Table_1_Exploring adolescent mental health during the COVID-19 crisis – strengths and difficulties.DOCX

IntroductionThe SARS-CoV-2 pandemic has significantly impacted children and adolescents, leading to mental health challenges. Knowledge on their resources and difficulties is crucial and there is a need for valid instruments to assess their psychosocial condition especially in this exceptional situation. We assessed psychopathological symptoms using the SDQ during the pandemic, comparing to pre-pandemic data. Our study aims to understand adolescents’ strengths and difficulties amidst COVID-19, evaluating the SDQ’s utility in crisis settings.MethodsWithin the German school-based surveillance study (“B-Fast”), we assessed behavioral strengths and difficulties in 664 adolescents aged 11–17 years during the peak of the German COVID-19 pandemic using the validated Strengths and Difficulties Questionnaire (SDQ) for both external and self-assessed data collection. Data were collected between November 2020 and April 2021. We compared self-assessed SDQ-scores to pre-pandemic data from a comparable sample and examined adolescent classification as “normal” or “borderline/abnormal” based on both external and self-assessed SDQ subscale scores using established cut-off values. Additionally, we conducted sex and rater-based score comparisons.ResultsIn our study, we observed a significant worsening of “Emotional Symptoms” compared to pre-pandemic levels, while “Conduct Problems” and “Prosocial Behavior” showed improvement. Variations in classification to “normal” and “abnormal” emerged when applying German versus British cut-off values. Females scored higher on “Emotional Symptoms” while males scored higher on “Hyperactivity Symptoms.” Correlations between external and self-assessed SDQ ratings ranged from 0.43 (p Discussion/conclusionOur study contributes to understanding the psychosocial impact of the COVID-19 pandemic on German adolescents. Compared to other symptoms, we observed a particular worsening in “Emotional Symptoms” based on our data. Despite the moderate correlation between parental and self-reported evaluations, there appears to be a certain discrepancy in the perception of adolescent quality of life. Therefore, it seems prudent to assess both the external and self-reported evaluations and amalgamate the results from both parties to obtain a comprehensive problem profile of the individual. These findings underscore the importance of using country-specific cutoff values and reaffirm the utility of the SDQ as a valuable assessment tool, even within the unique circumstances posed by a pandemic.</p

N100 amplitude decrease during 1 Hz-rTMS.

<p>(<b>A</b>) N100 amplitude reduction during 1 Hz-rTMS (group mean values). The TMS artifact (black box) has been cut out. Each curve represents an average of 100 trials (1–100, 101–200, …, 801–900). Electrodes C3, CP3’ and CP5’ were pooled. <i>Left</i>: TMS-evoked N100 amplitude continuously decreased during the stimuli 1–500. <i>Right</i>: N100 amplitude reached a plateau and was not further reduced by continued stimulation (pulses 500–900). (<b>B</b>) Single patient example. (<b>C</b>) TMS-evoked N100 amplitude was reduced during 1 Hz-rTMS regardless of the order of 1 Hz-rTMS vs. sham stimulation (blue: first 1 Hz-rTMS, second sham stimulation; red: first sham stimulation, second 1 Hz-rTMS; vertical bars show 0.95 confidence intervals). (<b>D</b>) Voltage and current source density (CSD) maps (blue areas indicate negativity, red areas positivity) show an N100 maximum above the stimulated left left central area and an intensity reduction during 1 Hz-rTMS. <i>Left</i>: N100 during stimuli 1–100. <i>Right</i>: N100 during stimuli 801–900.</p

Dipole moment of N100 during, pre and post rTMS.

<p>(<b>A</b>) The momentum of the dipole component shown in the dipole model on the right (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050073#pone-0050073-g004" target="_blank">Figure 4C</a>) is presented for the N100 time interval: before rTMS is shown in black, after 1 Hz-rTMS in red and after sham stimulation in blue. The TMS artifact (black box) has been cut out. (<b>B</b>) Momentum of the dipole component shown in the dipole model on the right (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050073#pone-0050073-g004" target="_blank">Figure 4C</a>) during 1 Hz-rTMS. The TMS artifact (black box) has been cut out. The lines illustrate representative trial blocks at the beginning, in the middle and at the end of 1 Hz-rTMS (trials 1–100, 501–600 and 801–900). (<b>C</b>) Source model (cf. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050073#pone-0050073-g003" target="_blank">Figure 3</a>).</p

Sample characteristics.

<p>(RMT = resting motor threshold; rTMS = repetitive transcranial magnetic stimulation).</p

TMS-evoked N100 amplitude reduction after 1 Hz-rTMS.

<p>(<b>A</b>) Comparison of N100 before rTMS (black) with after 1 Hz-rTMS (red) and after sham stimulation (blue): N100 amplitude was only reduced after 1 Hz-rTMS. TMS artifact (black box) has been cut out. (<b>B</b>) N100 amplitude was reduced after 1 Hz-rTMS but not after sham stimulation irrespective of ORDER (blue: first 1 Hz-rTMS, second sham stimulation; red: first sham stimulation, second 1 Hz-rTMS; vertical bars show 0.95 confidence intervals). (<b>C</b>) Voltage and current source density (CSD) maps (blue for negativity, red for positivity) show TMS-evoked N100 localization above the stimulated left primary motor cortex and an intensity reduction after 1 Hz-rTMS.</p

Source model of TMS-evoked N100.

<p>(<b>A</b>) The RAP-MUSIC (recursively applied and projected multiple signal classification) revealed a single source component located near the stimulated hand area of the primary motor cortex with an orientation approximately perpendicular to the precentral gyrus. (<b>B</b>) The first two principal components explained over 99% of the signal during the N100 time interval. The TMS artifact (black box) has been cut out. (<b>C</b>) The dipole moment of the single source component showed a maximum in the N100 interval. The TMS artifact (black box) has been cut out.</p

Comparison of TMS-evoked N100 amplitudes between trial blocks throughout the 1 Hz-rTMS session (Newman Keuls post hoc tests).

<p>Comparison of TMS-evoked N100 amplitudes between trial blocks throughout the 1 Hz-rTMS session (Newman Keuls post hoc tests).</p

Late positive deflection.

<p>P400+ is shown at electrodes CPz, Pz, P1, P2, PO1 and PO2 (averaged) for the walker- and scrambled condition. Typically developing controls are indicated by solid lines and ADHD by dashed lines.</p

Motor PINV topography for healthy control children.

<p>(top; from left to right: all responses, fast responses below median reaction time, slow responses above median reaction time) <b>and children with ADHD</b> (bottom; from left to right: responses off and on methylphenidate) for the motor PINV time interval (500–800 ms after the response trigger, motor post-processing).</p

ANOVA results (comparison children with ADHD versus healthy control children).

<p>ANOVA results (comparison children with ADHD versus healthy control children).</p