Gender and Age Differences in ADHD Symptoms and Co‑occurring Depression and Anxiety Symptoms Among Children and Adolescents in the BELLA Study

Attention-deficit/hyperactivity disorder (ADHD) is one of the most diagnosed neurodevelopmental disorders of childhood. Current studies addressing gender and age differences in ADHD are lacking. The present study aims to fill this research gap by dimensionally evaluating gender and age differences in ADHD symptoms, as measured by a DSM-5-based parent rating scale, in children and adolescents who participated in the two-year follow-up of the community-based BELLA study (n = 1326). Associations between ADHD symptoms and depression symptoms and anxiety symptoms were also examined. Multiple linear regressions revealed significant associations between gender and all ADHD symptoms. Age was significantly associated with hyperactive/impulsive symptoms. Additional multiple linear regressions demonstrated significant positive associations between depression and anxiety symptoms and ADHD symptoms. Further, female gender was found to be posi- tively associated with both depression and anxiety symptoms. These findings may suggest a need for more gender-specific approaches to ADHD diagnosis and treatment, as well as more research into the intersections of ADHD and depression and anxiety symptoms in children and adolescents.Peer Reviewe

The 2017/18 Health Behaviour in School-aged Children (HBSC) study – Methodology of the World Health Organization’s child and adolescent health study

The Health Behaviour in School-aged Children (HBSC) study is an international research project in collaboration with the World Health Organization (WHO) for over 35 years. HBSC is the largest study on child and adolescent health and one of the most important sources of data for the WHO’s international comparative health monitoring. Every four years, data on the health and health behaviour of students aged 11, 13 and 15, as well as the social contexts and conditions for growing up healthy, are collected. A total of 50 countries belong to the HBSC network, with 45 countries taking part in the 2017/18 survey. Germany has contributed to the HBSC surveys since 1993/94. For the most recent 2017/18 cycle, students at 146 schools in Germany were interviewed (response rate of schools: 15.6%). A net sample of n = 4,347 girls and boys was achieved for Germany (response rate: 52.7%). Participation was voluntary and the survey was conducted in German school years five, seven and nine (corresponding to ages 11, 13 and 15). A weighting procedure was applied to allow for representative findings on the health of children and adolescents in Germany. HBSC offers a valuable contribution to health monitoring and provides numerous starting points to identify needs, risk groups and fields of action to initiate targeted and actual needs-based measures of prevention and health promotion in the school setting

Item response theory and differential test functioning analysis of the HBSC-Symptom-Checklist across 46 countries

Background The Symptom Checklist (SCL) developed by the Health Behaviour in School-aged Children (HBSC) study is a non-clinical measure of psychosomatic complaints (e.g., headache and feeling low) that has been used in numerous studies. Several studies have investigated the psychometric characteristics of this scale; however, some psychometric properties remain unclear, among them especially a) dimensionality, b) adequacy of the Graded Response Model (GRM), and c) measurement invariance across countries. Methods Data from 229,906 adolescents aged 11, 13 and 15 from 46 countries that participated in the 2018 HBSC survey were analyzed. Adolescents were selected using representative sampling and surveyed by questionnaire in the classroom. Dimensionality was investigated using exploratory graph analysis. In addition, we investigated whether the GRM provided an adequate description of the data. Reliability over the latent variable continuum and differential test functioning across countries were also examined. Results Exploratory graph analyses showed that SCL can be considered as one-dimensional in 16 countries. However, a comparison of the unidimensional with a post-hoc bifactor GRM showed that deviation from a hypothesized one-dimensional structure was negligible in most countries. Multigroup invariance analyses supported configural and metric invariance, but not scalar invariance across 32 countries. Alignment analysis showed non-invariance especially for the items irritability, feeling nervous/bad temper and feeling low. Conclusion HBSC-SCL appears to represent a consistent and reliable unidimensional instrument across most countries. This bodes well for population health analyses that rely on this scale as an early indicator of mental health status

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Physical activity of older children and adolescents in Germany – Results of the HBSC study 2022 and trends since 2009/10

Background: Physical activity is central to health, beginning in childhood and adolescence, and regular monitoring provides important information for strategic decisions on promoting physical activity in Germany. Methods: The current survey cycle of the Health Behaviour in School-aged Children (HBSC) study gives an insight into the prevalence of the indicators daily recommended physical activity, high and low physical activity, and sporting activity among students aged between 11 and 15 for 2022. In addition, the data is compared to the survey cycles of the 2009/10, 2013/14, and 2017/18 school years and analysed over time. Results: The results of the current survey cycle show that 10.8 % of girls, 20.9 % of boys, and 12.4 % of gender diverse adolescents fulfil the daily physical activity recommendation. There are also major gender-specific differences for the other indicators. The group of gender diverse adolescents needs to be analysed further. The changes over time between 2009/10 and 2022 are relatively small. While girls' physical activity habits decreased slightly for the various indicators between 2009/10 and 2022, boys' prevalence remained relatively stable over the same period. Conclusions: Overall, in part due to the effects of the various COVID-19 lockdowns, the need for effective and population-based measures to promote physical activity in childhood and adolescence remains high

Traditional bullying and cyberbullying among children and adolescents in Germany – Cross-sectional results of the 2017/18 HBSC study and trends

Bullying is a specific form of violence that can potentially lead to numerous and long-term negative health implications. Despite consistent coverage in the media, particularly on cyberbullying, as of yet there are only few representative findings on the frequency of (cyber)bullying in Germany. This article analyses how widespread bullying and cyberbullying were at schools in Germany in 2018, what differences exist between girls and boys, age groups and various types of schools, and changes in bullying trends between 2002 and 2018. Our findings are based on an analysis of the data provided by the 2017/18 cycle (N=4,347 students, 53.0% female) and previous cycles of the German Health Behaviour in School-aged Children (HBSC) study. In the 2018 cycle, boys reported having bullied other children more frequently than girls, but were bullied just as often. 15-year-olds reported having bullied other children more frequently than 11- to- 13-year-olds but reported being bullied less frequently. Students at grammar schools (Gymnasium) least frequently reported any involvement in bullying. Only few children and adolescents reported cases of cyberbullying. Compared to all previous survey years, 2018 saw the lowest number of children that reported having bullied others. However, reports of having been bullied have remained almost stable. The findings highlight the need for evidence-based prevention and intervention anti-bullying programmes and measures across all types of general education schools and age groups

Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany

The COVID-19 pandemic has caused unprecedented changes in the lives of 1.6 billion children and adolescents. First non-representative studies from China, India, Brazil, the US, Spain, Italy, and Germany pointed to a negative mental health impact. The current study is the first nationwide representative study to investigate the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) and mental health of children and adolescents in Germany from the perspective of children themselves. A representative online survey was conducted among n = 1586 families with 7- to 17-year-old children and adolescents between May 26 and June 10. The survey included internationally established and validated instruments for measuring HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). Results were compared with data from the nationwide, longitudinal, representative BELLA cohort study (n = 1556) conducted in Germany before the pandemic. Two-thirds of the children and adolescents reported being highly burdened by the COVID-19 pandemic. They experienced significantly lower HRQoL (40.2% vs. 15.3%), more mental health problems (17.8% vs. 9.9%) and higher anxiety levels (24.1% vs. 14.9%) than before the pandemic. Children with low socioeconomic status, migration background and limited living space were affected significantly more. Health promotion and prevention strategies need to be implemented to maintain children’s and adolescents’ mental health, improve their HRQoL, and mitigate the burden caused by COVID-19, particularly for children who are most at risk.Peer Reviewe

Subjective health and well-being of children and adolescents in Germany – Cross-sectional results of the 2017/18 HBSC study

Subjective health is understood as a multidimensional construct that encompasses the physical, mental and social dimensions of a person’s well-being. Promoting the subjective health and well-being of children and adolescents has strong public health relevance because health impairments in childhood and adolescence are often associated with longterm health problems in adulthood. Therefore, it is very important to gain information about potential risk and resource factors involved. This article presents current prevalences for subjective health, life satisfaction and psychosomatic health complaints among children and adolescents in Germany aged 11, 13 and 15 years from the 2017/18 Health Behaviour in School-Aged Children (HBSC) study (N=4,347, 53.0% girls). It also examines the sociodemographic and psychosocial factors that influence subjective well-being. Most children and adolescents provided positive ratings of their health and life satisfaction. Nevertheless, about one third of girls and one fifth of boys were affected by multiple psychosomatic health complaints. Impairments in subjective well-being were particularly evident in girls, older adolescents, young people with low levels of family affluence and those under a lot of pressure at school. In contrast, high family support was associated with better subjective well-being. These results illustrate the need for target group-specific prevention and health promotion measures aimed at improving the subjective health and well-being of children and adolescents

Bewegungsverhalten von älteren Kindern und Jugendlichen in Deutschland – Ergebnisse der HBSC-Studie 2022 und Zeitverläufe seit 2009/10

Hintergrund: Bewegung ist bereits im Kindes- und Jugendalter zentral für die Gesundheit und ein regelmäßiges Monitoring gibt wichtige Hinweise für strategische Entscheidungen für die Bewegungsförderung in Deutschland. Methode: Mit der aktuellen Erhebungswelle der „Health Behaviour in School-aged Children (HBSC)“-Studie lässt sich die Prävalenz bei Schülerinnen und Schülern im Alter zwischen 11 und 15 Jahren für die Indikatoren tägliche Bewegungsempfehlung, hohe und geringe körperliche Aktivität sowie die sportliche Aktivität für 2022 berichten. Zudem werden die Daten im Vergleich zu den Erhebungswellen der Schuljahre 2009/10, 2013/14 und 2017/18 im zeitlichen Trend betrachtet. Ergebnisse: Die Ergebnisse der aktuellen Erhebungswelle zeigen, dass 10,8 % der Mädchen und 20,9 % der Jungen sowie 12,4 % der gender-diversen Jugendlichen die tägliche Bewegungsempfehlung erreichen. Auch für die weiteren Indikatoren bestehen zum Teil große geschlechtsspezifische Unterschiede. Die Gruppe der gender-diversen Jugendlichen gilt es weiter zu untersuchen. Die zeitlichen Veränderungen zwischen 2009/10 und 2022 sind relativ gering. Während von 2009/10 bis 2022 das Bewegungsverhalten bei Mädchen für die verschiedenen Indikatoren leicht abnimmt, zeigen sich bei den Jungen relativ stabile Prävalenzen im gleichen Zeitraum. Schlussfolgerungen: Insgesamt und auch aufgrund der Auswirkungen der verschiedenen COVID-19-Lockdowns ist und bleibt der Bedarf an effektiven und bevölkerungsbezogenen Maßnahmen der Bewegungsförderung im Kindes- und Jugendalter hoch