Skip to main content

Advertisement

SpringerLink
Log in

Risk and protective factors for the development of depressive symptoms in children and adolescents: results of the longitudinal BELLA study

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Mental health problems in children and adolescents are frequent, with a high risk of persistence into adulthood. Therefore, the investigation of determinants of onset and course of mental health problems is of high importance. The present paper investigates the impact of protective and risk factors on the development of depressive symptoms in children and adolescents. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KIGGS). Based on the first three measurement points of the BELLA study (covering a period of 2 years), the present analysis focused on children and adolescents aged 11–17 years at baseline (n = 1,643; 50.6 % female). A longitudinal growth modelling approach was used. Mental health problems in parents (parent-reports) predicted depressive symptoms in children and adolescents (self-reports) as well as the development of these symptoms over time. Further, child-reported protective factors of self-efficacy, positive family climate and social support were associated with less depressive symptoms at baseline. Additionally, positive changes in protective factors were associated with the development of less depressive symptoms over time. Finally, family climate and social support moderated the detrimental influence of parental psychopathology on child’s depressive symptoms. The addressed determinants for the development of depressive symptoms in children and adolescents are highly relevant for prevention and intervention strategies. Future research should investigate specific risk and protective factors focusing in detail on further mental health disorders and their development in children and adolescents.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kessler RC, Avenevoli S, Costello EJ, Georgiades K, Green JG, Gruber MJ, He JP et al (2012) Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 69(4):372–380. doi:10.1001/archgenpsychiatry.2011.160

    Article  PubMed Central  PubMed  Google Scholar 

  2. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602. doi:10.1001/archpsyc.62.6.593

    Article  PubMed  Google Scholar 

  3. Lopez AD, Murray CC (1998) The global burden of disease, 1990-2020. Nat Med 4(11):1241–1243. doi:10.1038/3218

    Article  CAS  PubMed  Google Scholar 

  4. Roza SJ, Hofstra MB, van der Ende J, Verhulst FC (2003) Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: a 14-year follow-up during childhood, adolescence, and young adulthood. Am J Psychiatry 160(12):2116–2121. doi:10.1176/appi.ajp.160.12.2116

    Article  PubMed  Google Scholar 

  5. Barkmann C, Schulte-Markwort M (2010) Prevalence of emotional and behavioural disorders in german children and adolescents: a meta-analysis. J Epidemiol Community Health. doi:10.1136/jech.2009.102467

    PubMed  Google Scholar 

  6. Belfer ML (2008) Child and adolescent mental disorders: the magnitude of the problem across the globe. J Child Psychol Psychiatry 49(3):226–236. doi:10.1111/j.1469-7610.2007.01855.x

    Article  PubMed  Google Scholar 

  7. 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(Suppl. 1):133–147. doi:10.1007/s00787-008-1015-y

    Article  PubMed  Google Scholar 

  8. Masten AS, Cutuli JJ, Herbers JE, Reed M-GJ (2009) Resilience in development. In: Snyder CR, Lopez SJ (eds) The handbook of positive psychology, 2nd edn. Oxford University Press, New York, pp 117–131

    Google Scholar 

  9. Rutter M (2000) Psychosocial influences: critiques, findings, and research needs. Dev Psychopathol 12(3):375–405

    Article  CAS  PubMed  Google Scholar 

  10. Ramchandani P, Psychogiou L (2009) Paternal psychiatric disorders and children’s psychosocial development. Lancet 374(9690):646–653. doi:10.1016/S0140-6736(09)60238-5

    Article  PubMed  Google Scholar 

  11. Mattejat F, Remschmidt H (2008) The children of mentally ill parents. Dtsch Arztebl Int 105(23):413–418. doi:10.3238/arztebl.2008.0413

    PubMed Central  PubMed  Google Scholar 

  12. Essau Cecilia A, Satoko S (2008) Parental psychopathology and parenting style attachment as risk factors of depression. In: Dobson Keith S, Dozois DJ (eds) Risk factors in depression. Elsevier, San Diego, pp 343–362

    Chapter  Google Scholar 

  13. Weissman MM, Warner V, Wickramaratne P, Moreau D, Olfson M (1997) Offspring of depressed parents: ten years later. Arch Gen Psychiatry 54:932–940

    Article  CAS  PubMed  Google Scholar 

  14. Luszczynska A, Scholz U, Schwarzer R (2005) The general self-efficacy scale: multicultural validation studies. J Psychol 139(5):439–457. doi:10.3200/JRLP.139.5.439-457

    Article  PubMed  Google Scholar 

  15. Bettge S, Ravens-Sieberer U (2003) Schutzfaktoren für die psychische Gesundheit von Kindern und Jugendlichen - empirische Ergebnisse zur Validierung eines Konzepts (Protective factors for mental health of children and adolescents - empirical results validating a concept). Gesundheitswesen 65(3):167–172. doi:10.1055/s-2003-38514

    Article  CAS  PubMed  Google Scholar 

  16. Tahmassian K, Jalali Moghadam N (2011) Relationship between self-efficacy and symptoms of anxiety, depression, worry and social avoidance in a normal sample of students. Iran J Psychiatry Behav Sci 5(2):91–98

    PubMed Central  PubMed  Google Scholar 

  17. Phillips TM (2012) The influence of family structure vs. family climate on adolescent well-being. Child Adolesc Social Work J 29(2):103–110. doi:10.1007/s10560-012-0254-4

    Article  Google Scholar 

  18. Bowes L, Maughan B, Caspi A, Moffitt TE, Arseneault L (2010) Families promote emotional and behavioural resilience to bullying: evidence of an environmental effect. J Child Psychol Psyc 51(7):809–817. doi:10.1111/j.1469-7610.2010.02216.x

    Article  Google Scholar 

  19. Youngblade LM, Theokas C, Schulenberg J, Curry L, Huang IC, Novak M (2007) Risk and promotive factors in families, schools, and communities: a contextual model of positive youth development in adolescence. Pediatrics 119(Suppl. 1):47–53. doi:10.1542/peds.2006-2089H

    Article  Google Scholar 

  20. Ezzell CE, Swenson CC, Brondino MJ (2000) The relationship of social support to physically abused children’s adjustment. Child Abuse Negl 24(5):641–651. doi:10.1016/S0145-2134(00)00123-X

    Article  CAS  PubMed  Google Scholar 

  21. Schwarzer R, Knoll N (2007) Functional roles of social support within the stress and coping process: a theoretical and empirical overview. Int J Psychol 42(4):243–252. doi:10.1080/00207590701396641

    Article  Google Scholar 

  22. Kaufman J, Yang BZ, Douglas-Palumberi H, Houshyar S, Lipschitz D, Krystal JH, Gelernter J (2004) Social supports and serotonin transporter gene moderate depression in maltreated children. Proc Natl Acad Sci USA 101(49):17316–17321. doi:10.1073/pnas.0404376101

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Ihle W, Esser G, Schmidt MH, Blanz B (2002) Die Bedeutung von Risikofaktoren des Kindes- und Jugendalters für psychische Störungen von der Kindheit bis ins frühe Erwachsenenalter. Kindheit und Entwicklung 11(4):201–211. doi:10.1026//0942-5403.11.4.201

    Article  Google Scholar 

  24. Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer D (2001) How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry 158(6):848–856. doi:10.1176/appi.ajp.158.6.848

    Article  CAS  PubMed  Google Scholar 

  25. Kazdin AE, Kraemer HC, Kessler RC, Kupfer DJ, Offord DR (1997) Contributions of risk-factor research to developmental psychopathology. Clin Psychol Rev 17(4):375–406. doi:10.1016/S0272-7358(97)00012-3

    Article  CAS  PubMed  Google Scholar 

  26. Dobson Keith S, Dozois DJ (2008) Assessing risk and resilience. Factors in models of depression. In: Dobson Keith S, Dozois DJ (eds) Risk factors in depression. Elsevier, San Diego, pp 2–16

  27. Kurth BM, Kamtsiuris P, Holling H, Schlaud M, Dolle R, Ellert U, Kahl H et al (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. doi:10.1186/1471-2458-8-196

    Article  PubMed Central  PubMed  Google Scholar 

  28. Ravens-Sieberer U, Otto C, Kriston L, Rothenberger A, Döpfner M, Herpertz-Dahlmann B, Barkmann C, et al (2014) The longitudinal BELLA study: design, methods and course of mental health problems. Eur Child Adolesc Psychiatry. doi:10.1007/s00787-014-0638-4

  29. Winkler J, Stolzenberg H (1999) Der Sozialschichtindex im Bundes-Gesundheitssurvey (Social class index in the Federal Health Survey). Gesundheitswesen 61:178–183

    Google Scholar 

  30. Lange M, Kamtsiuris P, Lange C, Schaffrath Rosario A, Stolzenberg H, Lampert T (2007) Messung soziodemographischer Merkmale im Kinder- und Jugendgesundheitssurvey (KiGGS) und ihre Bedeutung am Beispiel der Einschatzung des allgemeinen Gesundheitszustands (Sociodemographic characteristics in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) - operationalisation and public health significance, taking as an example the assessment of general state of health). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50(5–6):578–589. doi:10.1007/s00103-007-0219-5

    Article  CAS  PubMed  Google Scholar 

  31. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401. doi:10.1177/014662167700100306

    Article  Google Scholar 

  32. Barkmann C, Erhart M, Schulte-Markwort M, Group BS (2008) The German version of the Centre for Epidemiological Studies Depression Scale for Children: 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(Suppl. 1):116–124. doi:10.1007/s00787-008-1013-0

    Google Scholar 

  33. Fendrich M, Weissman MM, Warner V (1990) Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. Am J Epidemiol 131(3):538–551

    CAS  PubMed  Google Scholar 

  34. Klaghofer R, Braehler E (2001) Konstruktion und teststatistische Prüfung einer Kurzform der SCL-90-R (Construction and validation of a short form of the SCL-90-R). Z Klin Psychol Psychiatr Psychother 49(2):115–124

    Google Scholar 

  35. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L (1974) The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci 19(1):1–15. doi:10.1002/bs.3830190102

    Article  CAS  PubMed  Google Scholar 

  36. Schwarzer R, Jerusalem M (1995) Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M (eds) Measures in health psychology: a user’s portfolio. Causal and control beliefs. NFER-NELSON, Windsor, pp 35–37

    Google Scholar 

  37. Schwarzer R, Jerusalem M (1999) Skalen zur Erfassung von Lehrer- und Schülermerkmalen. Dokumentation der psychometrischen Verfahren im Rahmen der wissenschaftlichen Begleitung des Modellversuchs Selbstwirksame Schulen. Freie Universität Berlin, Institut für Psychologie

  38. Schneewind K, Beckmann M, Hecht-Jackl A (1985) Familienklima-Skalen. Bericht 8.1 und 8.2. Ludwig Maximilians Universität, Institut für Psychologie-Persönlichkeitspsychologie und Psychodiagnostik, München

  39. Moos RH, Moos BS (2009) Family environment scale manual and sampler set: development, applications and research, 4th edn. Mind Garden Inc, Palo Alto, CA

    Google Scholar 

  40. Donald CA, Ware JE (1984) The measurement of social support. Res Community Ment Health 4:325–370

    Google Scholar 

  41. Curran PJ, Harford TC, Muthen BO (1996) The relation between heavy alcohol use and bar patronage: a latent growth model. J Stud Alcohol 57(4):410–418

    Article  CAS  PubMed  Google Scholar 

  42. Cohen J (1988) Statistical power analysis for the behavioral sciences, Second Edition edn. Lawrence Erlbaum Associates, Hillsdale, NJ

    Google Scholar 

  43. Muthén LK, Muthén BO (2011) Mplus User’s Guide, 6th edn. Muthén & Muthén, Los Angeles, CA

    Google Scholar 

  44. Wiegand-Grefe S, Geers P, Petermann F, Plass A (2011) Children of mentally ill parents: the impact of parental psychiatric diagnosis, comorbidity, severity and chronicity on the well-being of children. Fortschr Neurol Psychiatr 79(1):32–40. doi:10.1055/s-0029-1245623

    Article  CAS  PubMed  Google Scholar 

  45. Beardslee WR, Gladstone TR, Wright EJ, Cooper AB (2003) A family-based approach to the prevention of depressive symptoms in children at risk: evidence of parental and child change. Pediatrics 112(2):e119–e131

    Article  PubMed  Google Scholar 

  46. Curry JF (2014) Future Directions in Research on Psychotherapy for Adolescent Depression. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53:1–17. doi:10.1080/15374416.2014.904233

    Article  Google Scholar 

  47. March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B et al (2007) The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry 64(10):1132–1143. doi:10.1001/archpsyc.64.10.1132

    Article  CAS  PubMed  Google Scholar 

  48. Rohde P, Feeny NC, Robins M (2005) Characteristics and Components of the TADS CBT Approach. Cognitive and behavioral practice 12(2):186–197. doi:10.1901/jaba.2005.12-186

    Article  PubMed Central  PubMed  Google Scholar 

  49. Ehrenberg MF, Cox DN, Koopman RF (1991) The relationship between self-efficacy and depression in adolescents. Adolescence 26(102):361–374

    CAS  PubMed  Google Scholar 

  50. Hintzpeter B, Klasen F, Schön G, Voss C, Hölling H, Ravens-Sieberer U, & the BELLA study group (2014) Mental health care use among children and adolescents in Germany – Results of the longitudinal BELLA study. Euro Child Adoles Psych (in this issue)

Download references

Acknowledgments

The authors thank all children, adolescents, their parents and young adults who participated in this research for their time and involvement. Further, we would like to thank the Robert Koch Institute for their ongoing support and co-operation. The BELLA study has been financially supported by various grants: Baseline, 1-year follow-up and 2-year follow-up of the BELLA study were financed by the German Science Foundation. The 6-year follow-up was funded by the German Federal Ministry of Health (BMG).

Conflict of interest

None of the authors has a conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Fionna Klasen, Christiane Otto, Levente Kriston & Ulrike Ravens-Sieberer

  2. Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Levente Kriston

  3. Evidence Based Practice Unit, University College London and Anna Freud Centre, London, UK

    Praveetha Patalay

  4. Robert Koch Institute, Berlin, Germany

    Robert Schlack

Authors
  1. Fionna Klasen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christiane Otto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Levente Kriston
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Praveetha Patalay
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Schlack
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ulrike Ravens-Sieberer
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The BELLA study group

Corresponding author

Correspondence to Fionna Klasen.

Additional information

Members of the BELLA study group are: Ulrike Ravens-Sieberer and Fionna Klasen, Hamburg (Principal Investigators), Claus Barkmann, Hamburg; Monika Bullinger, Hamburg; Manfred Döpfner, Köln; Beate Herpertz-Dahlmann, Aachen; Heike Hölling, Berlin; Franz Resch, Heidelberg; Aribert Rothenberger, Göttingen; Sylvia Schneider, Bochum; Michael Schulte-Markwort, Hamburg; Robert Schlack, Berlin; Frank Verhulst, Rotterdam; Hans-Ulrich Wittchen, Dresden.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 64 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klasen, F., Otto, C., Kriston, L. et al. Risk and protective factors for the development of depressive symptoms in children and adolescents: results of the longitudinal BELLA study. Eur Child Adolesc Psychiatry 24, 695–703 (2015). https://doi.org/10.1007/s00787-014-0637-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-014-0637-5

Keywords

Search

Navigation