Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007 • 50: 784-793

H. Hölling, M. Erhart, U. Ravens-Sieberer, R. Schlack

Behavioural problems in children and adolescents. First results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [pdf]

Abstract

Mental health problems in children and adolescents constitute health impairments with major implications regarding individual wellbeing as well as daily and social functioning. In addition, these problems often burden the social partners of the individual. Within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 14478 children and adolescents aged 3–17 answered the Strengths and Difficulties Questionnaire (SDQ) which assesses behavioral problems and strengths in the areas emotional problems, hyperactivity, behavioral problems, peer problems and prosocial behavior. According to the results of the Total Difficulties Score (SDQ) 11,5 % girls (G) and 17,8 % boys (B) are classified borderline or abnormal, respectively. 92,5 % (G) and 86,3 % (B) display an adequate pro social behavior. Most prevalent problem areas are behavioral problems (G = 11,9 %, B = 17,9 %), emotional problems (G = 9,7 %, B = 8,6 %) and hyperactivity problems (G = 4,8 %, B = 10,8 %). The test-data of approximately 8,1 % of the respondents with high socio-economic status (SES), 13,4 % of those with middle SES and 23,2 % of those with low SES hinted at mental health problems. Migrants are more frequently affected than non-migrants. Results point at the need for early detection and prevention of commencing mental health problems. Especially the noneasily accessible groups like those with low socioeconomic status or migrants have to be considered.

Keywords  Health survey - Children - Adolescents - SDQ - Mental health

Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007 • 50: 794-799

H. Hölling, R. Schlack

Eating disorders in children and adolescents. First results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [pdf]

Abstract

Eating disorders are included in the category of mental and behavioural disorders (ICD 10). They are among the most common chronic health problems encountered in children and adolescents. A total of 7,498 children and adolescents (weighted) aged 11 to 17 years answered the SCOFF questionnaire, a screening instrument to identify cases of suspected eating disorder. Parallel to the SCOFF questionnaire, further factors for possible eating disorders, such as the Body Mass Index (BMI), information on abnormal behaviour (using the Strengths and Difficulties Questionnaire, SDQ) smoking, sexual and body self-image assessment, were gathered to substantiate the results. In total, 21.9 % of the children and adolescents in Germany aged 11 to 17 years showed symptoms of eating disorders. With 28.9%, girls are more frequently affected than boys (15.2 %); this difference is highly significant. In the presence of almost identical initial values, the rate of subjects with abnormal SCOFF scores increases, starting from age 11 years, in girls as they age, while it drops in boys. Children and adolescents with low socioeconomic status (SES) are, with 27.6 %, almost twice as often affected than those with high SES (15.6 %). Migrants have an approx. 50 % higher rate compared to nonmigrants. A 2.5-fold increase in the percentage of individuals with normal weight who perceive themselves as too fat is found among those with abnormal SCOFF scores. Individuals with abnormal SCOFF scores smoke more and report more frequently about sexual harassment. Because of the severity, the tendency to chronification and the protracted therapy of the clinically apparent disorders, effective concepts for prevention should be developed.

Keywords  Health survey - Children - Adolescents - Eating disorders - SCOFF - Socioeconomic status

Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007 • 50: 800-809

M. Erhart, H. Hölling, S. Bettge, U. Ravens-Sieberer, R. Schlack

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): Risks and resources for the mental development of children and adolescents [pdf]

Abstract

Along with the salutogenetic approach in health sciences, the quest for factors exerting a protective effect on mental development and health has increasingly gained importance, complementing the study of risk factors. A total of 6,691 children and adolescents aged 11 to 17 years answered questionnaires on personal, social and family resources as part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Children with low socioeconomic status (SES) more frequently show deficits in their personal, social and family resources. Similarly, in children with migration background a higher percentage with poorly developed personal and social protective factors is found. Older children report less family resources but more social resources than younger children; in comparison to boys, girls have more social but less personal resources at their disposal. Clear connections are observed between protective factors and health-related risk-taking behaviour. Deficits in personal and family resources are associated with an increased risk for smoking. Although an increased percentage of smoking and alcohol consuming children and adolescents is found to be associated with well-developed social resources, the risk for drug experiences is not increased. The results prove the necessity to build up protective factors as a preventative measure. Especially in children and adolescents with weak protective factors, an increased risk of mental health problems can be expected in the presence of stressful events.

Keywords  Health survey - Children - Adolescents - Risks & protective factors - Mental health

Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007 • 50: 810-818

U. Ravens-Sieberer, U. Ellert, M. Erhart

Health-Related Quality of Life of Children and Adolescents in Germany. Norm Data from the German Health Interview and Examination Survey (KiGGS) [pdf]

Abstract

This study investigates the health-related quality of life of children and adolescents in Germany, using the internationally employed KINDL-R questionnaire for measuring the health-related quality of life of children and adolescents. In the National Health Interview and Examination Survey for Children and Adolescents (KiGGS) the parents of 14,836 children and adolescents aged 3–17 years completed the KINDL-R, as well as 6,813 children and adolescents (11–17 years old). The reliability (Cronbach's alpha = 0.85) and validity of the measurements using the KINDL-R were confirmed. The differences in health-related quality of life of children and adolescents from different social backgrounds and with different health statuses, which were to be expected on theoretical grounds, were demonstrated by the KINDL-R scores (size of effect “d” up to 1.52). The means and percentiles were calculated for the total sample as well as stratified by age group, sex, geographical region (East/West), migratory status and socio-economic status. The results of this study can be used as representative, normative data for the population of children and adolescents in Germany in general, as well as stratified for sociodemographic and socio-economic subpopulations, in order to interpret test scores on health-related quality of life (KINDL-R).

Keywords  Health Survey - Children - Adolescents - KINDL-R - Quality of life

Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007 • 50: 819-826

R. Schlack, H. Hölling

Children's and adolescents' experiences of violence based on subjective self-reporting. First results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [pdf]

Abstract

Experiences of violence in childhood and adolescence are connected with potentially serious consequences for physical and psychological health. Children and adolescents can experience violence as the perpetrator, the victim or the perpetrator/victim. As part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) 3382 boys and 3237 girls answered questions on the prevalence of experiences of violence over 12 months, divided into experiences as a perpetrator and as a victim. There were also questions on people's views on the propensity to instrumental and expressive violence. Altogether, 82.5% of girls (G) and 67.2% of boys (B) had not been involved in an act of violence in the last 12 months. 19.6% (B) and 9.9% (G) had been perpetrators; 5.2% (B) and 3.9% (G) had been victims and 7.6% (B) and 3.6% (G) had been perpetrators/victims of an act of violence. The amount of violence suffered by respondents with a high socioeconomic status (SES) was the lowest, with 81.0% never having been involved in acts of violence, compared with those with a lower SES (68.3%) and a medium SES (76.4%). Pupils at Hauptschule (school at lower secondary level providing a basic general education) and Gesamtschule (comprehensive school) as well as adolescents with a migrant background are more often affected by experiences of violence and have more permissive attitudes towards violence than those at Gymnasium (high school) or Realschule (school at lower secondary level providing more extensive general education) and children of non-migrants. Social disadvantage and a migrant background are associated with adolescents having more exposure to and a higher propensity for violence. Intervention programmes and improvements to basic social conditions may have a preventative effect. As no distinction can be made between familial violence and other forms of violence using the KiGGS data, care should be taken in interpreting it. Its significance lies in identifying risk groups.

Keywords  Health survey - Children - Adolescents - Violence - Socioeconomic status

Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007 • 50: 827-835

R. Schlack, H. Hölling, B.-M. Kurth, M. Huss

The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. Initial results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [pdf]

Abstract

The cardinal symptoms of attention-deficit/hyperactivity disorder (ADHD) are inattention, hyperactivity and impulsivity. Etiologically, ADHD is mainly put down to genetic causes; it entails a considerable range of psychosocial problems for those affected and their social environment. The parents of a total of 7,569 boys (B) and 7,267 girls (G) aged 3–17 who took part in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) answered a self-administered questionnaire including an ADHD diagnosis question and the Strengths and Difficulties Questionnaire (SDQ). In addition behavioural observations of 7,919 children (aged 3–11) were carried out during the medical and physical tests. Participants whose parents reported that they had ever been given an ADHD diagnosis by a doctor or psychologist were classified as ADHD cases. Participants were classified as suspected cases of ADHD if they had a value of ≥7 on the SDQ inattention/hyperactivity scale. ADHD had ever been diagnosed in 4.8 % of the children and adolescents altogether (B: 7.7 %, G: 1.8 %). Another 4.9 % of the participants can be considered as suspected cases. Already 1.8 % of the preeschoolers had been given an ADHD diagnosis. At primary school age (7–10 years old) the frequency of diagnosis rises sharply. At age 11–17, ADHD had ever been diagnosed in 1 in 10 boys and 1 in 43 girls. ADHD had been diagnosed significantly more frequently among participants of low socio-economic status (SES) than among participants of high SES. A diagnosis of ADHD is reported less often for migrants, they rank more frequently among the suspected cases. The discrepancy between confirmed and suspected cases of ADHD among migrants may point to lower diagnosis rates or lower utilization of medical services. The short- and long-term medical, social and health-economic effects of ADHD illustrate the major public health relevance of the disorder. As for prevention, the high share of genetic factors in ADHD etiology primarily suggests secondary prevention (early support and early diagnosis) and tertiary prevention measures. Further analysis of the KiGGS data could prospectively identify risk groups more precisely and refine preventional approaches.

Keywords  Health survey - Children - Adolescents - ADHD - Frequency of diagnosis - SDQ - Socioeconomic status

Results - Use of Medical Services

P. Kamtsiuris, E. Bergmann, P. Rattay, M. Schlaud

Use of medical services. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [pdf]

Abstract

The use of operations, visits to doctors and early diagnostic tests for children are examples of different services selected from the whole spectrum of preventative and therapeutic health service provisions in childhood and adolescence. In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is representative for Germany, 17,641 children and adolescents aged 0–17 or their parents were questioned on subjects such as their use of medical services. The use made of individual early diagnostic tests for children remains above the 90 % limit until the U7 test and drops to 89.0 % at U8, falling to 86.4 % at U9. 81 % of children took part in all the early diagnostic tests provided until age 6 (U3 to U9). Another 16 % only took advantage of some parts of this service and 3 % of the children never went to one of these check-ups. As was to be expected, the annual rate of visits to paediatricians drops as children get older from 95.1 % for 0–2-year-olds to 25.4 % of the 14–17-year-olds, while the rate of visits to general practitioners rises from 11.8 % to 53.1 %. If one tracks the rate of visits to specialist doctors all the way across childhood and adolescence, different paths emerge: while children aged 3–6 most often visit the ear, nose and throat doctor, at primary school age they mainly see opticians, and 14–17-year-olds most often visit doctors of internal medicine, dermatologists and surgeons. 37.1 % of the 0–17-year-old children and adolescents had undergone an operation. In order of declining frequency, the operations named were adenoidectomy (15.2 %), tonsillectomy (5.9 %), herniotomy (3.6 %) and appendectomy (2.4 %). Circumcisions had been carried out on 10.9 % of the boys. The different way medical services are used in different subgroups may not only depend on medical factors but also on social factors, medical attitudes and the availability of services provided.

Keywords  Health Survey - Children - Adolescents - Early diagnostic tests for children - Visits to doctors - Operations - Medical care

Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007 • 50: 851-862

C. Poethko-Müller, R. Kuhnert, M. Schlaud

Vaccination coverage and predictors for vaccination level. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [pdf]

Abstract

The level of childhood immunisation is an acknowledged indicator for health prevention. In Germany, vaccination is not compulsive. Continuous representative data derive only from school health examinations. From May 2003 until May 2006 the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was conducted and vaccination information on 16,460 participants was obtained. Using data on the vaccination cards, it was possible to make detailed analyses of vaccination coverage in children up to the age of 17. Different vaccine types were taken into consideration in defining the term ‘immunisation coverage’. The average prevalence of full immunisation for tetanus, diphtheria und polio as well as the coverage for the first dose of measles, mumps and rubella (MMR) vaccination was above 90% in children aged 2–17 years. Vaccination coverage for pertussis, Hib and hepatitis B is higher in younger than in older age groups. Compliance with the recommendation to have a second MMR dose and to make up of hepatitis B and pertussis immunisation is still low, especially in adolescents. In 7- to 17-year-old children the additional booster (recommended for 5- to 6-year-old children) is frequently missing.

Keywords  Health Survey - Children - Adolescents - Vaccination - Vaccination coverage - Predictors

Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007 • 50: 863-870

H. Knopf

Medicine use in children and adolescents. Data collection and first results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [pdf]

Abstract

In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), data on the current use of medicines during the last 7 days prior to the examination were collected from 17,450 subjects aged 0 to 17 years by means of a standardised interview conducted by a physician. 50.8 % of all children and adolescents reported to have used at least 1 medication. Prevalence was found to be highest (74.9 %) in the age group 0 to 2 years. Girls showed with 53.1% a significantly higher prevalence rate than boys (48.7 %). Children from families with low socioeconomic status and children from migrant families stated a less frequent use of medication compared to children from families with higher socio economic status and no migration background. Most frequently, the boys and girls used medicines for the treatment of respiratory tract conditions (ATC code R00: 16.8%). This was followed by Alimentary System and Metabolism (ATC code A00: 16.0%) and Dermatological Preparations (ATC code D00: 9.7%). The most frequent indications included with 12.4% of all medicines reported Other Specified Prophylactic Measures (ICD code Z29.8), with 11% Acute Rhinopharyngitis (ICD code J00), and with 10. 9 % Cough (ICD code R05). Most of the drugs named were prescribed by a doctor (58%), one quarter (25%) was independently bought without prescription, 14% came from other sources, including the medicine chest, and 2% were prescribed by a non-medical practitioner. Regarding the duration of use, short-term use (less than 1 week: 55%) was encountered most frequently, while a duration of use of at least one year was reported for 13% of all medicines named. The results presented here describe the key points of medicine use among children and adolescents in Germany and are representative for this population segment. Based on the extensive data collected, further aspects, such as co- and multi-medication, are addressed. In addition, special drug segments of public health interest shall be represented in the future.

Keywords  Health survey - Children - Adolescents - Medicine use - ATC classes - Indication

Last updated: June 2007