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Zusammenfassung. Theoretischer Hintergrund: Trainingsprogramme zur Emotionsregulation für Jugendliche sind notwendig, da eine Dysregulation der Emotionen die Entwicklung von psychischen Störungen begünstigen kann. Fragestellung: Ziel dieser systematischen Literaturübersicht ist es, einen Überblick über aktuelle Publikationen zu Trainingsprogrammen von 2015 – 2020 zu geben. Methode: Im Rahmen der Literaturrecherche konnten sechs Publikationen eingeschlossen werden. Ergebnisse: Es zeigten sich positive Effekte bei der Programmdurchführung durch externe Personen, vor allem durch Fachpersonen und keine bis negative Effekte bei der Durchführung durch das Schulpersonal. Ein positiver Einfluss durch die Einbeziehung der Eltern konnte in einem Trainingsprogramm vermutet werden, wobei die Ergebnisse statistisch nicht signifikant waren. Schlussfolgerung: Es zeigt sich die Notwendigkeit weiterer Evaluation von Trainingsprogrammen, welche sich vor allem auch mit dem Einbezug der Bezugspersonen beschäftigen und untersuchen, inwiefern Trainer_inneneffekte auch bei Studien mit einer besseren Vergleichbarkeit vorliegen.

An altered processing of negative salient stimuli has been suggested to play a central role in the pathophysiology of major depression (MD). Besides negative affective and social stimuli, physical pain as a subtype of negative sensory stimulation has been investigated in this context. However, the few neuroimaging studies on unpleasant sensory stimulation or pain processing in MD report heterogeneous findings. Here, we investigated 47 young females, 22 with MD and 25 healthy controls (HC) using fMRI (3.0 T). Four levels of increasingly unpleasant electrical stimulation were applied. Ratings of stimulus intensity were assessed by a visual analogue scale. fMRI-data were analyzed using a 2 × 4 ANOVA. Behavioral results revealed no group differences regarding accuracy of unpleasant stimulation level ratings and sensitivity to stimulation. Regarding neural activation related to increasing levels of unpleasant stimulation, we observed increasing activation of brain regions related to the pain and salient stimulus processing corresponding to increasingly unpleasant stimulation in controls. This modulation was significantly smaller in MD compared to controls, particularly in the dorsal anterior cingulate cortex, the somatosensory cortex, and the posterior insula. Overall, brain regions associated with the processing of unpleasant sensory stimulation, but also associated with the salience network, were highly reactive but less modulated in female patients with MD. These results support and extent findings on altered processing of salience and of negative sensory stimuli even of a non-painful quality in female patients with MD. Electronic supplementary material The online version of this article (10.1007/s00406-020-01123-0) contains supplementary material, which is available to authorized users.

Although self-injurious thoughts and behaviors are a global health concern, little is known about suicidal threat/gesture(s) where a person leads others to believe they want to end their lives when they have no intention to do so. This study assessed the lifetime prevalence of self-injurious thoughts and behaviors among both community adolescents (n = 1117) and in clinical youth (n = 191). Suicide threats/gestures were common among youth; 12.2% of community adolescents and 18.0% of clinical youth reporting having made a suicide threat/gesture, most commonly in the context of other self-injurious thoughts and behaviors. Across both samples, suicide threats/gestures were not uniquely associated with suicide attempts, and youth who reported suicide threats/gestures in the context of a history of self-harm or suicide plan(s) were no more likely to report a history of suicide attempt(s). Suicide threats/gestures were distinguished from suicide attempts in that they primarily fulfilled positive social functions, rather than autonomic functions. Findings suggest that suicidal threats/gestures are common in both community and clinical youth, and are not uniquely associated with suicide attempts, but rather function to communicate distress to others.

Although self-injurious thoughts and behaviors are a global health concern, little is known about suicidal threat/gesture(s) where a person leads others to believe they want to end their lives when they have no intention to do so. This study assessed the lifetime prevalence of self-injurious thoughts and behaviors among both community adolescents (n = 1117) and in clinical youth (n = 191). Suicide threats/gestures were common among youth; 12.2% of community adolescents and 18.0% of clinical youth reporting having made a suicide threat/gesture, most commonly in the context of other self-injurious thoughts and behaviors. Across both samples, suicide threats/gestures were not uniquely associated with suicide attempts, and youth who reported suicide threats/gestures in the context of a history of self-harm or suicide plan(s) were no more likely to report a history of suicide attempt(s). Suicide threats/gestures were distinguished from suicide attempts in that they primarily fulfilled positive social functions, rather than autonomic functions. Findings suggest that suicidal threats/gestures are common in both community and clinical youth, and are not uniquely associated with suicide attempts, but rather function to communicate distress to others.

Background: Investigating adolescents and young adults may provide a unique opportunity to understand developmental aspects of the neurobiology of depression. During adolescence, a considerable physiologic reorganization of both grey and white matter of the brain takes place, and it has been suggested that differences in grey-matter volumes during adolescence may reflect different maturational processes. Methods: We investigated grey-matter volumes in a comparatively large sample (n = 103) of adolescents and young adults (aged 12 to 27 years), 60 of them with a diagnosis of current depression. Results: Replicating previous studies, we found a clear whole-brain effect of age: the older the participants, the lower their global grey-matter volumes, particularly in the paracingulate and prefrontal cortices. Contrasting depressed and healthy youth in a whole-brain approach, we found greater grey-matter volumes in the dorsolateral prefrontal cortex of those with depression. Furthermore, a region-of-interest analysis indicated lower grey-matter volumes in the hippocampus in participants with depression compared with healthy controls. Limitations: The present study was limited because of a skewed sex distribution, its cross-sectional design and the fact that some participants were taking an antidepressant. Conclusion: During adolescence, restructuring of the brain is characterized by marked decreases in prefrontal grey-matter volumes, interpreted as a correlate of brain maturation. Findings of greater volumes in the prefrontal cortex, particularly in younger adolescents with depression, may suggest that these participants were more prone to delayed brain maturation or increased neuroplasticity. This finding may represent a risk factor for depression or constitute an effect of developing depression.

Borderline personality disorder (BPD) is characterized by interpersonal disturbances and dysfunctional behavior such as non-suicidal self-injury (NSSI). We recently observed neural alterations in BPD during social inclusion by enhanced activations within the dorsomedial prefrontal cortex (dmPFC) and the posterior cingulate cortex (PCC). To examine the specificity of these neural alterations, we now investigated participants with NSSI but without BPD and compared them to BPD and healthy controls (HC). Considering the association between NSSI and BPD, we further examined neural commonalities during social inclusion. Fifteen females diagnosed with BPD, 16 with NSSI and 17 HC were investigated by fMRI and the cyberball paradigm, focusing on social inclusion (p

Zusammenfassung. Kindesmisshandlung stellt einen bedeutenden Risikofaktor für die Entwicklung dar. Einzelne Formen von Kindesmisshandlung treten häufig nicht isoliert auf, sondern das gemeinsame Auftreten verschiedener Formen von Kindesmisshandlung stellt eher die Regel als die Ausnahme dar. Neben den langfristigen und vielfältigen individuellen Folgen führt Kindesmisshandlung jährlich zu einer hohen gesamtgesellschaftlichen Belastung. Die WHO hat Kindesmisshandlung als großes Public Health Problem identifiziert und die Vereinten Nationen haben den Kampf gegen Kindesmisshandlung zum Ziel in ihrer Agenda für nachhaltige Entwicklung gemacht. In dem vorliegenden Beitrag werden die Häufigkeit sowie das gemeinsame Auftreten unterschiedlicher Formen von Kindesmisshandlung sowie deren Assoziation mit psychischen und somatischen Folgen auf Basis einer bevölkerungsrepräsentativen Stichprobe untersucht und dargestellt. Die Ergebnisse verdeutlichen den Zusammenhang zwischen der Kumulation verschiedener Formen von Misshandlung und negativen Folgen für die Betroffenen. So ist das Risiko für negative Konsequenzen beim Erleben von vier oder mehr Formen von Misshandlung um das bis zu 10-fache erhöht. Viel zu selten werden die kumulativen Effekte von mehreren Belastungen berücksichtigt. Gerade weil die Wirkweisen über die Misshandlung, die Gesundheit beeinflusst, zunehmend gut untersucht sind, muss dieses Wissen im Gesundheitswesen stärker bei der Konzeption von Präventions- und Interventionsmaßnahmen berücksichtigt werden.

ZUSAMMENFASSUNG Gegenstand und Ziel Mobbing hat sich in internationalen Studien als signifikanter Risikofaktor für negative gesundheitliche Folgen gezeigt. Ziel dieser Studie war eine Erhebung dieser Faktoren in der Allgemeinbevölkerung Deutschlands. Methoden Eine repräsentative Stichprobe (N = 2424) der deutschen Allgemeinbevölkerung wurde zu ihren Erfahrungen mit Mobbing in der Schule und am Arbeitsplatz, Suizidversuchen und selbstverletzendem Verhalten und der Inanspruchnahme psychiatrischer und psychotherapeutischer Behandlung befragt. Zudem wurden aktuelle Depressions- und Angstsymptome erfasst. Ergebnisse Personen, die in der Schule gemobbt wurden, zeigten ein 10-fach erhöhtes Risiko, ebenfalls am Arbeitsplatz von Mobbing betroffen zu sein. Es zeigte sich ein starker Zusammenhang zwischen Mobbing und internalisierenden Verhaltensproblemen sowie einer erhöhten Behandlungsinanspruchnahme. Schlussfolgerung Mobbing stellt einen Risikofaktor für internalisierende Verhaltensauffälligkeiten in der Allgemeinbevölkerung in Deutschland dar. Klinische Relevanz In der Anamnese sollten Mobbingerfahrungen erfasst werden, um ggf. adäquate Hilfsmaßnahmen einleiten zu können.

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

Ablehnung in zwischenmenschlichen Situationen oder sozialer Ausschluss wird umgangssprachlich haufig als schmerzhaft beschrieben. Wissenschaftliche Untersuchungen konnten zeigen, dass sozialer Ausschluss in der Tat gleichzeitig mit der Aktivierung von neuronalen Netzwerken einhergeht, die auch bei physischem Schmerz reagieren. Unter experimentellen Bedingungen wird sozialer Ausschluss dabei vorwiegend mit dem Cyberball-Paradigma operationalisiert, das in dem vorliegenden Artikel vorgestellt wird. Da einerseits sozialer Ausschluss als Risikofaktor fur die Entwicklung psychischer Erkrankungen gilt und daruber hinaus Storungen der sozialen Interaktion ein diagnoseubergreifendes Symptom darstellen, ist die Untersuchung neurofunktioneller Korrelate sozialer Zuruckweisung nicht nur von grundlagenwissenschaftlichem, sondern auch von klinischem Interesse. In diesem Artikel werden Befunde zu neuronalen Korrelaten sozialer Zuruckweisung bei Patienten mit psychischen Erkrankungen vorgestellt, die zumeist mit funktionell-magnetresonanztomografischer Untersuchungen erhoben wurden. Wir fokussieren dabei auf Untersuchungen von Patienten mit emotional-instabiler Personlichkeitsstorung vom Borderline-Typ, mit nicht suizidalem selbstverletzendem Verhalten sowie mit depressiver Storung. Social exclusion is perceived as “hurtful” and is not only described by pain words. Research has shown, that social rejection activates neural networks that also react to the experience of physical pain. Under experimental conditions, social exclusion is operationalized by the so-called cyberball-paradigm that we introduce in this article. Considering social exclusion as a risk factor for several psychiatric disorders and dysfunctional social interaction is a frequent symptom across psychiatric diagnoses, the investigation of neural correlates of social exclusion seems not only a topic of interest fo basic research but may be an issue with remarkable clinical implications. In this article, we introduce findings on neural correlates of social exclusion and summarize functional magnetic resonance imaging studies in patients with borderline personality disorder, non-suicidal self-injurious behavior and depressive disorder.

Zusammenfassung. Obwohl suizidale Gedanken und Verhaltensweisen bei Jugendlichen ein häufiges Phänomen sind, wird die Datenlage zur Evaluation von spezifischen Therapieverfahren in der aktuellen AWMF-Leitlinie zur Suizidalität im Kindes- und Jugendalter als unzureichend eingestuft. Ziel dieser systematischen Literaturübersicht war es, die aktuellsten Erkenntnisse zu psychotherapeutischen Verfahren bei suizidalen Kindern und Jugendlichen zusammenzutragen und kritisch zu diskutieren. Aufbauend auf anderen aktuellen systematischen Reviews wurden in die aktuelle Übersicht 11 Studien eingeschlossen, die ab dem Jahr 2013 veröffentlicht wurden. Dabei handelt es sich um Studien zu Interventionen in Notaufnahmen, zu spezifischen psychotherapeutischen Ansätzen zur Suizidalität, zu Ansätzen, die auf bestimmte Patienten- oder Risikogruppen zugeschnitten sind, und um eine Studie zu einem Online-Therapieverfahren. Erste positive Effekte lassen sich für eine familienbasierte Intervention in der Notaufnahme (hinsichtlich geringerer Hospitalisierungsraten) und für dialektisch-behaviorale, kognitiv-verhaltenstherapeutische Maßnahmen sowie familienfokussierte Verfahren (hinsichtlich der Reduktion der Suizidalität) finden. Auch eine Studie zu einer online durchgeführten Therapie konnte erste unkontrollierte, positive Effekte zeigen. Dennoch lässt sich in der Zusammenschau der Studien festhalten, dass es weiterer Evaluation von Therapieverfahren für suizidale Jugendliche bedarf. Insbesondere sind hier Replikationen der bisherigen Evaluationsergebnisse sowie die Durchführung von Studien mit größeren Stichproben sowie längeren Follow-Up-Zeitabständen vonnöten.

In der Altersgruppe der Kinder und Jugendlichen stellt Suizid nach Verkehrsunfallen die zweithaufigste Todesursache dar. Neben Informationen zu Klassifikation, Epidemiologie, Atiologie, Symptomatik, Diagnostik und Therapieverfahren finden sich auch zahlreiche praktische Tipps und Hilfestellungen fur den Alltag in Praxis und Klinik wieder.

Non-suicidal self-injury (NSSI) is a common phenomenon among adolescents, but is often not disclosed due to fear of stigmatization. Social media is frequently used to publish photos of NSSI and share experiences with NSSI. Objectives of this study were to find out more about the motivation for publishing NSSI content and to investigate the effect that sharing this content on social media has on young people. In the current study, we interviewed N=59 participants (mean age = 16.7 years [SD = 1.2 years]; 72.9% female), who had all posted NSSI content within the past month on the social media platform Instagram. Semi-structured interviews were conducted via the Instagram messaging app. Interviews were analyzed qualitatively, assisted by the Software Atlas.ti 7. Participants were asked about their motivation for and their experiences with posting NSSI content online. Motivations for posting pictures online were mainly social (connecting, disclosure, communicating), while self-focused reasons like documenting NSSI or recovery were also mentioned. All participants reported having received positive reactions (being offered help, connecting, receiving empathy), as well as negative comments (harassment, being misunderstood) to their own NSSI content by other Instagram users. Participants' reactions to other users' NSSI content on Instagram was often identification with the content or being triggered, but also wanting to offer help or sometimes even being deterred from NSSI. None of the participants mentioned successful referral to professional help through their online NSSI activity. One target for future interventions could therefore be social media, or other online platforms, where adolescents might be more easily reached. Mental health practitioners should be aware of their clients' online activity and encourage reflection upon positive and negative effects of viewing or sharing NSSI content online.

Zusammenfassung. Theoretischer Hintergrund: Nichtsuizidales Selbstverletzendes Verhalten (NSSV) ist insbesondere im Jugendalter häufig und klinisch bedeutsam. Die Entwicklung einer konsensbasierten Leitlinie verfolgt das Ziel, die Diagnostik und die Behandlung von NSSV zu optimieren und Impulse für die Forschung zu geben. Als Leitlinie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Gesellschaften (AWMF) wurde diese erste Leitlinie zu NSSV verabschiedet und publiziert. Fragestellung und Methode: Die wichtigsten Empfehlungen zur Diagnostik und Behandlung von NSSV werden zusammengefasst und Forschungslücken aufgezeigt. Ergebnisse: In der Diagnostik von NSSV ist insbesondere die Einschätzung der Suizidalität zu berücksichtigen. Als erster Schritt ist die somatische Abklärung der Verletzungen und ggf. eine medizinische Erstversorgung zu nennen. Für die Evaluation des NSSV sind Häufigkeit, Methoden, Schmerzempfinden, Motive, Impulsivität als auch weitere familiäre und außerfamiliäre Einflussfaktoren zu erheben. Den Schwerpunkt der Behandlung bildet die Psychotherapie, insbesondere die kognitive Verhaltenstherapie, die Dialektisch-Behaviorale Therapie für Adoleszente und die Mentalisierungsbasierte Therapie für Adoleszente. Eine evidenzbasierte Indikation zur spezifischen Pharmakotherapie von NSSV existiert nicht. Schlussfolgerung: Die Leitlinie umfasst evidenz- und konsensusbasierte Empfehlungen zur Diagnostik und Therapie von NSSV. Die Implementierung soll zu einer Verbesserung der Versorgung von Patienten mit NSSV dienen.

Background Non-suicidal self-injury (NSSI) is a clinically significant behavior affecting approximately 18% of adolescents and young adults worldwide. The importance of NSSI is supported by its association with a broad spectrum of mental disorders. Despite its high relevance, evidence-based, specific, time-, and cost-effective treatment approaches are scarce. Cognitive behavioral therapy (CBT) seems effective in reducing the frequency of NSSI in adolescents and young adults. However, young people are often reluctant to seek professional help and effective interventions adressing NSSI are not sufficiently available across all regions of Germany. Research indicates that the majority of youth with risk behavior (including NSSI) prefer technology-based interventions. To date, effective interventions for adolescents and young adults with NSSI that are deliverd online are not available. Methods The present project aims to develop and evaluate an online intervention for adolescents and young adults with NSSI based on the content of a recently evaluated face-to-face short-term program that includes elements of CBT and dialectical behavior therapy (DBT): “The Cutting Down Programme” (CDP). The efficacy of the new online CDP intervention will be tested in a randomized controlled trial (RCT) in which n = 700 youths engaging in repetitive NSSI will participate in either an online psychoeducation (n = 350) or online CDP (n = 350). Within a postline assessment four months after baseline (end of treatment; T1), and follow-up evaluations 12 and 18 months after baseline (follow-ups; T2 and T3), NSSI and comorbid symptoms as well as quality of life will be assessed. It is hypothesized that participants receiving online CDP report a greater reduction in the frequency of NSSI within the last three months at T2 (primary endpoint) compared to those receiving online psychoeducation. Exploratory analyses will focus on predictors of treatment outcome. Discussion We report on the development and evaluation of an online intervention for adolescents and young adults engaging in NSSI based on the CDP. If supported by empirical evidence, an online-based intervention for NSSI might help to overcome the limited availability of adequate interventions for youth. Trial registration German Clinical Trials Register, DRKS00014623. Registered on 22 May 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3501-6) contains supplementary material, which is available to authorized users.

Borderline personality disorder (BPD) is characterized by interpersonal disturbances and dysfunctional behavior such as non-suicidal self-injury (NSSI). We recently observed neural alterations in BPD during social inclusion by enhanced activations within the dorsomedial prefrontal cortex (dmPFC) and the posterior cingulate cortex (PCC). To examine the specificity of these neural alterations, we now investigated participants with NSSI but without BPD and compared them to BPD and healthy controls (HC). Considering the association between NSSI and BPD, we further examined neural commonalities during social inclusion. Fifteen females diagnosed with BPD, 16 with NSSI and 17 HC were investigated by fMRI and the cyberball paradigm, focusing on social inclusion (p 0.05; FWE on cluster-level). To examine neural commonalities between BPD and NSSI compared to HC, we computed a conjunction analysis on neural activations under social inclusion. Significant increases in neural activation were observed in BPD within the dmPFC under social inclusion compared to NSSI and HC, whereas neural activations within the PCC did not differ between BPD and NSSI. The conjunction analysis revealed a common neurofunctional increase within the pregenual anterior cingulate cortex and the anterior insula in both, BPD and NSSI. We provide a further evidence regarding a disorder-specific neural reactivity within the dmPFC during social inclusion in BPD, whereas PCC activations may represent an unspecific neural alteration in BPD when compared to NSSI. In contrast, both clinical groups revealed a common neural increase within the salience network that may support the assumptions of a developmental continuum between these two psychiatric conditions.

Humans engage in social interactions and have a fundamental need and motivation to establish and maintain social connections. Neuroimaging studies particularly focused on the neural substrates of social exclusion in healthy subjects (HC), borderline personality disorder (BPD), and major depression (MD). However, there is evidence regarding neural alterations also during social inclusion in BPD that we intended to elucidate in our study. Considering that patients with BPD often have comorbid MD, we investigated patients with BPD, and comorbid MD, patients with MD without BPD, and a sample of HC. By investigating these two clinical samples within one study design, we attempted to disentangle potential confounds arising by psychiatric disorder or medication and to relate neural alterations under social inclusion specifically to BPD. We investigated 48 females (15 BPD and MD, 16 MD, and 17 HC) aged between 18 and 40 years by fMRI (3T), using the established cyberball paradigm with social exclusion, inclusion, and passive watching conditions. Significant group-by-condition interaction effects (p < 0.05, FWE-corrected on cluster level) were observed within the dorsolateral (dlPFC) and dorsomedial prefrontal cortex (dmPFC), the temporo-parietal junction (TPJ), the posterior cingulate cortex (PCC), and the precuneus. Comparisons of estimated neural activations revealed that significant interaction effects were related to a relative increase in neural activations during social inclusion in BPD. In detail, we observed a significant increase in differential (social inclusion vs. passive watching) neural activation within the dmPFC and the PCC in BPD compared to both, MD and HC. However, significant interaction effects within the dlPFC and the TPJ could not specifically be linked to BPD considering that they did not differ significantly between the two clinical groups in post-hoc comparisons. Our study supports previous results on effects of social and inclusion in BPD, and provides further evidence regarding disorder specific neural alterations in BPD for brain regions associated with self-referential and mentalizing processes during social inclusion.

Background Child maltreatment of all types is a serious concern for society, and it is important to monitor trends in incidence in order to inform child welfare agencies and policy-makers about emerging issues. In Germany, however, information on such trends is limited: apart from official sources, the only published study is a comparison of surveys conducted in 1992 and 2011 that had focused primarily on sexual abuse. The present study is the first to look at more recent trends and to examine other types of maltreatment as well. Methods We compared the datasets of two population-based nationwide surveys, one conducted in 2010 (N = 2504) and the other in 2016 (N = 2510). Both had used identical methodology. Participants aged 14 years and older had been selected randomly using the Kish selection grid method, and information about childhood experiences of abuse had been solicited using the Childhood Trauma Questionnaire. Results The overall percentage of respondents who reported having experienced at least one type of child maltreatment decreased over the 6 years, from 35.3% in 2010 to 31.0% in 2016; however, the percentages who reported multiple types of maltreatment remained stable. The decrease in any type of maltreatment was mainly driven by fewer reports of physical neglect, which was likelier to be reported by older respondents who had experienced privation during the (post-) war years and whose representation was lower in the later survey. There was a significant increase over time in the prevalence of emotional abuse, with respondents aged 26–45 years reporting higher rates of this type of maltreatment. The prevalence rates of other types of maltreatment remained unchanged. All effect sizes were very small. Conclusions At present, the systems in place in Germany for monitoring the occurrence of child maltreatment are insufficient. While this study contributes to a better understanding, more information is needed, particularly on populations that have been excluded or underrepresented in previous research efforts. As has been done elsewhere, large databases should be set up, using identical methodologies and definitions, in order to accurately assess trends over time in different types of abuse and neglect.

Many European countries have accommodated large numbers of refugees, around of a third of whom are aged less than 18 years. Because of the high level of potentially traumatizing experiences before and during migration and often stressful situations after arrival in host countries, refugee minors are a group that is particularly vulnerable to psychiatric impairment. Several European studies showed high impairment of refugees, especially unaccompanied refugee minors, particularly with regard to posttraumatic stress disorder. European countries are faced with increased needs for psychotherapists and psychiatrists in general, but also with culture- and language-sensitive tools for diagnosis, crisis management, and psychotherapy for refugees in particular. Novel approaches such as short skills-training catered to refugees (such as Students and Refugees Together) and the screening tool Providing Online Resource and Trauma Assessment for Refugees are presented in this chapter, along with first evidence regarding psychotherapeutic interventions for child and adolescent refugees.

BackgroundSocial media presents an important means for social interaction, especially among adolescents, with Instagram being the most popular platform in this age-group. Pictures and communication about non-suicidal self-injury (NSSI) can frequently be found on the internet.MethodsDuring 4 weeks in April 2016, n = 2826 (from n = 1154 accounts) pictures which directly depicted wounds on Instagram were investigated. Those pictures, associated comments, and user accounts were independently rated for content. Associations between characteristics of pictures and comments as well as weekly and daily trends of posting behavior were analyzed.ResultsMost commonly, pictures depicted wounds caused by cutting on arms or legs and were rated as mild or moderate injuries. Pictures with increasing wound grades and those depicting multiple methods of NSSI generated elevated amounts of comments. While most comments were neutral or empathic with some offering help, few comments were hostile. Pictures were mainly posted in the evening hours, with a small peak in the early morning. While there was a slight peak of pictures being posted on Sundays, postings were rather evenly spread across the week.ConclusionsPictures of NSSI are frequently posted on Instagram. Social reinforcement might play a role in the posting of more severe NSSI pictures. Social media platforms need to take appropriate measures for preventing online social contagion.

Introduction Non-suicidal self-injury (NSSI) is a symptom of borderline personality disorder (BPD). However, NSSI often occurs independently of BPD. Altered neural processing of social exclusion has been shown in adolescents with NSSI and adults with BPD with additional alterations during social inclusion in BPD patients. Aims of this study were to investigate differences in neural processing of social inclusion and exclusion situations between adolescents with NSSI and young adults with BPD and NSSI. Methods Using fMRI, neural processing of positive and negative social situations (paradigm: “Cyberball”) was explored. Participants were 14 adolescents with NSSI, but without BPD (Mage = 15.4; SD = 1.9), 15 adults with BPD and NSSI (Mage = 23.3; SD = 4.1), as well as 15 healthy adolescents (Mage = 14.5; SD = 1.7), and 16 healthy adults (Mage = 23.2; SD = 4.4). Results Behavioral results showed enhanced feelings of social exclusion in both patient groups as compared to healthy controls but only the NSSI group showed enhanced activation during social exclusion versus inclusion compared to the other groups. While both NSSI and BPD groups showed enhanced activation in the ventral anterior cingulate cortex during social exclusion as compared to their age-matched controls, enhanced activation during social inclusion as compared to a passive watching condition was mainly observed in the BPD group in the dorsolateral and dorsomedial prefrontal cortex, and the anterior insula. Discussion While neural processing of social exclusion was pronounced in adolescents with NSSI, BPD patients also showed increased activity in a per se positive social situation. These results might point toward a higher responsiveness to social exclusion in adolescents with NSSI, which might then develop into a generalized increased sensitivity to all kinds of social situations in adults with BPD.

Background Child maltreatment and its consequences are considered a major public health problem. So far, there is only one study from Germany reporting prevalence rates on different types of maltreatment. Methods A representative sample of the German general population was examined for experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ) between September and November 2016. A total of 2510 (53.3% female) participants between 14 and 94 years (M = 48.8 years) were enrolled. Besides the CTQ, a range of sociodemographic information was collected. The interrelatedness of different types of maltreatment was examined using configuration analysis and predictors for maltreatment were identified by performing binary logistic regression analyses. Results Overall, 2.6% (f: 3.9%, m: 1.2%) of all participants reported severe emotional abuse, 3.3% (f: 3.4%, m: 3.3%) severe physical abuse, 2.3% (f: 3.7%, m: 0.7%) severe sexual abuse, 7.1% (f: 8.1%, m: 5.9%) severe emotional neglect and 9% (f: 9.2%, m: 8.9%) severe physical neglect. Women were more likely to report at least moderate sexual and emotional abuse than men. The largest difference between age groups was reported for physical neglect, with participants aged over 70 years reporting the highest rates. Participants who reported childhood maltreatment were more likely to be unemployed or have lower educational outcomes. The most common combination of maltreatment types were physical and emotional neglect, all five types of maltreatment combined and physical and emotional neglect and physical abuse combined. Conclusions Child maltreatment, especially physical neglect is common in the German population. Women seem to be at greater risk for sexual and emotional abuse than men. Knowledge about different types of maltreatment based on the Childhood Trauma Questionnaire (CTQ) can help to put findings of future studies into an epidemiological and societal context.

Background: 25–35% of adolescents in random samples drawn from German schools have been found to have manifested at least one episode of nonsuicidal self-injury (NSSI). The prevalence in samples from child and adolescent psychiatric clinics is approximately 50%. NSSI can arise as a symptom in the setting of various types of mental illness. Methods: This review is based on a selective literature search carried out in the PubMed, PsycINFO, and Cochrane Library databases, with special consideration of regional study samples. Results: NSSI is usually resorted to as a dysfunctional coping strategy for emotional regulation. The main risk factors for NSSI include bullying, accompanying mental illnesses, and a history of abuse and neglect in childhood. Neurobiological studies have shown abnormal stress processing in persons with NSSI and an elevated pain threshold in persons with repetitive NSSI. Psychotherapeutic interventions of various kinds lessen the frequency of NSSI; to date, no particular type of psychotherapy has been found to be clearly superior to the others. Randomized controlled trials have revealed small to moderate effects from dialectic-behavioral therapy and mentalization-based therapy in adolescent patients. No psychoactive drug has yet been found to possess specific efficacy against NSSI in adolescents. Conclusion: The first ever German-language clinical guidelines for the treatment of NSSI have now been issued. Psychotherapy is the treatment of first choice. More research is needed so that subgroups with different disease courses can be more clearly defined.

Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre–post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive–behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.

Purpose of Review Non-suicidal self-injury (NSSI) is a common mental health threat among adolescents. This review aims to present the current literature on epidemiology, etiology, and therapeutic approaches with a focus on the period of adolescence. Recent Findings NSSI is widespread among adolescents both in community as well as in clinical settings with lifetime prevalence rates between 17 and 60% in recent studies. It is influenced by multiple factors including social contagion, interpersonal stressors, neurobiological background, as well as emotional dysregulation and adverse experiences in childhood. Summary There is still a lack of studies regarding the psychotherapeutic as well as the psychopharmacological treatment of NSSI in adolescence. Furthermore, sufficient evidence for prevention programs is missing.

BackgroundSocial media has become increasingly important for communication among young people. It is also often used to communicate suicidal ideation.AimsTo investigate the link between acute suicidality and language use as well as activity on Instagram.MethodA total of 52 participants, aged on average around 16 years, who had posted pictures of non-suicidal self-injury on Instagram, and reported a lifetime history of suicidal ideation, were interviewed using Instagram messenger. Of those participants, 45.5% reported suicidal ideation on the day of the interview (acute suicidal ideation). Qualitative text analysis (software ATLAS.ti 7) was used to investigate experiences with expressions of active suicidal thoughts on Instagram. Quantitative text analysis of language use in the interviews and directly on Instagram (in picture captions) was performed using the Linguistic Inquiry and Word Count software. Language markers in the interviews and in picture captions, as well as activity on Instagram were added to regression analyses, in order to investigate predictors for current suicidal ideation.ResultsMost participants (80%) had come across expressions of active suicidal thoughts on Instagram and 25% had expressed active suicidal thoughts themselves. Participants with acute suicidal ideation used significantly more negative emotion words (Cohen's d = 0.66, 95% CI: 0.088-1.232) and words expressing overall affect (Cohen's d = 0.57, 95% CI: 0.001-1.138) in interviews. However, activity and language use on Instagram did not predict acute suicidality.ConclusionsWhile participants differed with regard to their use of language in interviews, differences in activity and language use on Instagram were not associated with acute suicidality. Other mechanisms of machine learning, like identifying picture content, might be more valuable.

Diverse environmental contaminants, including the plasticizer di(2-ethylhexyl)phthalate (DEHP), are hepatocarcinogenic peroxisome proliferators in rodents. Peroxisome proliferator-activated receptor-alpha (PPAR-alpha) activation and its sequelae have been proposed to constitute a mode of action (MOA) for hepatocarcinogenesis by such agents as a sole causative factor. Further, based on a hypothesized lower sensitivity of humans to this MOA, prior reviews have concluded that rodent hepatocarcinogenesis by PPAR-alpha agonists is irrelevant to human carcinogenic risk.Herein, we review recent studies that experimentally challenge the PPAR-alpha activation MOA hypothesis, providing evidence that DEHP is hepatocarcinogenic in PPAR-alpha-null mice and that the MOA but not hepatocarcinogenesis is evoked by PPAR-alpha activation in a transgenic mouse model. We further examine whether relative potency for PPAR-alpha activation or other steps in the MOA correlates with tumorigenic potency. In addition, for most PPAR-alpha agonists of environmental concern, available data are insufficient to characterize relative human sensitivity to this rodent MOA or to induction of hepatocarcinogenesis.Our review and analyses raise questions about the hypothesized PPAR-alpha activation MOA as a sole explanation for rodent hepatocarcinogenesis by PPAR-alpha agonists and therefore its utility as a primary basis for assessing human carcinogenic risk from the diverse compounds that activate PPAR-alpha. These findings have broad implications for how MOA hypotheses are developed, tested, and applied in human health risk assessment. We discuss alternatives to the current approaches to these key aspects of mechanistic data evaluation.

Mode of action (MOA) information is increasingly being applied in human health risk assessment. The MOA can inform issues such as the relevance of observed effects in laboratory animals to humans, and the variability of response within the human population. Several collaborative groups have developed frameworks for analyzing and utilizing MOA information in human health risk assessment of environmental carcinogens and toxins, including the International Programme on Chemical Safety, International Life Sciences Institute, and U.S. Environmental Protection Agency. With the goal of identifying gaps and opportunities for progress, we critically evaluate several of these MOA frameworks. Despite continued improvement in incorporating biological data in human health risk assessment, several notable challenges remain. These include articulation of the significant role of scientific judgment in establishing an MOA and its relevance to humans. In addition, binary (yes/no) decisions can inappropriately exclude consideration of data that may nonetheless be informative to the overall assessment of risk. Indeed, the frameworks lack a broad consideration of known causes of human disease and the potential for chemical effects to act additively with these as well as endogenous background processes. No integrated analysis of the impact of multiple MOAs over the same dose range, or of varying MOAs at different life stages, is included. Separate consideration of each MOA and outcome limits understanding of how multiple metabolites, modes, and toxicity pathways contribute to the toxicological profile of the chemical. An extension of the analyses across outcomes with common modes is also needed.

Leukemia is the leading cause of cancer resulting in mortality of children, and there is some evidence suggesting the increased incidence rate increasing during the recent decades. Limited human evidence indicates an increased risk of developing leukemia in childhood as a result of pesticide exposure, with possible significance of exposure occurring during the developmental periods including preconception, pregnancy, and childhood. This review examines the results of relevant literature on the timing of pesticide exposure and leukemia diagnosed in childhood. Results suggest that the risk from pesticide exposure seems to be greater during pregnancy. Other findings indicate that maternal occupational exposure may be more of a greater concern than the paternal occupational exposure; and that the residential indoor use of pesticides tends to result in higher risk estimates than the residential outdoor use. Only limited data are available on particular pesticides, genetic factors, critical windows of exposure ...

The population of the United States is aging, and an ever-increasing number of Americans are afflicted with neurodegenerative diseases. Because the pathogenesis of many of these diseases remains unknown, we must consider that environmental factors may play a causal role. This review provides an overview of the epidemiologic evidence for environmental etiologies for neurodegenerative diseases such as Alzheimer disease, Parkinson disease, parkinsonian syndromes (multiple system atrophy and progressive supranuclear palsy), and amyotrophic lateral sclerosis. Epidemiologic evidence for an association between environmental agents’ exposure and neurodegenerative diseases is not conclusive. However, there are indications that there may be causal links, and the need for more research is obvious.

Substituted (6-methyl-2-pyridyl)methyllithium species were reacted with 1,2-epoxyoctane and 2-methyl-2,3-epoxynonane. The monosubstituted epoxide reacted efficiently with lutidyllithium and a number of 2-substituted (6-methyl-2-pyridyl)methyllithium derivatives. The trisubstituted epoxide gave low yields of adducts with all (2-pyridyl)methyllithium species studied. These results are discussed in the context of a proposed synthesis of cananodine.

The news industry is undergoing shrinking newspaper circulations, cuts in science and health coverage, and expansion of Internet news sources. We examine the impact of these changes using a case study set in Libby, Montana. In 1999, a Seattle newspaper story focused attention on asbestos exposure and related diseases in this small town. In 2009, that newspaper became an online-only newspaper, just as coverage of a related criminal trial began. Later that year the U.S. Environmental Protection Agency issued a public health emergency. Online newspaper archives and a collaboration between the University of Montana's journalism and law schools contributed to coverage of these developments. Continued efforts to promote interest in and skills needed for high-quality public health and environmental reporting are needed.

Substituted (6-methyl-2-pyridyl)methyllithium species were reacted with 1,2-epoxyoctane and 2-methyl-2,3-epoxynonane. The monosubstituted epoxide reacted efficiently with lutidyllithium and a number of 2-substituted (6-methyl-2-pyridyl)methyllithium derivatives. The trisubstituted epoxide gave low yields of adducts with all (2-pyridyl)methyllithium species studied. These results are discussed in the context of a proposed synthesis of cananodine.

This overview paper provides the historical context for the incorporation of lifestage-specific concerns in human health risk assessment, briefly explains the process employed in a lifestage framework for risk assessment, and discusses the scientific rationale for how utilizing lifestage data will strengthen the overall risk assessment process. This risk assessment approach will add value by: (1) providing a more complete evaluation of the potential for vulnerability at different lifestages, including a focus on the underlying biological events and incorporation of mode of action information related to different critical developmental periods; (2) evaluating the potential for toxicity during all lifestages after early lifestage exposure; (3) reviewing the importance of integrating exposure information and adverse health effects across lifestages; and (4) serving as a basis to extend some aspects of the children's health risk assessment framework to all lifestages. Birth Defects Res (Part B), 2008. © 2008 Wiley-Liss, Inc.

Globally, a number of large infant/child prospective studies have been launched to examine environmental and genetic determinants of common diseases of children, such as asthma, developmental delay and behaviour abnormalities, as well as the consequences of early exposure for adult diseases. While several of these studies are relatively very large—over 100 000 subjects—and are adequately powered to examine their principal outcomes of interest, none of the individual studies are of sufficient size to examine the relationship between exposures they are measuring and rare diseases such as childhood cancer. To date, the few established risk factors for specific forms of childhood cancer have largely been identified in case-control studies. Yet, despite many such investigations evaluating postulated risk factors for paediatric malignancies during the past five decades, few consistently established aetiologic factors are known. Recent review papers have summarized many promising hypotheses, including pre-natal and post-natal exposure to pesticides, maternal and early infancy dietary factors, paternal pre-conception occupational exposures and smoking, the interplay of maternal or early postnatal immune system handling of common infections, determinants of high birth weight and other factors. Employment of prospective cohort follow-up of children and adolescents from pregnancy or birth using cohort or nested case-cohort designs, in conjunction with prospective biological sample collection, offers promising opportunities for advancing knowledge of aetiology. This is a result of improved assessment of parental and early life exposures, measurement of biological samples for pre-diagnostic effects, clarification of the temporal relationship between exposure and outcome, reduction of differential recall between parents of cases vs controls and the prospect of understanding the determinants of selection bias. The concept of bringing the various cohorts of infants and children together in an international collaboration arose during planning for the National Children’s Study (NCS), a childhood cohort study in the United States of 100 000 participants. Participants at a 2004 workshop convened to consider whether this cohort would be of sufficient size to include cancer as a feasible outcome; they concluded that this study would have insufficient power for this purpose due to the rarity of all forms of childhood cancer. However, a collaboration of the existing and planned large childhood cohorts globally might provide the power necessary to obtain prospective evidence on potential causes of childhood cancer. This idea was developed further and a proposal was presented to the National Institute for Child Health and Human Development (NICHD), National Cancer Institute (NCI) and the US Environmental Protection Agency (EPA). Along with funding support from the National Institute of Health’s Office of Rare Diseases, these organizations held a workshop in 2005, bringing together representatives from 11 cohorts in four continents, accounting for 700 000 children (Table 1), as well as experts in epidemiology, paediatric oncology, genetics, toxicology and other disciplines. Its purpose * Corresponding author. U.S. Environmental Protection Agency, National Center for Environmental Assessment, 1200 Pennsylvania Avenue, NW, 8623D, Washington, DC, 20460 USA. E-mail: brown.rebecca@epa.gov 1 National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA. 2 Murdoch Childrens Research Institute, Melbourne, Australia. 3 National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA. 4 National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA. 5 National Center for Maternal and Infant Health, Peking University Health Science Center, Beijing, China. 6 Department of Epidemiology, University of California, Los Angeles, CA, USA. The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org Published by Oxford University Press on behalf of the International Epidemiological Association The Author 2007; all rights reserved. Advance Access publication 25 January 2007 International Journal of Epidemiology 2007;36:724–730 doi:10.1093/ije/dyl299