Child and Adolescent Psychiatry
Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy

Early detection of depression and anxiety symptoms between the ages of 16 and 22

Many young people in Germany suffer from mental disorders, with depression and anxiety disorders being particularly common. In order to recognize and prevent mental stress as early as possible, we have developed a method for the early detection of mental illnesses in the areas of depression and anxiety disorders as part of this study project. The main objectives are to improve the mental health and quality of life of adolescents and young adults and to prevent mental illness. Our focus here is on the prevention of depression and anxiety disorders.

More about the study

The project "Role of parenting stress for child and parental well-being" exists in cooperation with the "Frühe Hilfen" of the department "Family and Family Policy" at the German Youth Institute (DJI). The aim of the research project is to investigate in a pilot project 1) the experienced daily parenting stress in real time by means of an Ecological Momentary Assessment (EMA) and 2) the role of parenting stress for the well-being of children. In addition, 3) to examine the role of subjectively experienced parenting stress on parent-child interactions. To this end, parents with children aged 6 months to 3 years, will be studied in a mixed-methods design over a two-week period using questionnaires and saliva samples. In addition to testing the instruments and the feasibility of the study design, the results will provide initial indications of the interactions between parental and child psychophysiological states and how early intervention services can be adapted to meet the needs of parents who experience high levels of stress in their parenting role.

The transition to parenthood is accompanied by a variety of biological, behavioral, social, and psychological changes (Saxbe/Rossin-Slater/Goldenberg 2018). During the perinatal period (from pregnancy to one year postpartum), the risk for sleep disturbances, increased psychosocial stress, mental illness, and changes in physical health, including unhealthy weight gain, increases (Endres et al. 2015). These factors can negatively impact parent-child interactions, which in turn are critical to the child's later health (Olson/Bates/Bayles 1990).
With this in mind, it can be summarized that the perinatal period is a critical life stage for parent and child health. Digital approaches, such as apps or digital consultation hours, which have also gained importance in prevention research in recent years, are one way of offering families low-threshold support that is available at all times.

Publications

• Versele, V., Deforche, B., Aerenhouts, D., Clarys, P., Devlieger, R., Bogaerts, A., Liel, C., Löchner, J., Deliens T. (2022). Recommendations for the Development of Family-Based Interventions Aiming to Prevent Unhealthy Changes in Energy Balance-Related Behavior during the Transition to Parenthood: A Focus Group Study. Nutrients 14, no. 11: 2346. MDPI. https://doi. org/10.3390/nu14112346, IF 2022: 5,719.

What do I wish I had known before I developed a mental health disorder? What was most helpful for me in psychotherapy?
Based on these key questions, the Mental Health Crowd has developed a smartphone and web-based app to promote mental health and well-being - the Mental Health Guide. The goal here is to strengthen Mental Health Literacy in the general population. This refers to knowledge about mental illness and health. The acceptance and effectiveness in terms of improving Mental Health Literacy of the Mental Health Guide will be tested within the framework of this research project.
The aim is to include 150 young people from the age of 14 years in a randomized controlled study (pre-post assessment, 3- and 6-month follow-up). Over six months, the training group will use the Mental Health Guide and finally be compared with the waiting group receiving no additional mental health information (treatment as usual).

Collaborating partners are:

• Prof. Dr. Caterina Gawrilow (Department of Psychology, Eberhard Karls- Universität Tübingen
• Dominique de Marné and Lasse Münstermann(Mental Health Crowd).

The bidirectional effect relationship between emotions and immune system activity is a central research topic in PNI. Previous research has established links between negative emotions such as fear and sadness and systemic inflammation. In this regard, if not properly regulated, negative emotions can cause biological wear and tear in the body that may increase the risk for morbidity and mortality. In this study, the influence of emotional states on the concentration of immunoglobulin-A in saliva will be investigated in an outpatient monitoring over a period of one week, thus providing evidence on the importance of psychological variables on immune system activity in the daily life of the subjects.

(Emotional Competence and Well-Being in Young People).

The ECoWeB project aims to develop and disseminate a mobile application (app) that provides engaging and personalized tools and psychological skills to promote emotional well-being and prevent mental health problems in adolescents and young adults.
The project team consists of eight European countries (United Kingdom, Germany, Belgium, Spain, Greece, Czech Republic, Denmark, and Switzerland) working together to improve mental health care and access for youth:

• Using technology as a tool to assess and promote emotional well-being.
• Delivering empirically supported mental health interventions via a mobile application to meet the needs of adolescents.
• Improving access to mental health care and preventing mental health problems among youth.

As part of the ECoWeB project, the MyMoodCoachApp was developed. Our app aims to:

• Better understand young people's emotions and emotional capacities by tracking emotions through a mobile app and through web assessments over a year.
• To promote well-being and prevent poor mental health by providing tools and exercises that can be done in the mobile app.

Participants are young people aged 16-22 years from the UK, Germany, Spain, and Belgium who do NOT have current or previous psychiatric disorders or acute suicidality. Recruitment is complete with n=3800 participants.

Study website
https://www.ecowebproject.eu/
https://www.mymoodcoach.com/

Study protocol

• Newbold, A., Warren, F.C., Taylor, R.S. Hulme, C., Burnett, S., Aas, B., Botella, C., Burkhardt, F., Ehring, T., Fontaine, J.R.J., Frost, M., Garcia-Palacaios, A., Greimel, E., Hoessle, C., Hovasapian, A., Huyghe, V., Löchner, J., Molinari, G., Pekrun, R., Platt, B., Rosenkranz, T., Scherer, K.R., Schlegel, T., Schulte-Körne, G., Suso, C., Voigt, V., Watkins, E.R. (2020). Promotion of mental health in young adults via mobile phone app: study protocol of the ECoWeB emotional competence for well-being in young adults) cohort multiple randomised trials. BMC Psychiatry 20, 458 Springer Nature. IF 2021: 3.388

Because the children of depressed parents are at greatest risk of developing depression themselves, prevention programs for this population have important public health significance. The PRODO study was a randomized controlled trial (RCT) of a family- and group-based CBT prevention program for children of depressed parents. We translated and adapted the Raising Healthy Children prevention program (Compas et al., 2009) into German language and culture. 135 children and adolescents (aged 8-17 years) with no psychiatric history and their parents with a depressive disorder participated in the study. After a clinical interview and baseline testing, families were randomly assigned to either the prevention intervention or the control group with usual care. The intervention consisted of 8 weekly and 4 monthly sessions in groups of 3-4 families based on three modules: psychoeducation about parental depression, coping strategies for children, and parent training. Follow-up assessments took place after the intervention, 9 and 15 months after baseline. Assessments included clinical interviews with parents and children and questionnaires assessing psychopathology, knowledge of depression, cognitive and emotional factors, and parenting style. Our hypothesis was that participants in the experimental group would be at lower risk for depression compared with the control group, which received no intervention, as indicated by a lower number of depressive episodes at 15-month follow-up and a lower number of psychopathological symptoms at 9- and 15-month follow-up.

Publications

• Sfärlea, A., Takano, K., Buhl, C., Löchner, J., Greimel, E., Salemink E., Schulte-Körne, G., Salemink, E., Platt, B (2021). Emotion Regulation as a Mediator in the Relationship Between Cognitive Biases and Depressive Symptoms in Depressed, At-risk and Healthy Children and Adolescents. Res Child Adolesc Psychopathol 49, 1345-1358.Springer. https://doi.org/10.1007/s10802-021-00814-z IF 2022: 3,406
• Buhl, C., Sfärlea, A. , Loechner, J., Starman-Wöhrle, K., Salemink, E., Schulte-Körne, G., & Platt, B. (2021). Biased Maintenance of Attention on Sad Faces in Clinically Depressed Youth: An Eye-Tracking Study. Child Psychiatry & Human Development., Springer. https://doi.org/10.1007/s10578-021-01229-z. IF 2021:2.35
• Löchner J., Platt, B., Starman, K., Takano, K., Engelmann, L., Voggt, E., Loy, F., Bley, M., Winogradow, D., Hämmerle, ^S ., Neumeier E., Wermuth, I., Schmitt, K., Oort, F., Schulte-Körne, G., (and. rev.). A randomized controlled trial of a preventive intervention for the children of parents with depression: mid-term effects, mediators and moderators. BMC Psychiatry. Springer Nature. IF 2021: 3.388
• Löchner, J., Starman, K., Sfärlea, A., Oort, F., Thompsen, L., Schule-Körne, G., Platt, B., (2020). Risk of Depression in the Offspring of Parents with Depression: The Role of Emotion Regulation, Cognitive Style, Parenting and Life Event. Child Psychiatry and Human Development. Springer. 51, 294-309. https://doi.org/10.1007/s10578-019-00930-4 IF 2021: 2.35
• Sfärlea, A., Löchner, J., Neumüller, J., Asperud Thomsen, L., Starman, K., Salemink, E., Schulte-Körne, G., & Platt, B. (2019). Passing on the half-empty glass: A transgenerational study of interpretation biases in children at risk for depression and their parents with depression. Journal of Abnormal Psychology, 128(2), 151-161. https://doi.org/10.1037/abn0000401
• Löchner, J.*, Starman, K.*, Galuschka, K., Tamm, J., Schulte-Körne, G., Rubel, J., Platt, B., (2018). Preventing depression in the offspring of parents with depression: A systematic review and meta-analysis of randomised controlled trials. Clinical Psychology Review. Science Direct. Mar; 60:1-14. doi: 10.1016/j.cpr.2017.11.009 IF 2021: 12,792
• Löchner, J., Platt, B. (2022). Depression in childhood and adolescence: timely identification, prevention, and effective treatment. In Depression in childhood and adolescence. Kohlhammer. Eds Greimel E., & Schulte-Körne, G.
• Löchner, J. (2018). Transmission and Prevention of Depression in the Offspring of Parents with Depression - Differences and changes in psychopathology, emotion regulation and attributional style. Dissertation, Faculty of Medicine, LMU.

Study: "Kinder in Deutschland 2022/Kinder von 0-3 Jahren in Deutschland
Nationwide representative study after the Corona pandemic", in cooperation with the National Center for Early Help (NZFH).

This study aims to investigate psychosocial stress factors of families with children aged 0-3 years and their utilization behavior of preventive services.
The focus of this research project is parental and child well-being, after extensive contact-restricting measures have been taken repeatedly since spring 2020, which have also strongly changed the everyday life of families. In the online survey launched in March 2022, it was possible to include questions on the experience of the situation due to the war in Ukraine at short notice.
In 2022, the NZFH will again collect data on psychosocial stress among families with 0- to 3-year-old children in Germany and on their knowledge and use of generally accessible support services as well as specific early help services, analogous to the KiD 0-3 study of 2015. For the study, the NZFH is cooperating with pediatricians' and adolescents' practices to recruit parents to participate in the study. In addition to the information provided by the parents, a pediatric assessment of the child's health and developmental status is obtained.
The results are used to identify children and parents who are particularly affected, to make their need for help visible, and to further develop both early help and pediatric care and adapt them even better to the needs of families.
The study is funded by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth as part of the Federal Foundation for Early Help from the Federal Government's action program "With Corona for Children and Adolescents".

Study website:
https://www.fruehehilfen.de/forschung-im-nzfh/praevalenz-und-versorgungsforschung/kid-0-3-repraesentativbefragung-2022

Publications of previous study

• Lux, U., Entleitner-Phleps, C., Löchner, J., Walper, S., Langmeyer, A.N., & Ulrich, S.M., (2022). Help needs and utilization of support services in single-parent, step, and nuclear families. Befunde aus zwei repräsentativen deutschen Studien / Need for support and use of prevention services in nuclear, single parent and stepfamilies. Findings from two representative German studies. Health care. Georg Thieme. IF 2022: 0.419
• Ulrich, S. M., Renner, I., Lux, U., Walper, S., & Löchner, J. (2022). Families with increased parental stress and conflict potential: a target group for psychosocial support services? The Public Health Service, 84, 1-8. https://doi.org/10.1055/a-1867-4415 IF 2022: 0.419
• Ulrich, S.U., Löchner, J., Walper, S. Ghezih, S., Lux, U. (2022.). What are the psychosocial stresses of families with a child with a developmental disability and what support services do they use? Results from a longitudinal population study. Childhood and development. Hogrefe. vol. 31, pp. 164-173, 2022. https://doi.org/10.1026/0942-5403/a000384 IF: 2022: 0.802
• Ulrich, S. M., Löchner. J., Paul, M., Lux, U. (2021). Stability and change in self-reported psychosocial stress among parents of small children-results of the longitudinal study "Kinder in Deutschland - KiD 0-3". Dtsch Arztebl Int;118(35-36):595-6. Deutscher Ärzteverlag.doi: 10.3238/arztebl.m2021.0262. IF 2021: 5.594.
• Lux, U., Löchner, J., & Liel, C. (2020). Stresses from the very beginning. Frühe Kindheit 03/20 German League for the Child in Family and Society e.V.
• Lorenz, S., Sann, A., Ulrich, S.M., Löchner, J., Seilbeck, C., Liel, C., Walper, S., (in press). Living situations and burdens of families with infants and young children in Germany- Central results of the study "Children in Germany - KiD 0-3". NZFH.