were analysed using mixed effect models., Results: Pre-post comparisons revealed increased self-efficacy (d = -0.80) and self-esteem (d = -0.68) among participants with below-average scores prior to the intervention. Additionally, there was a decrease in self-reported depressive symptoms (d = 0.76), self-reported posttraumatic stress symptoms (d = 0.58), self-reported internalizing behavior problems (d = 0.74), caregiver-reported internalizing behavior problems (d = 0.76), and self-reported externalizing behavior problems (d = 0.52) for participants with clinically relevant scores prior to the intervention. These improvements were stable in the 3-month follow-up assessment. Furthermore, the intervention proved its feasibility in standard care within the context of the evaluation study., Conclusions: The results of the pilot study provide preliminary evidence for the feasibility and potential effectiveness of ANKOMMEN but further research is needed to obtain valid evidence for the efficacy of the intervention., (© 2024. The Author(s).)

Major depressive disorder (MDD) in young people is a common psychiatric disorder, but treatment options are limited. Agomelatine has demonstrated short-term efficacy and safety in pediatric patients. We report here the results of a 92-week open-label extension (OLE). The international, multicenter, double-blind, study randomized 400 patients (80 children, 320 adolescents) with moderate-to-severe MDD to one of four treatment groups: agomelatine 10 mg (n = 102), agomelatine 25 mg (n = 95), placebo (n = 103), and fluoxetine 10-20 mg (n = 100). After 12 weeks, patients who could benefit from treatment continuation were offered entry into an optional OLE during which they received agomelatine 10 or 25 mg for a further 92 weeks. A total of 339 patients (271 adolescents) entered the OLE. Treatment groups considered for the OLE analysis reflected those received in the double-blind and OLE periods: agomelatine (10 or 25 mg) in both (ago/ago, n = 170); placebo then agomelatine 10-25 mg (pcb/ago, n = 85); or fluoxetine then agomelatine 10-25 mg (fluox/ago, n = 84). Mean age (± SD) at entry into the double-blind phase (Week 0) was 13.6 ± 2.7 years and 61.9% were female. Mean changes in Children's Depression Rating Scale revised (CDRS-R) raw total score from Week 12 to last post-Week 12 value in the three groups were - 16.3 ± 12.2 (ago/ago), - 18.9 ± 16.1 (pcb/ago), and - 16.1 ± 15.5 (fluox/ago), reflecting the difference in efficacy between treatments during the double-blind period, and heterogeneity at W12 between the treatment groups. Adverse events considered related to treatment occurred in 14.5% of patients: 15.3% ago/ago, 16.5% pcb/ago, and 10.7% fluox/ago. Three patients (all adolescents) experienced treatment-related severe adverse events: two treated with ago/ago and one treated with pcb/ago. Among the adolescents, one treatment-related severe adverse event in a patient in the pcb/ago group led to study withdrawal. Agomelatine was associated with continuous improvement in depressive symptoms without unexpected safety signals. These findings support the safe use of agomelatine in a pediatric population with moderate-to-severe MDD for up to 104 weeks.Trial registration No: EUDRACT No. 2015-002181-23., (© 2024. The Author(s).)

Objectives: Child maltreatment (CM) is a major risk factor across the lifespan. While research on CM and its consequences has risen strongly during the last decades, research is mainly focused on the prevalence of types of CM incidents. As valid prevalence rates on timing and chronicity of CM are lacking to date, we aimed to assess the timing of experienced CM by describing the age of onset, duration, and prevalence at each year of age for each CM subtype in a population-based sample., Study Design: Cross-sectional, observational study in a representative sample., Methods: Using different sampling steps including a random route procedure, a probability sample of the German population above the age of 16, encompassing 2514 persons (50.6% female, mean age: 50.08 years) was generated. Participants were asked about sociodemographic information in a face-to-face interview, CM was assessed using the ICAST-R questionnaire., Results: The earliest mean age of onset was seen in neglect with 8.07 (±3.07) years for boys and 7.90 (±2.96) years for girls, while the mean age of onset for sexual abuse was in adolescence with 13.65 (±3.86) years for boys and 13.91(±3.17) years for girls. The overall duration of CM was lowest for sexual abuse with 2.12 (±2.01) years for boys and 2.35 (±1.73) years for girls, the highest duration was seen for emotional abuse with 4.00 (±3.54) years for boys and 4.21 (±3.77) years for girls., Conclusions: Our novel results provide important epidemiological information for prevention efforts., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Recent studies show the high prevalence of child maltreatment in Germany and that assaults by hospital staff also pose a problem. Since 2020, the Joint Federal Committee has been calling for institutional safeguarding measures (ISM) to protect and support those affected in hospitals. The aim of this study is to analyze the level of knowledge and action competencies regarding child maltreatment among hospital staff and the extent to which ISM are implemented in hospitals., Methods: A survey was administered to 1011 participants before they took part in two online courses on child protection and protection measures in hospitals, with questions regarding self-assessed level of knowledge and competence on child protection and the occurrence of cases of maltreatment and protective measures in their own institution. Data were analyzed using descriptive methods., Results: It becomes apparent that the knowledge and competencies of hospital staff regarding child protection are in the middle range. In hospitals, cases of maltreatment that occur outside the institution are particularly common, but violence by staff or other patients of the same age also plays a significant role. Of the respondents, 93.6% stated that their institution had already developed at least one element of an ISM, but only 1.0% of respondents reported that all the elements surveyed had already been fully developed., Discussion: Hospitals in Germany seem to be largely on the path to better protect children and adolescents from maltreatment and to support those affected. However, there are still deficits in the competencies of employees and the implementation of the ISM elements. More resources need to be made available by hospital operators and the public sector for this purpose., (© 2024. The Author(s).)

Background: Child maltreatment (CM) can have devastating and potentially lifelong effects for those affected and is a major contributor to mental health problems. To tackle public health problems it is crucial to have reliable data on CM. The aim of this study is to assess the prevalence and predictors of CM in a nationwide sample of the German population of young adults., Methods: The study population (young adults aged 18 to 31 years) stems from the KiGGS Cohort study, the longitudinal branch of the German Health Interview and Examination Survey for children and adolescents. This sample meets the criteria of the United Nations Sustainable Development Goals (SDG) indicator 16.2.3. The data was collected between 2014 and 2017. CM were assessed with the Childhood Trauma Questionnaire (CTQ) in. In addition, socio-demographic variables and other known risk factors for CM were assessed. A total of 6433 (47.8% female) participants were included in the analyses. Binary logistic regression analyses were used to investigate predictors of maltreatment subtypes. Ordinal regression was used to examine their association with experience of multiple forms of CM., Results: Overall, 18.4% (f: 20.9%, m: 16.1%) of the participants reported having experienced at least one type of CM; 6.7% (f: 8.8%, m: 4.8%) reported experiences of emotional abuse, 3.7% (f: 3.9%, m: 3.5%) physical abuse, 3.5% (f: 5.3%, m: 1.7%) sexual abuse, 9.0% (f: 9.9%, m: 8.2%) emotional neglect and 8.6% (f: 8.5%, m: 8.7%) physical neglect. Gender, subjective social status, education and household dysfunction (e.g. living with an individual who is using substances) emerged as significant predictors for different types of CM. Additionally, all these factors were significant risk factors for experiencing cumulative CM., Conclusions: CM is common in the German population, with almost one in five people experiencing at least one type of CM. The results reveal important risk factors for the occurrence of CM. In particular, people with lower social status and those who grew up in dysfunctional households are at higher risk of CM. Greater support for this vulnerable population may reduce the prevalence of CM., (© 2024. The Author(s).)

Prevention of Child Sexual Abuse: Prevention Programs and Safeguarding Concepts in the Context of Sports, Musical Education, and Religious Organizations Prevalence rates of child sexual abuse by caregivers in private and non-public institutions underscore the need for implementing safeguarding concepts. However, factors driving the implementation of prevention and safeguarding in the field are not well understood. What supportive and inhibiting factors can be identified in the implementation of safeguarding concepts and prevention programs? Content analysis of semi-structured interviews with professional and volunteer staff in clubs and institutions (n = 10, 69 % female) as well as with individuals who experienced child sexual abuse during their childhood (n = 3, 66 % female). Safeguarding concepts in clubs or religious institutions were primarily initiated by umbrella organizations. Current incidents of child maltreatment, public pressure, and media attention substantially increased the need for preventive actions. The provision of training, resources, and networking structures by umbrella organizations further facilitated their implementation. Main implementation challenges included limited personnel and time resources, lack of expertise, insufficient training opportunities, and absence of guidelines and support from umbrella organizations. Due to club leaders' limited knowledge and resources an independent implementation of safeguarding concepts is largely lacking without concrete guidelines and support from umbrella organizations. To upscale safeguarding, public policies or incentive systems such as state-funded child protection certifications are thus paramount.