Skip to main content

Advertisement

Log in

Depressive symptoms of children and adolescents in a German representative sample: results of the BELLA study

  • ORIGINAL CONTRIBUTION
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Background

In Europe, a considerable proportion of children and adolescents is affected by depressive symptoms, impairing their everyday life and social functioning.

Objectives

The aim of this paper is to provide an overview of the depressive symptoms in children and adolescents in Germany, addressing risk factors, comorbidity, and impact of depressive symptoms on everyday life.

Methods

In the BELLA study, the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a representative sample of young people aged 7–17 years was enrolled. Depressiveness, assessed by the CES-DC, as well as other mental health problems were examined in the context of risk and protective factors.

Results

Depressive symptoms showed high prevalence in parent- and self-reports. Higher depression scores were found in those with a high number of psychosocial risks existing in the family, and they decreased as the number of protective factors the children and adolescents had at their disposal increased. Although only half of the boys and girls with high depression scores were regarded as significantly impaired, all of them had a much higher risk for additional mental health problems. Furthermore, their health-related quality of life was limited compared to their peers who had low depression scores.

Conclusions

To differentiate between clinically significant depression and milder forms, it is necessary to take into account the different perspectives of children and their parents. Prevention and intervention should acknowledge the widespread distribution of depressive symptoms in children and adolescents, the high comorbidity of depressive and other mental health problems and the impact of depression on the aspects of everyday life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Achenbach TM (1991a) Manual for the child behavior checklist/4-18 and 1991 profile. University of Vermont, Depart- ment of Psychiatry, Burlington

    Google Scholar 

  2. Achenbach TM (1991b) Manual for the youth self-report and 1991 profile. University of Vermont, Department of Psychiatry, Burlington

    Google Scholar 

  3. Aichberger MC, Schouler-Ocak M, Rapp MA, Heinz A (2008) Transcultural aspects of depression. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 51:436–442

    Article  CAS  Google Scholar 

  4. American Psychiatric Association (1995) Diagnostic and statistical manual of mental disorders 4th edn (DSM IV). APA, Washington, DC

    Google Scholar 

  5. Barkmann C, Erhart M, Schulte-Markwort M, the BELLA study group (2008) The German version of the Centre for Epidemiological Studies Depression Scale for Children (CES-DC): psychometric evaluation in a population-based survey of 7 to 17 years old children and adolescents – results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl1):116–124

    Google Scholar 

  6. Bettge S, Ravens-Sieberer U (2005) Seelische Gesundheit von Kindern und Jugendlichen in Deutschland–die Bella-Studie. Psychomed 4:214–222

    Google Scholar 

  7. Bettge S, Ravens-Sieberer U, Wietzker A, Hölling H (2002) Ein Methodenvergleich der child behavior checklist und des strengths and difficulties questionnaire. Gesundheitswesen 64(Suppl 1):S119–S124

    Article  PubMed  Google Scholar 

  8. Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, Perel J, Nelson B (1996) Childhood and adolescent depression: a review of the past 10 years: part I. J Am Acad Child Adolesc Psychiatry 35:1427–1439

    Article  CAS  PubMed  Google Scholar 

  9. Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, McKenzie Neer S (1997) The screen for child anxiety related emotional disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36:545–553

    Article  CAS  PubMed  Google Scholar 

  10. Brandt A (1994) Der Einfluss von Belastungen, Beschwerden und sozialer Unterstützung auf den Medikamentenkonsum von Müttern zwischen 20 und 50 Jahren. Dissertation, Medizinische Hochschule Hannover

  11. Brooks-Gunn J, Petersen AC (1991) Studying the emergence of depression and depressive symptoms during adolescence. J Youth Adolesc 20:115–119

    Article  Google Scholar 

  12. Cibis A, Bramesfeld A, Blume A, Havers A, Hegerl U (2008) Optimised services for depressed patients: the German alliance against depression. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 51:430–435

    Article  CAS  Google Scholar 

  13. Collishaw S, Maughan B, Goodman R, Pickles A (2004) Time trends in adolescent mental health. J Child Psychol Psychiatry 45:1350–1362

    Article  PubMed  Google Scholar 

  14. Conners K (1996) Conners’ rating scale—revised technical manual. Multi-Health Systems Inc, New York

    Google Scholar 

  15. Costello EJ, Foley DL, Angold A (2006) 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: II: developmental epidemiology. J Am Acad Child Adolesc Psychiatry 45:8–25

    Article  PubMed  Google Scholar 

  16. Döpfner M, Lehmkuhl G (2000) Diagnostik-system für psychische Störungen im Kindes- und Jugendalter nach ICD–10 und DSM-IV (DISYPS-KJ). 2. erweiterte Auflage. Huber, Bern

    Google Scholar 

  17. Dührssen A, Lieberz K (1999) Der Risiko-Index. Vandenhoeck & Ruprecht, Göttingen

    Google Scholar 

  18. Duggal S, Carlson EA, Sroufe LA, Egeland B (2001) Depressive symptomatology in childhood and adolescence. Dev Psychopathol 13:143–164

    Article  CAS  PubMed  Google Scholar 

  19. Fendrich M, Warner V, Weissman MM (1990) Screening for depressive disorder in children and adolescents: assessing the validity of the CES-DC. Am J Epidemiol 31:538–551

    Google Scholar 

  20. Goodman R (1999) The extended version of the strengths and difficulties questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 40:91–799

    Article  Google Scholar 

  21. Harrington R, Clark A (1998) Prevention and early intervention for depression in adolescence and early adult life. Eur Arch Psychiatry Clin Neurosci 248:32–45

    Article  CAS  PubMed  Google Scholar 

  22. Herpertz-Dahlmann B, Wille N, Hölling H, Vloet TD, Ravens-Sieberer U, BELLA study group (2008) Disordered eating behaviour and attitudes, associated psychopathology and health- related quality of life: results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl1):82–91

    Google Scholar 

  23. Ihle W, Esser G (2002) Epidemiologie psychischer Störungen im Kindes- und Jugendalter: Prävalenz, Verlauf, Komorbidität und Geschlechtsunterschiede. Psychol Rundsch 53:159–169

    Article  Google Scholar 

  24. Kovacs M (1996) Presentation and course of major depressive disorder during childhood and later years of the life span. J Am Acad Child Adolesc Psychiatry 35:705–715

    Article  CAS  PubMed  Google Scholar 

  25. Kovacs M, Devlin B (1998) Internalizing disorders in childhood. J Child Psychol Psychiatry 39:47–63

    Article  CAS  PubMed  Google Scholar 

  26. Kurth B-M (2007) The German health interview and examination survey for children and adolescents (KiGGS): an overview of its planning, implementation and results taking into account aspects of quality management. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 50:533–546

    Article  Google Scholar 

  27. Kurth B-M, Kamtsiuris P, Hölling H, Schlaud M, Dölle R, Ellert U, Kahl H, Knopf H, Lange M, Mensink GBM, Neuhauser H, Schaffrath Rosario A, Scheidt-Nave C, Schenk L, Schlack R, Stolzenberg H, Thamm M, Thierfelder W, Wolf U (2008) The challenge of comprehensively mapping children’s health in a nation-wide health survey: design of the German KiGGS-study. BMC Public Health 8:196

    Google Scholar 

  28. Lehmkuhl G, Walter D, Lehmkuhl U (2008) Depressive disorders in children and adolescents. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 51:399–405

    Article  CAS  Google Scholar 

  29. Lynch F, Mills C, Daly I, Fitzpatrick C (2006) Challenging times: prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents. J Adolesc 29:555–573

    Article  PubMed  Google Scholar 

  30. Meltzer H, Gatward R, Goodman R, Ford T (2000) Mental health of children and adolescents in Great Britain: office for national statistics. Stationery Office, London

    Google Scholar 

  31. Morgan JF, Reid F, Lacey H (1999) The SCOFF questionnaire: assessment of a new screening tool for eating disorders. Br Med J 319:1467–1468

    CAS  Google Scholar 

  32. Park RJ, Goodyer IM (2000) Clinical guidelines for depressive disorders in childhood and adolescence. Eur Child Adolesc Psychiatry 9:147–161

    Article  CAS  PubMed  Google Scholar 

  33. Ravens-Sieberer U, Gosch A, Rajmil L, Erhart M, Bruil J, Duer W, Auquier P, Power M, Abel T, Czemy L, Mazur J, Czimbalmos A, Tountas Y, Hagquist C, Kilroe J, The European KIDSCREEN Group (2005) KIDSCREEN-52 quality-of-life measure for children and adolescents. Expert Rev Pharmacoeconomics Outcomes Res 5:353–364

    Article  Google Scholar 

  34. Ravens-Sieberer U, Kurth B-M, KiGGS study group, BELLA study group (2008) The mental health module (BELLA study) within the German Health Interview and Examination Survey of Children and Adolescents (KiGGS): study design and methods. Eur Child Adolesc Psychiatry 17(Suppl1):10–21

    Google Scholar 

  35. Ravens-Sieberer U, Wille N, Erhart M, Bettge S, Wittchen H-U, Rothenberger A, Herpertz-Dahlmann B, Resch F, Hölling H, Bullinger M, Barkmann C, Schulte-Markwort M, Döpfner M as the BELLA study group (2008) Prevalence of mental health problems among children and adolescents in Germany: results of the BELLA study within the National Health Interview and Examination Survey. Eur Child Adolesc Psychiatry 17(Suppl1):22–33

  36. Reinherz HZ, Paradis AD, Giaconia RM, Stashwick CK, Fitzmaurice G (2003) Childhood and adolescent predictors of major depression in the transition to adulthood. Am J Psychiatry 160:2141–2147

    Article  PubMed  Google Scholar 

  37. Rutter M, Quinton D (1977) Psychiatric disorder–ecological factors and concepts of causation. In: McGurk M (ed) Ecological factors in human development. North-Holland, Amsterdam, pp 173–187

    Google Scholar 

  38. Schulte-Markwort M, Marutt K, Riedesser P (2002) Cross-walk ICD-10–DSM-IV. Huber-Verlag, Bern

    Google Scholar 

  39. Verrips GHW, Stuifbergen MC, den Ouden AL, Bonsel GJ, Gemke RJBJ, Paneth N, Verloove-Vanhorick SP (2001) Measuring health status using the health utilities index: agreement between raters and between modalities of administration. J Clin Epidemiol 54:475–481

    Article  CAS  PubMed  Google Scholar 

  40. Weissman MM, Orvaschel H, Padian N (1980) Children’s symptom and social functioning self-report scales: comparison of mothers’ and children’s reports. J Nerv Ment Dis 168:736–740

    Article  CAS  PubMed  Google Scholar 

  41. Wille N, Bettge S, Ravens-Sieberer U, BELLA study group (2008) Risk and protective factors for children’s and adolescents’ mental health: results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl1):133–147

    Google Scholar 

  42. Wille N, Bettge S, Wittchen H-U, Ravens-Sieberer U, BELLA study group (2008) How impaired are children and adolescents by mental health problems? Results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl1): 42–51

    Google Scholar 

  43. Wolfersdorf M (2008) Depression and suicide. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 51:443–450

    Article  CAS  Google Scholar 

  44. World Health Organization (1994) International classification of diseases, 10th revision (ICD-10). World Health Organization, Geneva

    Google Scholar 

Download references

Conflict of interest

All authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Susanne Bettge MPH.

Additional information

Members of the BELLA study group: Ulrike Ravens-Sieberer (Principal Investigator), Claus Barkmann, Susanne Bettge, Monika Bullinger, Manfred Döpfner, Michael Erhart, Beate Herpertz-Dahlmann, Heike Hölling, Franz Resch, Aribert Rothenberger, Michael Schulte-Markwort, Nora Wille, Hans-Ulrich Wittchen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bettge, S., Wille, N., Barkmann, C. et al. Depressive symptoms of children and adolescents in a German representative sample: results of the BELLA study. Eur Child Adolesc Psychiatry 17 (Suppl 1), 71–81 (2008). https://doi.org/10.1007/s00787-008-1008-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-008-1008-x

Keywords

Navigation