Assessment of Psychological Distress and Peer Relations among Trans Adolescents—An Examination of the Use of Gender Norms and Parent–Child Congruence of the YSR-R/CBCL-R among a Treatment-Seeking Sample

Among trans adolescents, increased psychological distress is reported in the literature. The goal of this study was to examine psychological distress, associated peer relations and parent report congruence among the treatment-seeking sample of the Gender Identity Special Consultation (GISC) for youth at the Charite Berlin. Further, differences between the instruments' binary gender norms were investigated. Retrospectively, we analyzed clinical data derived from the GISC. By initial interviews and using the Youth Self-Report and Child Behavior Checklist, n = 50 trans adolescents aged 12-18 years (M = 15.5) were examined for psychological problems and peer relations. Congruence between self and parent report was analyzed by correlations. Half of the sample reported suicidality, self-harm and bullying. Trans adolescents showed significantly higher internalizing and total problems than the German norm population. The congruence between self and parent report proved to be moderate to high. The level of congruence and poor peer relations were identified as predictors of internalizing problems. Significant differences between the female vs. male gender norms emerged regarding mean scores and the number of clinically significant cases. Data provide valuable implications for intervention on a peer and family level. There are limitations to the suitability of questionnaires that use binary gender norms, and further research on adequate instruments and assessment is needed

Screening zur frühen Identifizierung des psychosozialen Unterstützungsbedarfs bei Kindern psychisch erkrankter Eltern

Background: Children of mentally ill parents have an increased risk for mental disorders themselves, which is increased once again by the experience of abuse and neglect. Objective: The aim of this study is to present the development and preliminary piloting of a specific screening procedure that enables an early identification of a possible need for support in children with mentally ill parents. Material and methods: For children of mentally ill parents, two screening procedures were developed. In the parent questionnaire of the "children screening" mental abnormalities of the children and adolescents (6-18 years old) as well as resources are collated in an abbreviated form (mental abnormalities: 26 items, available resources: 4 items). In the "family screening" familial risk and stress factors (8 items) are also enquired about in a self-report of the parents as well as indications for abuse and neglect in the family (9 items). Results: Both screening procedures are easy to evaluate with the help of a traffic light system. The responsible psychiatrist receives a preliminary estimation and definite indications on the current need for psychosocial treatment and support of the whole family and particularly the children. Subsequently, they can initiate further steps for the integrated care of the family. Conclusion: The children and family screening procedures are economical in time and easily understandable screening procedures for identification of the need for treatment and support of the family. Subsequently, after the final validation it is planned to systematically implement the screening procedures in the psychiatric care of mentally ill parents. In this way the far-reaching negative consequences for these children can be prevented

Almost 2 years into the COVID-19 pandemic: an update on parental stress, parent mental health, and the occurrence of child maltreatment

Increased parental stress, poorer mental health, and an increase in the occurrence of child maltreatment (CM) have been reported in earlier phases of the COVID-19 pandemic. However, data from later phases of the pandemic are not yet available. We conducted a cross-sectional, representative survey among 1087 parents (48.8% female; mean age 41.72 years, SD = 9.15) in Germany in December 2021. Data were compared to a previous representative sample, assessed in August 2020 (N = 1024), and to normative scores of the outcome measures. Predictors for the occurrence of CM were analyzed by logistic regression. Pandemic-related stress and general stress were higher and physical and mental health were poorer in the December 2021 sample than in the August 2020 sample. Occurrence rates of CM varied between 5 and 56%. Verbal emotional abuse (n = 607, 56%), witnessing domestic violence (n = 446, 41%), and emotional neglect (n = 435, 40%) were most frequently reported. For these subtypes, parental risk for alcohol abuse (OR 2.1–2.7) and parental recent experience of violence (OR 2.1–5.1) were the strongest predictors. Across all subtypes of CM, parents reporting child maltreatment showed poorer scores on all stress outcomes, with medium–large-effect sizes. Results confirm a high burden within the families, almost 2 years into the pandemic. Occurrence rates of a broad spectrum of CM subtypes raise further concerns for the well-being of children. Family-oriented intervention efforts are needed to stabilize families and provide targeted support. Longitudinal studies are needed for a description of families at risk for poorer outcomes

Evaluation of an Early Intervention Model for Child and Adolescent Victims of Interpersonal Violence

Only the minority of youth exposed to traumatic events receive mental health care, as trauma-informed clinical services are lacking or are poorly accessible. In order to bridge this gap, the Outpatient Trauma Clinic (OTC) was founded, an easily accessible early, short-time intervention, with onward referral to follow-up treatment. This report presents the OTC’s interventional approach and first outcome data. Using a retrospective naturalistic design, we analyzed trauma- and intervention-related data of the sample (n = 377, 55.4% female, mean age 10.95, SD = 4.69). Following drop-out analyses, predictors for treatment outcome were identified by logistic regression. The majority (81.9%) was suffering from posttraumatic stress disorder (PTSD) or adjustment disorders. Around one forth dropped out of treatment; these cases showed higher avoidance symptoms at presentation. In 91%, psychological symptoms improved. Experience of multiple traumatic events was the strongest predictor for poor treatment outcome (B = −0.823, SE = 0.313, OR = 0.439, 95% CI 0.238–0.811). Around two thirds were connected to follow-up treatment. The OTC realized a high retention rate, initial improvement of symptoms and referral to subsequent longer-term psychotherapeutic treatment in the majority. Further dissemination of comparable early intervention models is needed, in order to improve mental health care for this vulnerable group

Psychological and nutritional correlates of objectively assessed physical activity in patients with anorexia nervosa

Background: Physical activity (PA) plays a role in the course of anorexia nervosa (AN). Objective: To assess the association between PA, nutritional status and psychological parameters in patients with AN. Method: Using a wearable activity monitor, PA was assessed in 60 female AN inpatients, by step count and time spent in 4 metabolic equivalent (MET)-intensity levels: sedentary behaviour, light, moderate and vigorous PA. In addition, BMI, psychological (patient-reported outcome questionnaires) and nutritional parameters (body fat, energy and macronutrient intake) were assessed. Results: The study population spent little time in vigorous PA. BMI on admission and discharge was higher when more time was spent in sedentary behaviour, and lower with more time spent in light PA. Relationships between PA and patient-reported outcomes were weak and limited to an association between vigorous PA and compulsiveness. Low fat mass was associated with more time spent in light PA, while subjects with higher step counts showed less intake of energy, carbohydrates and fat. Conclusion: The relationship between inadequate food intake and increased PA in patients with AN requires further investigation

Belastungen, positive Veränderungen und Ressourcen von Familien in der COVID-19-Pandemie

Theoretischer Hintergrund: Die Maßnahmen zur Eindämmung der COVID-19-Pandemie stellten Familien vor Herausforderungen. Es fehlt an Studien, welche die umfassende Vielfalt der subjektiven Erfahrungen abbilden. Fragestellung: Ziel ist, Belastungen, positive Veränderungen und Ressourcen in Familien zu erfassen. Methode: 4 967 Eltern (87.6 % weiblich, 86.7 % mit Hochschulreife) minderjähriger Kinder (0 – 17 Jahre) nahmen an einer Online-Erhebung im August 2020 teil. Belastungen, positive Veränderungen und Ressourcen während der Pandemie wurden durch offene Fragen erfasst. Auf Basis der Freitextantworten wurde ein Kategoriensystem entwickelt und ausgewertet. Ergebnisse: Die Vereinbarkeit von Beruf und Privatleben (12 %), Sorgen um die Entwicklung der Pandemie (11 %) und eingeschränkte Betreuung und schulische Bildung (9 %) wurden am häufigsten als Belastungen genannt. Positive Veränderungen waren vermehrte Wertschätzung, Dankbarkeit und neue Einstellungen (16 %), engere Beziehungen innerhalb der Familie (13 %) und mehr Zeit mit Menschen (11 %). Wichtige Ressourcen für Familien waren das soziale Miteinander innerhalb der Familie (19 %) und positive Aktivitäten (13 %). Diskussion und Schlussfolgerung: Ansatzpunkte für familienzentrierte Präventionsmaßnahmen sind die Offenhaltung von Betreuungseinrichtungen, eine Flexibilisierung der Arbeitssituation, eine fortlaufende Aufklärung über notwendige Maßnahmen, Stärkung digitaler Unterstützungsangebote einschließlich der Verbesserung der Medienkompetenz, die Ermöglichung von Freizeitaktivitäten, sowie die Verbesserung psychosozialer Unterstützungsmaßnahmen.Theoretical Background: The COVID-19 pandemic and the resulting consequences led to new family challenges (e. g., school and daycare closings, home office). Studies examining the variety of experiences are scarce. Objective: We examined (1) what burdened families the most during the pandemic, (2) whether there were positive changes in families, and (3) what resources helped parents to manage the crisis. Method: We conducted an online survey in August 2020 in Germany with N = 4 967 parents (87.6 % female, 86.7 % higher school education) with minor children (0 – 17 years). We analysed their answers to three open-ended-questions: (1) “Overall, what caused you the most stress during the pandemic?” (2) “What has changed for the better during the pandemic?” (3) “What helped you the most during the pandemic?”. We used an inductive approach and developed a category system based on the answers. We analysed the frequencies of developed categories using MAXQDA (VERBI Software, 2019). Results: Parents were stressed most by the difficult compatibility of job and family life (12.0 %), worries about the progression of the pandemic (11.1 %), and the closure of care facilities and education institutions (8.5 %). On the other hand, parents also reported positive changes that emerged from the pandemic: more gratitude and new attitudes (16.1 %); closer relationships within the family (13.0 %); and more time to spend with others (10.6 %). Family resources were: social interaction within the family (19.1 %), outside family life (10.9 %), and increased positive activities (13.3 %). Discussion and Conclusion: Our results provide insight into the individual experiences of families during the COVID-19 pandemic in Germany. Based on the results, needs- and family-based interventions can be derived that focus on reducing the burden, on maintaining the positive changes on a long-term basis, and on strengthening family resources. Examples are opening child-care facilities, establishing flexible work arrangements, allowing social contact in social bubbles, providing information on actions, strengthening media competence, providing positive activities, training awareness for positive changes and resources, and disseminating support measures

Relationship between Borderline Personality Disorder, Emotional Availability, and Cortisol Output in Mother-Child Dyads

Background: Mothers with borderline personality disorder (BPD) often show altered emotional availability toward their own child and heightened stress vulnerability. The aims of the present study were (1) to examine total cortisol output in saliva during mother-child interaction in mothers with BPD and their children and (2) to test whether maternal nonhostility as a subscale of emotional availability mediates the relationship between maternal BPD and child total cortisol output. Methods: We investigated 16 mothers with BPD and 30 healthy control mothers (HC) and 29 children of mothers with BPD and 33 children of HC mothers. Children were between 5 and 12 years old. Salivary cortisol was collected prior to and twice after an episode of a 21-min standardized play situation between mother and child. Nonhostility was rated using the emotional availability scales. Analyses of covariance were computed to test for group differences in total cortisol output (measured with area under the curve with respect to ground). Pearson's correlation was calculated to test the association between maternal and child total cortisol output. To test the second question, a mediation analysis according to Preacher and Hayes was conducted. Results: Mothers with BPD and their children had lower total cortisol output. Maternal and child total cortisol output was significantly correlated. Contrary to our hypothesis, maternal nonhostility did not mediate the relationship between BPD and child total cortisol output. Conclusion: Results imply that the hormonal stress activity of mothers with BPD and their children is altered, which may reflect modified stress regulation and stress vulnerability in mother and child and may impact on mother-child interaction. The finding of a positive association between mother's and child total cortisol output could indicate an intergenerational transmission of these alterations

The mediating role of attachment and anger: exploring the impact of maternal early-life maltreatment on child abuse potential.

BACKGROUND Maternal early-life maltreatment (ELM) increases the risk of subsequent child maltreatment, but the underlying mechanisms of these intergenerational effects remain largely unknown. Identifying these mechanisms is crucial for developing preventive interventions that can break the cycle of abuse. Notably, previous research has shown that ELM often results in attachment insecurity and altered anger characteristics. Therefore, this study determines whether these characteristics mediate the relationship between maternal history of ELM and child abuse potential. METHODS The study sample included 254 mothers, of whom 149 had experienced ELM to at least a moderate degree. Maternal ELM was assessed using the Childhood Experience of Care and Abuse (CECA) interview. Attachment insecurity, trait anger and anger expression, and maternal abuse potential were assessed using the Vulnerable Attachment Questionnaire (VASQ), State-Trait Anger Expression Inventory (STAXI), and Child Abuse Potential Inventory (CAPI), respectively. RESULTS The severity of maternal ELM predicted higher child abuse potential, with attachment insecurity and anger suppression mediating this effect. Specifically, higher levels of maternal ELM were associated with greater attachment insecurity and increased anger suppression, resulting in a higher child abuse potential. Although higher levels of trait anger were directly associated with higher child abuse potential, this parameter did not mediate the relationship with ELM. In addition, no significant associations were observed between outwardly expressed anger and ELM or child abuse potential. All analyses were adjusted for maternal mental disorders, years of education, and relationship status. DISCUSSION Attachment insecurity and anger suppression may serve as pathways linking the maternal history of ELM to the risk of child abuse, even when considering maternal psychopathology. Overall, our findings indicate that interventions aimed at strengthening attachment and improving anger suppression may be beneficial for all mothers with ELM history and high child abuse potential, not just those who suffer from mental illness

Immediate impact of child maltreatment on mental, developmental, and physical health trajectories

Objective: The immediate impact of child maltreatment on health and developmental trajectories over time is unknown. Longitudinal studies starting in the direct aftermath of exposure with repeated follow-up are needed. Method: We assessed health and developmental outcomes in 6-month intervals over 2 years in 173 children, aged 3-5 years at study entry, including 86 children with exposure to emotional and physical abuse or neglect within 6 months and 87 nonmaltreated children. Assessments included clinician-administered, self- and parent-report measures of psychiatric and behavioral symptoms, development, and physical health. Linear mixed models and latent growth curve analyses were used to contrast trajectories between groups and to investigate the impact of maltreatment features on trajectories. Results: Maltreated children exhibited greater numbers of psychiatric diagnoses (b = 1.998, p < .001), externalizing (b = 13.29, p < .001) and internalizing (b = 11.70, p < .001) symptoms, impairments in cognitive (b = -11.586, p < .001), verbal (b = -10.687, p < .001), and motor development (b = -7.904, p = .006), and greater numbers of medical symptoms (b = 1.021, p < .001) compared to nonmaltreated children across all time-points. Lifetime maltreatment severity and/or age at earliest maltreatment exposure predicted adverse outcomes over time. Conclusion: The profound, immediate, and stable impact of maltreatment on health and developmental trajectories supports a biological embedding model and provides foundation to scrutinize the precise underlying mechanisms. Such knowledge will enable the development of early risk markers and mechanism-driven interventions that mitigate adverse trajectories in maltreated children

A Central Clearing Clinic to Provide Mental Health Services for Refugees in Germany

Objective: To determine migration related distress pattern in refugees and feasibility of a de novo established, central low-threshold outpatient clinic serving more than 80,000 newly arrived refugees in the metropole of Berlin. Methods: In an observational cohort study the relative prevalence of major psychiatric disorders by age, place of living within berlin, language and region of origin were assessed in a refugee cohort from 63 nationalities speaking 36 languages. Findings: Within 18 months, a total of 3,096 cases with a mean age of 29.7 years (11.7) have been referred from all 12 districts and 165 of 182 subdistricts of Berlin to the CCC. 33.7% of the patients were female. The three most frequent diagnoses were unipolar depression (40.4%), posttraumatic stress disorder (24.3%), and adjustment disorder (19.6%). Conclusion: The present data gives insight into the distribution of mental disorders in a large sample of refugees and provides evidence that a CCC is an effective service to quickly and broadly provide psychiatric consultations and thus to overcome classical barriers refugees usually experience in the host communities. In Berlin, Germany, and Europe treatment resources for this population should focus on stress and trauma related disorders