Knappe S, König K, Zink JJ
… +2 more, Glasow N, Lewitzka U
Z Kinder Jugendpsychiatr Psychother
· 2026 Mar · PMID 41404673
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In-Hospital Suicides in Children and Adolescents: First Analyses of the Werner Felber Institute Database on Child and Adolescent Psychiatric Wards Suicide is a significant challenge and a clinical phenomenon among adole...In-Hospital Suicides in Children and Adolescents: First Analyses of the Werner Felber Institute Database on Child and Adolescent Psychiatric Wards Suicide is a significant challenge and a clinical phenomenon among adolescents and young adults. Suicide risk for youth receiving inpatient psychiatric treatment is likely increased, given higher levels of psychosocial strain among inpatients than among youth in the general population. To report on the number, frequency, and characteristics of in-hospital suicide attempts and suicides among children and adolescents receiving inpatient psychiatric treatment. Our analyses are based on the Werner-Felber-Institute Database, which includes all cases from 2019 to 2024, inasmuch as data on age, gender, or year of suicidal behavior were available. Assessment of characteristics related to suicidal behavior included data on hazardousness, lethality, psychopathology, likelihood for discovery, method, and motive. Eight cases of suicide and 85 suicide attempts were reported among youth, with a mean age of 15.63 and 15.84 years. Compared to in-hospital suicide behavior in adults, these numbers were substantially lower for suicide but substantially higher for suicide attempts. Most suicide attempts among children and adolescents took place within the hospital building, using intoxication. The results provide first insights into suicide behavior among youth receiving inpatient psychiatric treatment. The high number of suicide attempts points to a significant risk constellation even while in clinical care. To delineate targeted preventive interventions, we need greater accuracy in data collection.
Teichmann M, Golub Y, Roessner V
… +1 more, Kuitunen-Paul S
Z Kinder Jugendpsychiatr Psychother
· 2026 May · PMID 41404672
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Prevalence and Correlates of Smoking Behavior Among Patients with Substance Use Disorders in a Specialized Adolescent Psychiatric Outpatient Clinic Germany lacks recent data on the incidence and severity of tobacco use...Prevalence and Correlates of Smoking Behavior Among Patients with Substance Use Disorders in a Specialized Adolescent Psychiatric Outpatient Clinic Germany lacks recent data on the incidence and severity of tobacco use and tobacco use disorders (TUD) in high-risk populations, especially among adolescent outpatients with substance use disorders (SUDs). We collected data from 134 adolescents in a specialized SUD outpatient unit for adolescent psychiatric patients using structured interviews (consumption and disorder symptoms) and a sociodemographic caregiver questionnaire (education, subjective financial status, and housing status). Descriptive data and linear regression models present possible associations between consumption, disorder diagnoses, and social demographics. There were high 30-day prevalence rates for smoking (95 %), daily smoking (79 %), heavy or very heavy smoking (61 % and 23 % among smokers, respectively), and past-year TUD (77 %). Daily average consumption of = 11.0 cigarettes was associated with a lower age at first use (= 12.6 years), which in turn was lower for those with a lower level of education and a worse financial situation. The extremely high prevalence of smoking, early onset of use, and high rate of TUD highlight the urgent need for tailored smoking cessation programs for adolescents with SUD.
Hess L, Hertel C, Lerch S
… +2 more, Reichl C, Kaess M
Z Kinder Jugendpsychiatr Psychother
· 2026 Mar · PMID 41364018
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Adolescent borderline personality disorder (BPD) is associated with an elevated risk of suicidal behavior, with suicide reattempts often considered a hallmark of the disorder. However, empirical evidence linking BPD to s...Adolescent borderline personality disorder (BPD) is associated with an elevated risk of suicidal behavior, with suicide reattempts often considered a hallmark of the disorder. However, empirical evidence linking BPD to suicide reattempts in youth remains limited and inconsistent. This study investigates whether BPD predicts suicide reattempts in a high-risk clinical adolescent sample. We drew our data from two longitudinal clinical samples ( = 323, 87 % female, = 15.11, = 1.54) with specialized treatment for self-harm and risk-taking behavior. We assessed BPD and suicide attempts at baseline and two annual follow-ups, using multinomial logistic regression to test whether BPD at baseline predicted suicide reattempts. Overall, 21 % of adolescents reported at least one suicide reattempt during the follow-up period. While a BPD diagnosis and a higher number of fulfilled BPD criteria were significantly associated with ever having attempted suicide, neither was significantly associated with suicide reattempts. Among adolescents receiving specialized care, BPD is linked to a history of suicide attempts but does not independently predict repeated attempts, challenging assumptions about chronic suicidal risk and treatment resistance as defining features of BPD and underscoring the need to differentiate between initial and recurrent suicidal behaviors.
Müller H, Berthold D, Kiepke-Ziemes S
… +1 more, Doering BK
Z Kinder Jugendpsychiatr Psychother
· 2026 Jul · PMID 41364003
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A Stepped Bereavement Care Model for Children and Young People Losing a caregiver can have a profound impact on the health and quality of life of children and young people (CYP). The provision of needs-based support fo...A Stepped Bereavement Care Model for Children and Young People Losing a caregiver can have a profound impact on the health and quality of life of children and young people (CYP). The provision of needs-based support for this group is questionable. Germany lacks a structured framework that could organize bereavement care for CYP, incorporate the various professional groups and institutions involved, and lead to the establishment of quality standards. This article discusses an Irish stepped-care model at an international level. Adapting it to the German context and disseminating can contribute to the professionalization of bereavement care for CYP. We adapted the stepped-care model through an iterative consensus process involving experts in psychology, psychotherapy, grief counselling, bereavement support, and social work. The German adaptation outlines a four-stage model, beginning at the societal level. Support is tailored to the specific needs of CYP and their families, with support options including the social environment, low-threshold services, and psychotherapy. Facilitating transitions between the levels of care is particularly important to accommodate the dynamic nature of support needs. Establishing a stepped-care framework can contribute to a more needs-based approach to caring for bereaved CYP. Implementing this model requires a systematic identification of needs to avoid potential gaps in care.
Z Kinder Jugendpsychiatr Psychother
· 2026 Mar · PMID 41293817
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Suicide Among Adolescents: Prior Use of Psychiatric Services and Opportunities Offered by Digital Prevention Programs Suicide prevention in adolescence poses a challenge to society as a whole, in which child and adolesc...Suicide Among Adolescents: Prior Use of Psychiatric Services and Opportunities Offered by Digital Prevention Programs Suicide prevention in adolescence poses a challenge to society as a whole, in which child and adolescent psychiatry plays a central role in view of the high prevalence of mental disorders among suicides. But how often do adolescents actually seek psychiatric help before committing suicide? This review looks at contact rates with psychiatry and other institutions prior to suicide. It examines how nonlethal suicide attempts often precede suicide as a "warning signal," and which individual and structural barriers prevent young people from seeking psychiatric help. Furthermore, it discusses whether messenger-based prevention programs reach those adolescents who do not seek psychiatric care. This review highlights existing gaps in care and identifies possible starting points for digital prevention strategies in practice.
Degenhardt F, Wohlleber E, Spitczok von Brisinski I
… +9 more, Godo B, Radtke F, Freitag CM, Holtmann M, Hinney A, Siniatchkin M, Schaaf CP, Hebebrand J, Nöthen MM
Z Kinder Jugendpsychiatr Psychother
· 2026 Jan · PMID 41257338
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Genetic Diagnostics in Children and Adolescents with Mental Disorders In Germany, genetic testing is part of the guideline-based diagnostic work-up for patients with intellectual disability. This is particularly the case...Genetic Diagnostics in Children and Adolescents with Mental Disorders In Germany, genetic testing is part of the guideline-based diagnostic work-up for patients with intellectual disability. This is particularly the case for patients who show additional symptoms (i. e. malformations, epilepsy) or abnormal growth (i. e. microcephaly or macrocephaly). Implementation of diagnostic genetic testing is currently hampered by the still-limited practical experience of colleagues practicing child and adolescent psychiatry (CAP) and the little-practiced interaction with physicians working in clinical genetics. Additionally, the current funding modalities for genetic testing are not well-suited for routine clinical care in CAP. This paper presents a guide for physicians working in CAP who aim to implement guideline-based genetic testing into their routine clinical care. It focuses on steps relevant to ordering genetic testing, from obtaining informed consent to receiving and reporting the test results to those affected.
Z Kinder Jugendpsychiatr Psychother
· 2026 May · PMID 41222403
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Depressive Disorders - From ICD-10 to ICD-11 This article presents the main changes in the classification of depressive disorders associated with the transition from ICD-10 to ICD-11. We evaluate the changes regarding t...Depressive Disorders - From ICD-10 to ICD-11 This article presents the main changes in the classification of depressive disorders associated with the transition from ICD-10 to ICD-11. We evaluate the changes regarding their relevance for diagnostic assessment during childhood and adolescence and the current state of research. Some changes were implemented in the categorization of disorders: In ICD-11, depressive disorders are listed as a disorder group separately from bipolar disorders and now include both dysthymic disorder as well as mixed depressive and anxiety disorder. With the introduction of ICD-11, the diagnostic criteria for depressive episodes were revised, however, specific considerations for diagnoses in children and adolescents remain unaddressed. The ICD-11 newly introduces the diagnosis of premenstrual dysphoric disorder as a depressive disorder, in parallel to DSM-5. In addition, it introduced seven diagnostic specifiers that describe depressive disorders beyond the diagnosis. The clinical descriptions and diagnostic guidelines were comprehensively updated with the revision of the ICD criteria and supplemented with developmental characteristics, which are particularly relevant for the assessment of children and adolescents. However, the guidelines are not yet included in the German draft version currently available online. More research with children and adolescents is needed to evaluate the reliability of the updated diagnostic criteria for this age group.
Z Kinder Jugendpsychiatr Psychother
· 2025 Nov · PMID 41222299
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Impairments in reward processing and inhibitory control are key neurocognitive dysfunctions implicated in various mental disorders during adolescence, including major depressive disorder (MDD) and behavioral addictions (...Impairments in reward processing and inhibitory control are key neurocognitive dysfunctions implicated in various mental disorders during adolescence, including major depressive disorder (MDD) and behavioral addictions (BAs). They are associated with greater symptom severity and poorer treatment outcomes. Among adults, repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) has shown promise as a neuromodulation approach targeting these neural circuits. However, evidence regarding the neurophysiological effects of rTMS in adolescents with these conditions remains scarce. This study investigates the acute, short-term, and medium-term effects of high-frequency rTMS on neurophysiological markers and clinical symptoms in adolescents with MDD and BAs. This protocol describes a double-blind, randomized, sham-controlled trial enrolling adolescents 12-17 years diagnosed with MDD or BAs. We randomized the participants to receive either active rTMS (15 Hz, 120 % resting motor threshold, 1,600 pulses per session in 40 trains of 4 s) or sham stimulation. We studied the immediate rTMS effects after and during a singular rTMS session in both diagnostic groups as well as the effects of 12 rTMS sessions for the MDD group. We assessed self-report via the Children's Depression Rating Scale-Revised (CDRS-R) and craving scales adapted for BA. The neurophysiological outcomes include EEG-derived event-related potentials (Reward Positivity, N45, P300, P60, N100, LPP) to examine reward processing, cortical excitability/inhibition, and cue reactivity. The statistical analyses applied mixed-effects models with a planned sample size of 32 participants per group. This study provides novel insights into the neurophysiological mechanisms underlying rTMS effects on the DLPFC in adolescent MDD and BAs. Demonstrating modulation of reward- and inhibition-related EEG markers alongside clinical improvement could strengthen the evidence for rTMS as a safe and effective intervention, while informing future personalized treatment strategies for these vulnerable populations.
Neumann A, Seifert M, Kliemt R
… +4 more, Claus F, Schmitt J, Swart E, Baum F
Z Kinder Jugendpsychiatr Psychother
· 2026 Jan · PMID 41212890
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Changes in the Utilization in a Flexible and Integrated Model Project for Child and Adolescent Psychiatry in Germany We tested hypotheses regarding patients in a flexible and integrative care model of a Child and Adoles...Changes in the Utilization in a Flexible and Integrated Model Project for Child and Adolescent Psychiatry in Germany We tested hypotheses regarding patients in a flexible and integrative care model of a Child and Adolescent Psychiatry unit offering intensive treatment in an outpatient setting (TIBAS) (intervention group, IG) compared to a control group (CG): reduction in inpatient/daycare treatment and length of stay, increase in outpatient care in hospital, lower readmission and emergency admission rates. We included patients treated between 2018 and 2021 based on routine data from the statutory health insurance system. We formed matched comparison groups from structurally similar control clinics using propensity score matching. The comparison of the IG and the CG referred to the year before and after study inclusion. We analyzed data from a total of 1,806 children and adolescents. The evaluation points towards a strengthening of outpatient care in the IG. However, we found no reduction in the duration of inpatient or daycare treatment nor in the length of stay in the IG compared to the CG across all diagnoses, nor did we determine a decrease in readmission or emergency admission rates. The results indicate an intensification of outpatient care in the model hospital, without evidence of its effects on inpatient utilization. Evaluations of patient-related outcomes of the model project with a comparison group will follow.
von Trott J, Primbs R, Iglhaut L
… +9 more, Kaubisch S, Saffenreuther AK, Piechaczek CE, Kloek M, Keim PM, Zsigo C, Feldmann L, Schulte-Körne G, Greimel E
Z Kinder Jugendpsychiatr Psychother
· 2025 Nov · PMID 41048100
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"ich bin alles": A Web-Based Information Portal on Depression and Mental Health in Children and Adolescents "ich bin alles" is a digital information portal that provides evidence-based information on depression and ment..."ich bin alles": A Web-Based Information Portal on Depression and Mental Health in Children and Adolescents "ich bin alles" is a digital information portal that provides evidence-based information on depression and mental health in children and adolescents through a website and associated social media channels. The service is aimed at children and adolescents aged 12-18 with and without depression as well as their parents. The aims are 1) to educate about depression and prevention and treatment options, 2) to strengthen mental health and increase help-seeking behaviour, and 3) to destigmatise the disorder. Evidence-based information on the symptoms, diagnosis, causes, and course of depression as well as guideline-based treatment are provided to the target groups, thus fostering specific knowledge and concrete help for early diagnosis and treatment. In addition, children, adolescents, and their parents receive information about prevention options. The website is scientifically evaluated on an ongoing basis. A central aspect in all phases of the project is the active participation of all target groups, who continuously contribute to the development of content, website design, and social-media channels as well as to the evaluation. Information regarding "ich bin alles" is distributed in a variety of ways, including workshops, media, and scientific congresses. This article provides the first comprehensive introduction of the project in a scientific journal and informs about the development of evidence-based digital information tools as well as how to disseminate "ich bin alles" among colleagues and target groups.
Z Kinder Jugendpsychiatr Psychother
· 2026 May · PMID 41036862
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A paucity of research exists on the subject of positive child relationship behavior toward parents, particularly in children with mental disorders. We invited the mothers of children 3 to 7 years with mental disorders a...A paucity of research exists on the subject of positive child relationship behavior toward parents, particularly in children with mental disorders. We invited the mothers of children 3 to 7 years with mental disorders according to the ICD-10 to complete questionnaires on positive child relationship behavior, child behavior problems, maternal psychopathology, dysfunctional parenting, and maternal sense of competence. 71 children (56 boys and 15 girls, mean age = 64.07 [ = 11.75] months with their mothers (mean age = 33.94 [ = 6.49] years) participated in this pilot study. Children with primarily internalizing disorders did not differ from the general population regarding the frequency of positive relationship-relevant behavior toward their mothers. Conversely, children with externalizing disorders and those with a residual diagnosis exhibited significantly lower frequencies of positive behavior toward their mothers. Dysfunctional parenting behavior and maternal psychopathology did not correlate with the frequency of children's positive relationship behavior toward their mothers. However, maternal sense of competence correlated significantly positively with positive child relationship behavior. It is imperative to systematically assess positive child relationship behavior as perceived by their parents to obtain a more comprehensive perspective on the child.
Z Kinder Jugendpsychiatr Psychother
· 2026 Mar · PMID 41017200
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The Safety Plan as a (Supplementary) Brief Intervention for Adolescents with Suicidal Behavior The forthcoming German S3 guideline on managing suicidal behavior recommends the implementation of a safety plan for suicida...The Safety Plan as a (Supplementary) Brief Intervention for Adolescents with Suicidal Behavior The forthcoming German S3 guideline on managing suicidal behavior recommends the implementation of a safety plan for suicidal behavior in adolescents. To be effectively used in a future suicidal crisis, this safety plan should be completed together with the adolescent. This self-efficacy increasing plan includes, among other things, the identification of (early) warning signs of an impending suicidal crisis, a step-by-step list of individualized coping strategies, and - if these fail - specific contact information for supportive individuals, professional help resources, and the emergency number of the department for child and adolescent psychiatry. Originally developed for adults by Stanley and Brown, the safety plan has since been modified, expanded, and supplemented with youth-specific aspects (e. g., involvement of parents). After a brief overview of the evidence, this article describes the safety plan intervention in detail. We made a master version for adaptation and personal use, including detailed instructions, available online. First feedback from adolescents following the implementation of the safety plan has been positive, and the intervention is well-received. Therapists using the safety plan also find it helpful in treating suicidal behavior in adolescents. Future scientific studies will show whether this therapy component can reduce suicidal behavior in different subgroups.
Reiß F, Volk C, Behn S
… +8 more, Kaman A, Klos L, Burchartz A, Hinz T, Hanssen-Doose A, Woll A, Niessner C, Ravens-Sieberer U
Z Kinder Jugendpsychiatr Psychother
· 2025 Nov · PMID 40994078
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Mental Health and Physical Activity among Adolescents from Different Social Backgrounds: Results of the German COMO-Study Investigating the effects of the COVID-19 pandemic is central to future health strategies. This...Mental Health and Physical Activity among Adolescents from Different Social Backgrounds: Results of the German COMO-Study Investigating the effects of the COVID-19 pandemic is central to future health strategies. This article provides population-based data on the mental health and physical activity of children and adolescents in Germany, considering sociodemographic characteristics. The data refer to the population-based representative COMO-study with 5240 participants aged 4 to 17 years, surveyed between October 2023 and February 2024. It assessed mental health problems (SDQ), health-related quality of life (HRQoL, KIDSCREEN-10); and physical activity (WHO physical activity recommendation, sport) and calculated prevalence stratified by age, gender, and socioeconomic status (SES) as well as regression analyses. 21 % of youth reported mental health problems, 14.5 % had low HRQoL, and 19.8 % fulfilled the WHO activity recommendation. Adolescents with low SES showed more mental health problems (29.9 % low vs. 10.7 % high), lower HRQoL, and were less active both in sports clubs (46.8 % low vs. 77.1 % high) and outside sports clubs. Physical activity was associated with fewer mental health problems (OR = 0.66-0.74) and higher HRQoL (OR = 1.19-1.73). Differences in age and gender showed heterogeneous results. Five years into the pandemic, socioeconomic inequalities in mental health, well-being, and physical activity persist. Physical activity can be a promising complementary approach to promoting mental health in youth.
Z Kinder Jugendpsychiatr Psychother
· 2026 Jul · PMID 40994077
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The Potential Iatrogenic Effects of Interview, Experimental, and Prevention Studies of Self-Injurious Behavior in Children and Adolescents: A Literature Review Suicidal thoughts and behavior and nonsuicidal self-injury...The Potential Iatrogenic Effects of Interview, Experimental, and Prevention Studies of Self-Injurious Behavior in Children and Adolescents: A Literature Review Suicidal thoughts and behavior and nonsuicidal self-injury have a high prevalence rate in adolescence and young adulthood. Nevertheless, there are numerous research gaps, some of which are associated with concerns that assessing suicidality and conducting studies with suicidality/nonsuicidal self-injury stimuli could lead to iatrogenic effects. This literature review provides an overview of survey, prevention, and experimental studies that have investigated the question of the potential iatrogenic effects of studies of suicidality and self-injury in adolescents and young adults. For this review, we considered 21 studies. In summary, the vast majority of studies found no evidence of iatrogenic effects such as more suicidal thoughts, self-injurious behavior, or severe psychological stress as a result of study participation. The results indicate to decision-makers that current guidelines should enable and promote the ethical conduct of studies with sensitive content, such as suicidality and self-injury. The central relevance of increased scientific studies is twofold: first, in terms of the increase in knowledge and, second, in terms of the sustainable improvement of care.