Mental health from a Person-centred Perspective: Analyzing mental health problems, risk factors and outcomes in children, adolescents and young adults

The relevance of mental health problems has accumulated over the last few years in light of the potential detrimental effects of the worldwide pandemic. The burden of mental ill-health with its various negative long-term consequences for children, family and the high indirect and direct costs for society raises the essentiality to make mental health promotion a central issue. General scientific research on mental health problems among children and adolescence has largely relied on variable-centred methodology (e.g., multiple regression, factor analysis, cumulative risk index) by focusing mainly on explaining relationships between variables (i.e., linear association and single relationship). However, this method assumes homogeneity of mental health problems and risk factors for mental ill-health within a population, however there is likelihood for diversity of individual patterns for types of problems and exposure to multiple risk factors. The current dissertation uses a person-centred approach, a complementary and promising method to identify subpopulations with heterogenous patterns of mental health problems and to investigate different risk subgroups. The aims of the present work include the exploration and modelling of patterns and transitions of mental health problems with a focus on the importance of parental factors, the examination of multiple risks and the manifestation of mental disorders. In Study I, the central question was: “How do mental health problems differ across individuals and time”. Based on a sample of almost 1,300 children and adolescents (age range 8 – 26), a three-class solution identified a normative class, an emotional problem class, and a multiple problem class. The findings confirm the stability of mental health problems as common rather than atypical. According to Latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time, while 14.7% of individuals showed a persistent pattern of mental health problems across time. Co-occurring internalizing and externalizing problems (i.e., multiple problem class) were found in 11.3% of the sample and diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class. Taken together, implications for prevention can be formulated based on the findings including the importance of early, continuous, and gender-sensitive preventive interventions to ameliorate the mental health burden for the young and their family. In Study II, the mediating role of parenting dimensions between parental personality and adolescent mental health problems was investigated with a cross-sectional sample of 4,258 German adolescents (48.7% male, 11–17 years). The results underline and extend previous indications of direct associations between parental personality and their children’s mental health problems by highlighting the adverse role of neuroticism with increased externalizing and internalizing problems. Furthermore, results confirmed a positive effect of parental warmth and behavioural control on externalizing and internalizing problems and a negative effect of psychological control on both problems. An important finding includes the mediating role of parenting. Results showed negative associations between parental neuroticism as well as psychological control and adolescent mental health and highlighted their mutually reinforcing negative effect. To summarise, a good entry point for effective preventive intervention to ameliorate mental health problems during adolescence could include early screening of personality traits that may result in maladaptive parenting practises and therefore could be a guidance towards a better preparation for parenthood. In Study III, a longitudinal survey data of 10,853 German children, adolescents and young adults was used to examine 27 robust risk and protective factors for mental health across multiple domains (i.e. individual, family, social) to identify four subgroups of individuals with different risk profiles: a basic-risk (51.4%), high-risk (23.4%), parental-risk (11.8%) and social-risk class (13.4%). Results confirmed the crucial role of family-specific risk factors across the extracted classes and point towards parents as a key target to develop effective interventions to promote children’s health. Risk classes are associated with negative mental health outcomes (e.g., mental health problems, depression, ADHD). Gender differences were found. In conclusion, results contribute to previous research by stressing the effect of multiple risk factor on youth mental health. Future approaches to ameliorate mental health problems should include a combination of strengthening protective factors, involving parents and targeting schools. The findings of the present dissertation which include the importance of co-occurring mental health problems (Study I) and the examination of multiple risk factors (Study III) as well as the central role of parents (Study II), highlight the necessity to intervene early, continuous and on different levels of society. Implications and future research directions are discussed, focusing on the societies responsibility to guarantee that the most vulnerable and most important members have a chance for a healthy development. While important steps have been taken toward mental health prevention, there is still a lot of potential for research and practise

Constrained firms, not subsistence activities: evidence on capital returns and accumulation in Peruvian microenterprises

We investigate the returns to capital and capital accumulation using panel data of Peruvian micro enterprises (MEs). Marginal returns to capital are found to be very high at low levels of capital, but rapidly decreasing at higher levels. The dynamic analyses of capital accumulation in MEs suggest that credit constraints explain a major part of the variation in firm growth. We find a very large positive effect of household non-business wealth on capital stocks of MEs. We also show a sizable effect of risk on accumulation and pronounced interactions between wealth and risk. The presented evidence is consistent with poorly endowed entrepreneurs who operate in imperfect capital markets and a very risky environment

Co-occurrence, stability and manifestation of child and adolescent mental health problems: a latent transition analysis

Background Complex constellations of socio-emotional and behavioural problems (i.e., mental health problems) in childhood and adolescence are common and heighten the risk for subsequent personality, anxiety and mood disorders in adulthood. Aims of this study included the examination of patterns of mental health problems (e.g., externalizing-internalizing co-occurrence) and their transitions to reported mental disorders by using a longitudinal person-centered approach (latent class and latent transition analysis). Methods The sample consisted of 1255 children and adolescents (51.7% female, mean age = 12.3 years, age range 8–26 years) from three time points of the comprehensive mental health and wellbeing BELLA study. Children and their parents completed the German SDQ (Strength and Difficulties Questionnaire, Goodman, 1997) and reported on diagnoses of ADHD, depression, and anxiety. Results Latent class analysis identified a normative class, an emotional problem class, and a multiple problem class. According to latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time; 14.7% of individuals showed a persistent pattern of mental health problems. Diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class. Conclusions Results highlight the need for early prevention of mental health problems to avoid accumulation and manifestation in the transition to adolescence and young adulthood

Recent advances in rehabilitation for Parkinson’s Disease with Exergames: A Systematic Review

Objective: The goal of this contribution is to gather and to critically analyze recent evidence regarding the potential of exergaming for Parkinson’s disease (PD) rehabilitation and to provide an up-to-date analysis of the current state of studies on exergame-based therapy in PD patients. Methods: We performed our search based on the conclusions of a previous systematic review published in 2014. Inclusion criteria were articles published in the indexed databases Pubmed, Scopus, Sciencedirect, IEEE and Cochrane published since January 1, 2014. Exclusion criteria were papers with a target group other than PD patients exclusively, or contributions not based on exergames. Sixty-four publications out of 525 matches were selected. Results: The analysis of the 64 selected publications confirmed the putative improvement in motor skills suggested by the results of the previous review. The reliability and safety of both Microsoft Kinect and Wii Balance Board in the proposed scenarios was further confirmed by several recent studies. Clinical trials present better (n = 5) or similar (n = 3) results than control groups (traditional rehabilitation or regular exercise) in motor (TUG, BBS) and cognitive (attention, alertness, working memory, executive function), thus emphasizing the potential of exergames in PD. Pilot studies (n = 11) stated the safety and feasibility of both Microsoft Kinect and Wii Balance Board, potentially in home scenarios as well. Technical papers (n = 30) stated the reliability of balance and gait data captured by both devices. Related metaanalyses and systematic reviews (n = 15) further support these statements, generally citing the need for adaptation to patient’s skills and new input devices and sensors as identified gaps. Conclusion: Recent evidence indicates exergame-based therapy has been widely proven to be feasible, safe, and at least as effective as traditional PD rehabilitation. Further insight into new sensors, best practices and different cognitive stadiums of PD (such as PD with Mild Cognitive Impairment), as well as task specificity, are required. Also, studies linking game parameters and results with traditional assessment methods, such as UPDRS scores, are required. Outcomes for randomized controlled trials (RCTs) should be standardized, and follow-up studies are required, particularly for motor outcomes

The whole is greater than the sum of its parts: profiles of multiple mental health risk factors using Latent class analysis

Background The exposure to an accumulation of various risk factors during childhood and adolescence relative to a single risk is associated with poorer mental health. Identification of distinct constellations of risk factors is an essential step towards the development of effective prevention strategies of mental disorders. A Latent class analysis (LCA) extracts different combinations of risk factors or subgroups and examines the association between profiles of multiple risk and mental health outcomes. Methods The current study used longitudinal survey data (KiGGS) of 10,853 German children, adolescents and young adults. The LCA included 27 robust risk and protective factors across multiple domains for mental health. Results The LCA identified four subgroups of individuals with different risk profiles: a basic-risk (51.4%), high-risk (23.4%), parental-risk (11.8%) and social-risk class (13.4%). Multiple risk factors of the family domain, in particular family instability were associated with negative mental health outcomes (e.g. mental health problems, depression, ADHD) and predominately comprised late adolescent girls. The social environment represented a more common risk domain for young males. Conclusion The understanding of multiple risk and different risk “profiles” helps to understand and adjust targeted interventions with a focus on vulnerable groups

The developmental course of mental health problems among children and adolescents. Results of the KiGGS cohort

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Psychische Auffälligkeiten bei Kindern und Jugendlichen in Deutschland – Querschnittergebnisse aus KiGGS Welle 2 und Trends

Psychische Auffälligkeiten bei Kindern und Jugendlichen gehen mit individuellen und familiären Beeinträchtigungen sowie gesellschaftlichen Folgekosten einher. Zur KiGGS-Basiserhebung (2003 – 2006) waren 20,0 % der Kinder und Jugendlichen psychisch auffällig. In diesem Beitrag werden die aktuellen Prävalenzen aus KiGGS Welle 2 (2014 – 2017) berichtet und im Trend mit den Daten aus der KiGGS-Basiserhebung verglichen. Als Indikator dienten die Elternangaben des Stärken-und-Schwächen-Fragebogens (SDQ) für 3- bis 17-jährige Kinder und Jugendliche. Die Prävalenz psychischer Auffälligkeiten liegt zu KiGGS Welle 2 bei 16,9 %. Der rückläufige Trend betrifft insbesondere Jungen im Alter von 9 bis 17 Jahren. Mädchen und Jungen aus Familien mit niedrigem sozioökonomischen Status sind deutlich häufiger als Gleichaltrige aus Familien mit mittlerem und hohem sozioökonomischen Status psychisch auffällig. Diese Befunde werden vor dem Hintergrund verschiedener Maßnahmen der Gesundheitsförderung und -versorgung diskutiert.Peer Reviewe

ADHD in children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood and adolescence and is associated with functional, psychosocial and cognitive impairment. As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (2014-2017), parents of children and adolescents aged between 3 and 17 years reported whether their child was diagnosed with ADHD by a physician or psychologist. Overall, 4.4% of children and adolescents have been diagnosed with ADHD in Germany. In comparison, the KiGGS baseline study (2003-2006) showed a reduction of lifetime ADHD diagnoses of almost one percentage point over a period of ten years. The reduction of parent-reported ADHD diagnoses primarily occurred among 3- to 8-year old children and boys. The results are discussed in terms of health promotion and the introduction of health care measures.Peer Reviewe