Anxiety, hyperkinetic syndrome, learning disabilities, depression, addictions, and eating disorders: The list of mental disorders affecting children and adolescents is long. If left unaddressed during childhood and adolescence, mental health problems often carry over into adulthood. "One in five children and adolescents is affected by mental disorders," says Falkai. "In adults, the figure rises to one in four. This makes mental illness one of the greatest challenges in medicine.”
Growing up as a risk factor: the risk of mental illness increases with age
As they grow older, adolescents are exposed to stress as they finish school, begin a professional career, form their own social networks, and find social roles. Nevertheless, the risk of mental illness is not only due to the maturation process. Research at the DZPG focuses on specific risk factors. Falkai explains: "The number of mental disorders in children and adolescents increased significantly during the coronavirus pandemic, with contact restrictions, loneliness, and higher levels of domestic violence". The increase is confirmed by a study conducted by the BKK umbrella organization on behalf of the Children's Health Foundation. It shows that in the pandemic years 2020 and 2021, 15-19-year-old female policyholders in particular suffered from psychological symptoms. Anxiety and adjustment disorders were observed at above-average rates. And the next crisis is already here: "We are also observing an increase in post-traumatic stress disorder and depression due to external stressors such as armed conflicts.”
Prevention before treatment
"Many of the DZPG's research projects are aimed at prevention," says Prof. Falkai. "Many mental disorders develop their first symptoms even before they become manifest. In practice, these first external signs are often unspecific: "They include sleep disturbances, inner restlessness, and physical complaints such as stomach aches, headaches, and back pain. Eventually, this development can lead seamlessly to anxiety disorders. A deterioration in concentration and therefore in school performance is also frequently observed. Experts are registering increasing numbers of cases in such areas as well: Among schoolchildren, potentially psychosomatic complaints such as headaches, stomachaches, and backaches, as well as problems falling asleep and depression, have increased significantly over the years. That's one of the findings of WHO's Health Behavior in School-aged Children (HBSC) study.
Preventing mental disorders in young people
The DZPG's research on primary prevention is aimed at this early stage: the goal is to reduce the likelihood that children and adolescents will develop mental disorders. Prof. Dr. Andreas Meyer-Lindenberg, Director of the Central Institute for Mental Health in Mannheim and spokesperson for the DZPG, explains: "The first step is to measure mental health at all. The DZPG is currently carrying out such a measurement in Bochum with the German Health Barometer. A representative sample of the population is regularly asked about their mental health. This makes it possible to measure changes in the mental health of the population - for example, during an economic crisis or a pandemic - so that measures can be taken to prevent a collapse.
Research for children at risk
The risk of mental illness is not the same for all children and adolescents in Germany: "We know risk factors that can trigger or exacerbate mental illness. Premature birth is one of them," says Falkai. This is the focus of the DZPG site in Tübingen. As part of an early detection program, the families of premature babies are closely monitored in order to identify possible early symptoms of mental illness and to reduce the family stress caused by the premature birth. At the same time, a large cohort of twins is being followed to understand risk and resilience factors, identify early symptoms and offer intervention options.
However, risks also arise in the further course of the disease. Prof. Dr. Dr. Andreas Heinz, Director of the Department of Psychiatry and Psychotherapy CCM at the Charité - Universitätsmedizin Berlin and spokesperson for the DZPG: "One factor is socio-economic status, particularly with regard to barriers to access to health care, but also mental health literacy: How much do I know about mental health? Growing up in an urban area and having one or both parents unemployed are also risk factors for mental disorders. Minority status is another risk factor. For this reason, the DZPG launched a project in the Wattenscheid district of Bochum. An above-average number of people there live in precarious circumstances, have a migration background, or are affected by unemployment. Under the motto "Urban Mental Health" (UMH), the Research and Treatment Center for Mental Health (FBZ) at the Ruhr University Bochum is developing a novel prevention concept. For the first time, it brings together science, policy, and practice to improve the mental health of children and adolescents. The project aims to improve the mental health of teachers by increasing their resilience, and to develop a curriculum for students to improve their mental health literacy. If successful, it could become a blueprint for the whole of Germany.
Mental health problems of parents as a risk factor
Researchers at the FU Berlin are focusing on children of parents who have difficulty dealing with their children because of their own mental stress. This can mean, for example, that one or more parents suffer from a mental illness (e.g. depression or anxiety disorders) or have limited social or financial resources. Research shows that such stressors can be associated with increased parental stress, which in turn can make it more difficult to communicate and interact with one's children. An app is being developed as a low-threshold way for parents to strengthen their own mental health and promote positive parenting behaviors.
Earlier diagnosis for a better start in adulthood
The DZPG is also conducting research into secondary prevention, i.e. improving the chances of treatment by detecting diseases at an early stage. Falkai: "The DZPG is currently evaluating centers for the early detection and initial treatment of mental illnesses and wants to improve the information available to the public. The goal is for children, adolescents and their families to have access to competent early detection centers that specialize in mental disorders. "Only experts can distinguish symptoms that indicate a mental illness from those that are part of normal maturation and development processes.”
References
Child Health Report 2023 of the Child Health Foundation: https://www.kindergesundheit.de/Die-Stiftung/Kindergesundheitsberichte/Kindergesundheitsbericht_digital.pdf
Health Behavior in School-aged Children (HBSC) study, WHO: https://www.who.int/europe/initiatives/health-behaviour-in-school-aged-children-(hbsc)-study/highlights
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